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(A) Mean hedonic ratings ± standard error and (B) individual hedonic ratings of the six e-cigarettes sampled (2 flavor levels × 3 nicotine levels) by 19 subjects. E-cigarettes contained either 4.7% or 9.3% cherry flavoring and 0, 6, or 12 mg/mL of nicotine. Different letters above the bars in (A) indicate significant differences in hedonic ratings per Tukey's honest significant difference test, p < .05. Note the difference in y-axis range between (A) and (B) for clarity. Abbreviations on the right y-axes represent semantic labels of the labeled hedonic scale. MLSI = most liked sensation imaginable; LE = like extremely; LVM = like very much; LM = like moderately; LS = like slightly; DS = dislike slightly; DM = dislike moderately; DVM = dislike very much; DE = dislike extremely; MDSI = most disliked sensation imaginable.
Source publication
Introduction:
To examine the interaction between an added flavoring (cherry) and nicotine on the perception of electronic cigarette (e-cigarette) aerosol and how this impacts the appeal of flavored e-liquids.
Methods:
19 subjects (13 male, 6 female) vaped 6 commercially available e-liquids with varying contents of nicotine (0, 6, 12 mg/mL) and c...
Contexts in source publication
Context 1
... <.0005], but not flavor level [F(1,18) = 2.72, p > .05] on liking. As shown in Figure 1A, hedonic ratings among the six samples (3 nicotine levels × 2 flavor levels) decreased systematically as the nicotine content increased. In contrast, hedonic ratings tended to increase as the concentration of cherry flavor increased from 4.7% to 9.3%, although this tendency did not reach statistical significance. ...
Context 2
... mean hedonic ratings for all six samples were above neutral ("0" on left y-axis). Hedonic responses were symmetrically distributed ( Figure 1B), suggesting that there were no individuals with a strong disliking of the e-liquid aerosols. Figure 2 displays log mean intensity ratings for four attributes-sweetness, cherry flavor, harshness, and bitterness-at two flavor levels (black bars, 4.7% cherry flavor; gray bars, 9.3% cherry flavor) and three nicotine concentrations (0, 6, and 12 mg/mL). ...
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... This suggests that the risk is not limited to combustible tobacco products, such as cigarettes, but also encompasses e-cigarettes and other tobacco products, including cigars, pipes, and smokeless tobacco. This is consistent with the study of Pullicin et al. 17 which observed an increase in perceived irritation and bitterness and a decrease in perceived sweetness when nicotine was added to e-cigarette aerosols. On the other hand, a systematic review by Ralho et al. 12 found that while e-cigarette smokers have a higher susceptibility to changes in oral biological tissues compared to former smokers or never smokers, e-cigarettes are less harmful than conventional cigarettes. ...
INTRODUCTION
This study aims to assess the relationship between use of tobacco products and taste and smell disorders.
METHODS
A secondary dataset analysis of cross-sectional data from the National Health Interview Survey (NHIS) 2021 survey cycle, a nationally representative annual cross-sectional interview of non-institutionalized US civilians, was used. Participants' senses of smell and taste are assessed using self-reported questions. Participants were categorized into five groups based on their tobacco use: non-tobacco users; cigarettes only; e-cigarettes only; cigar, pipe, or smokeless tobacco; and poly-tobacco product users. Disorders were defined as any self-reported difficulty in smelling, tasting, or reporting unpleasant odors or persistent tastes. Weighting procedures were used to estimate the national prevalence of taste, smell, and other disorders, stratified by tobacco products used. Adjusted logistic regression models were used to determine the association between tobacco products used and taste or smell compared to non-tobacco users.
RESULTS
A total of 40.2 million US adults reported experiencing smell or taste disorders. Nearly one in 10 adults reported a taste disorder (9.8%), and 13.4% indicated a smell disorder. The prevalence of taste or smell disorder was higher among females (17.5%), Hispanics (19.5%), individuals identified as ‘other’ racial minorities (21.1%), and lower income groups (21%). Compared to non-tobacco users, the highest odds of experiencing smell or taste disorders were among poly-tobacco product users (adjusted odds ratio, AOR=1.44; 95% CI: 1.31–1.58), followed by e-cigarette-only users (AOR=1.38; 95% CI: 1.02–1.87), cigarette-only smokers (AOR=1.17; 95% CI: 1.04–1.32), and users of cigars, pipes, or smokeless tobacco (AOR=1.15; 1.00; and 1.33; respectively).
