Abstract
INTRODUCTION: E-cigarettes with fruit and candy flavors are appealing among young adults. This study examined the prospective predictors of young adults' flavored e-cigarette use to inform regulation and prevention efforts. METHODS: We used the wave 1 (2013-2014) and wave 2 (2014-2015) data of the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative cohort study of U.S. youth and adults. We analyzed a sample of young adults aged 18-34 (n = 12,383) to identify wave 1 prospective predictors (i.e., socio-demographic characteristics, mental health symptoms, marijuana use, tobacco use, and e-cigarette harm perceptions) of wave 2 flavored e-cigarette use. RESULTS: At wave 2, 8.0% of young adults used e-cigarettes, and 2.5% and 5.5% used tobacco and menthol (TM) and non-tobacco and non-menthol flavors (NTM) flavors, respectively. In the multivariable model, significant prospective predictors (wave 1) of NTM flavored e-cigarette use compared to TM flavored e-cigarette use (wave 2) were younger age (18-24 years) (AOR = 1.82, p < 0.001), female gender (AOR=1.81, p < 0.001), education attainment of high school graduate and higher (AOR=1.60, p = 0.024), marijuana use (AOR=1.96, p < 0.001), ever but non-past-month cigarette smoking (AOR=2.75, p < 0.001), never cigarette smoking (AOR=5.08, p = 0.016), and lower harm perception of e-cigarettes (AOR=1.59, p = 0.005). CONCLUSION: This study highlights high rates of NTM flavor use and specific predictors of NTM flavored e-cigarettes use among young adults in the U.S. Regulation and prevention efforts for curbing flavored e-cigarette use among young adults should focus on these risk factors and high-risk groups (e.g., 18-24 years, female, and never cigarette smokers).