Do flavour descriptions influence subjective ratings of flavoured and unflavoured e-liquids among non-smoking and non-vaping UK adolescents?

Introduction: Youth use of electronic cigarettes (e-cigarettes/vapes) is rising globally. Identifying the factors driving this increase is important, in order to prevent health harms. One factor that may be associated with youth appeal is the flavour description on e-liquid packaging. Methods: We conducted an online observational study in a UK sample of 120 adolescent participants (aged 11–17 years). We compared subjective responses to e-liquid packaging flavour descriptions (primary analyses: flavoured versus unflavoured; secondary analyses: candy/sweet flavour versus fruit flavour). Outcome variables were packaging appraisal, packaging receptivity, perceived harm, and perceived audience. Results: Packaging appraisal ratings were higher for e-liquids with flavoured versus unflavoured descriptions (mean difference 5.9, 95% CI 4.2 to 7.6, p <.001). Likewise, packaging receptivity ratings were higher for e-liquids with flavoured versus unflavoured descriptions (mean difference 4.2, 95% CI 2.8 to 5.6, p <.001, respectively). Adolescents also perceived e-liquids with flavoured (versus unflavoured) descriptions as less grown-up (mean difference -5.2, 95% CI -7.3 to -3.1, p <.001). However, we did not find evidence for a difference in perceived harm. Conclusions: Although there were differences in subjective ratings of e-liquids with flavoured and unflavoured descriptions, adolescents generally had low appraisal and receptivity for e-liquids, and they perceived them as being grown-up and harmful. Further research is needed to examine adolescent responses to flavour descriptions on additional e-cigarette products (e.g., disposable vapes), and other aspects of e-cigarette packaging (e.g., colours, imagery, and branding), before making policy recommendations.