E-liquid flavors and nicotine concentration choices over 6 months after a smoking cessation attempt with ENDS: Secondary analyses of a randomized controlled trial
- 09algor
- Jan 10
- 2 min read
11 January 2025
INTRODUCTION
E-cigarettes, also called electronic nicotine delivery systems (ENDS) or vapes, are increasingly popular among smokers and are often used to attempt to quit combustible cigarettes1. ENDS seems to be an effective and less expensive alternative to nicotine replacement therapy (NRT)2-4. Unlike most NRT products, ENDS are available with a broad range of e-liquid flavors and nicotine concentrations, giving smokers a range of choices to potentially substitute cigarettes5-8. Smokers who try ENDS have the option to change nicotine concentrations and flavors over time7,9,10.
When smokers switch to ENDS, observational data suggests that they tend to initially choose tobacco flavors, but long-term users are likely to report choosing fruity flavors7,9,10. The flavor preferences may change over time and users may use different flavors concurrently10-12. Flavor variety may even help ex-smokers remain abstinent9,10, as some studies reported that limiting flavors may drive them back to smoking cigarettes or dissuade smokers from switching to ENDS9,13,14. ENDS users who use e-liquids with nicotine, quit smoking more successfully than those who use e-liquids without nicotine15-17.
Studies on the use of ENDS flavors and nicotine concentrations have been mainly cross-sectional, showing prevalence of ENDS use at a single time-point, though it would be preferable to measure changes in vaping or smoking status over time. Since these studies typically included experienced ENDS users, their participants are not likely to represent the population of those who use ENDS to quit smoking. They also rely solely on self-reports, which are often inaccurate measures. The few existing randomized controlled trials of ENDS for smoking cessation restricted participants’ choice of nicotine concentrations and flavors2,16-18. The drawback of such RCTs with restricting flavors and nicotine concentration choices is that they do not reflect the typical experience with ENDS use in most countries where many e-liquid flavorings and nicotine concentrations are available. Thus, we need to analyze data from prospective cohorts that follow up smokers from their quit attempt and continue tracking them over time in a context where a choice of flavors and nicotine concentrations are available.
We therefore seized the unique opportunity to use data from the Efficacy, Safety, and Toxicology of ENDS (ESTxENDS) randomized controlled trial19, which provided free ENDS devices and 24 combinations of e-liquids to smokers who wanted to quit, along with standard-care smoking cessation counseling. We aimed to describe the choice of e-liquids and nicotine concentrations over time, comparing the use of e-liquid flavors and the liquids’ nicotine concentration between participants who only used ENDS (exclusive e-cigarette users) to those who used ENDS and smoked (dual users), collecting data at 5-time points over a 6-month period.