The impact of non-tobacco e-cigarette flavoring on e-cigarette uptake, cigarette smoking reduction, and cessation: A secondary analysis of a nationwide clinical trial

Introduction: The impact of e-cigarette flavoring on e-cigarette uptake and switching to e-cigarettes among adults who smoke is critical to e-cigarette regulation in the United Sates. The purpose of this secondary analysis was to assess the impact of e-cigarette flavoring choice on e-cigarette uptake and changes in cigarette smoking in a large nationwide trial of e-cigarette provision in the United States.

Methods: A free four-week supply of e-cigarettes was provided with minimal instructions to use to adults who smoke (N = 427). Participants selected from five flavor options: tobacco, menthol, blue/blackberry (one flavor), apple melon, or iced fruit. Participants could choose up to two flavors for each of two, two-week provisions of e-cigarettes.

Results: Participants who received an e-cigarette were 52 % female, 32 % non-white, and smoked an average (SD) of 14.8 (7.2) cigarettes per day at baseline. Only 5 % (n = 22) of participants chose to exclusively receive tobacco flavor. Compared to participants who exclusively received the tobacco flavor, participants who received any other flavor combination had greater e-cigarette uptake at the end of product provision (74 % vs. 55 %), were more likely to reduce cigarette smoking by at least 50 % at the end of product provision (34 % vs. 14 %) and at the final 6-month follow up (29 % vs. 5 %), and numerically, but not statistically, more likely to be abstinent from cigarettes at the end of product provision (11 % vs. 5 %) and the final 6-month follow-up (14 % vs. 5 %).

Conclusions: Results suggest that non-tobacco e-cigarette flavors may be more appealing than tobacco flavors, and better promote uptake of e-cigarettes and cigarette smoking reduction. Large-scale randomized trials in which participants are assigned to either tobacco or non-tobacco flavors are critical.