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The Association of E-cigarette Flavors With Satisfaction, Enjoyment, and Trying to Quit or Stay Abstinent From Smoking Among Regular Adult Vapers From Canada and the United States: Findings From the 2018 ITC Four Country Smoking and Vaping Survey.
Nicotine Tob Res. 2020 10 08; 22(10):1831-1841.NT

Abstract

AIMS

This study examined whether nontobacco flavors are more commonly used by vapers (e-cigarette users) compared with tobacco flavor, described which flavors are most popular, and tested whether flavors are associated with: vaping satisfaction relative to smoking, level of enjoyment with vaping, reasons for using e-cigarettes, and making an attempt to quit smoking by smokers.

METHODS

This cross-sectional study included 1603 adults from Canada and the United States who vaped at least weekly, and were either current smokers (concurrent users) or former smokers (exclusive vapers). Respondents were categorized into one of seven flavors they used most in the last month: tobacco, tobacco-menthol, unflavored, or one of the nontobacco flavors: menthol/mint, fruit, candy, or "other" (eg, coffee).

RESULTS

Vapers use a wide range of flavors, with 63.1% using a nontobacco flavor. The most common flavor categories were fruit (29.4%) and tobacco (28.7%), followed by mint/menthol (14.4%) and candy (13.5%). Vapers using candy (41.0%, p < .0001) or fruit flavors (26.0%, p = .01) found vaping more satisfying (compared with smoking) than vapers using tobacco flavor (15.5%) and rated vaping as very/extremely enjoyable (fruit: 50.9%; candy: 60.9%) than those using tobacco flavor (39.4%). Among concurrent users, those using fruit (74.6%, p = .04) or candy flavors (81.1%, p = .003) were more likely than tobacco flavor users (63.5%) to vape in order to quit smoking. Flavor category was not associated with the likelihood of a quit attempt (p = .46). Among exclusive vapers, tobacco and nontobacco flavors were popular; however, those using tobacco (99.0%) were more likely than those using candy (72.8%, p = .002) or unflavored (42.5%, p = .005) to vape in order to stay quit.

CONCLUSIONS

A majority of regular vapers in Canada and the US use nontobacco flavors. Greater satisfaction and enjoyment with vaping are higher among fruit and candy flavor users. While it does not appear that certain flavors are associated with a greater propensity to attempt to quit smoking among concurrent users, nontobacco flavors are popular among former smokers who are exclusively vaping. Future research should determine the likely impact of flavor bans on those who are vaping to quit smoking or to stay quit.

IMPLICATIONS

Recent concerns about the attractiveness of e-cigarette flavors among youth have resulted in flavor restrictions in some jurisdictions of the United States and Canada. However, little is known about the possible consequences for current and former smokers if they no longer have access to their preferred flavors. This study shows that a variety of nontobacco flavors, especially fruit, are popular among adult vapers, particularly among those who have quit smoking and are now exclusively vaping. Limiting access to flavors may therefore reduce the appeal of e-cigarettes among adults who are trying to quit smoking or stay quit.

Authors+Show Affiliations

Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada.Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC. Hollings Cancer Center, Medical University of South Carolina, Charleston, SC.School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.O'Neill Institute for National & Global Health Law, Georgetown University Law Center, Washington, DC.Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY.Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada.Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada.Melbourne Centre for Behaviour Change, School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia. Cancer Council Victoria, Melbourne, VIC, Australia.Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY.Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada.Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada.Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY.Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada.Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada.Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY.Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada. Ontario Institute for Cancer Research, MaRS Centre, Toronto, Ontario, Canada.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32449933

