Flavors and high nicotine levels in e-cigarettes fuel addiction among young users

A study[1] conducted by the American organization Truth Initiative examines the associations between flavors, nicotine concentration and nicotine dependence among young people (15 to 24 years) who are regular users of e-cigarettes. The results show that flavors (fruity or menthol) as well as very high nicotine levels promote consumption, maintain dependence and reduce intentions to quit.

The study was conducted among 1,430 young Americans aged 15 to 24 who reported using an e-cigarette in the 30 days preceding the survey.[2]. Youth were asked about the flavors and nicotine levels they used most often in fall 2020 (Menthol, fruity, tobacco – and nicotine levels ranging from 0 to 5% or 0mg/ml to 50mg/ml). Nicotine dependence was assessed by asking how long they vaped after waking up.

Unlike the European Union and Canada, where nicotine concentrations in e-cigarettes cannot exceed 2 % (20mg/ml), there are no nicotine concentration restrictions in the United States.

High nicotine levels associated with lower intentions to quit

Unsurprisingly, the results show that young e-cigarette users who vaped products containing higher levels of nicotine were more addicted. Those who used products with a high nicotine concentration (5 % or more or 50mg/ml) were almost twice as likely to vape within half an hour of waking than those who used nicotine concentrations between 0 and 2.9 % (0 to 29 mg/ml). More than 6 in 10 young people (61.5%) using high nicotine products (3 to 5%, 30 mg/ml to 50 mg/ml) reported using them on the 10 days in the month preceding the survey, compared with 36% of those using products with a nicotine content of 0 to 2.9%.

Higher nicotine concentrations were also associated with greater frequency of e-cigarette use and lower intentions to quit vaping. The majority of e-cigarette users (60.8 %) who used products containing 0 to 2.9 % nicotine reported an intention to quit within a year, compared with less than half (46.8 %) of those who used nicotine concentrations of 5 % or higher.

Flavors help maintain addiction

The results of the study also show that, for products with the same nicotine concentration, young people consumed more e-cigarettes when they were flavoured with fruity or menthol flavours, and this from half an hour after waking up, than when they were flavoured with tobacco.

High-nicotine e-cigarettes and the many flavors that go with them became a growing concern in 2015 when JUUL debuted flavored pods containing 5 % of nicotine. Products with more than 5 % nicotine concentrations accounted for just 0.7 % of market share in 2015. Three years later, they accounted for more than two-thirds — 67.2 % — of the market. The study found that the average nicotine concentration in e-cigarette products increased from 2.10 % to 4.34 % between 2013 and 2018, an increase of 106.7 %.

The authors state that given the rapid evolution of e-cigarette supply and the wide variety of flavors and nicotine strengths associated with them, more comprehensive regulation of these flavors and nicotine concentration levels is needed to limit nicotine addiction among youth. Currently, 338 U.S. jurisdictions restrict flavored nicotine products in some form.

Keywords: Vaping, nicotine, flavors, electronic cigarettes, addiction

©Tobacco Free Generation

AE

---

[1] Elizabeth K. Do, Katie O'Connor, Jennifer M. Kreslake, Samantha C. Friedrichsen, Donna M. Vallone & Elizabeth C. Hair (2022) Influence of Flavors and Nicotine Concentration on Nicotine Dependence in Adolescent and Young Adult E-Cigarette Users , Substance Use & Misuse, DOI: 10.1080/10826084.2022.2034876[2] Truth Initiative, Higher nicotine levels in fruit-, menthol-, and mint-flavored e-cigarettes is tied to greater nicotine dependence, February 17, 2022, accessed February 21, 2022National Committee Against Smoking |