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Effects of E-cigarette Flavors on Youth TCORS 2.0

Effects of E-cigarette Flavors on Youth

Status
Completed
Phases
Phase 1
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT03634839
Enrollment
42
Registered
2018-08-17
Start date
2022-11-07
Completion date
2023-07-20
Last updated
2024-08-09

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Nicotine Use Disorder

Brief summary

This study is an examination of the influence of sweet and cooling flavors on the appeal and abuse potential of nicotine-containing e-cigarettes among susceptible youth.

Detailed description

Researchers will examine the influence of sweet and cooling flavors on the appeal and abuse potential of nicotine-containing e-cigarettes among susceptible youth. Participants will rate the flavor intensity, coolness, sweetness, and irritation experienced using validated rating scales. Forty youth (18-20 years of age) who have experience with e-cigarettes and will participate in 1 laboratory session. They will receive 1 nicotine concentrations (36mg/ml nicotine salt) during the session; during the session they will be exposed, in random order, to sweet (watermelon) and sweet-cooling (watermelon-menthol) flavors combined with the assigned session nicotine concentration.

Interventions

DRUGFlavoring Agents

Flavor of e-liquid - sweet or tobacco

DRUGNicotine

Nicotine level (36 mg/ml)

Sponsors

National Institute on Drug Abuse (NIDA)
CollaboratorNIH
Yale University
Lead SponsorOTHER

Study design

Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
OTHER
Masking
TRIPLE (Subject, Caregiver, Investigator)

Masking description

Flavor and nicotine concentration is blinded to participant. Research staff and investigators are blinded to flavor order administer to participants.

Eligibility

Sex/Gender
ALL
Age
18 Years to 20 Years
Healthy volunteers
No

Inclusion criteria

* Ages 18-20 years * Able to read and write * Used e-cigs at least 10 times in lifetime * Used e-cigs in past 30 days

Exclusion criteria

* Current use of non-prescription substances besides nicotine, marijuana, alcohol * Any significant current medical or psychiatric condition * Known hypersensitivity to propylene glycol * Pregnant or lactating females * Uncontrolled asthma * Nut/e-liquid flavorant allergy * current marijuana (tetrahydrocannabinol) vaping + E-cigarette or vaping use Associated Lung Injury (EVALI) symptoms

Design outcomes

Primary

MeasureTime frameDescription
Liking: Difference Score in Liking/Wanting of Each E-cigarette ConditionFollowing administration of e-cigarette condition 1 (+10 minutes), following administration of e-cigarette condition 2 (+40)The Labeled Hedonic Scale will be used to ask about liking and wanting of the e-cigarette (one item Visual Analog Scale with ratings ranging from most disliked sensation imaginable to most liked sensation imaginable with higher values indicating greater liking). Specific scale semantic structure and corresponding values: most disliked imaginable=-100, dislike extremely=-62.9, dislike very much=-41.6, dislike moderately=-17.6, dislike slightly=-5.9, neutral=0, like slightly=6.3, like moderately=17.8, like very much=44.4, like extremely=65.7, most liked imaginable=100.
Reinforcing Efficacy: Difference Score in Drug Effects of Each E-cigarette ConditionFollowing administration of e-cigarette condition 1 (+10 minutes), following administration of e-cigarette condition 2 (+40)Difference between e-cigarette effects for each e-cigarette condition as measured by the computerized version of the Drug Effects Questionnaire (DEQ). Participants will self-report their responses using a computer mouse to indicate where on the scale response falls. A modified version of the Drug Effects Questionnaire (DEQ) will be used in which participants rate acute responses to the e-cigarette on a 0-100mm scale from not at all (0mm) to extremely (100mm). Higher values indicate stronger reinforcing efficacy (i.e., wanting/liking effects).
Craving: Change in Craving Score for E-cigaretteAt baseline (+0 minutes), Following administration of e-cigarette condition 1 (+10 minutes), following administration of e-cigarette condition 2 (+40)Difference from baseline in craving for each e-cigarette condition will be measured by the Generalized Labeled Magnitude Scale (gLMS). Participants will self-report their craving for e-cigarettes using a computer mouse to indicate where on the scale response falls. The Generalized Labeled Magnitude Scales (gLMS) are category ratio scales with seven semantic labels: no sensation, barely detectable, weak, moderate, strong, very strong, and strongest imaginable, positioned quasi-logarithmically as per empirically determined semantic magnitudes on a 0-100 scale (strongest imaginable at the 100 end).
Irritation/Harshness: Difference Score in Irritation of Harshness of Each E-cigarette ConditionFollowing administration of e-cigarette condition 1 (+10 minutes), following administration of e-cigarette condition 2 (+40)Difference in irritation at each e-cigarette condition as measured by the computerized Generalized Labeled Magnitude Scale (gLMS). Participants will self-report their responses using a computer mouse to indicate where on the scale response falls. The Generalized Labeled Magnitude Scales (gLMS) are category ratio scales with seven semantic labels: no sensation, barely detectable, weak, moderate, strong, very strong, and strongest imaginable, positioned quasi-logarithmically as per empirically determined semantic magnitudes on a 0-100 scale (strongest imaginable at the 100 end).

