Preferences, use, and perceived access to flavored e-cigarettes among United States adolescents and young adults

Citing concern over youth use, the Food and Drug Administration announced a prioritized enforcement policy against cartridge-based (reusable pod) e-cigarettes in non-menthol, non-tobacco flavors, effective February 2020. Data are needed regarding youth e-cigarette access and use behaviors following this policy.

Highlights

• Near universal youth use of fruit, sweet, menthol, or fruit-ice e-cigarette flavors.
• Most youth used of reusable pod systems and/or disposable “pod” e-cigarettes.
• Despite FDA policy, youth had ample access to flavored and pod-based products.
• Flavor preferences were associated with youth characteristics and behaviors.
• Stronger policies needed to reduce youth access to and use of flavored e-cigarettes.

Methods

This cross-sectional national (USA) online panel survey, conducted March/April 2021, included 2253 participants ages 14–20 who ever used e-cigarettes ≥3 times (73% past 30-day users). Participants reported their flavor preferences, use reasons, and perceived ease of access. Latent class analysis categorized participants according to their preferred e-cigarette flavors, and multinominal logistic regression identified sociodemographic and behavioral correlates of class membership.

Results

Most past 30-day e-cigarette users used reusable pod (77%) or modern disposable (68%) devices, ≥1 non-tobacco (92%), sweet (76%), and/or menthol flavors including fruit-ice (70%) (flavor and device categories not mutually exclusive). Most past 30-day users (70%) and non-users (63%) perceived it would be somewhat or very easy to acquire e-cigarettes in flavors they like. Latent class analysis identified four e-cigarette flavor preference classes: mint (34% of sample), no preference (29%), fruit/sweet (28%), and dislikes ≥1 flavor (10%). Relative to no preference, membership in fruit/sweet (RRR: 1.87; 95% CI: 1.37, 2.57) and mint (RRR: 3.85; 95% CI: 2.77, 5.36) classes was associated with using e-cigarettes ≥50 times. Fruit/sweet membership was inversely associated with combustible tobacco use (RRR: 0.50; 95% CI: 0.38, 0.66).

Conclusion

Young e-cigarette users maintained ample access to flavored and cartridge-based products. Stronger access restrictions and enforcement are required to reduce youth e-cigarette use.