Flavors Remain a Major Driver of Youth E-Cigarette Use

ABSTRACT

Over the past decade, the landscape ofyouth e-cigarette use has been dynamic.1,2 E-cigarettes have been the most commonly used tobacco product among US youths since 2014,1 and in 2019, current (past30-day) e-cigarette use prevalence reached a peak among middle-school (10.5%) and high-school (27.5%) students.3 During 2020 to 2021, the COVID-19 pandemic resulted in virtual learning for students, which impacted youth access to e-cigarettes, including from social sources;in 2020, before COVID-19 was declared a pandemic, more than half of youths who currently used e-cigarettes reported getting their e-cigarettes from a friend.3 Nonetheless, in 2021, more than 2 million US middle- and high-school students used e-cigarettes.2 POLICIES TO REDUCE YOUTH E-CIGARETTE USE Flavors remain a major driver ofyouth e-cigarette use.2 A majority of youths who currently use e-cigarettes report flavors are a reason they used the products, and, in 2021,84.7% of youths who used e-cigarettes reported using a flavored product2;the most commonly used flavor types among youths were fruit (71.6%), followed by candy, desserts, or other sweets (34.1 %);mint (30.2%);and menthol (28.8%).2 Public health concerns over youth e-cigarette use have fueled the adoption of policies focused on flavored e-cigarettes. [...]as of February 2022, seven statesand more than 300communities have enacted restrictions on the sale of at least some flavored e-cigarettes;many of these laws include mentholflavored products.4 Research suggests these local laws are associated with reduced availability, marketing, and sales of restricted products.5 However, there is variation inthe specificproducts, flavors, and store types covered by these laws.4 FACTORS THAT DIMINISH POLICY IMPACT Noncomprehensive policies, such as those that exempt certain flavors, can lead to shifts in behaviors by consumers that might diminish the policy's intended effects.5 For example, following the January 2020 national restriction on the sale of certain flavored cartridge-based e-cigarettes (excluding menthol and tobacco), increases occurred in US sales of mentholflavored e-cigarettes and disposable e-cigarettes, the latter of which were still available for sale with fruit, candy, mint, and other flavors.6 Disposable e-cigarette use increased among US youths during 2019 to 2020, and in 2020, among youths who used flavored e-cigarettes, menthol use was 34.3% among those who used disposable e-cigarettes and 48.4% among those who used prefilled cartridges or pods.3 Actions by manufacturers can diminish the impact of flavored e-cigarette restrictions. CORRESPONDENCE Correspondence should be sent to Brian A. King, PhD, MPH, Office on Smoking and Health, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS S107-7, Atlanta, GA 30341 (e-mail baking@cdc.gov).