To compare e-cigarette flavors preferred and reasons for use and discontinued use across never, current, and former e-cigarette users and cigarette smokers.
We recruited 1567 participants aged 18–34 years through Facebook ads targeting tobacco users and nonusers in August 2014 to complete an online survey. We assessed tobacco use, preferred flavors, and reasons for e-cigarette use and discontinued use.
Our sample was 49 % male, 87 % White; 56 % current cigarette smokers; and 53 % e-cigarette users. Current e-cigarette users used an average of 20.9 days in the past 30 (SD = 11.7) and 55.2 puffs/day (SD = 37.3). Compared to never and current smokers, former smokers used e-cigarettes more frequently (p’s <0.001). Among users and nonusers, the most preferred was fruit flavors, and the most commonly reported reason for e-cigarette use was “they might be less harmful than cigarettes”. The most endorsed reason for discontinued e-cigarette use was “using other tobacco products instead”. Never, current, and former smokers had distinct reasons for e-cigarette use and discontinued use and differed in flavor preferences.
Regulating marketing and flavors may impact e-cigarette uptake by young adults.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Benowitz NL, Goniewicz ML (2013) The regulatory challenge of electronic cigarettes. JAMA 310(7):685–686
Berg CJ, Barr DB, Stratton E, Escoffery C, Kegler MC (2014) Attitudes toward e-cigarettes, reasons for initiating e-cigarette use, and changes in smoking behavior after initiation: a pilot longitudinal study of regular cigarette smokers. Open J Prev Med 4(10):789–800
Berg CJ, Escoffery C, Bundy L, Haardoerfer R, Zheng P, Kegler MC (2015a) Cigarette users interest in using or switching to electronic nicotine delivery systems (ENDS) or smokeless tobacco for harm reduction, cessation, or novelty. Nicotine Tob Res 17(2):245–255
Berg CJ, Stratton E, Schauer GL, Lewis M, Wang Y, Windle M, Kegler MC (2015b) Perceived harm, addictiveness, and social acceptability of tobacco products and marijuana among young adults: marijuana, hookah, and electronic cigarettes win. Subst Use Misuse 50(1):79–89
Bombard JM, Pederson LL, Nelson DE, Malarcher AM (2007) Are smokers only using cigarettes? Exploring current polytobacco use among an adult population. Addict Behav 32(10):2411–2419
Bullen C, McRobbie H, Thornley S, Glover M, Lin R, Laugesen M (2010) Effect of an electronic nicotine delivery device (e cigarette) on desire to smoke and withdrawal, user preferences and nicotine delivery: randomised cross-over trial. Tob Control 19(2):98–103
Bullen C, Howe C, Laugesen M, McRobbie H, Parag V, Williman J, Walker N (2013) Electronic cigarettes for smoking cessation: a randomised controlled trial. Lancet 382(9905):1629–1637
Cahn Z, Siegel M (2011) Electronic cigarettes as a harm reduction strategy for tobacco control: a step forward or a repeat of past mistakes? J Public Health Policy 32(1):16–31
Callahan-Lyon P (2014) Electronic cigarettes: human health effects. Tob Control 23(Suppl 2):ii36–ii40
Caponnetto P, Campagna D, Cibella F, Morjaria JB, Caruso M, Russo C, Polosa R (2013) EffiCiency and Safety of an eLectronic cigAreTte (ECLAT) as tobacco cigarettes substitute: a prospective 12-month randomized control design study. PLoS One 8(6):e66317
Carpenter CM, Wayne GF, Pauly JL, Koh HK, Connolly GN (2005) New cigarette brands with flavors that appeal to youth: tobacco marketing strategies. Health Aff (Millwood) 24(6):1601–1610
Chen IL (2013) FDA summary of adverse events on electronic cigarettes. Nicotine Tob Res 15(2):615–616
DiFranza JR, Richards JW, Paulman PM, Wolf-Gillespie N, Fletcher C, Jaffe RD, Murray D (1991) RJR Nabisco’s cartoon camel promotes camel cigarettes to children. JAMA 266(22):3149–3153
Enofe NC, Berg CJ, Nehl E (2014) Alternative tobacco product use among college students: who is at highest risk? Am J Health Behav 38(2):180–189
Etter JF (2010) Electronic cigarettes: a survey of users. BMC Public Health 10:231
Etter JF, Bullen C (2014) A longitudinal study of electronic cigarette users. Addict Behav 39(2):491–494
Farsalinos KE, Polosa R (2014) Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: a systematic review. Ther Adv Drug Saf 5(2):67–86
Gartner CE, Hall WD, Chapman S, Freeman B (2007) Should the health community promote smokeless tobacco (snus) as a harm reduction measure? PLoS Med 4(7):e185
