Preferred Electronic Nicotine Delivery Systems Flavors and Tobacco Use Patterns

Background: Flavors may be important in understanding use of electronic nicotine delivery systems (ENDS), but little is known about who uses which flavors and how these preferences may affect tobacco use trajectories. This study examined how ENDS flavor preference varied by demographics, tobacco history, motives, and expectancies for ENDS. The association between ENDS flavor preference and patterns of use of cigarettes and ENDS over 6 months was also examined. Methods: Data come from the baseline wave of a longitudinal observational study of adult dual cigarette and ENDS users (N = 406). Participants were 40% female, aged 18-70, and 48% White, 34% Black, 12% Asian, and 12% identified with other racial backgrounds. At baseline, participants completed questionnaires and seven days of ecological momentary assessment of all tobacco use. Flavor preferences were grouped into four categories: tobacco (12%), menthol/mint (34%), sweet (45%), and other (9%). Results: Flavor preference differed by participant age and race. Users of sweet flavored ENDS were significantly younger, F(3, 403) = 23.56, p < .001, than those who used tobacco or menthol. Black dual users were significantly more likely than other racial groups to use menthol and less likely to use sweet flavors, c2(9) = 54.42, p < .001. Tobacco patterns and dependence also varied by flavor preference. Dual users who preferred sweet flavors smoked cigarettes fewer days, F(3, 402) = 4.62, p < .001, than those who preferred tobacco and menthol flavors. Users who preferred sweet flavors also were significantly less cigarette dependent than others, F(3, 402) = 5.26, p = .001. Those who preferred sweet flavors were more likely to use rechargeable ENDS devices with refillable cartridges, c2(6)= 77.78, p < .001. Dual users who preferred sweet flavors also differed significantly from others in motives and expectancies, more strongly endorsing boredom reduction expectancies, F(3, 401) = 6.90, p < .001, and motives related to taste and sensory experience, F(3, 398) = 8.74, p < .001. Conclusions: Dual users who preferred sweet flavors ENDS emerged as a distinct subset differing in all domains: demographics, tobacco history, motives, and expectancies. Findings have implications for interventions and regulations.