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Highlights • ENDS were the tobacco products most likely to be tried first. • Fruit was the favorite flavor, followed by menthol/mint/wintergreen. • Preference for flavor varied by age, sex and racial/ethnic background. • Those who preferred fruit flavor were twice as likely to have tried ENDS first. • Those who preferred menthol/mint/wintergreen were less likely to have tried ENDS first., Among youth who use electronic nicotine delivery systems (ENDS), e-cigarettes are often the first tobacco product tried. Flavor is a common reason for experimentation with e-cigarettes. This study assessed flavor preferences and the choice of ENDS as an initial product among youth by selected demographic characteristics. The analysis sample included 1549 participants who had ever tried ENDS, drawn from a national online survey of youth aged 13–18 in 2017. Fruit was the most common favorite flavor among ENDS users, followed by menthol/mint/wintergreen. Preference for flavor varied by age, sex and racial/ethnic background. ENDS were the tobacco products most likely to be tried first, particularly among participants under age 17. Those who preferred fruit flavor were twice as likely to have tried ENDS first, compared to those with other flavor preferences, while those who preferred menthol/mint/wintergreen flavor were half as likely to have tried ENDS first. Our findings support an association between flavor and ENDS use. Our research supports previous findings indicating that: 1) flavor is one of the primary reasons for experimentation with ENDS among youth; 2) fruit flavor is strongly associated with use of ENDS as the first tobacco product; and 3) preference of fruit flavor varies by age, sex and racial/ethnic background. These findings have relevance for developing targeted messages for specific youth audiences and implications for tobacco regulatory policies. In addition to January 2020 federal regulations, the authors recommend tighter restrictions, specifically that the marketing and sale of all e-cigarette flavors other than tobacco be eliminated.

Objective: In this study, we assessed differences in type, number, and perceptions of ENDS flavors used at initiation and currently among 4 smoking and ENDS use profiles of US adults with a history of smoking and ENDS use. Methods: Our nationally representative survey sample included 1814 participants. We estimated Rao–Scott χ2 and adjusted odds ratios. Use profiles included: (1) Dual Users (current smokers/current ENDS users), (2) ENDS Rejecters (current smokers/former ENDS users), (3) Switchers (former smokers/current ENDS users), and (4) Quitters (former smokers/former ENDS users). Results: Multiple flavor use at initiation was associated with higher odds of being a Dual User or Switcher. Those who used mint/wintergreen/menthol flavored ENDS at initiation had lower odds of being an ENDS Rejecter (vs Dual User). Current use of tobacco/unflavored or menthol/mint/wintergreen flavor was associated with higher odds of being a Dual User (vs Switcher). Switchers were more likely to perceive flavors as safe in ENDS and rate flavors as important to their ENDS use. Conclusions: Multiple flavor use at initiation, perceiving flavors as safe, and use of specific flavors (mint/wintergreen/menthol) at initiation may discourage rejecting ENDS. However, current use of traditional cigarette flavors (ie, tobacco, menthol) may promote sustained smoking.

In three experiments, rats were presented compound solutions consisting of a common element, saccharin, mixed with one of two different flavor elements, cinnamon and wintergreen. Rats in the experimental groups consistently received a toxicosis-inducing injection following one compound solution but not following the other compound solution. Rats in the control groups received toxicosis-inducing injections half the time following each of the compound solutions. After training in each experiment, there were tests for conditioning to the saccharin alone. The experimental groups drank significantly more than the control groups, indicating that the aversion to the partially reinforced saccharin in isolation was less when the different flavor cues were more highly correlated with reinforcement. In Experiment III, there was also a test for conditioning to the cinnamon or wintergreen flavor alone. The experimental group drank significantly less of the continuously reinforced flavor than the control group did of the partially reinforced flavor. These results are similar to those reported within more traditional conditioning paradigms.