From Yummy Gummy to Arctic Ice: Adolescents' Use of Flavored Tobacco Products

Background: Smoking rates are declining among U.S. adolescents, but use of other tobacco products is steady or rising. We examined awareness and use of various tobacco products (e-cigarettes, cigars, little cigars, cigarillos, moist snuff, and snus) by demographics, and rates of flavored tobacco product use.

Methods: A nationally representative probability-based cross-sectional survey of 1336 adolescents 13-17 years old conducted in 2014.

Results: Overall, 23.3% of participants tried at least one tobacco product (17.8% conventional cigarettes, 9.1% e-cigarettes, 7.8% cigars, 6.6% little cigars, 6.7% cigarillos, 4.3% moist snuff, and 2.1% snus) and 12% tried multiple tobacco products. White adolescents were more aware of e-cigarettes, smokeless tobacco and cigars, but Black adolescents were more likely to be aware of and use little cigars and cigarillos. Among those who tried any tobacco product, 35.6% reported their first tobacco product was flavored, with significant variation by product (64.8% of e-cigarette users started with a flavored product, 56.7% snus, 47.5% moist snuff, 45.4% cigarillos, and 35.5% little cigars).  Only 24.7% of conventional cigarette smokers started with a flavored cigarette; for 80% of them it was a menthol cigarette. Among those who used tobacco products 6 times or more, 39% (cigarillos) to 56% (e-cigarettes) reported using flavored products often or always.

Conclusions: Many U.S. adolescents begin tobacco experimentation with flavored products and many use multiple tobacco products.  Surveillance and clinical treatment of adolescent tobacco use should address multiple tobacco products.  Policies limiting availability of flavored cigarettes should be extended to include menthol and other tobacco products.