NEW YORK, April 22 (UPI) — Vaping devices or e-cigarettes flavored with menthol, coffee and watermelon, among others, potentially drive addiction by making the products more appealing and increasing their use, experts told UPI.
Although the flavors themselves aren’t making vaping products more addictive, they may cause users to indulge more frequently, the experts said.
Like cigarettes, the primary addictive substance in vaping devices or e-cigarettes is nicotine, they added.
Addiction to vaping is “primarily about the active substance in the product, which is either nicotine or cannabinoids,” Maciej L. Goniewicz, a pharmacist and researcher in the Department of Health Behavior at Roswell Park Comprehensive Cancer Center in Buffalo, N.Y., told UPI in a phone interview.
“The flavors, which are are widely available and used by all age groups, seem to increase the likelihood of more frequent use,” he said.
Of particular concern is that research suggests “young people are more likely to try products with the flavors,” Goniewicz said.
What the studies say
Studies regarding the use of vaping devices or e-cigarettes and the potential for addiction to them have been proliferating in recent years as vaping becomes more common, according to Goniewicz.
And the research published to date has spotted some significant trends.
In March, for example, a study in mice published by the journal Nicotine & Tobacco Research found the rodents tended to prefer the kinds of nicotine solutions found in vaping devices that contained “higher sweetener concentrations.”
Smaller studies in human subjects have also spotted similar tendencies.
Goniewicz and his colleagues tested blood nicotine concentrations for a 2020 study and found that daily smokers who used vaping devices flavored with cherry and menthol had higher levels of addictive nicotine in their blood than those who smoked traditional cigarettes.
They also found that users of flavored vaping devices had longer “puff durations” — meaning they inhaled for more extended periods of time — than traditional cigarette smokers.
Similarly, a 2021 study found that “ice”-flavored e-cigarettes may increase the risk for nicotine dependence among young adults who use them and that users of these so-called “hybrid” vapes, which combine sweet fruit and cooling mint or menthol flavors, were nearly 50% more likely to smoke traditional cigarettes and develop symptoms of nicotine dependence than non-users.
“Nicotine products that taste sweet and are flavored appeal to youth,” one of that study’s co-authors, Adam Leventhal, told UPI in an email.
“One of the key reasons is that nicotine is naturally bitter and irritates the airways and oral cavity, [but] flavors and sweeteners help mask nicotine’s unpleasant taste,” said Leventhal, who is the executive director of the Institute for Addiction Science at the University of Southern California.
That appeal can make a huge difference, as a study by Goniewicz and his team found that users of flavored vaping devices were more likely to turn to them as part of efforts to quit smoking traditional cigarettes.
A more recent study by Leventhal and his team, published this month by the journal JAMA Network Open, found that high school-aged vapers were more likely to engage in “frequent, chronic vaping and polytobacco use” if they used vaping devices with higher concentrations of nicotine — and that these young users may not even be aware of the nicotine content of their preferred products.
A national public health issue
Nicotine use among young people can adversely affect brain development, specifically the brain circuits that control attention and learning, according to the National Institute on Drug Abuse.
Other risks associated with nicotine use in young people include mood disorders, such as depression and anxiety, and permanent problems with impulse control, the agency says.
In addition, the Food and Drug Administration has received thousands of reports of serious lung illnesses associated with vaping, including dozens of deaths nationally.
It is working with the Centers for Disease Control and Prevention to investigate the cause of these illnesses, though a thickening agent called Vitamin E acetate has been identified as a “chemical of concern among people with e-cigarette or vaping associated lung injuries,” some of which have resulted in the need for a lung transplant.
Still, research by the National Institute on Drug Abuse and others has highlighted the growing popularity of vaping devices among teens and the concern that young users may not even be aware of the nicotine content of these products.
The institute also notes that the “easy availability of these devices, alluring advertisements, various e-liquid flavors and the belief that they’re safer than cigarettes have helped make them appealing to this age group.”
That said, efforts to limit this “easy availability” have yielded mixed results. In 2016, the FDA established a rule for e-cigarettes and their liquid solutions, making them subject to government regulation as tobacco products.
Three years later, in 2019, the federal government raised the legal minimum age of sale of tobacco products, including vaping devices, to 21 from 18.
Under this new restriction, minors can no longer legally buy e-cigarettes in stores or online, and the FDA has been increasingly hesitant to approve flavored vaping products for sale and use, in part because of their appeal among teens.
In fact, the Supreme Court recently upheld the agency’s decision to reject applications from two manufacturers of flavored e-cigarette products and its regulation prohibiting retailers from marketing flavored vaping devices.
This means that, officially, product labeling for e-cigarettes cannot legally include references to flavors, but this ban is not strictly enforced, according to Goniewicz.
That may be why assessments of e-cigarette use among teams — including one study of nearly 11,000 high schoolers in the United States published in February — continue to suggest that as many as one in four is vaping.
“Flavors make the product more attractive and easier to use, but it is also the marketing — the vaping device with a unicorn on the device or a fancy design is not [targeting] a 60-year-old smoker,” Goniewicz said.
“Of course, manufacturers and distributors want to make money, but they can do more by not making [their products] trendy, easy to use and cheap to use,” he said.
