VAPERS who no longer smoke cigarettes prefer fruit and dessert e-liquids over tobacco flavours, according to the findings of a major survey overseen by a leading doctor.

The data from nearly 70,000 Americans who vape or have tried vaping, and took part in the US Flavours Survey initiated by Dr Konstantinos Farsalinos and a team of colleagues has now been submitted to the US Food and Drug Administration.

The government department asked for feedback in response to its Advanced Notice Of Proposed Rulemaking on vape (and other “tobacco product”) flavours earlier this year and Dr Farsalinos, a research fellow and cardiologist who has published over 50 studies and articles on smoking, tobacco harm and e-cigarettes, believed it was vital someone gathered data direct from vapers across America to help shape new government policy.
Lead author Dr Farsalinos says the research team, which includes two of his colleagues from the University of Patras in Greece and Dr. Christopher Russell from the Centre for Substance Use Research in the UK, will also publish an analysis of the data in an academic journal.

The study and questionnaire was designed by Dr Farsalinos and Dr Russell and the sample consisted of individuals aged 18 and older living in the US who have ever used an e-cigarette (even a single puff). They were invited to complete an online questionnaire that was available through FDA 21 CFR Part 11 compliant software.

To eliminate duplicate and ineligible entries, the researchers allowed only one submission from each unique American IP address.

After eliminating duplicate entries, there were 69,233 responses. Participants came from all 50 US states and the District of Columbia, and 72.4 per cent were male. The mean age of the group was 34.6. Almost 95 per cent of survey participants had at least tried cigarettes in their lives, and 81.6 per cent were established smokers at some time.

A large majority of participants — 81.3 per cent — were former smokers, and 68.2 per cent quit smoking more than 12 months ago.

Adult vapers tended to prefer sweet vape juice over tobacco flavours, which a study by Dr Russell in 2016 taken from survey data had already shown. However the new survey showed vapers have an even more pronounced preference for fruit and dessert flavours over tobacco than the 2016 one.

While 14.8 per cent of the ex-smokers in the 2016 Russell data were sometime-users of tobacco flavours, just 7.7 per cent of the exclusive vapers in the new survey vape tobacco. The vapers who also smoke, also prefer non-tobacco flavours. Just 9.1 per cent of dual users (vapers who also smoke) sometimes vape tobacco flavours.

All groups in both surveys overwhelmingly prefer flavours like fruit, dessert and confection flavors, what the FDA calls "characterizing flavors".

Among former smokers, 83.2 per cent vape fruit flavours at least some of the time, 72.3 per cent vape dessert sometimes, and 47.7 per cent vape CONFECTION. Dual users also preferred those kinds of flavours, as did never-smoking vapers. The choices were almost identical in the 2016 survey proving very little has changed in vapers’ preferences and tobacco flavour remains the least favourite option for all vapers, regardless if they are former cigarette smokers.

Dr Farsalinos said: “A few months ago, the FDA announced an ANPRM for flavours in tobacco products, including e-cigarettes. They then opened a public comment docket where anyone could submit commentaries, opinions, proposals and data.

"As you may know, I am always trying my best to submit comments whenever there is this possibility, raising concerns and presenting potential problems with proposed regulations throughout the world. In this case, I also submitted a file which was NOT a comment or an opinion piece but the data from the big US Flavours survey that we completed in May….

“In brief, we found extensive use of non-tobacco flavours among all smoking subgroups, including former smokers who were using e-cigarettes at the time of smoking cessation. Similar patterns were observed not only at e-cigarette use initiation but also at the time of smoking cessation and at the time of survey participation. Fruit and dessert/pastry/bakery flavours were the most prevalent choices of the adult established, dedicated US e-cigarette users who participated to this study. The same flavours were also considered particularly important in their effort to quit smoking and to prevent relapse to smoking.”

The survey came as a response to the FDA issuing a call for comments on regulation of flavoured tobacco products, including e-juice, back in March.

The agency said it aimed to limit flavours’ appeal to adolescents, whilst considering the role that they are having in helping adult smokers take the leap from smoking to vaping.

Once the public have had their say, the FDA will propose a new rule and after 60 days of gaining further feedback a new rule will be implemented.

FDA Commissioner Scott Gottlieb issued a press statement at the time in which he seemed to give weight to supposed evidence that flavoured e-cigarettes are addicting young people, while also noting ex-smokers found non tobacco-flavoured vape juice crucial in not returning to cigarettes.

He said: “We must… consider how best to address flavours in non-combustible products like e-cigarettes – given both their clear appeal to youth but also the potential role certain flavours may play in helping some adult smokers transition to potentially less harmful tobacco products.”

He added: “I’ve talked to ex-smokers, who’ve told me that they quit cigarettes altogether and that they now vape. “And they’ve also told me it was the flavours that helped them make that transition off combustible cigarettes. Now I know anecdotes aren’t the same as data. And the ANPRM specifically seeks data on this issue.”

The file submitted to the FDA by Dr. Konstantinos Farsalinos, can be read here.