CONCLUSIONS
Tobacco product use was associated with an increased risk of smell and taste disorders. The rising use of e-cigarettes among adolescents and young adults is particularly concerning given the limited understanding of the sensory effects of e-cigarettes and their growing popularity among younger populations. The study findings highlight the need for interventions aimed at reducing tobacco use of all kinds.
... Pullicin et al. in 2020 demonstrated that the addition of cherry flavor affected the sensory perception and appeal to e-C aerosol. Flavored e-C aerosol increased perceived sweetness and improved liking but increasing concentration of nicotine nullified the pleasing effect of the sweet flavor [44]. Further, it was also shown that e-C smokers preferred their usual brand but demonstrated higher average puff duration with strawberry flavor as compared to tobacco [45]. ...
The availability of a wide range of flavored e-cigarettes is one of the primary reasons for vaping initiation and persistent use among adolescents and young people. This plethora of flavors available on the market are crafted using different flavoring agents such as cinnamaldehyde, vanillin, benzaldehyde, ethyl maltol, menthol, and dimethylpyrazine. Recent studies have brought to light the potential risks associated with e-cigarette flavoring agents and their effects on various organ systems, both with and without nicotine. Research has demonstrated that flavoring agents can induce inflammation, endothelial dysfunction, epithelial barrier disruption, oxidative stress, DNA damage, electrophysiological alterations, immunomodulatory effects, and behavioral changes, even independently of nicotine. Notably, these negative outcomes adversely affect cardiovascular system by reducing cell viability, decreasing endothelial nitric oxide synthase, nitric oxide bioavailability, soluble guanylyl cyclase activity and cyclic guanosine monophosphate accumulation, impairing endothelial proliferation and tube formation, and altering vasoreactivity resulting in vascular dysfunction. In the heart, these agents decrease parasympathetic activity, induce depolarization of resting membrane potential, loss of rhythmicity, increase isovolumic relaxation time, and change in ventricular repolarization and ventricular tachyarrhythmias. It is found that the specific response elicited by flavoring agents in different organ systems varies depending on the flavor used, the concentration of the flavoring agent, and the duration of exposure. However, the literature on the effects of flavoring agents is currently limited, emphasizing the need for more preclinical and randomized clinical trials to gain a deeper understanding and provide further evidence of the harmful effects of flavored e-cigarette use. In summary, recent research suggests that flavoring agents themselves can have detrimental effects on the body. To fully comprehend these effects, additional preclinical and clinical studies are needed to explore the risks associated with flavored e-cigarette usage.
... A 2-puff session will be conducted to test each of the 10 conditions, followed by ratings of appeal and sensory attributes during a 10-minute washout period between conditions. A similar study design has been used to examine the differential appeal of EC flavors, nicotine levels, and the interactive effects between flavor and nicotine [19,[21][22][23]. The study has been applied for registration at clinicaltrials.gov ...
... There will be a 10-minute washout period between conditions to minimize carryover effects, where participants will be instructed to rinse their mouth and spit at least three times with room-temperature water [21]. The washout period stems from the fact that plasma nicotine levels return to baseline 40 minutes after a 10-puff vaping session [27], suggesting that 8 minutes will be sufficient for nicotine levels to return to baseline after two puffs. ...
... Also, the 10 test liquids will all be tobacco-flavored, thus flavor effects cannot be assessed. This design was chosen to minimize participant burden and based on the fact that the impact of nicotine concentration on sensory experiences was consistent across different flavors [21]. Still, the study will support future studies aimed to develop e-liquid product standards on EC nicotine dimensions other than concentration and form (i.e., nicotine isomer), as well as the interaction between EC nicotine dimensions and flavoring and their long-term behavioral effects. ...
