Effects of non-tobacco flavors and nicotine on e-cigarette product appeal among young adult never, former, and current smokers

Abstract

Background: E-cigarette regulations targeting products that disproportionately appeal to never-smokers may optimize population health. This laboratory study of young adults tested whether differences in appeal between e-cigarettes with non-tobacco-flavored (vs. tobacco-flavored) and nicotine-containing (vs. nicotine-free) solutions varied by smoking history.

Methods: Current (N = 53), former (N = 25), and never (N = 22) cigarette smokers who vape (Mean[SD] age = 25.4[4.4] years) administered standardized e-cigarette doses varied by a Flavor (fruit, menthol, tobacco) × Nicotine (nicotine-containing [6 mg/mL], nicotine-free) within-subject double-blind design. Participants rated each dose's appeal (0-100 scale). Covariate-adjusted interactions tested whether smoking history moderated flavor and nicotine effects.

Results: Appeal was higher for fruit and menthol than tobacco flavors in each group. The fruit vs. tobacco appeal difference was greater in never smokers (fruit-tobacco estimate = 19.6) than current smokers (estimate = 12.1) but not former smokers (estimate = 12.6). The menthol vs. tobacco difference was greater in never smokers (menthol-tobacco estimate = 17.3) than former (estimate = 6.0) and current (estimate = 7.2) smokers. Appeal was lower for nicotine-containing than nicotine-free solutions in each group; this difference was greater in never smokers (nicotine-nicotine-free estimate = -17.3) than former (estimate = -7.0) and current (estimate = -10.6) smokers. Compared to tobacco flavors, nicotine's appeal-reducing effects were suppressed by fruit and menthol flavors in never smokers.

Conclusions: Higher appeal of non-tobacco-flavored (vs. tobacco-flavored) and lower appeal of nicotine-containing (vs. nicotine-free) e-cigarettes may be widespread in young adults but disproportionately amplified in never smokers. Non-tobacco flavors may suppress nicotine's appeal-lowering qualities in never smokers. The impact of regulating non-tobacco flavors in e-cigarettes may vary by smoking history.

Keywords: Flavors; Product appeal; Tobacco regulatory science; Young adults; e-Cigarettes.

Fig. 1.

Product appeal of e-cigarettes with fruit, menthol, and tobacco flavored solutions, by smoking history (M ± SE). *Appeal rating significantly different between respective flavor and tobacco flavor within smoking history group (P_corr < 0.05). †Extent of difference in appeal between respective flavor and tobacco flavor significantly differs between respective group and never smokers (P_corr < 0.05). Appeal = Average of “liking,” “willingness-to-use-again” and “disliking” (reverse-scored) (range 0–100). P_corr = P-value corrected for multiple tests to control study-wise false discovery rate of .05.

Fig. 2.

Product appeal of e-cigarettes with nicotine and nicotine-free solutions, by smoking history (M ± SE). *Appeal rating significantly different from nicotine-free within smoking history group (P_corr < 0.05). †Extent of difference in appeal between nicotine and nicotine-free significantly differs between respective group and never smokers (P_corr < 0.05). Appeal = Average of “liking,” “willingness-to-use-again” and “disliking” (reverse-scored) (range 0–100). P_corr = P-value corrected for multiple tests to control study-wise false discovery rate of .05.

Fig. 3.

Product appeal of e-cigarettes with nicotine and nicotine-free solutions, by flavor and smoking history (M ± SE). *Extent of difference in appeal between nicotine and nicotine-free significantly differs between respective flavor and tobacco flavor within smoking history group (P_corr < 0.05). Appeal = Average of “liking,” “willingness-to-use-again” and “disliking” (reverse-scored) (range 0–100). P_corr = P-value corrected for multiple tests to control study-wise false discovery rate of .05.