Flavored ENDS Use among adults Who have Used Cigarettes and ENDS, 2016-2017.

Introduction:
This text is a study on the use and perception of flavored electronic nicotine delivery systems (ENDS) among adult smokers with a history of cigarette and ENDS use. The study uses data from the 2016 and 2017 Tobacco Products and Risk Perceptions Surveys conducted by the Georgia State University Tobacco Center of Regulatory Science (TCORS). The study aims to understand how perceptions of flavors in ENDS contribute to their harm reduction potential and to gain insight into public perceptions regarding the importance and safety of ENDS flavors.

Key Points:

* The study uses data from a national probability sample of US adults with a history of cigarette and ENDS use.
* The study examines the association between perceptions and use of flavored ENDS during ENDS initiation and current use among 4 cigarette smoking and ENDS use profiles: Dual Users, ENDS Rejecters, Switchers, and quitters.
* The study found that use of non-traditional flavors and multiple flavors, in particular fruit, was associated with being a Switcher or Dual User versus being an ENDS Rejecter or quitter.
* The study also found that perceiving ENDS flavors as safe was associated with being a Switcher or Dual User versus being an ENDS Rejecter or quitter.
* Participants who reported using tobacco or unflavored ENDS at initiation had lower odds of being a Switcher as compared to being a Dual User.
* Participants who reported using fruit flavored ENDS at initiation had lower odds of being an ENDS Rejecter following covariate adjustment.
* Participants who reported using 2 or more ENDS flavors at initiation were associated with higher odds of being a Dual User or Switcher as compared to ENDS Rejection and quitting.
* The study suggests that use of traditional cigarette flavors is associated with sustained smoking and specifically dual use of ENDS and cigarettes.

Main Message:
The study highlights the importance of ENDS flavors in adult smoker's cessation or dual use/sustained nicotine addiction. The study suggests that use of traditional cigarette flavors in ENDS is associated with sustained smoking and discourage smokers from switching to exclusive ENDS use. The study also suggests that multiple ENDS flavors at initiation and belief that flavors are safe in ENDS may be associated with continued ENDS use at initiation. The FDa should consider these issues when evaluating which flavors should be subject to regulation. The study also suggests that a careful analysis is needed to evaluate the impact of banning certain ENDS flavors and whether this would be appropriate for the protection of public health.

Jones DM, ashley DL, Weaver SR, Eriksen MP. Flavored ENDS Use among adults Who have Used Cigarettes and ENDS, 2016-2017. Tobacco regulatory science. 2019;5(6):518-531. doi:10.18001/TRS.5.6.4