'Ice' Flavored e-Cigarettes Tied to Nicotine Dependence Among Young Adults

By Lisa Rapaport

June 18, 2021

(Reuters Health) - Young adults who use e-cigarettes with fruity "cooling" flavors like blueberry-ice and melon-ice may be at higher risk of nicotine dependence than vapers who favor other flavor types, a new study suggests.

Researchers examined data on 344 young adults (mean age 21.2 years) in Los Angeles, California, who completed online surveys from May to August 2020 and reported using e-cigarettes in the past 30 days. Overall, 48.8% of current e-cigarette users reported most often using so-called ice flavors, while others reported favoring fruity and sweet flavors (33.7%) or menthol and mint flavors (17.4%).

Participants who used ice flavors most often reported significantly more vaping in the past 30 days than those who mainly used menthol or mint flavors (b=4.4) and fruity or sweet flavors (b=3.6). Favoring ice-flavored e-cigarettes was also associated with more daily vaping episodes than preferring fruity or sweet flavors (b=2.4).

A preference for ice flavors was also associated with significantly higher odds of smoking traditional combustible cigarettes in the past 30 days compared with vapers who preferred menthol or mint flavors (odds ratio 2.7) as well as higher odds of vaping dependence compared with vapers with a preference for sweet or fruity flavors (OR 2.6).

"When young adults use ice-flavored e-cigarettes the combination of fruity/sweet flavors with cooling sensations might be particularly appealing, promote deeper inhalation, and encourage continued use," said lead study author Adam Leventhal, director of the University of Southern California Institute for Addiction Science in Los Angeles.

Some current federal regulations of e-cigarette flavors designed to prevent e-cigarette use in young people target fruit, mint, and dessert flavors - all flavors favored by teens and young adults - but exempt menthol flavors, Leventhal said by email.

Newer ice-flavored e-cigarettes appear to fall in a regulatory gray area because they combine sweet and fruity flavors targeted by some regulations with menthol or cooling flavors that aren't targeted, Leventhal said.

"Whether and how policy makers will regulate ice flavors, which might combine menthol and fruit/dessert flavors, is unclear," Leventhal said.

One limitation of the current study is that all outcomes were self-reported and subject to recall bias, the study team notes in Tobacco Control. The survey also didn't distinguish between use of e-cigarettes with and without nicotine, or assess the amount of nicotine concentration in products that participants used.

However, the findings illustrate the importance of clinicians asking youth detailed questions about vaping and tobacco use, including what flavors of they prefer, said Danielle Davis of the department of psychiatry at the Yale School of Medicine in New Haven, Connecticut, who wasn't involved in the study.

"Clinicians might ask youth questions like 'does your e-cigarette produce cooling sensations in your mouth or throat?' to determine if they use products with menthol, including ice flavors," Davis said by email.

"It's important to consider that additives that produce cooling sensations in e-cigarettes may make the nicotine in these products more palatable thus making it easier for youth to use at higher levels and/or more often, which may result in greater nicotine dependence," Davis said.

SOURCE: https://bit.ly/3wNStbC Tobacco Control, online June 14, 2021.

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