Most experts agree that sweet flavors such as cotton candy and mango help entice teens to try their first-ever puff on an electronic cigarette. But what keeps them coming back?
Flavors appear to play a role in that too, according to a new study of Los Angeles high school students. Those who vaped with flavors other than tobacco and menthol were more likely to maintain their habit over the long term -- and they took more puffs each time they reached for their device.
The findings, published Monday in the journal Pediatrics, provide another piece of evidence to help experts understand the causes of a skyrocketing addiction crisis across the country. Millions of teenagers are vaping, and hundreds of thousands of them will develop a nicotine addiction that prompts them to switch to smoking regular cigarettes.
"Once they've started, if they use a sweetly flavored product, they're more likely to stick with it," said study leader Adam Leventhal, director of the USC Health, Emotion and Addiction Laboratory.
"It's that simple," he said. "If the product you're using is really appealing, you're more hard-pressed to put it away."
E-cigarettes lack many of the carcinogenic ingredients found in traditional cigarettes, but they still contain an array of chemicals with unknown health effects. Aside from the direct risks, epidemiologists have found that teens who vape are more likely to become smokers than their peers who don't vape. That's significant because smoking is the leading cause of preventable deaths.
The Food and Drug Administration took action to restrict kid-friendly flavors in regular cigarettes in 2009. But when it did so, it failed to extend its new rules to electronic cigarettes. By 2014, the national Centers for Disease Control and Prevention reported that vaping among adolescents had increased by nearly 800% in just three years. More than 80% of teenagers who vaped said they did it because "it comes in flavors I like."
"Those increases were pretty striking," Leventhal said. "They sparked our interest."
So Leventhal and his team decided to examine whether teenagers who tried vaping with fruity or dessertlike flavors developed a notably higher frequency or intensity in the behavior over the next six months.
The researchers examined five sets of questionnaires from 478 Los Angeles high school students who said they vaped. The questionnaires were filled out twice a year, beginning when the students were in 10th grade and ending in the spring of their senior year.