Use of Electronic Nicotine Delivery Systems or Cigarette Smoking After US Food and Drug Administration-Prioritized Enforcement Against Fruit-Flavored Cartridges

Abstract

Importance: The Center for Tobacco Products (CTP) of the US Food and Drug Administration prioritized its enforcement efforts against non-tobacco-, non-menthol- (fruit-) flavored cartridge electronic nicotine delivery systems (ENDS) in February 2020. Objective: To evaluate adults' use of ENDS and cigarette smoking following the CTP's prioritized enforcement efforts against fruit-flavored cartridge ENDS. Design, Setting, and Participants: In this population-based, nationally representative US cohort study, data were collected from the Population Assessment of Tobacco and Health Study from December 2018 to November 2019 (hereafter referred to as 2019) and/or from September 2020 to December 2020 (Adult Telephone Survey, hereafter referred to as 2020). Adults (aged ≥21 years) who used ENDS in the past 30 days and smoked cigarettes in the past 30 days or quit smoking cigarettes in the past year (n = 3173) were evaluated. Data were analyzed from January 1, 2022, to May 2, 2023. Exposure: ENDS flavor-device combinations used. Main Outcomes and Measures: Outcome measures were cross-sectional prevalence of ENDS flavor-device combinations used in 2019 (n = 2654) and 2020 (n = 519) and longitudinal transitions in cigarette smoking (cessation [no smoking in the past 30 days in 2020 among those who smoked in 2019; n = 876] and relapse [smoking in the past 30 days in 2020 among those who recently quit in 2019; n = 137]) as a function of ENDS flavor-device combination used in 2019. Results: The sample in 2019 included 2654 individuals (55% male [95% CI, 53%-58%]). Among those who used ENDS and smoked cigarettes, fruit-flavored cartridge ENDS use decreased from 13.9% (95% CI, 12.1%-15.9%) in 2019 to 7.9% (95% CI, 5.1%-12.1%) in 2020 (P =.01), whereas fruit-flavored disposable ENDS use increased from 4.0% (95% CI, 3.1%-5.1%) in 2019 to 14.5% (95% CI, 11.6%-18.0%) in 2020 (P