Flavored ENDS Use among Adults Who Have Used Cigarettes and ENDS, 2016-2017

Objective: In this study, we assessed differences in type, number, and perceptions of ENDS flavors used at initiation and currently among 4 smoking and ENDS use profiles of US adults with a history of smoking and ENDS use. Methods: Our nationally representative survey sample included 1814 participants. We estimated Rao–Scott χ² and adjusted odds ratios. Use profiles included: (1) Dual Users (current smokers/current ENDS users), (2) ENDS Rejecters (current smokers/former ENDS users), (3) Switchers (former smokers/current ENDS users), and (4) Quitters (former smokers/former ENDS users). Results: Multiple flavor use at initiation was associated with higher odds of being a Dual User or Switcher. Those who used mint/wintergreen/menthol flavored ENDS at initiation had lower odds of being an ENDS Rejecter (vs Dual User). Current use of tobacco/unflavored or menthol/mint/wintergreen flavor was associated with higher odds of being a Dual User (vs Switcher). Switchers were more likely to perceive flavors as safe in ENDS and rate flavors as important to their ENDS use. Conclusions: Multiple flavor use at initiation, perceiving flavors as safe, and use of specific flavors (mint/wintergreen/menthol) at initiation may discourage rejecting ENDS. However, current use of traditional cigarette flavors (ie, tobacco, menthol) may promote sustained smoking.