Gray N, Henningfield JE, Benowitz NL, Connolly GN, Dresler C, Fagerstrom K, Jarvis MJ, Boyle P (2005) Toward a comprehensive long term nicotine policy. Tob Control 14(3):161–165
Heatherton TF, Kozlowski LT, Frecker RC, Rickert W, Robinson J (1989) Measuring the heaviness of smoking: using self-reported time to the first cigarette of the day and number of cigarettes smoked per day. Br J Addict 84(7):791–799
Hersey JC, Ng SW, Nonnemaker JM, Mowery P, Thomas KY, Vilsaint MC, Allen JA, Haviland ML (2006) Are menthol cigarettes a starter product for youth? Nicotine Tob Res 8(3):403–413
Hua M, Alfi M, Talbot P (2013) Health-related effects reported by electronic cigarette users in online forums. J Med Internet Res 15(4):e59
King BA, Alam S, Promoff G, Arrazola R, Dube SR (2013) Awareness and ever-use of electronic cigarettes among US adults, 2010–2011. Nicotine Tob Res 15(9):1623–1627
King BA, Patel R, Dube SR (2015) Trends in Awareness and use of electronic cigarettes among US adults, 2010–2013. Nicotine Tob Res 17(2):219–227
Klein SM, Giovino GA, Barker DC, Tworek C, Cummings KM, O’Connor J (2008) Use of flavored cigarettes among older adolescent and adult smokers: United States, 2004–2005. Nicotine Tob Res 10(7):1209–1214
Lovato C, Linn G, Stead LF, Best A (2003). Impact of tobacco advertising and promotion on increasing adolescent smoking behaviours. Cochrane Database Syst Rev 4:CD003439
McMillen R, Maduka J, Winickoff J (2012) Use of emerging tobacco products in the United States. J Environ Public Health 2012:989474
Pearson JL, Richardson A, Niaura R, Abrams D, Vallone D (2011) Electronic cigarette awareness, use, and risk perceptions among current and former smokers. Society for Research on Nicotine and Tobacco, Toronto
Ramo DE, Prochaska JJ (2012) Broad reach and targeted recruitment using Facebook for an online survey of young adult substance use. J Med Internet Res 14(1):e28
Rath JM, Villanti AC, Abrams DB, Vallone DM (2012) Patterns of tobacco use and dual use in US young adults: the missing link between youth prevention and adult cessation. J Environ Public Health 2012:679134
Richardson A, Ganz O, Stalgaitis C, Abrams D, Vallone D (2013) Noncombustible tobacco product advertising: how companies are selling the new face of tobacco. Nicotine Tob Res. doi:10.1093/ntr/ntt200
Riker CA, Lee K, Darville A, Hahn EJ (2012) E-cigarettes: promise or peril? Nurs Clin North Am 47(1):159–171
Stepanov I, Jensen J, Hatsukami D, Hecht SS (2008) New and traditional smokeless tobacco: comparison of toxicant and carcinogen levels. Nicotine Tob Res 10(12):1773–1782
Stratton K, Shetty P, Wallace RB, Bondurant S (2001) Clearing the smoke: assessing the science base for tobacco harm reduction. DC, National Academy Press, Washington
Substance Abuse and Mental Health Services Administration (SAMHSA) (2013) Results from the 2012 national survey on drug use and health: summary of national findings, NSDUH series H-46, HHS publication no. (SMA) 13-4795. Substance Abuse and Mental Health Services Administration, Rockville
Villanti AC, Richardson A, Vallone DM, Rath JM (2013) Flavored tobacco product use among US young adults. Am J Prev Med 44(4):388–391
Wakefield M, Flay B, Nichter M, Giovino G (2003) Role of the media in influencing trajectories of youth smoking. Addiction 98(Suppl 1):79–103
Wayne GF, Connolly GN (2002) How cigarette design can affect youth initiation into smoking: camel cigarettes 1983–93. Tob Control 11(Suppl 1):I32–I39
Zhu SH, Gamst A, Lee M, Cummins S, Yin L, Zoref L (2013) The use and perception of electronic cigarettes and snus among the US Population. PLoS One 8(10):e79332
Zhu SH, Sun JY, Bonnevie E, Cummins SE, Gamst A, Yin L, Lee M (2014) Four hundred and sixty brands of e-cigarettes and counting: implications for product regulation. Tob Control 23(Suppl 3):iii3–iii9
Conflict of interest
The authors declare no conflicts of interest.
Statement of ethical approval
The Emory University Institutional Review Board approved this study, IRB# 00073636.
This research was supported by the National Cancer Institute (1K07CA139114-01A1; PI: Berg) and the Georgia Cancer Coalition (PI: Berg).
This article is part of the special issue “Electronic Cigarettes and Public Health”.
About this article
Cite this article
Berg, C.J. Preferred flavors and reasons for e-cigarette use and discontinued use among never, current, and former smokers. Int J Public Health 61, 225–236 (2016). https://doi.org/10.1007/s00038-015-0764-x
- Harm reduction
- Smoking cessation
- Tobacco marketing
- Tobacco control