Objectives
E-cigarettes pose significant risks to youth, but smokers may benefit from switching to e-cigarettes by reducing their exposure to toxicants, which creates a challenge for the Food and Drug Administration (FDA) in regulating e-cigarettes to protect population health. This study aims to develop e-liquid product standards for nicotine form and concentration that reduce the appeal of e-cigarettes to young people while keeping e-cigarettes available as a safer alternative for smokers.
Design and participants
A single-visit, double-blinded, randomized crossover design will be used to examine the effects of e-liquids with varying fractions of free-base nicotine (5%, 25%, 45%, 65%, 85%) among a sample of 66 young adult EC users and 66 older adult smokers, across ecologically valid total nicotine concentrations (20 mg or 50 mg/mL).
Interventions and outcomes
A 2-puff session will be conducted to test each of the 10 e-liquids in randomly assigned sequences, followed by a 10-minute washout period and participant ratings on appeal and sensory attributes such as throat hit and harshness, as well as behavioral intentions for continued use. Generalized linear mixed models will be used to determine a free-base nicotine level that has limited or no appeal to young adult e-cigarette users while remaining acceptable to smokers.
Conclusions
This study will provide the FDA with scientific evidence regarding the effect of product standards that mandate a minimum threshold for the fraction of free-base nicotine.
Trial registration
The study is registered on clinicaltrials.gov under the identifier NCT05864586 .
... Some prior laboratory studies have identified trends (Krishnan-Sarin et al., 2017;Rosbrook & Green, 2016) or significant effects (Baker et al., 2021), indicating that flavors increase the reinforcing properties of e-cigarettes at higher doses of nicotine. In contrast, others have found flavors increase the rewarding effects only in low-or no-nicotine e-cigarettes (DeVito et al., 2020;Leventhal et al., 2019;Pullicin et al., 2020). These discrepant findings could be related to variation in several important features of e-cigarettes used in these studies including nicotine dose, use of freebase nicotine versus nicotine salt, or available flavors. ...
... Self-reported abstinence was assessed prior to each experimental session, and sessions were rescheduled if participants reported use in the prior 16 hr. Of note, the duration of required abstinence in similar prior studies has ranged from 2 hr (Leventhal et al., 2019;Pullicin et al., 2020) to ≥24 hr (Vargas-Rivera et al., 2021). The puffing procedure, in this study, was adapted from procedures used in prior studies (Krishnan-Sarin et al., 2017;Vansickel et al., 2012) for our remote procedures. ...
... Our findings provide support for the hypothesis that preferred e-cigarette flavors mask the acute aversive qualities of nicotine (i.e., increasing appeal) more at lower rather than higher nicotine doses (Patten & De Biasi, 2020). This is consistent with prior findings that nicotine elicits irritation and thus flavors' influence on e-cigarette liking is diminished with greater nicotine doses (Pullicin et al., 2020). However, other research on flavors suggests that well-liked flavors may simply increase the pleasantness of electronic nicotine delivery systems (ENDS) rather than mask the aversiveness of nicotine per se (Baker et al., 2021). ...
