E-cigarette devices, brands, and flavors attract youth: Informing FDA's policies and priorities to close critical gaps

Purpose: Identify e-cigarette devices, brands, and flavor types used by adolescents and young adults soon after the enactment of flavor restrictions, youth access laws, FDA's enforcement prioritization against some flavored pod/cartridge-based e-cigarettes, and during COVID-19 pandemic-related school closures. Methods: National cross-sectional online survey (N = 4,351) in May 2020 assessed popularity, ever- and past-30-day use of e-cigarette device types (pod/cartridge-based, disposables, others), brands, flavor types and flavorenhancers, by age group (under age 21 and 21 and over). Results: While pod/cartridge-based e-cigarettes had the highest ever-use (82.7% <21; 69.8% >= 21) and were most often-used (41.9% <21; 41.4% >= 21), most past 30-day-users (50.8% <21; 61.9% >= 21) and 7-day-users (36.0% <21; 56.7% >= 21) used disposables. Mint/menthol was the most-used flavor type (pod/cartridge-based: 48.2% <21, 48.1% >= 21; disposables: 51.6% <21, 56.4% >= 21), followed by fruit (pod/cartridge-based: 37.4% <21, 35.5%>= 21; disposables: 51.6% >21, 46.2% >= 21), and sweet/dessert/candy flavor types (pod/cartridge-based: 24.4% <21, 24.7% >= 21; disposables: 29.7% <21, 33.8% >= 21). Participants reported using add-on e-cigarette flavor-enhancers (pod/cartridge-based: 24.6%; disposables: 31.3%). Conclusion: Soon after FDA's January 2020 announcement of prioritized enforcement against flavored pod/cartridge-based e-cigarettes and during the pandemic lockdown, adolescents' and young adults' past 30-day use included mostly flavored disposables rather than pod/cartridge-based e-cigarettes, mint/menthol flavors, and some used add-on flavor enhancers. To reduce youth use, comprehensive regulation of e-cigarette devices and flavors should be enacted and enforced at federal, state, and local levels.

Automated summary

The study found that during the period of flavor restrictions and youth access laws, as well as the COVID-19 pandemic, adolescents and young adults were more likely to use disposable e-cigarettes and those with mint/menthol, fruit, and sweet/dessert/candy flavors. Additionally, some participants also used flavor enhancers.