Experimental Forum 2: Two Years After the 2020 Food and Drug Administration Guidance on E-Cigarette Flavors

ABSTRACT

Putatively, flavorings afford adult cigarette smokers options to switch to vaping.1 But the flavorings are also perceived to be attractive to people who have never smoked cigarettes, with particular concern about nicotine initiation by underage youths.2 In particular, the flavor and type of device on which nicotine use is initiated may influence later nicotine dependence in young adults.3 In the United States, three broad classes of vaping device are common (1) single-unit disposable devices roughly equivalent to a pack of cigarettes;(2) homemade devices with, for example, customizable nicotine liquid tanks, batteries, and mouthpieces;and (3) devices with a rechargeable battery and replaceable cartridges containing nicotine liquid. Creating complicated relationships, and further limiting possible benefits to smoking cessation in the public health audience's eyes, Altria (formerly Philip Morris) purchased a major stake in JUUL in 2018. In addition to stay-at-home mandates, fear of contracting the respiratory illness was noted to increase motivation to quit cigarette smoking.8 Interestingly, e-cigarette users also reported greater quit attempts (41 %) than did cigarette smokers (26%) because of COVID-19 fears.9 In addition, various state and local prohibitions against public vaping and fluctuations in product cost have also occurred. Because of changes in sampling necessitated by the COVID-19 pandemic, data quality in large population-based surveys remains an area of active investigation, including potential discontinuities that could limit comparisons overtime. [...]we note that one or two time points since the Guidance was released may not portend sustained changes in behavior.