Prior research suggests that flavors can influence the pharmacological effects of nicotine. We used commercially available JUUL pods to examine whether preferred menthol versus tobacco flavor increased the addictive potential of nicotine per se. This study recruited 15 regular JUUL e-cigarette users to complete a 2 × 2 factorial crossover trial using an entirely remote video format. Participants completed a sampling baseline session to identify preferred JUUL flavor (menthol vs. tobacco) followed by four counterbalanced experimental sessions separated by ≥ 48 hr: (a) low-nicotine dose (3% JUUL)/nonpreferred flavor; (b) low dose/preferred flavor; (c) high-nicotine dose (5% JUUL)/nonpreferred flavor; and (d) high dose/preferred flavor. In each experimental session, participants completed a puffing procedure followed by subjective ratings of e-cigarette liking and wanting (ELW), urges, and reinforcement using a JUUL pod purchase task. There was a dose-by-flavor interaction for average ELW (F = 4.58, p = .041) in which ELW was significantly greater for the preferred than the nonpreferred flavor at the low-nicotine dose but not the high-nicotine dose. There were also dose-by-flavor interactions for pre- to post-puffing change in overall urge to vape (F = 5.97, p = .021) and urge strength (F = 4.96, p = .049), with greater reductions in overall urge/strength for the preferred compared to the nonpreferred flavor at the low but not the high dose. We found no significant interaction effects for purchase task outcomes. Using a fully remote experimental puffing procedure, our findings suggest preferred flavors increase the rewarding effects most for lower nicotine e-cigarettes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
... When given 10 different flavors that included flavors categorized as sweet or non-sweet by the researchers, non-treatment seeking vapers rated the sweet flavors as sweeter than non-sweet flavors, which were still sweeter than the no flavor condition (Goldenson et al., 2016), but flavor condition did not influence ratings of throat hit. Finally, when Pullicin et al. (2020) gave current eCig users V2 eCigs with varying amounts of nicotine, a greater concentration increased irritation ratings (as expected) and more notably, significantly depressed sweetness ratings. Collectively, it seems sweet smelling e-liquids increase sweetness and decrease bitterness, but potential influences on harshness/throat hit are less clear. ...
... Conversely, when nicotine-free propylene glycol/vegetable glycerine (PG/VG) mixtures were co-presented with fruity or confectionary-associated odorants (iso-amyl acetate, ethyl butyrate, vanillin, and ethyl maltol) in young adults who did not regularly use nicotine containing products, the fruity aromas (iso-amyl acetate, ethyl butyrate) increased sweetness but not pleasantness, while the confectionary aromas (vanillin, ethyl maltol) increased pleasantness but not sweetness. Other reports also find that sweetness and throat hit/irritation are positive and negative predicts of appeal in vapers (Goldenson et al., 2016;Kim et al., 2016), while acknowledging that throat hit/irritation may be a positive attribute in dual users who also smoke combustible tobacco (Pullicin et al., 2020). ...
Thousands start smoking or vaping daily, despite long-standing efforts by public health authorities to curb initiation and use of nicotine containing products. Over the last 15 years, use of electronic nicotine delivery systems has increased dramatically, with a diverse range of products on the market, including pod-based, disposable, and refillable electronic cigarettes (eCigs). Originally intended for harm reduction and smoking cessation, eCigs may encourage nicotine use among never smokers, given the vast range of appealing flavors that are available. To better understand abuse liability and to facilitate appropriate regulations, it is crucial to understand the science of flavor, and flavor perception within the context of eCig use. Here, we (a) provide a brief primer on chemosensory perception and flavor science for addiction and nicotine researchers, and (b) highlight existing some literature regarding flavor and nicotine use, with specific attention given to individual differences in perception, and interaction between different sensory modalities that contribute to flavor. Dramatic increases in use of eCigs highlights the importance of flavor science in contemporary addiction research, both with regards to public health and regulatory efforts. Other recent work summarizes findings on flavored e-liquids and eCig use, but none have focused explicitly on chemosensory processes or flavor perception as they relate to appeal and use of such products. We argue flavor science needs to be considered as perceptual and behavioral phenomena, and not merely from analytical, toxicological and pharmacological perspectives; we help address this gap here.
... Taste sensitivity to PTC and PROP, a heritable trait in humans, is influenced by polymorphisms in bitter taste receptor genes (Guo and Reed, 2001). Nicotine is the primary source of bitter taste in e-cigarettes, and there is a positive association between nicotine concentration and ratings of bitterness (Pullicin et al., 2020). While the relationship between taster status and e-cigarette use has not been directly examined, it is interesting to consider whether non-tasters of PTC/PROP are also more prone to e-cigarette use. ...
