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Observational Study
. 2019 Nov;144(5):e20190789.
doi: 10.1542/peds.2019-0789.

Flavored E-cigarette Use and Progression of Vaping in Adolescents

Adam M Leventhal  1   2 , Nicholas I Goldenson  3 , Junhan Cho  3 , Matthew G Kirkpatrick  3 , Rob S McConnell  3 , Matthew D Stone  4 , Raina D Pang  3 , Janet Audrain-McGovern  5 , Jessica L Barrington-Trimis  3
Affiliations
Observational Study

Flavored E-cigarette Use and Progression of Vaping in Adolescents

Adam M Leventhal et al. Pediatrics. 2019 Nov.

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.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Dr Goldenson left the University of Southern California on February 10, 2019, and started as an employee of Juul Laboratories as of March 4, 2019. He met criteria for authorship before leaving the University of Southern California, and he had no role in revising the article after leaving the University of Southern California and joining Juul Laboratories; the other authors have indicated they have no potential conflicts of interest to disclose.

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