Self-reported use of flavored tobacco products among middle- and high-school students in the U.S. increased in 2017, reversing a downward trend from previous years, according to data from the annual National Youth Tobacco Survey (NYTS).
Among current users of tobacco products, use of flavored products declined from 69.4% in the 2014 survey to 57.7% in 2016, but then rebounded to 63.6% in the 2017 survey, driven by the increasing popularity of flavored e-cigarettes, reported Hongying Dai, PhD, of the University of Nebraska Medical Center in Omaha.
Overall, use of any tobacco product declined from 17.3% in 2014 to 13.6% in 2017. No change was seen in menthol cigarette use during the period, and a decrease followed by a leveling off in usage was seen for flavored cigars, hookahs, and smokeless tobacco, according to the research letter in JAMA Pediatrics.
Among e-cigarette smokers, use of flavored products had declined from 63.3% in 2014 to 51.4% in the 2016 survey, before increasing to 58.7% in 2017. Last spring, FDA Commissioner Scott Gottlieb, MD, warned that the flavored e-cigarette Juul had become “wildly popular” with underage users.
Gottlieb has since declared teen use of Juul and other e-cigarettes an epidemic, citing more recent survey data showing that from 2017 to 2018, the overall proportion of teens using e-cigarettes doubled (11% to 21%).
The newly published analysis of NYTS data further highlights the need for restrictions on the marketing and sale of flavored e-cigarettes, said Dai.
“This [lack of regulation] has led to a proliferation of flavored tobacco products in the marketplace,” she told MedPage Today. “Flavoring has become one of the leading reasons for current tobacco use among youth.”
Dai noted that in the 2013-2014 NYTS, 81% of e-cigarette users, 79% of hookah users, 74% of cigar users, 69% of smokeless tobacco users, and 67% of snus users attributed the availability of appealing flavors for their tobacco use.
The newly published analysis included 78,265 middle- and high-school (55.9%) students responding to the survey from 2014 to 2017 (49.2% girls, 57.0% non-Hispanic white).
Tobacco researcher Scott McIntosh, PhD, of the University of Rochester Medical Center in New York, told MedPage Today that even though e-cigarettes are generally accepted to be safer than combustible cigarettes, it is not yet known if the flavorings commonly added to e-cigarettes are safe.
“We know that flavors like cinnamon are perfectly safe to eat, but we have no idea if they are safe to vaporize and inhale because that hasn’t been studied,” he said. “We also know that flavors mask the harshness of what is being inhaled.”
The University of Rochester Medical Center and the Roswell Park Comprehensive Cancer Center has been awarded a $19 million grant by the National Cancer Institute to study flavorings in tobacco products.
McIntosh said understanding the impact of flavors on e-cigarette and other tobacco product toxicity as well as their impact on user behaviors will be the key focus of the planned studies.
“Some flavors may be more dangerous than others, but we really don’t know that,” he said. “We need a better understanding of what these flavors do at a cellular level when inhaled.”
This research was supported by the National Cancer Institute and the National Institutes of Health.
Dai reported no conflicts of interest related to this work.