Flavored Tobacco Product Use in Youth and Adults: Findings From the First Wave of the PATH Study (2013-2014).
BACKGROUND
The 2009 Family Smoking Prevention and Tobacco Control Act banned characterizing flavors other than menthol in cigarettes but did not restrict their use in other forms of tobacco (e.g., smokeless, cigars, hookah, e-cigarettes).


METHODS
A cross-sectional analysis of Wave 1 data from 45,971 U.S. adults and youth, aged ≥12 years in the Population Assessment of Tobacco and Health (PATH) Study collected in 2013-2014, was conducted in 2016. This study examined (1) the prevalence and reasons for use of flavored tobacco products; (2) the proportion of ever tobacco users reporting that their first product was flavored; and (3) correlates of current flavored tobacco product use.


RESULTS
Current flavored (including menthol) tobacco product use was highest in youth (80%, aged 12-17 years); and young adult tobacco users (73%, aged 18-24 years); and lowest in older adult tobacco users aged ≥65 years (29%). Flavor was a primary reason for using a given tobacco product, particularly among youth. Eighty-one percent of youth and 86% of young adult ever tobacco users reported that their first product was flavored versus 54% of adults aged ≥25 years. In multivariable models, reporting that one's first tobacco product was flavored was associated with a 13% higher prevalence of current tobacco use among youth ever tobacco users and a 32% higher prevalence of current tobacco use among adult ever users.


CONCLUSIONS
These results add to the evidence base that flavored tobacco products may attract young users and serve as starter products to regular tobacco use.
Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Electronic address: avillanti@truthinitiative.org.
Andrea C
AC
Villanti
Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia.
Amanda L
AL
Johnson
Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland.
Bridget K
BK
Ambrose
Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina.
K Michael
KM
Cummings
Westat, Rockville, Maryland; Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia.
Cassandra A
CA
Stanton
Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia.
Shyanika W
SW
Rose
Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia.
Shari P
SP
Feirman
Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland.
Cindy
C
Tworek
Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia.
Allison M
AM
Glasser
Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Jennifer L
JL
Pearson
Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia.
Amy M
AM
Cohn
Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, Maryland.
Kevin P
KP
Conway
Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Raymond S
RS
Niaura
Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, New York.
Maansi
M
Bansal-Travers
Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, New York.
Andrew
A
Hyland
D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D066300:Electronic Nicotine Delivery Systems; D005260:Female; D005421:Flavoring Agents; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D000074606:Smoking Prevention / Q000331:legislation & jurisprudence*; D062789:Tobacco Products / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D014029:Tobacco Use Disorder / Q000453:epidemiology / Q000517:prevention & control*; D014481:United States; D055815:Young Adult
D005421:Flavoring Agents