Discrete product choices made by young adults who vape regularly reveal segments of flavor and nicotine focused users

AbstractIntroduction: Electronic cigarette ("eCig") use, or "vaping," is increasingly prevalent. Factors such as flavor and nicotine level may influence selection and use of eCigs. A better understanding of the role product attributes play in eCig preferences is necessary to inform evidence-based regulation of electronic nicotine delivery systems (ENDS). Methods: Here, we used choice-based conjoint (CBC) analysis to quantify different attributes that influence eCig preferences, including flavors, nicotine level, cooling/"ICE" properties, and user reviews. Young adults aged 18 to 25 who had vaped at least once in the past 7 days completed 18 choice tasks, as well as the Penn State Electronic Cigarette Dependence Index (PSECDI). They also answered questions about other nicotine product use and perceived eCig risk. CBC analysis was used to determine utility scores for each attribute.Results: Flavor was the most important attribute, followed by nicotine level. Sweet flavors, particularly candy ones, had the highest utility scores. Two segments of participants were identified via latent class analysis. The first segment was influenced predominately by nicotine level (with 5% nicotine receiving the highest utility score), whereas the second segment placed greater importance on sweet flavors. Segment 1 membership was associated with higher nicotine dependence, as well as greater likelihood of cigarette or cigar use.Conclusion: In young adults who vape regularly, flavor is the most important factor in eCig preferences, and sweet flavors – especially candy themed–were most preferred. We also found evidence of two segments: one that appeared more nicotine-focused, and one that appeared more flavor-focused.Implications: A discrete choice experiment revealed segments of flavor-focused and nicotine-focused eCig users. Strikingly, the more nicotine-focused users, defined strictly via their behavior in a choice task, were also more dependent and more likely to use combustible tobacco. Understanding why individuals choose particular eCig products can help inform public health efforts and policy making.