Flavored e-cigarette use and its association with subsequent short-term e-cigarette abstinence among youth, young adults and adults: Findings from the United States longitudinal population assessment of tobacco use and health, 2016 to 2023.

Abstract

Aims: This study examined e-cigarette flavor use and its prospective association with short-term e-cigarette abstinence among youth (12-17 years old), young adults (18-24 years old) and adults (25+ years old) using United States (US)-representative data.

Design: Observational study using longitudinal data obtained from the Population Assessment of Tobacco and Health (PATH) study, waves 4-7 (2016-2023). A lagged design assessed three wave-pairings per participant.

Setting: Household computer-assisted self-interviews of US youth and adults from 2016 to 2023.

Participants: A total of n = 8418 non-institutionalized youth and adults in the US.

Measurements: The primary exposure was past 30-day e-cigarette flavor use at the previous wave using the following mutually exclusive flavor groupings: exclusive tobacco flavor or flavorless e-cigarette use, exclusive menthol/mint flavor, exclusive sweet flavors (e.g. candy, fruit, chocolate, clove/spice) or use of multiple e-cigarette flavors (defined as individuals vaping multiple flavor combinations from: tobacco/flavorless, menthol/mint and sweet flavors); the primary outcome was past 30-day e-cigarette abstinence at the subsequent wave (yes/no). Generalized estimating equation (GEE) models examined prospective association between e-cigarette flavor type and covariates [e.g. demographics, e-cigarette dependence (time to first e-cigarette: ≤ 30 minutes of waking vs. > 30 minutes), dual cigarette and e-cigarette use (yes/no)], on e-cigarette abstinence (primary outcome). We ran an overall GEE model adjusting for age group and three individual GEE models stratified by age group. All estimates were weighted.

Results: Exclusive sweet flavors were the most common e-cigarette flavor used among youth (46%), young adults (44%) and adults (41%). In the adjusted model, young adults [adjusted odds ratio (AOR) = 3.63, 95% confidence interval (CI) = 3.0-4.3, P < 0.001] and adults (AOR = 4.58, 95% CI = 3.8-5.6, P < 0.001) who vaped in the past 30 days had higher odds of subsequent e-cigarette abstinence compared with youth who vaped in the past 30 days. Across ages, among past 30-day vapers, exclusive tobacco/flavorless e-cigarette use was prospectively associated with increased e-cigarette abstinence (AOR = 2.2, 95% CI = 1.9-2.5, P < 0.001), multiple-flavor-use was associated with decreased e-cigarette abstinence (AOR = 0.61, 95% CI = 0.53-0.71, P < 0.001), compared with exclusive menthol or sweet-flavored e-cigarette use. Dual e-cigarette and cigarette use was prospectively associated with reduced e-cigarette abstinence in young adults (AOR = 0.60, 95% CI = 0.50-0.80, P < 0.001), yet increased e-cigarette abstinence in adults (AOR = 1.4, 95% CI = 1.1-1.6, P < 0.001).

Summary: Among adults and youth in the United States, exclusive vaping of sweet, menthol or multiple flavors, compared with tobacco/flavorless products, appears to decrease odds of later short-term e-cigarette abstinence.