Study: Flavor restrictions could make major progress in fighting youth vaping epidemic

Major progress could be made in fighting the youth vaping epidemic with a complete restriction on sweet flavorings and cooling agents in both cartridge and disposable e-cigarette devices, according to a new study from the Center for Tobacco Research at The Ohio State University Comprehensive Cancer Center. The current U.S. Food and Drug Administration (FDA) flavor ban only applies to cartridge electronic cigarette devices.

A new study published in the Journal of Studies on Addiction and Drugs by researchers with the Center for Tobacco Research suggests that sweet flavorings and cooling agents like menthol keep youth puffing e-cigarettes, and the majority indicate they would likely stop vaping if e-liquid flavors were limited to tobacco-flavor only.

Rates of e-cigarette use among young adults and adolescents remain high, despite federal restrictions that limit the availability and appeal to youth. This new study sought to examine how restricting flavors could affect adolescent and young adult e-cigarette usage.

Researchers surveyed 1,414 individuals between the ages of 14 and 17 regarding their e-cigarette use and behaviors. This included demographic and self-reported information about the type of device used, usage habits, preferred flavors, and intent to discontinue use of the vaping device in response to proposed hypothetical comprehensive flavor ban.

Overall, nearly 39% of survey respondents reported they would stop using their e-cigarettes if tobacco and menthol-flavored e-liquids were the only options available, and nearly 71% would quit vaping under a tobacco-only product standard.

Our data add to an expanding body of evidence showing that youth have a preference for sweet flavorings that make vaping easier for novice users of e-cigarette products, priming them for a potential lifetime of dependency to nicotine."

Alayna Tackett, PhD, senior author of the study and a researcher with the Center for Tobacco Research at the OSUCCC – James. Tackett is a pediatric psychologist and assistant professor in the division of medical oncology at Ohio State's College of Medicine

Banning flavors in e-cigarettes

In February 2020, the U.S. Food and Drug Administration (FDA) put restrictions on flavorings for cartridge/pod e-cigarette (vape) devices, but the ban did not extend to disposable devices or to menthol flavoring for all devices. Sales of e-cig cartridge products went down; however, disposable devices and menthol-flavored pod/cartridge devices went up.

In April 2022, the FDA issued proposed product standards banning menthol flavoring in cigarettes and cigars, but the benefits of these product standards could be weakened by the role of substitute products still available in the market.

Researchers say it is critical to take a closer look at how flavorings impact usage behaviors in youth and adult populations to inform this federal legislation.

Tackett noted that adolescents and young adults using flavors with cooling additives (such as fruit ice) reported higher odds of discontinuing use under a tobacco-only product standard compared with users who preferred menthol flavor only, indicating an important distinction between these groups. (Fruit ice refers to e-cigarette flavors that have a fruit base characterizing flavor with a cooling additive such as menthol or a synthetic cooling agent.)

"In this sample of adolescents and young adults, it appears that non-tobacco flavors may be important for their interest in and continued use of e-cigarettes," she says.

It is unknown if the current self-reported intentions would extend to actual behavior in the natural environment and how this may impact use or uptake of other tobacco products. Future research might benefit from examining this scenario in areas or states that have flavor restrictions using a more representative sample (the convenience sample used was majority white and majority female).

Cigarette smoking remains the leading cause of preventable death in the United States. Tackett says preventing use of e-cigarettes among young people is a crucial goal for public health, but she also points to the potential impact of e-cigarette regulation on adults who smoke and have begun using e-cigarettes as an alternative to quitting altogether.

"Many adults prefer using non-tobacco flavors to switch from combustible cigarettes to e-cigarettes," said Tackett. "Flavor restriction policies should consider the best ways to protect public health while supporting adults who are interested in choosing potentially less harmful alternatives to combustible cigarettes."