Flavored e-cigarette use and its association with subsequent short-term e-cigarette abstinence among youth, young adults and adults: Findings from the United States longitudinal population assessment of tobacco use and health, 2016 to 2023.

AIMS: This study examined e-cigarette flavor use and its prospective association with short-term e-cigarette abstinence among youth (12-17 years old), young adults (18-24 years old) and adults (25+ years old) using United States (US)-representative data.

DESIGN

Observational study using longitudinal data obtained from the Population Assessment of Tobacco and Health (PATH) study, waves 4-7 (2016-2023). A lagged design assessed three wave-pairings per participant.

SETTING

Household computer-assisted self-interviews of US youth and adults from 2016 to 2023.

PARTICIPANTS

A total of n = 8418 non-institutionalized youth and adults in the US.

MEASUREMENTS: The primary exposure was past 30-day e-cigarette flavor use at the previous wave using the following mutually exclusive flavor groupings: exclusive tobacco flavor or flavorless e-cigarette use, exclusive menthol/mint flavor, exclusive sweet flavors (e.g. candy, fruit, chocolate, clove/spice) or use of multiple e-cigarette flavors (defined as individuals vaping multiple flavor combinations from: tobacco/flavorless, menthol/mint and sweet flavors); the primary outcome was past 30-day e-cigarette abstinence at the subsequent wave (yes/no). Generalized estimating equation (GEE) models examined prospective association between e-cigarette flavor type and covariates [e.g. demographics, e-cigarette dependence (time to first e-cigarette: ≤ 30 minutes of waking vs. > 30 minutes), dual cigarette and e-cigarette use (yes/no)], on e-cigarette abstinence (primary outcome). We ran an overall GEE model adjusting for age group and three individual GEE models stratified by age group. All estimates were weighted.

RESULTS

Exclusive sweet flavors were the most common e-cigarette flavor used among youth (46%), young adults (44%) and adults (41%). In the adjusted model, young adults [adjusted odds ratio (AOR) = 3.63, 95% confidence interval (CI) = 3.0-4.3, P < 0.001] and adults (AOR = 4.58, 95% CI = 3.8-5.6, P < 0.001) who vaped in the past 30 days had higher odds of subsequent e-cigarette abstinence compared with youth who vaped in the past 30 days. Across ages, among past 30-day vapers, exclusive tobacco/flavorless e-cigarette use was prospectively associated with increased e-cigarette abstinence (AOR = 2.2, 95% CI = 1.9-2.5, P < 0.001), multiple-flavor-use was associated with decreased e-cigarette abstinence (AOR = 0.61, 95% CI = 0.53-0.71, P < 0.001), compared with exclusive menthol or sweet-flavored e-cigarette use. Dual e-cigarette and cigarette use was prospectively associated with reduced e-cigarette abstinence in young adults (AOR = 0.60, 95% CI = 0.50-0.80, P < 0.001), yet increased e-cigarette abstinence in adults (AOR = 1.4, 95% CI = 1.1-1.6, P < 0.001).

SUMMARY: Among adults and youth in the United States, exclusive vaping of sweet, menthol or multiple flavors, compared with tobacco/flavorless products, appears to decrease odds of later short-term e-cigarette abstinence.