Title: Flavored E-cigarette Use and Progression of Vaping in Adolescents.
Authors: Leventhal, Adam M; Goldenson, Nicholas I; Cho, Junhan; Kirkpatrick, Matthew G; McConnell, Rob S; Stone, Matthew D; Pang, Raina D; Audrain-McGovern, Janet; Barrington-Trimis, Jessica L
Published In Pediatrics, (2019 11)
Abstract: OBJECTIVES: Electronic cigarettes (e-cigarettes) are available in nontraditional flavors (eg, fruit and candy) that are banned in combustible cigarettes in the United States. Whether adolescent use of e-cigarettes in nontraditional flavors prospectively predicts continuation of vaping and progression to more frequent vaping is unknown. METHODS: High school students in Los Angeles, California, completed 5 semiannual surveys (2014-2017 [10th grade to 12th grade]). Among past-6-month e-cigarette users at survey waves 1 to 4 (N = 478), e-cigarette flavor (or flavors) used was coded into 2 mutually exclusive categories at each wave (use of ≥1 nontraditional flavors [fruit, candy, sweet or dessert, buttery, blends or combinations, and other] versus exclusive use of tobacco, menthol or mint, or flavorless). Flavor used during waves 1 to 4 was modeled as a time-varying, time-lagged regressor of vaping status and frequency outcomes 6 months later at waves 2 to 5. RESULTS: Across waves 1 to 4, there were 739 (93.8%) observations of nontraditional-flavor use and 49 (6.2%) observations of exclusive use of tobacco, mint or menthol, or flavorless e-cigarettes. Use of e-cigarettes in nontraditional flavors (versus only tobacco, mint or menthol, or flavorless) was positively associated with vaping continuation (64.3% vs 42.9%; adjusted odds ratio = 3.76 [95% confidence interval 1.20 to 10.31]) and past-30-day number of puffs per nicotine vaping episode (mean: 3.1 [SD 5.5] vs 1.5 [SD 3.8]; adjusted rate ratio = 2.41 [95% confidence interval 1.08 to 5.92]) 6 months later. Flavor used was not associated with the subsequent number of past-30-day vaping days or episodes per day. CONCLUSIONS: Adolescents who vaped e-cigarettes in nontraditional flavors, compared with those who exclusively vaped tobacco-flavored, mint- or menthol-flavored, or flavorless e-cigarettes, were more likely to continue vaping and take more puffs per vaping occasion 6 months later.
PubMed ID: 31659004
MeSH Terms: Adolescent; Electronic Nicotine Delivery Systems/statistics & numerical data*; Female; Flavoring Agents*; Government Regulation*; Humans; Male; Models, Statistical; Sex Distribution; Surveys and Questionnaires; United States Food and Drug Administration; United States/epidemiology; Vaping/epidemiology*; Vaping/legislation & jurisprudence; Vaping/prevention & control