Patterns of flavored e-cigarette use among adults vapers in the United States: an online cross-sectional survey of 69,233 participants

Abstract Background. Flavored e-cigarettes remain a controversial topic with regulators planning or already implementing restrictions worldwide. In this study we examined patterns of flavors use in e-cigarettes among a convenience sample of US adult vapers. Methods. Participants aged ≥ 18 years who reported ever using an e-cigarette were included in the study (N = 69233) and responded to an online questionnaire. Their smoking status was recorded as well as patterns of flavors use at e-cigarette use initiation, at the time of the survey and at the time of smoking cessation (for former smokers who were using e-cigarettes at the time of quitting). Results. The most popular flavors at e-cigarette use initiation were fruit (82.8%), followed by dessert/pastry/bakery (68.6%) and candy/chocolate/sweet (52.2%). Slightly higher prevalence was observed in never compared to current and former smokers for fruit and dessert/pastry/bakery. Tobacco flavors were used by 20.8% of the participants and was by far least prevalent among never smokers. Similar patterns were observed with participants’choices at the time of the survey, but tobacco flavors use was substantially reduced (7.7%). Only 2.1% reported tobacco as the single most often used flavor. The most prevalent flavor at the time of quitting smoking was again fruit (83.3%), followed by dessert/pastry/bakery (68.0%) and candy/chocolate/sweet (44.5%). These flavors were considered the most helpful for quitting smoking. Tobacco flavor use at the time of smoking cessation was reported by 15.0% while 9.3% considered it helpful for quitting smoking. Conclusion. Non-tobacco flavors were popular among the US adult vapers who participated to the study, and were popular choices at the time of quitting smoking for former smokers. Tobacco flavors use prevalence was low and was further reduced over time. Regulators should consider the flavors choice of adult consumers, especially those who quit smoking, when preparing legislation on flavored e-cigarettes.