Countries

United States

Participant flow

Recruitment details

84 young adults (18-20 years) were screened for eligibility between November 7, 2022 and June 12, 2023 through Snapchat and referrals from previous participants.

Pre-assignment details

A total of 40 participants completed the study. Specifically, 49 out of 84 participants were randomized, but 7 did not show up and 2 withdrew. Of the 35 who were not randomized, 18 did not meet inclusion criteria and 17 did not show up.

Participants by arm

ArmCount
Sweet Non-menthol Then Sweet Menthol, Each With Nicotine 36mg/ml
Participants attended a one-time, two-hour laboratory session with two exposures to flavored nicotine-containing e-liquids in a randomized order. They first received Durasmoke watermelon (50:50 PG/VG base) e-liquid. After a 30-minute break, they then received Durasmoke watermelon-menthol (50:50 PG/VG base) e-liquid, each with a nicotine salt concentration of 36 mg/mL. Flavoring Agents: Flavor of e-liquid - sweet or tobacco Nicotine: Nicotine level (36 mg/ml)
20
Sweet Menthol Then Sweet Non-menthol, Each With Nicotine 36mg/ml
Participants attended a one-time, two-hour laboratory session with two exposures to flavored nicotine-containing e-liquids in a randomized order. They first received Durasmoke watermelon-menthol (50:50 PG/VG base) e-liquid. After a 30-minute break, they then received Durasmoke watermelon (50:50 PG/VG base) e-liquid, each with a nicotine salt concentration of 36 mg/mL. Flavoring Agents: Flavor of e-liquid - sweet or tobacco Nicotine: Nicotine level (36 mg/ml)
22
Total42

Withdrawals & dropouts

PeriodReasonFG000FG001
First Intervention (2 Hours)Adverse Event02

Baseline characteristics

CharacteristicSweet Non-menthol Then Sweet Menthol, Each With Nicotine 36mg/mlSweet Menthol Then Sweet Non-menthol, Each With Nicotine 36mg/mlTotal
Age, Categorical
<=18 years
0 Participants0 Participants0 Participants
Age, Categorical
>=65 years
0 Participants0 Participants0 Participants
Age, Categorical
Between 18 and 65 years
20 Participants22 Participants42 Participants
Age, Continuous19.0 years
STANDARD_DEVIATION 0.7
19.2 years
STANDARD_DEVIATION 0.8
19.1 years
STANDARD_DEVIATION 0.8
Currently enrolled in a degree program17 Participants15 Participants32 Participants
Ever vaped cooling flavor20 Participants22 Participants42 Participants
Grade
Barely passing (D's)
0 Participants1 Participants1 Participants
Grade
Excellent (A's)
14 Participants13 Participants27 Participants
Grade
Fair (C's)
1 Participants2 Participants3 Participants
Grade
Good (B's)
5 Participants6 Participants11 Participants
Past-month other tobacco use12 Participants12 Participants24 Participants
Past-month vaped THC18 Participants7 Participants25 Participants
Preferred e-cigarette device
Any pod device other than a JUUL
2 Participants1 Participants3 Participants
Preferred e-cigarette device
Disposable pod device
16 Participants20 Participants36 Participants
Preferred e-cigarette device
JUUL
1 Participants1 Participants2 Participants
Preferred e-cigarette device
Vape pen
1 Participants0 Participants1 Participants
Preferred e-cigarette nicotine level
50-59mg/mL or 5.0-5.9%
14 Participants16 Participants30 Participants
Preferred e-cigarette nicotine level
I don't know the concentration
2 Participants5 Participants7 Participants
Preferred e-cigarette nicotine level
Other concentrations
4 Participants1 Participants5 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Asian
5 Participants1 Participants6 Participants
Race (NIH/OMB)
Black or African American
2 Participants2 Participants4 Participants
Race (NIH/OMB)
More than one race
1 Participants0 Participants1 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
1 Participants1 Participants2 Participants
Race (NIH/OMB)
White
11 Participants18 Participants29 Participants
Region of Enrollment
United States
20 participants22 participants42 participants
Sex: Female, Male
Female
11 Participants11 Participants22 Participants
Sex: Female, Male
Male
9 Participants11 Participants20 Participants
Vaping age of onset14.8 years
STANDARD_DEVIATION 1.9
15.6 years
STANDARD_DEVIATION 1.7
15.2 years
STANDARD_DEVIATION 1.8
Vaping frequency6.0 days per week
STANDARD_DEVIATION 1.8
6.1 days per week
STANDARD_DEVIATION 1.4
6.1 days per week
STANDARD_DEVIATION 1.6

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
0 / 400 / 42
other
Total, other adverse events
0 / 402 / 42
serious
Total, serious adverse events
0 / 400 / 42

Outcome results

Primary

Craving: Change in Craving Score for E-cigarette

Difference from baseline in craving for each e-cigarette condition will be measured by the Generalized Labeled Magnitude Scale (gLMS). Participants will self-report their craving for e-cigarettes using a computer mouse to indicate where on the scale response falls. The Generalized Labeled Magnitude Scales (gLMS) are category ratio scales with seven semantic labels: no sensation, barely detectable, weak, moderate, strong, very strong, and strongest imaginable, positioned quasi-logarithmically as per empirically determined semantic magnitudes on a 0-100 scale (strongest imaginable at the 100 end).

