• Andrea C Villanti, Amanda L Johnson, Bridget K Ambrose, K Michael Cummings, Cassandra A Stanton, Shyanika W Rose, Shari P Feirman, Cindy Tworek, Allison M Glasser, Jennifer L Pearson, Amy M Cohn, Kevin P Conway, Raymond S Niaura, Maansi Bansal-Travers, and Andrew Hyland.
• 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.
• Am J Prev Med. 2017 Aug 1; 53 (2): 139-151.

IntroductionThe 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).MethodsA 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.ResultsCurrent 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.ConclusionsThese results add to the evidence base that flavored tobacco products may attract young users and serve as starter products to regular tobacco use.Copyright © 2017 American Journal of Preventive Medicine. All rights reserved.

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