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‘Ice’ flavoured e-cigarette use among young adults
  1. Adam Leventhal1,
  2. Hongying Dai2,
  3. Jessica Barrington-Trimis1,
  4. Steve Sussman1
  1. 1 Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California, USA
  2. 2 Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
  1. Correspondence to Dr Adam Leventhal, Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA 90089, USA; adam.leventhal{at}


Background ‘Ice’ e-cigarette flavours—marketed as a combination of fruity/sweet and cooling flavours (eg, ‘blueberry ice’ or ‘melon ice’)—recently entered the US market. The prevalence and correlates of ice flavoured e-cigarette use in young adults are unknown.

Methods This cross-sectional study of a Los Angeles, California, USA, cohort analysed data from the past 30-day e-cigarette (current) users (n=344; M (SD)=21.2 (0.4) years old) who completed web-based surveys from May–August 2020. The exposure variable was self-reported e-cigarette flavour used most often in the past month (menthol/mint, fruit/sweet or ice). Outcomes included self-reported combustible tobacco use, vaping dependence symptoms, frequency of use and device type used.

Results Among current e-cigarette users, 48.8% reported using ice flavours most often, 33.7% predominately used fruit/sweet and 17.4% used menthol/mint. Using primarily ice-flavour was associated with reporting more past-30-day vaping days (vs menthol/mint: b=4.4, 95% CI (1 to 7.7); vs fruit/sweet: b=3.6, 95% CI (0.8 to 6.4)) and more episodes per vaping day versus fruit/sweet users (b=2.4, 95% CI (0.5 to 4.3)). Ice-flavour users were less likely than menthol/mint users to use JUUL/cartridge-based rechargeable (OR=0.1, 95% CI (0.03 to 0.45)) and more likely than sweet/fruit users to use disposable non-cartridge (OR=3.9, 95% CI (2.1 to 7.4)) devices than refillable/rechargeable tank/pen or other devices. Ice users had greater odds of past 30-day combustible tobacco use versus menthol/mint users (OR=2.7, 95% CI (1.3 to 5.7)) and vaping dependence symptoms than versus sweet/fruit users (OR=2.6, 95% CI (1.5 to 4.4)).

Conclusion Young adult use of ice flavoured e-cigarettes may be common and positively associated with combustible tobacco use, nicotine vaping frequency and dependence and use of disposable e-cigarette devices. Further study of the prevalence, determinants and health effects of ice flavoured e-cigarette use is warranted.

  • surveillance and monitoring
  • electronic nicotine delivery devices
  • public policy

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  • Contributors Access to data and data analysis: HD had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: AL, HD. Acquisition, analysis or interpretation of data: AL, HD, JB-T, SS. Drafting of the manuscript: AL, HD. Critical revision of the manuscript for important intellectual content: AL, HD, JB-T, SS. Statistical analysis: HD. Obtained funding: AL.

  • Funding Research reported in this publication was supported by the National Cancer Institute under Award Number U54CA180905 (AL/Pentz) and by the National Institute on Drug Abuse Award Number K24DA048160 (AL).

  • Disclaimer The funding agency had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.