Young people who use flavored tobacco at first are more likely to keep using tobacco later, study says

Young people who first try a flavored tobacco product are at higher risk of using tobacco later on, according to a new study.

The study, published Wednesday in the medical journal JAMA Network Open, analyzed data from nearly 12,000 youth and more than 26,000 adults in the United States. Data was collected from 2013 to 2014 and 2014 to 2015 to determine how many people started by using flavored tobacco products and how many continued to use tobacco products a year later.

Researchers asked subjects about flavored or non-flavored tobacco products, including cigarettes, e-cigarettes, cigars, cigarillos, hookah tobacco, pipe tobacco and smokeless tobacco. Flavored products could be mint, menthol, clove, spice, candy, fruit, chocolate, alcoholic beverages or sweet flavors.

The study highlights that “flavors in tobacco products put users at risk for subsequent tobacco use and that this is not limited to a single product,” such as e-cigarettes, said Dr. Andrea Villanti, an associate professor of psychiatry and psychology at the University of Vermont and a lead author of the study.

Researchers found that young people ages 12 to 17 and 18 to 24 were more likely than older adults to try flavored products.

Between the two phases of the study, 12.1% of youth, 27.6% of young adults and 8.3% of adults became new users of a tobacco product after never using a given product before. The younger the person, the more likely they were to use flavored tobacco products and then progress to non-flavored tobacco products later.

When compared with those who used a non-flavored product at first, first use of a flavored cigarette, e-cigarette, cigar products, hookah and smokeless tobacco in the first phase studied was associated with current regular use of those products among young adults and adults age 25 and older in the second phase.

Villanti noted that using menthol cigarettes first was related to subsequent daily cigarette use in all age groups. And the study also found that young adults and adults who began smoking flavored e-cigarettes progressed to frequent e-cigarette use.

Flavored e-cigarette use among young people in the United States increased from 2014 to 2018, according a report from the US Centers for Disease Control and Prevention and the US Food and Drug Administration.

Current use of flavored e-cigarettes has increased among high school students since 2014 and among middle school students since 2015, according to the report.

Dr. Sharon Levy, director of the adolescent substance use and addiction program at Boston’s Children’s Hospital, said the study findings didn’t surprise her at all.

“In my practice, kids tell me they often start because they’re tempted by the flavors, they want to taste them,” said Levy, who was not involved in the new study. “Who can blame them? Creme brulee, s’more flavors – they’re really kid-friendly.”

Levy said the study findings are a “good place to start” and could influence conversations about bans on flavored products.

“Hopefully this will push the legislation forward,” Levy said. “There’s been a huge discussion on banning flavored products for e-cigarettes, hopefully this will annihilate that argument.”