... In studies directly examining e-cigarette use, sweet flavor additives such as piña colada, cotton candy, and cherry increase ratings of sweetness, and ratings of sweetness are positively associated with liking (Goldenson et al., 2016;Kim et al., 2016;Mead et al., 2019;Pullicin et al., 2020;Baker et al., 2021a). Conversely, subjects rate flavors such as tobacco as harsher, more bitter, and more irritating; these ratings are negatively correlated with liking (Kim et al., 2016;Mead et al., 2019;Baker et al., 2021a). ...
... A subset of these studies also found no evidence of a "masking effect" whereby flavors alter nicotine's irritant properties. For example, harshness ratings of nicotinecontaining e-cigarettes did not decrease with addition of cherry or other sweet flavors (Mead et al., 2019;Pullicin et al., 2020;Baker et al., 2021a). However, sweet flavor additives did improve overall ratings of liking as compared to nicotine-only e-cigarettes (Baker et al., 2021a). ...
While rates of smoking combustible cigarettes in the United States have trended down in recent years, use of electronic cigarettes (e-cigarettes) has dramatically increased, especially among adolescents. The vast majority of e-cigarette users consume “flavored” products that contain a variety of chemosensory-rich additives, and recent literature suggests that these additives have led to the current “teen vaping epidemic.” This review, covering research from both human and rodent models, provides a comprehensive overview of the sensory implications of e-cigarette additives and what is currently known about their impact on nicotine use. In doing so, we specifically address the oronasal sensory contributions of e-cigarette additives. Finally, we summarize the existing gaps in the field and highlight future directions needed to better understand the powerful influence of these additives on nicotine use.
... In addition to menthol, sweet flavors in tobacco products are often associated with positive attitudes, reminders of other enjoyable food products, and product appeal, particularly for younger compared to older adults (Feirman et al., 2016;Huang et al., 2017;Kim et al., 2016;Leventhal et al., 2020;Meernik et al., 2019;Vu et al., 2019;Zare et al., 2018). For example, fruit and other sweet flavors in e-cigarettes are perceived as sweeter, smoother, and less bitter than tobacco-flavored (or flavorless) e-cigarettes, and perceived sweetness increases tobacco product appeal/liking (Goldenson et al., 2016;Kim et al., 2016;Leventhal et al., 2020;Pullicin et al., 2020). Overall, research linking sensory attributes and attitudes with tobacco use behavior outcomes suggests that positive reasons for using flavored tobacco and lower perceptions of harm may be associated with continued use of products over time (Feirman et al., 2016). ...
Use of flavored tobacco has been associated with lower likelihood of short-term abstinence from tobacco. It is unknown whether longer-term associations exist, particularly for a variety of products and specific flavor categories.
Using adult survey data from the Population Assessment of Tobacco and Health (PATH) Study (2013–2018), we tested associations of past 30-day tobacco product use at wave 2 using both a 2-category any flavor versus unflavored variable and 4-category specific flavor (menthol/mint, sweet, and both menthol/mint and sweet) versus unflavored variable with past 12-month cessation from the same product two years later at wave 4. Separate models were run for each product (combustible cigarettes, cigars, hookah, e-cigarettes, and smokeless), adjusting for wave 1 sociodemographic characteristics.
For all five products, past 30-day use of any flavored (versus unflavored) product at wave 2 was associated with reduced likelihood of same-product cessation at wave 4. Most specific flavor categories were associated with reduced odds of same-product cessation across all products. Any flavor use was also associated with reduced likelihood of longer-term cessation (i.e., past 24-months at both waves 3 and 4) and cessation from all five tobacco products for most products. Exploratory moderation results indicated that the association between e-cigarette flavor use and lower likelihood of cessation was stronger for young adults (18–24) versus older adults (25+).
Current use of flavored tobacco products is associated with lower likelihood of product cessation. Flavored tobacco products warrant consideration in regulatory policy to reduce the adverse public health impact of tobacco use.
... A parallel can be drawn to the psychopharmacology and abuse liability assessment of nonnicotine drugs, which found that some compounds have dose-dependent psychoactive effects (e.g., some drugs can act as sedatives at higher doses but a stimulant at lower doses). There is already some evidence indicating that increasing concentration levels of some flavorants in e-cigarette solutions might have linear or nonlinear effects on the product's sensory attributes and appeal (Pullicin et al., 2020;Rosbrook & Green, 2016). ...
