"Children and youth prefer sweet flavors. We know that flavors increase appeal to young or inexperienced users," said lead researcher Andrea Villanti, an associate professor with the University of Vermont's Center on Behavior and Health. "Something that tastes like candy is more palatable to a young person than tobacco flavor on its own."
Her team found that young people who first try a flavored vape, cigar or smokeless tobacco are much more likely to still be using that product a year later.
For example, twice as many kids and young adults who first try a flavored e-cigarette will still be vaping a year later, compared with those who first try a tobacco-flavored vape, the study found.
The results support recent efforts by the Trump administration and some states to ban flavored e-cigarettes.
In response to growing pressure, e-cigarette maker Juul announced last week that it would suspend sales of all flavored pods for its vaping device. Only tobacco and menthol flavors will remain on the market, pending review by the U.S. Food and Drug Administration.
But Villanti noted that the problem extends far beyond vaping.
"E-cigarettes are getting a lot of attention right now, and they also have a lot of flavors, but this is a problem we have across all product categories," Villanti said. "It's not just an e-cigarette issue."
Regulations against flavorings in tobacco products remain weak, Villanti said. Cigarettes are the only tobacco product in which flavors are banned, although menthol cigarettes have been allowed to remain on the market.
To see whether flavors attract young people to tobacco and then help keep them using, Villanti and her team used data from an ongoing federally funded study that tracks tobacco use in the United States.
The researchers assessed data collected in 2013-2014 to see whether people are more likely to first try a flavored e-cigarette or other tobacco product. They then looked at data gathered a year later to see if those who first tried a flavored product were still using tobacco.
Seven out of 10 kids who were new users of tobacco first tried a flavored product, as well as more than half of young adults, researchers found.
Those young adults who started with a flavored product were more likely to stick with it, data from the second wave revealed. Current daily users included:
- Twice as many first-time users of flavored e-cigarettes or pipe tobacco,
- Three and a half times as many filtered cigar users,
- Twice as many hookah tobacco users,
- Half again as many users of cigarillos, cigars or smokeless tobacco.
"If you're younger than 25, the first product you probably use is flavored and you're more likely to continue to use tobacco products if you're introduced to a flavored product first," said Dr. Jamie Rutland, who reviewed the study. He's an assistant clinical professor of pulmonology and critical care at the University of California, Riverside.
Adults also were more likely to keep using a tobacco product if they first tried a flavored version, the study showed.
The new study "confirms what everybody already thought," Rutland said, adding that flavors have contributed to the recent boom in vaping.
"This was a study done five years ago, when they collected the data," noted Rutland, an American Lung Association national spokesman. "I think the data, if they collected it now, would be even more compelling."
The new study was published Oct. 23 in the journal JAMA Network Open.
Sources: Andrea Villanti, Ph.D., M.P.H., associate professor, University of Vermont Center on Behavior and Health, Burlington; Cedric "Jamie" Rutland, M.D., assistant clinical professor, pulmonology and critical care, University of California, Riverside; Oct. 23, 2019, JAMA Network Open.
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