Sex and gender in relation to use of e-cigarette product characteristics in united states datasets: a systematic review.

Abstract

Introduction: Electronic cigarette (e-cigarette) product characteristics impact appeal, addictive potential, toxicity, and/or harm reduction potential. We conducted a systematic review to characterize sex and gender differences in e-cigarette product characteristics used in the United States (US).

Methods: Included studies used US population representative datasets to assess sex/gender differences, sex-specific findings, or differences by sexual or gender minority (SGM) status in relation to e-cigarette product characteristics (e.g., flavors, nicotine (i.e., nicotine in e-liquid), cannabis vaping (i.e., cannabis in e-liquid), device types, other). Additionally, articles had to be written in English and published in peer-reviewed journals. Searches were conducted in PubMed on March 9, 2024 and in PsycInfo and Medline on February 23, 2025.

Results: The 52 included papers used 7 datasets and addressed flavor (N=28), nicotine (N=14), cannabis vaping (N=15), device (N=6), and other characteristics (N=3; 1 package size; 2 other toxicant exposure). Samples included youth (N=23) and/or adults (N=32). Although data are somewhat mixed, taken together findings indicate that while prevalence of e-cigarette use is higher in males, within those who use e-cigarettes, prevalence of flavor use is higher in females, prevalence of nicotine and cannabis vaping and open (adjustable) device type use is higher in males.

Conclusions: E-cigarette product characteristics are a tractable target for regulation. Understanding e-cigarette product characteristics used by males and females in the US could shed light on sex and gender differences in the course of e-cigarette use and the addictive potential, appeal, or harm reduction potential of e-cigarette products.

Implications: There are sex and gender differences in the use and cessation of tobacco products like combustible cigarettes. E-cigarettes have become more popular and characteristics such as flavors, nicotine, cannabis vaping (i.e., cannabis in e-liquid), and device types impact appeal and addiction potential. This review is the first to synthesize the literature on sex and gender in relation to e-cigarette characteristics among United States youth and adults and highlight gaps where more research is needed. This information can help guide that regulation and other efforts related to e-cigarette so they are as effective as possible across sex and gender groups.