Scientists and regulators need parsimonious methods of characterizing flavored e-cigarettes which may vary widely in both chemical flavoring constituents and marketing descriptors. This laboratory experiment characterized user-reported appeal and experience of five cross-cutting sensory attributes (sweetness, bitterness, smoothness, harshness, coolness) of 10 common e-cigarette flavors. In a within-subject double-blind single-visit protocol, current nicotine/tobacco product users (N = 119) self-administered a single puff of each e-liquid flavor via a pod-style device and rated its appeal and sensory attributes on 0-100 scales. Custom-manufactured e-liquids, nicotine concentration: M (SD) = 23.4 (0.9) mg/mL, representative of commonly marketed fruit (green apple, strawberry), dessert (dark chocolate, vanilla), mint (peppermint, spearmint), nonmint cooling (menthol, koolada), and tobacco (subtle tobacco, full-flavored tobacco) flavor descriptors were used and their constituents were independently analyzed. Results largely demonstrated that a flavor's sensory attributes concorded with its marketed flavor descriptor. Among the 10 flavors, vanilla was rated sweetest (B[difference vs. mean of 9 other flavors] = 14.44, 95% CI [10.84, 18.03]), full-flavored tobacco was most bitter, B = 8.34, 95% CI [4.73, 11.96], subtle tobacco was most harsh, B = 5.69, 95% CI [1.70, 9.68], and peppermint scored highest in both smoothness, B = 6.98, 95% CI [3.13, 10.82], and coolness, B = 29.25, 95% CI [25.50, 33.01]. Flavors with higher appeal ratings tended to be sweeter, smoother, cooler, and less bitter and harsh. Chemical analysis found numerous flavoring constituents among study products without any clear differentiation of chemicals being present in particular flavor categories, which underscores the utility of using sensory ratings to characterize different-flavored e-cigarettes over and above constituent analyses. Characterizing e-cigarette flavors by subjective sensory attributes may be useful in future research and regulatory activities. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
... While some studies found this attenuation for fruit and menthol/mint flavors for young adult vapers and adult cigarette smokers [112][113][114][115][116] other studies found no such association with fruit, menthol, or sweet flavors for young adult exclusive e-cigarette users or young adult menthol cigarette smokers. 97,117,118 One animal study also failed to show this association, with no affect of arctic blast flavor on responding for nicotine injection or aerosolized e-liquid. 119 However, another animal study showed that i.p. menthol injections led to more lever presses for lower nicotine and fewer for higher nicotine, as well as a higher nicotine breakpoint, than without menthol. ...
Introduction:
Many adult cigarette smokers use electronic cigarettes (e-cigarettes) to cut down on or quit smoking cigarettes. E-cigarettes with higher abuse potential and appeal might facilitate complete switching. E-liquid nicotine concentration and flavor are two of the characteristics that may affect the abuse potential and appeal of e-cigarettes. The objective of this systematic review was to compile results from survey, animal, human laboratory, and clinical studies to understand the possible effects of nicotine concentration and flavor on abuse potential and appeal of e-cigarettes in adult current and former cigarette and e-cigarette users.
Methods:
A comprehensive literature search was conducted in Ovid Medline and PsycINFO followed by citation tracking in Web of Science Core Collection. Peer-reviewed studies published in English between 2007 and August 2020 were selected that analyzed differences between e-liquid nicotine concentration and/or flavors, had outcome measures related to abuse potential and/or appeal, and included adult humans (18+) or animals. 1624 studies were identified and screened. A qualitative synthesis of results was performed.
Results:
Results from 104 studies included in this review suggest that higher nicotine concentration and access to a variety of flavors are likely to be associated with higher abuse potential and appeal of e-cigarettes for adult current and former cigarette and e-cigarette users.
Conclusions:
Higher nicotine concentrations and the availability of a variety of flavors in e-cigarettes might facilitate complete substitution for cigarettes. Future e-cigarette regulations should take into account their impact on smokers, for whom e-cigarettes may be a cessation tool or reduced-harm alternative.
