title: Impact of flavour variability on electronic cigarette use experience: an internet survey.
abstract: BACKGROUND
  A major characteristic of the electronic cigarette (EC) market is the availability of a large number of different flavours. This has been criticised by the public health authorities, some of whom believe that diverse flavours will attract young users and that ECs are a gateway to smoking. At the same time, several reports in the news media mention that the main purpose of flavour marketing is to attract youngsters. The importance of flavourings and their patterns of use by EC consumers have not been adequately evaluated, therefore, the purpose of this survey was to examine and understand the impact of flavourings in the EC experience of dedicated users.
  
  
  METHODS
  A questionnaire was prepared and uploaded in an online survey tool. EC users were asked to participate irrespective of their current smoking status. Participants were divided according to their smoking status at the time of participation in two subgroups: former smokers and current smokers.
  
  
  RESULTS
  In total, 4,618 participants were included in the analysis, with 4,515 reporting current smoking status. The vast majority (91.1%) were former smokers, while current smokers had reduced smoking consumption from 20 to 4 cigarettes per day. Both subgroups had a median smoking history of 22 years and had been using ECs for 12 months. On average they were using three different types of liquid flavours on a regular basis, with former smokers switching between flavours more frequently compared to current smokers; 69.2% of the former subgroup reported doing so on a daily basis or within the day. Fruit flavours were more popular at the time of participation, while tobacco flavours were more popular at initiation of EC use. On a scale from 1 (not at all important) to 5 (extremely important) participants answered that variability of flavours was "very important" (score = 4) in their effort to reduce or quit smoking. The majority reported that restricting variability will make ECs less enjoyable and more boring, while 48.5% mentioned that it would increase craving for cigarettes and 39.7% said that it would have been less likely for them to reduce or quit smoking. The number of flavours used was independently associated with smoking cessation.
  
  
  CONCLUSIONS
  The results of this survey of dedicated users indicate that flavours are marketed in order to satisfy vapers' demand. 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 ECs by youngsters is currently minimal, it seems that implementing regulatory restrictions to flavours could cause harm to current vapers while no public health benefits would be observed in youngsters. Therefore, flavours variability should be maintained; any potential future risk for youngsters being attracted to ECs can be sufficiently minimized by strictly prohibiting EC sales in this population group.
authors.affiliation: Onassis Cardiac Surgery Center, Sygrou 356, Kallithea 17674, Greece. kfarsalinos@gmail.com.
authors.forename: Konstantinos E
authors.initials: KE
authors.lastname: Farsalinos
authors.forename: Giorgio
authors.initials: G
authors.lastname: Romagna
authors.forename: Dimitris
authors.initials: D
authors.lastname: Tsiapras
authors.forename: Stamatis
authors.initials: S
authors.lastname: Kyrzopoulos
authors.forename: Alketa
authors.initials: A
authors.lastname: Spyrou
authors.forename: Vassilis
authors.initials: V
authors.lastname: Voudris
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D057566:Self Report; D012907:Smoking / Q000453:epidemiology / Q000523:psychology*; D011795:Surveys and Questionnaires; D013649:Taste; D061485:Tobacco Use Cessation Devices / Q000706:statistics & numerical data*