Evidence submitted to the FDA concerning the impact of flavor variability on e-cigarette use experience

Friday, 08 August 2014 17:58

Evidence submitted to the FDA concerning the impact of flavor variability on e-cigarette use experience

By Dr Farsalinos

Today, I submitted a second comment to the FDA, presenting the paper: Farsalinos KE, Romagna G, Tsiapras D, Kyrzopoulos S, Spyrou A, Voudris V. Impact of flavour variability on electronic cigarette use experience: an internet survey. Int J Environ Res Public Health 2013;10:7272-7282.

This is a survey of 4618 adult electronic cigarette users. They were asked to present their experience from using different flavors with electronic cigarettes and how this had influenced their smoking cessation efforts. You can see the submitted comment below (Comment Tracking Number: 1jy-8doh-ketu).

IMPACT OF FLAVORS VAARIABILITY ON ELECTRONIC CIGARETTE USE EXPERIENCE BY ADULT DEDICATED CONSUMERS

Comment Submitted in Response to FDA Regarding Proposed Rule Deeming Tobacco Products to be Subject to the Federal Food, Drug, and Cosmetic Act, as Amended by the Family Smoking Prevention and Tobacco Control Act; Regulations on the Sale and Distribution of Tobacco Products and Required Warning Statements for Tobacco Products

Konstantinos Farsalinos, MD

Onassis Cardiac Surgery Center, Kallithea, Greece

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

I am submitting an online survey of dedicated electronic cigarette users (all aged >18 years) about the impact of flavor variability on electronic cigarette use experience, for the FDA's consideration. The study was published in a peer-reviewed medical journal.

Farsalinos KE, Romagna G, Tsiapras D, Kyrzopoulos S, Spyrou A, Voudris V. Impact of flavour variability on electronic cigarette use experience: an internet survey. Int J Environ Res Public Health 2013;10:7272-7282.

Electronic cigarette users, irrespective of their smoking status, were asked to respond to an online questionnaire concerning the type of flavors used with electronic cigarettes and the importance of flavors availability and variability in partially or completely substituting smoking with electronic cigarette use.

In total, 4618 participants aged >18years were included in the analysis (2200 of them were US residents), with 91.1% of them using electronic cigarettes only (all were former smokers), while the rest were dual users. Participants had a median smoking history of 22 years, and had been using electronic cigarettes for 12 months.

The main results of the study were:

• ·         The most popular flavor types were fruit (69.4%), followed by sweet (61.4%) and tobacco (43.9%) flavors.
• ·         On average, electronic cigarette consumers used 3 different types of flavors on a regular basis. Of note, the number of flavors used was independently associated with complete substitution of smoking with electronic cigarette use.
• ·         Tobacco flavors were the most popular at initiation of electronic cigarette use, but there was a subsequent switch to other types of flavors.
• ·         The majority of participants (68.3%) switched between flavors daily or within the same day.
• ·         More than half of participants reported that the reason for using different flavors is a phenomenon of taste (or smell) receptor tolerance from using the same flavor for long-term.
• ·         Almost half of participants reported that if flavors variability was limited it would increase their craving for cigarettes, while 39.7% mentioned that it would be more difficult for them to quit smoking or reduce cigarette consumption.
• ·         On a scale from 1 (not at all important) to 5 (extremely important) participants answered that variability of flavors was “very important” (score = 4) in their effort to reduce or quit smoking.

The results of this survey indicate that flavors are marketed in order to satisfy the demand and needs of adult electronic cigarette users. They appear to contribute to both perceived pleasure and the effort to reduce cigarette consumption or quit smoking. Due to the fact that adoption of electronic cigarettes by youngsters is currently minimal, it seems that implementing regulatory restrictions to flavors could cause harm to current vapers while no public health benefits would be observed in youngsters. Therefore, flavors variability should be maintained. Any potential future risk for youngsters being attracted to electronic cigarettes can be sufficiently minimized by strictly prohibiting electronic cigarette sales in this population group.