Implications:
E-cigarettes may provide a reduced-harm alternative to cigarettes for smokers unwilling/unable to quit or serve as a path for quitting all nicotine products. Higher nicotine concentrations and flavor variety are associated with higher abuse potential and appeal of e-cigarettes. Higher abuse potential and appeal products may help facilitate complete switching from cigarettes to e-cigarettes. Regulation of nicotine concentration and flavors aimed at decreasing naïve uptake may inadvertently decrease uptake and complete switching among smokers, reducing the harm reduction potential of e-cigarettes. Evidence-based effects of regulating nicotine concentration and flavors must be considered for the population as a whole, including smokers.
... Helen et al., 2018). Added to this, few studies have investigated the interaction between flavors and nicotine concentration among e-cigarette users Pullicin et al., 2020;Rosbrook & Green, 2016). Most of these studies have reported on the effect of flavors, nicotine strength, and their interaction on sensory attributes, such as liking/wanting Rosbrook & Green, 2016), coolness (Rosbrook & Green, 2016), and perceived sweetness (Pullicin et al., 2020). ...
... Added to this, few studies have investigated the interaction between flavors and nicotine concentration among e-cigarette users Pullicin et al., 2020;Rosbrook & Green, 2016). Most of these studies have reported on the effect of flavors, nicotine strength, and their interaction on sensory attributes, such as liking/wanting Rosbrook & Green, 2016), coolness (Rosbrook & Green, 2016), and perceived sweetness (Pullicin et al., 2020). One clinical study conducted by Rosbrook and Green (2016) determined that menthol contributes to the sensory impact of e-liquids when nicotine concentration is low, while also reducing the perceived irritation and harshness produced by inhalation when nicotine concentration is high (Rosbrook & Green, 2016). ...
... One clinical study conducted by Rosbrook and Green (2016) determined that menthol contributes to the sensory impact of e-liquids when nicotine concentration is low, while also reducing the perceived irritation and harshness produced by inhalation when nicotine concentration is high (Rosbrook & Green, 2016). One clinical study conducted by Pullicin et al. (2020) has examined interactions between fruit flavors (i.e., cherry) and nicotine on the perception of e-cigarette aerosols. This study found that the appeal of e-cigarette aerosols decreased as nicotine concentration increased, while perceived sweetness improved liking (Pullicin et al., 2020). ...
Objective: The objective of this study is to examine the relationships between e-cigarette flavors, nicotine concentration, and their interaction on measures of nicotine dependence.
Methods: Survey data are drawn from a cross-sectional convenience sample of past 30-day e-cigarette users aged 15 to 24 years (N = 2037) collected between October 2020 and November 2020. Participants were asked to provide information about the e-cigarette products they used most regularly. Only those with available information on flavors (fruit, mint, menthol/ice, and tobacco), nicotine concentration (0-2.9%, 3-4.9%, and 5% or greater), and time to first vape after waking (within 30 minutes, greater than 30 minutes) were included in analyses (N = 1430). Generalized linear regression models were used with log link and binary distribution to assess the relationship between flavors, nicotine concentration, and nicotine dependence. Effect modification by nicotine concentration was assessed using an interaction term for flavors by nicotine concentration. Models were adjusted for age, race/ethnicity, gender, and financial situation.
Findings: Fruit, mint, and menthol flavor user groups had a very similar dose-response relationship between nicotine concentration and prevalence of vaping within 30 minutes. These groups showed that the prevalence of vaping within 30 minutes gradually increased as nicotine concentration increased. Meanwhile, tobacco flavor user groups demonstrated a decrease in prevalence of vaping within 30 minutes, as nicotine concentration increased.
Conclusion: Results highlight the need for understanding how e-cigarette product characteristics like flavors and nicotine concentration can facilitate nicotine dependence to e-cigarettes. Findings suggest that comprehensive e-cigarette product regulation of all flavors and reducing nicotine concentration will help to reduce the risk for nicotine dependence among young people.
