The use of flavored tobacco products has been associated with tobacco experimentation among youth and young adults. In fact, the initial use of menthol or mint-flavored cigarettes places youth, young adults, and adults ≥25 years of age at risk for subsequent tobacco use, according to the results of a longitudinal cohort study published in JAMA Network Open.

Investigators sought to explore the prevalence of first use of flavored tobacco products in new tobacco users and the link between initial flavored use of a given tobacco product and tobacco use 1 year later, including the progression of tobacco use. The current cohort study represented a longitudinal analysis of data from the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative study that included data compiled from 2013 to 2014 (wave 1) and from 2014 to 2015 (wave 2). Study participants were noninstitutionalized individuals, including 11,996 youth and 26,447 adults, who were involved in both waves of the PATH Study. Data analysis was performed between July 2016 and June 2019. The main study outcome was the prevalence of use of a tobacco product at wave 2.

The mean age of all participants was 14.5 years among youth, 21.1 years among young adults, and 50.3 years among adults. Overall, 71.9% of the youth (95% CI, 69.7%-74.0%) and 57.6% of the young adults (95% CI, 54.9%-60.3%) who were new tobacco users during the 10- to 13-month follow-up period used flavored products. Youth were between 12 and 17 years of age, young adults were between 18 and 24 years of age, and adults were ≥25 years of age.

Initial use of a menthol, mint, or other flavored cigarette verified at wave 1 was positively associated with prior 12-month and prior 30-day cigarette use in all age groups at wave 2 compared with the initial use of a nonflavored cigarette, as follows:


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Youth

Past 12-month flavored cigarette use: adjusted prevalence ratio (aPR), 1.14 (95% CI, 1.05-1.25); past 30-day flavored cigarette use: aPR, 1.15 (95% CI, 1.00-1.31); past 12-month menthol or mint cigarette: aPR, 1.18 (95% CI, 1.08-1.29); past 30-day menthol or mint cigarette: aPR, 1.19 (95% CI, 1.04-1.37).

Young Adults

Past 12-month flavored cigarette use: aPR, 1.09 (95% CI, 1.04-1.15); past 30-day flavored cigarette use: aPR, 1.13 (95% CI, 1.06-1.21); past 12-month menthol or mint cigarette use: aPR, 1.10 (95% CI, 1.05-1.16); past 30-day menthol or mint cigarette use: aPR, 1.15 (95% CI, 1.07-1.23).

Adults

Past 12-month flavored cigarette use: aPR, 1.10 (95% CI, 1.05-1.15); past 30-day flavored cigarette use: aPR, 1.09 (95% CI, 1.04-1.14); past 12-month menthol or mint cigarette use: aPR, 1.13 (95% CI, 1.08-1.18); and past 30-day menthol or mint cigarette use: aPR, 1.12 (95% CI, 1.07-1.17).

In addition, “[a]mong young adults, first use of flavored e-cigarettes (aPR, 2.05; 95% CI, 1.61-2.61), any cigars (aPR, 1.60; 95% CI, 1.26-2.02), cigarillos (aPR, 1.49; 95% CI, 1.08-2.05), filtered cigars (aPR, 3.69; 95% CI, 2.08-6.57), hookah (aPR, 1.91; 95% CI, 1.23-2.98), and any smokeless tobacco (aPR, 1.54; 95% CI, 1.08-2.20) was prospectively associated with current regular use of these products at wave 2 compared with the first nonflavored use,” the authors wrote.

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Furthermore, among adults, the initial use of flavored electronic cigarettes (aPR, 1.60; 95% CI, 1.41-1.82), any cigars (aPR, 1.56; 95% CI, 1.29-1.87), cigarillos (aPR, 1.29; 95% CI, 1.01-1.64), filtered cigars (aPR, 1.79; 95% CI, 1.25-2.54), hookah (aPR, 5.66; 95% CI, 2.04-15.71), and any smokeless tobacco (aPR, 1.55; 95% CI, 1.32-1.82) was prospectively associated with the current regular use of these products at wave 2 compared with the first nonflavored tobacco use.

The investigators concluded that flavors in tobacco products were associated with subsequent tobacco use among youth and young adults. Future studies on the topic are warranted to gain a better understanding of the role played by flavors in the progression of tobacco use and trajectories over time.

Reference

Villanti AC, Johnson AL, Glasser AM, et al. Association of flavored tobacco use with tobacco initiation and subsequent use among US youth and adults, 2013-2015. JAMA Netw Open. 2019;2(10):e1913804.