Preferred flavors and tobacco use patterns in adult dual users of cigarettes and ENDS.

Introduction:
This text provides an analysis of a study examining the relationship between tobacco use patterns and flavored electronic nicotine delivery systems (ENDS) among adult dual users. The study focuses on how user characteristics and attitudes differ by e-cigarette flavor preference and how ENDS flavor preference relates to changes in cigarette and ENDS use frequency over 12 months.

Key Points:

* The study included 406 adult dual users, with 12.6% preferring tobacco-flavored ENDS, 34.7% preferring menthol/mint, 44.8% preferring sweet flavors, and 7.9% preferring other flavors.
* User characteristics, such as age, race, education level, and cigarette brand, were significantly associated with ENDS flavor preference.
* Participants who preferred sweet flavors had lower cigarette use frequency and cigarette nicotine dependence scores compared to those who preferred non-sweet flavors.
* Participants who preferred menthol flavors were more likely to use rechargeable ENDS devices with pre-filled cartridges, while those who preferred sweet or other flavors were more likely to use rechargeable devices with refillable cartridges.
* Participants who preferred sweet flavors had higher boredom reduction expectancies and endorsed stronger dependence motives related to taste and sensory experience compared to those who preferred menthol flavors.
* Over 12 months, all ENDS flavor groups decreased their cigarette use frequency, but the reductions for the sweet flavor preference group were significantly larger than those for the menthol flavored group.
* at 12 months, 23.8% of participants reported no ENDS use over the past 30 days, with no significant differences in ENDS quit rate by flavor preference.

Main Message:
The study highlights the importance of considering user characteristics and preferences when regulating tobacco products. The findings suggest that dual users who prefer sweet-flavored ENDS may be a distinct subset of ENDS users who differ in all examined domains, including demographics, tobacco use history, motives, and expectancies. additionally, dual users who prefer sweet flavors experienced significantly larger decreases in cigarette use frequency over 12 months. These results suggest that regulators must carefully balance the need to prevent naïve users from initiating ENDS use with the potential harm reduction benefit of smokers completely switching away from combustible cigarettes.

Rest EC, Brikmanis KN, Mermelstein RJ. Preferred flavors and tobacco use patterns in adult dual users of cigarettes and ENDS. addictive behaviors. 2022;125:107168. doi:10.1016/j.addbeh.2021.107168