Reasons for using flavored liquids among electronic cigarette users: A concept mapping study

Background: Electronic cigarettes (ECIGs) aerosolize liquids often containing flavorants for inhalation. Few studies have examined the role of flavors in ECIG use. This study's purpose was to examine reasons for flavored ECIG use using a mixed-method approach, concept mapping (CM).

Methods: Forty-six past 30-day adult ECIG users recruited from vape forums/conferences completed three online CM tasks. Participants brainstormed responses to a prompt: "A specific reason I use flavored e-liquid in my electronic cigarette product is…". The final 107 brainstormed statements were sorted by participants into groups of similar content. Participants rated each statement on a 7-point scale (1-Definitely NOT a reason to 7-Definitely a reason) based on a prompt: "This is a specific reason why I used flavored e-liquid in my electronic cigarette product in the past month." A cluster map was generated from participants' sorting and ratings using CM statistical software. Cluster mean ratings were compared.

Results: Analysis revealed five clusters of reasons for flavored ECIG use including Increased Satisfaction/Enjoyment, Better Feel/Taste than Cigarettes, Variety/Customization, Food Craving Suppression, and Social Impacts. Statements in the Increased Satisfaction/Enjoyment and Better Feel/Taste than Cigarettes clusters were rated significantly higher than statements from other clusters (ps<0.05). Some statements indicated flavors were perceived as masking agents for nicotine or other bad tastes associated with cigarette smoking making ECIG use more palatable.

Conclusions: Flavored ECIGs are used for many reasons. Some statements suggested flavors may increase the rewarding and possible addictive effects of ECIGs. These results support continued examination of the role of flavors and ECIG use behaviors.