Citation

Gravely, Shannon, et al. "The Association of E-cigarette Flavors With Satisfaction, Enjoyment, and Trying to Quit or Stay Abstinent From Smoking Among Regular Adult Vapers From Canada and the United States: Findings From the 2018 ITC Four Country Smoking and Vaping Survey." Nicotine & Tobacco Research : Official Journal of the Society for Research On Nicotine and Tobacco, vol. 22, no. 10, 2020, pp. 1831-1841.
Gravely S, Cummings KM, Hammond D, et al. The Association of E-cigarette Flavors With Satisfaction, Enjoyment, and Trying to Quit or Stay Abstinent From Smoking Among Regular Adult Vapers From Canada and the United States: Findings From the 2018 ITC Four Country Smoking and Vaping Survey. Nicotine Tob Res. 2020;22(10):1831-1841.
Gravely, S., Cummings, K. M., Hammond, D., Lindblom, E., Smith, D. M., Martin, N., Loewen, R., Borland, R., Hyland, A., Thompson, M. E., Boudreau, C., Kasza, K., Ouimet, J., Quah, A. C. K., O'Connor, R. J., & Fong, G. T. (2020). The Association of E-cigarette Flavors With Satisfaction, Enjoyment, and Trying to Quit or Stay Abstinent From Smoking Among Regular Adult Vapers From Canada and the United States: Findings From the 2018 ITC Four Country Smoking and Vaping Survey. Nicotine & Tobacco Research : Official Journal of the Society for Research On Nicotine and Tobacco, 22(10), 1831-1841. https://doi.org/10.1093/ntr/ntaa095
Gravely S, et al. The Association of E-cigarette Flavors With Satisfaction, Enjoyment, and Trying to Quit or Stay Abstinent From Smoking Among Regular Adult Vapers From Canada and the United States: Findings From the 2018 ITC Four Country Smoking and Vaping Survey. Nicotine Tob Res. 2020 10 8;22(10):1831-1841. PubMed PMID: 32449933.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Association of E-cigarette Flavors With Satisfaction, Enjoyment, and Trying to Quit or Stay Abstinent From Smoking Among Regular Adult Vapers From Canada and the United States: Findings From the 2018 ITC Four Country Smoking and Vaping Survey. AU - Gravely,Shannon, AU - Cummings,K Michael, AU - Hammond,David, AU - Lindblom,Eric, AU - Smith,Danielle M, AU - Martin,Nadia, AU - Loewen,Ruth, AU - Borland,Ron, AU - Hyland,Andrew, AU - Thompson,Mary E, AU - Boudreau,Christian, AU - Kasza,Karin, AU - Ouimet,Janine, AU - Quah,Anne C K, AU - O'Connor,Richard J, AU - Fong,Geoffrey T, PY - 2020/01/20/received PY - 2020/05/19/accepted PY - 2020/5/26/pubmed PY - 2021/1/9/medline PY - 2020/5/26/entrez SP - 1831 EP - 1841 JF - Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco JO - Nicotine Tob Res VL - 22 IS - 10 N2 - AIMS: This study examined whether nontobacco flavors are more commonly used by vapers (e-cigarette users) compared with tobacco flavor, described which flavors are most popular, and tested whether flavors are associated with: vaping satisfaction relative to smoking, level of enjoyment with vaping, reasons for using e-cigarettes, and making an attempt to quit smoking by smokers. METHODS: This cross-sectional study included 1603 adults from Canada and the United States who vaped at least weekly, and were either current smokers (concurrent users) or former smokers (exclusive vapers). Respondents were categorized into one of seven flavors they used most in the last month: tobacco, tobacco-menthol, unflavored, or one of the nontobacco flavors: menthol/mint, fruit, candy, or "other" (eg, coffee). RESULTS: Vapers use a wide range of flavors, with 63.1% using a nontobacco flavor. The most common flavor categories were fruit (29.4%) and tobacco (28.7%), followed by mint/menthol (14.4%) and candy (13.5%). Vapers using candy (41.0%, p < .0001) or fruit flavors (26.0%, p = .01) found vaping more satisfying (compared with smoking) than vapers using tobacco flavor (15.5%) and rated vaping as very/extremely enjoyable (fruit: 50.9%; candy: 60.9%) than those using tobacco flavor (39.4%). Among concurrent users, those using fruit (74.6%, p = .04) or candy flavors (81.1%, p = .003) were more likely than tobacco flavor users (63.5%) to vape in order to quit smoking. Flavor category was not associated with the likelihood of a quit attempt (p = .46). Among exclusive vapers, tobacco and nontobacco flavors were popular; however, those using tobacco (99.0%) were more likely than those using candy (72.8%, p = .002) or unflavored (42.5%, p = .005) to vape in order to stay quit. CONCLUSIONS: A majority of regular vapers in Canada and the US use nontobacco flavors. Greater satisfaction and enjoyment with vaping are higher among fruit and candy flavor users. While it does not appear that certain flavors are associated with a greater propensity to attempt to quit smoking among concurrent users, nontobacco flavors are popular among former smokers who are exclusively vaping. Future research should determine the likely impact of flavor bans on those who are vaping to quit smoking or to stay quit. IMPLICATIONS: Recent concerns about the attractiveness of e-cigarette flavors among youth have resulted in flavor restrictions in some jurisdictions of the United States and Canada. However, little is known about the possible consequences for current and former smokers if they no longer have access to their preferred flavors. This study shows that a variety of nontobacco flavors, especially fruit, are popular among adult vapers, particularly among those who have quit smoking and are now exclusively vaping. Limiting access to flavors may therefore reduce the appeal of e-cigarettes among adults who are trying to quit smoking or stay quit. SN - 1469-994X UR - https://www.unboundmedicine.com/medline/citation/32449933/The_Association_of_E_cigarette_Flavors_With_Satisfaction_Enjoyment_and_Trying_to_Quit_or_Stay_Abstinent_From_Smoking_Among_Regular_Adult_Vapers_From_Canada_and_the_United_States:_Findings_From_the_2018_ITC_Four_Country_Smoking_and_Vaping_Survey_ L2 - https://academic.oup.com/ntr/article-lookup/doi/10.1093/ntr/ntaa095 DB - PRIME DP - Unbound Medicine ER -