Trends in E-cigarette Flavour Use and Demographic Correlates among US Youth from 2020 to 2023

Bae D, Rahman T, Sanchez LMM, Miech R, Harlow AF, Han DH, Cho J, Sussman S, Dai HD, Meza LR, Mason T, Leventhal A.
Trends in E-cigarette Flavour Use and Demographic Correlates among US Youth from 2020 to 2023
Tob Control. 2025 Aug 12:tc-2024-059186. doi: 10.1136/tc-2024-059186. Epub ahead of print. PMID: 40803830.

Background: As US electronic cigarette (e-cigarette) flavour policies became increasingly restrictive during 2020-2023, flavoured e-cigarette use by the youth might have shifted.

Methods: US eighth, 10th and 12th graders in the Monitoring the Future study assessed the past 12-month nicotine vaping by flavour, in annual cross-sectional surveys over 2020-2023 (n=91 220). Among the past 12-month users (n=17 761), the e-cigarette flavour youth reported using most often was analysed by year, demographic/vaping pattern and year × demographic/vaping interaction using log-binomial regression.

Results: Among all respondents, past 12-month vaping of non-tobacco flavoured and tobacco/unflavoured products both declined over 2020-2023. Among past 12-month users, the proportion of youth who vaped a non-tobacco flavour remained unchanged from 2020 to 2023 (95.1-95.6%); fruit/ice-fruit (60.2-78.1%) and unflavoured (2.0-3.6%) product use rose and mint (24.7-6.8%), sweet/dessert (3.6-2.0%) and tobacco (2.8-0.8%) flavour use declined. Menthol flavour use increased non-linearly (6.7% in 2020, 15.9% in 2021, 8.7% in 2023). Collapsed across years, male, 12th grade, rural and frequent vaping statuses were associated with higher menthol use, and female, eighth and 10th grade, non-frequent vaping and suburban/town statuses were associated with higher fruit/ice-fruit use. Cross-year fruit/ice-fruit use increases were heightened in eighth graders (relative risk (RR)_year= 1.13). Youth menthol use declined in cities (RR_year=0.87) but increased in rural areas (RR_year=1.33).

Conclusion: During 2020-2023, most US youth vaped non-tobacco flavours. Reducing the availability of: (1) fruit/ice-fruit flavoured e-cigarettes might impact most US youth, especially younger teens and (2) menthol-flavoured e-cigarettes might especially impact youth vulnerable to frequent vaping and rural youth.