Perceptions and use intentions of flavored versus unflavored tobacco products among young adults in Georgia: A cross-sectional study.

Introduction: Tobacco product marketing uses flavors to influence consumer perceptions, especially among youth and young adults. In Georgia, where tobacco use is among the highest in the WHO European Region, flavored products are widely available and unregulated. Limited data exist on young adults' perceptions of flavored versus unflavored products.

Methods: This study aimed to assess how young adults in Georgia perceive flavored versus unflavored tobacco products in terms of harm, addictiveness, and social acceptability, and how these perceptions relate to their use intentions. A cross-sectional online survey (April-June 2024) included 400 participants aged 18-25 years measured perceptions on a 1-7 scale for flavored and unflavored cigarettes, e-cigarettes, and heated tobacco products. Perceptions were categorized as less, equal, or more harmful/addictive/acceptable. Multivariable logistic regression examined associations between these perceptions and past-month use and use intentions.

Results: Most participants perceived flavored and unflavored products similarly, but perceptions varied across product types. Flavored e-cigarettes were most often rated as more acceptable (13%) and addictive (12.5%) compared to unflavored e-cigarettes - more frequently than flavored cigarettes (9.5% acceptable, 7.5% addictive) or flavored HTPs (7% acceptable, 9.8% addictive) when compared to their unflavored counterparts. Perceiving flavored products as more harmful to self was associated with lower past-month cigarette use (adjusted odds ratio, AOR=0.18; 95% CI: 0.08-0.40), while perceiving flavored products as more addictive was associated with higher e-cigarette use (AOR=2.78; 95% CI: 1.06-7.28). Among non-past-month users, higher perceived harm to others was associated with lower intention to use flavored cigarettes (AOR=0.040; 95% CI: 0.003-0.622).

Conclusions: Although most participants perceived flavored and unflavored products similarly, small differences in some perceptions contributed to differences in certain use behaviors, supporting stronger regulation of flavored products in Georgia. However, as this is a cross-sectional study, further prospective research is needed to confirm these findings and guide policy.