Characteristics Associated With Ice Flavor Use Among Middle and High School Students Currently Using E-cigarettes: National Youth Tobacco Survey, 2023.

Abstract

Purpose: To examine ice flavor use and its correlates among middle and high school students who currently (any past 30 days) used e-cigarettes.

Methods: The 2023 National Youth Tobacco Survey (NYTS) assessed for the first time the use of e-cigarette flavors that included the word "ice" or "iced" in the name. Using logistic regression, data from the 2023 NYTS were used to examine differences in sociodemographic characteristics and tobacco use behaviors by ice flavor use among students who currently used e-cigarettes (n = 1,565).

Results: Among middle and high school students who currently used e-cigarettes, an estimated 1.1 million or 57.9% reported ice flavor use. Youth who currently used e-cigarettes were more likely to use ice flavors if they used e-cigarettes on ≥20 of the past 30 days compared to 1-5 days (adjusted odds ratio [aOR] = 2.31, 95% confidence interval [CI] = 1.36 to 3.94); used fruit (aOR = 2.27, 95% CI = 1.36 to 3.80), candy (aOR = 2.73, 95% CI = 1.54 to 4.82), or mint flavors (aOR = 3.63, 95% CI = 1.98 to 6.65) compared to those who did not use the respective flavor type; reported any nicotine dependence compared to those who did not (aOR = 1.71, 95% CI = 1.04 to 2.80); or had mild/moderate (aOR = 1.97, 95% CI = 1.01 to 3.83) or severe psychological distress (aOR = 2.41, 95% CI = 1.25 to 4.62) compared to those without psychological distress.

Conclusions: The present study found that ice-flavored e-cigarette use among youth was associated with the use of e-cigarettes for ≥20 days, the use of fruit, candy, or mint flavors, any symptoms of nicotine dependence, and psychological distress (mild/moderate, severe). The emergence of novel flavor categories and features of e-cigarettes warrant continued surveillance to provide an understanding of associated use patterns, especially among youth.

Implications: This study examined ice flavor use and its correlates among middle and high school students who currently use e-cigarettes. Ice-flavored e-cigarette use among youth was positively associated with frequent e-cigarette use, use of fruit, candy, or mint flavors, and any symptoms of nicotine dependence. Additionally, the likelihood of ice-flavored e-cigarette use was associated with the severity of psychological distress.