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S. Shiffman, M. Sembower, J. Pillitteri, K. Gerlach, J. Gitchell | 07 March 2015

Nonsmoking teens show very low interest in using e-cigarettes, even when presented with a variety of flavors described as, for example, raspberry, bubble gum, gummy bear, and vanilla bean, according to our study published online in the journal Nicotine & Tobacco Research. Proponents of e-cigarettes have argued that, because e-cigarettes are much less hazardous than traditional combustible tobacco cigarettes, use of e-cigarettes by smokers could greatly reduce the health harms due to smoking. However, some have worried that e-cigarettes might attract teens who do not smoke, especially if e-cigarettes were offered in appealing flavors.

Concerns about initiation of e-cigarette use by nonsmoking teens have focused on the expected and assumed appeal of flavors. It is important to replace assumptions with data. Our study shows that flavor descriptors, even those expected to appeal to youth, do not do so. This is reassuring because nonsmoking teens would gain no health benefit from using e-cigarettes, since they don’t smoke. In contrast adult smokers could dramatically reduce health risks by switching from tobacco cigarette smoking to e-cigarette use.

We surveyed 216 nonsmoking teens ages 13-17 and 432 adult smokers of combustible tobacco cigarettes about their interest in a range of potential e-cigarette flavors. Each participant completed an online questionnaire assessing his or her interest in ENDS across 15 flavor descriptors. The flavor descriptors included both traditional tobacco (classic tobacco, menthol, dark tobacco blend) and other (black & blue berry, blood orange, bubble gum, butter crunch, cotton candy, double espresso, gummy bear, peach tea, pomegranate, raspberry, single malt scotch, vanilla bean) flavor types. In addition, to mask the purpose of the survey, participants indicated their interest in ice cream and bottled water in the same sets of flavors (except tobacco flavors). Product interest was indicated on a 0-10 scale (0=“not at all interested”; 10=“very interested”).

Asked on a scale of 0-10 about interest in using e-cigarettes, offered in a list of flavors, teens reported minimal interest (mean=0.41+/-0.14 SE), and teens’ interest did not vary across flavors. Flavors just didn’t seem to matter to these nonsmoking teens.

Among adult smokers of combustible tobacco cigarettes, interest in e-cigarette flavors was greatest among recent users of e-cigarettes (mean=3.19+/-0.21), followed by past users (mean=1.62+/-0.17) and never users (mean=1.08+/-0.15). Recent e-cigarette users indicated an interest in flavors such as vanilla bean, double espresso, and raspberry; none of which appealed to nonsmoking teens.

Overall, the study produced three key findings that emphasize the differences between flavor perception among adult smokers and teen nonsmokers:

  • Many ENDS flavors appeal to adult smokers without appealing to nonsmoking teens;
  • Non-smoking teens do not find ENDS appealing to use; and
  • Non-smoking teens’ interest in using ENDS does not vary according to which flavor descriptor is associated with the ENDS.

Knowledge about which flavors appeal most to adult smokers without appealing to nonsmoking teens presents an opportunity to greatly reduce health risks among adult smokers without increasing the risks for youth.

Study Disclosure

The study was supported by NJOY, a company that markets e-cigarettes and vaping products, but does not make or sell any combustion tobacco products. All authors of the paper work for Pinney Associates and have provided consulting services to NJOY on e-cigarettes and vaping products. NJOY was involved in discussion of the study design, but had no role in study execution, data collection, data analysis, or writing of the published manuscript. All decisions related to the study were made by the authors.

Disclosure

Since conducting and publishing this research, PinneyAssociates has begun providing consulting services on tobacco harm minimization (including nicotine replacement therapy and digital vapor products) to Niconovum USA, RJ Reynolds Vapor Company, and RAI Services Company, all subsidiaries of Reynolds American Inc. In the past three years, PinneyAssociates has consulted to GlaxoSmithKline Consumer Healthcare on smoking cessation and NJOY on electronic cigarettes. SS and JGG also own an interest in intellectual property for a novel nicotine medication, an option for which has been sold to Niconovum USA.

Saul Shiffman, PhD, Mark. A. Sembower, MA, Janine L. Pillitteri, PhD, Karen K. Gerlach, PhD, MPH, and Joe Gitchell, PinneyAssociates, Inc.