Trends in e-cigarette flavour use and demographic correlates among US youth from 2020 to 2023.

Background: As US electronic cigarette (e-cigarette) flavour policies became increasingly restrictive during 2020-2023, flavoured e-cigarette use by the youth might have shifted.

Methods: US eighth, 10th and 12th graders in the Monitoring the Future study assessed the past 12-month nicotine vaping by flavour, in annual cross-sectional surveys over 2020-2023 (n=91 220). Among the past 12-month users (n=17 761), the e-cigarette flavour youth reported using most often was analysed by year, demographic/vaping pattern and year × demographic/vaping interaction using log-binomial regression.

Results: Among all respondents, past 12-month vaping of non-tobacco flavoured and tobacco/unflavoured products both declined over 2020-2023. Among past 12-month users, the proportion of youth who vaped a non-tobacco flavour remained unchanged from 2020 to 2023 (95.1-95.6%); fruit/ice-fruit (60.2-78.1%) and unflavoured (2.0-3.6%) product use rose and mint (24.7-6.8%), sweet/dessert (3.6-2.0%) and tobacco (2.8-0.8%) flavour use declined. Menthol flavour use increased non-linearly (6.7% in 2020, 15.9% in 2021, 8.7% in 2023). Collapsed across years, male, 12th grade, rural and frequent vaping statuses were associated with higher menthol use, and female, eighth and 10th grade, non-frequent vaping and suburban/town statuses were associated with higher fruit/ice-fruit use. Cross-year fruit/ice-fruit use increases were heightened in eighth graders (relative risk (RR)_year= 1.13). Youth menthol use declined in cities (RR_year=0.87) but increased in rural areas (RR_year=1.33).

Conclusion: During 2020-2023, most US youth vaped non-tobacco flavours. Reducing the availability of: (1) fruit/ice-fruit flavoured e-cigarettes might impact most US youth, especially younger teens and (2) menthol-flavoured e-cigarettes might especially impact youth vulnerable to frequent vaping and rural youth.