Survey of Youth Finds That Majority Who Used Tobacco Started With Flavored Product


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Among a survey of youth 12 to 17 years of age, the majority who self-reported ever experimenting with tobacco started with a flavored product, and most current tobacco users reported use of flavored products, according to a study published by JAMA.


Most tobacco use begins during youth and young adulthood. Recent declines in prevalence of cigarette smoking among youth have coincided with increased use of e-cigarettes and hookahs. Although flavors other than menthol are prohibited in cigarettes in the United States, flavored noncigarette tobacco products are widely available and may appeal to youth, according to background information in the article.


Bridget K. Ambrose, Ph.D., M.P.H., of the Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Md., and colleagues examined flavored tobacco use among U.S. youth using data from the Population Assessment of Tobacco and Health Study, a household-based, nationally representative study of 45,971 adults and youth (12-17 years) in the United States. Youth responded to questions about ever and past 30-day use of tobacco products including cigarettes, e-cigarettes, hookahs, cigars, pipe tobacco, all types of smokeless tobacco, dissolvable tobacco, bidis, and kreteks. For each product ever used, youth answered whether the first product they used was flavored (e.g., “Was the first e-cigarette you used flavored to taste like menthol, mint, clove, spice, candy, fruit, chocolate, alcohol [such as wine or cognac], or other sweets?”).


Of the 13,651 youth enrolled and included in this analysis, 51 percent were male, 55 percent non-Hispanic white, 14 percent non-Hispanic black, and 23 percent Hispanic; average age was 14.5 years. The majority of youth ever-users reported that the first product they had used was flavored, including 89 percent of ever hookah users, 81 percent of ever e-cigarette users, 65 percent of ever users of any cigar type, and 50 percent of ever cigarette smokers. For past 30-day youth tobacco use, the overall proportion of flavored product use was 80 percent among users of any product and 89 percent among hookah users, 85 percent among e-cigarette users, 72 percent among users of any cigar type, and 60 percent among cigarette smokers. Youth consistently reported product flavoring as a reason for use across all product types, including e-cigarettes, hookahs, cigars, smokeless tobacco, and snus pouches.


“Consistent with national school-based estimates, this study confirms widespread appeal of flavored products among youth tobacco users. In addition to continued proven tobacco control and prevention strategies, efforts to decrease use of flavored tobacco products among youth should be considered,” the authors write.

(doi:10.1001/jama.2015.13802; Available pre-embargo to the media at http:/


Editor’s Note: Funded by the National Institute on Drug Abuse, National Institutes of Health, and the U.S. FDA, Department of Health and Human Services. The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.


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