Patterns of flavored e-cigarette use at the time of quitting smoking: comparison between American young adults (18-24 years old) and older adults (>24 years old)

Background. Flavored e-cigarettes remain a controversial public health topic, with disagreement on their potential benefits and harms. In this study we compared patterns of flavor use in e-cigarettes at the time of quitting smoking between young adults (18-24 years old) with older adults (>24 years old). Methods. A convenience sample of US adults who formerly smoked and reported e-cigarette use every day or some days during the period of quitting smoking were included in the study (N=51641) and responded to an online questionnaire. Participants were divided into young adults (n=9895) and older adults (n=41746). Results. The most popular flavors used regularly by young adults and older adults were fruit (92.3% and 81.3%, P<0.001), followed by dessert/pastry/bakery (67.3% and 68.1%, P=0.054) and candy/chocolate/sweet (49.7% and 43.3%, P<0.001). Fruit was the most prevalent single most often used flavor for both groups but was more prevalent in young adults (63.4% vs. 46.0% in older adults, P<0.001), followed by dessert/pastry/bakery which was more prevalent in older adults (32.1% vs. 22.7% in young adults, P<0.001). Tobacco flavor was the single most often used flavor by 1.1% of young and 6.0% of older adults (P<0.001). From logistic regression analysis, being a young adult was positively associated with the use of fruit (OR:1.68, 95%CI:1.18-2.39), menthol (OR:1.60, 95%CI:1.10-2.32), mint/wintergreen (OR:1.55, 95%CI:1.02-2.89) and non-alcoholic/non-coffee drink (OR:1.87, 95%CI:1.20-2.89) flavors, and negatively associated with the use of tobacco (OR:0.53, 95%CI:0.35-0.80) flavor at the time of quitting smoking. Conclusion. Non-tobacco flavors were popular among the US adult former-smoking vapers at the time of quitting smoking, but different flavor preferences exist between young and older adults. Tobacco flavor use prevalence was low. Regulators should consider the flavor choice of adult consumers who use e-cigarettes at the time of quitting smoking, particularly young adults, when preparing legislation on flavored e-cigarettes.