Time frame: At baseline (+0 minutes), Following administration of e-cigarette condition 1 (+10 minutes), following administration of e-cigarette condition 2 (+40)

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Sweet Non-menthol, Nicotine 36mg/mlCraving: Change in Craving Score for E-cigarette2.72 score on a scaleStandard Error 0.22
Sweet Menthol, Nicotine 36mg/mlCraving: Change in Craving Score for E-cigarette2.43 score on a scaleStandard Error 0.22
p-value: 0.135t-test, 2 sided
Primary

Irritation/Harshness: Difference Score in Irritation of Harshness of Each E-cigarette Condition

Difference in irritation at each e-cigarette condition as measured by the computerized Generalized Labeled Magnitude Scale (gLMS). Participants will self-report their responses using a computer mouse to indicate where on the scale response falls. The Generalized Labeled Magnitude Scales (gLMS) are category ratio scales with seven semantic labels: no sensation, barely detectable, weak, moderate, strong, very strong, and strongest imaginable, positioned quasi-logarithmically as per empirically determined semantic magnitudes on a 0-100 scale (strongest imaginable at the 100 end).

Time frame: Following administration of e-cigarette condition 1 (+10 minutes), following administration of e-cigarette condition 2 (+40)

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Sweet Non-menthol, Nicotine 36mg/mlIrritation/Harshness: Difference Score in Irritation of Harshness of Each E-cigarette Condition20.92 score on a scaleStandard Error 1.68
Sweet Menthol, Nicotine 36mg/mlIrritation/Harshness: Difference Score in Irritation of Harshness of Each E-cigarette Condition22.86 score on a scaleStandard Error 1.68
p-value: 0.21t-test, 2 sided
Primary

Liking: Difference Score in Liking/Wanting of Each E-cigarette Condition

The Labeled Hedonic Scale will be used to ask about liking and wanting of the e-cigarette (one item Visual Analog Scale with ratings ranging from most disliked sensation imaginable to most liked sensation imaginable with higher values indicating greater liking). Specific scale semantic structure and corresponding values: most disliked imaginable=-100, dislike extremely=-62.9, dislike very much=-41.6, dislike moderately=-17.6, dislike slightly=-5.9, neutral=0, like slightly=6.3, like moderately=17.8, like very much=44.4, like extremely=65.7, most liked imaginable=100.

Time frame: Following administration of e-cigarette condition 1 (+10 minutes), following administration of e-cigarette condition 2 (+40)

Population: After each of the two puff bouts, we evaluated participants' reference for the overall experience of the e-cigarette using the LHS, which is a bipolar category ratio scale that spans from -100 (most disliked) to 100 (most liked), with 'neither liked nor disliked' positioned as the midpoint. The scale labels were places along the scale based on their semantic magnitude.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Sweet Non-menthol, Nicotine 36mg/mlLiking: Difference Score in Liking/Wanting of Each E-cigarette Condition1.268 score on a scaleStandard Error 3.158
Sweet Menthol, Nicotine 36mg/mlLiking: Difference Score in Liking/Wanting of Each E-cigarette Condition-3.916 score on a scaleStandard Error 3.158
p-value: 0.053t-test, 2 sided
Primary

Reinforcing Efficacy: Difference Score in Drug Effects of Each E-cigarette Condition

Difference between e-cigarette effects for each e-cigarette condition as measured by the computerized version of the Drug Effects Questionnaire (DEQ). Participants will self-report their responses using a computer mouse to indicate where on the scale response falls. A modified version of the Drug Effects Questionnaire (DEQ) will be used in which participants rate acute responses to the e-cigarette on a 0-100mm scale from not at all (0mm) to extremely (100mm). Higher values indicate stronger reinforcing efficacy (i.e., wanting/liking effects).

Time frame: Following administration of e-cigarette condition 1 (+10 minutes), following administration of e-cigarette condition 2 (+40)

Population: To examine wanting/liking, we used subscales from the Drug Effects Questionnaire (DEQ), following the approach established in previous literature. Four items were used to measure wanting/liking effects (the average of 'I feel good e-cigarette effects', 'I want more of that e-cigarette I received', 'I feel the e-cigarette strength', and 'I like the e-cigarette effect').

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Sweet Non-menthol, Nicotine 36mg/mlReinforcing Efficacy: Difference Score in Drug Effects of Each E-cigarette Condition37.06 score on a scaleStandard Error 3.01
Sweet Menthol, Nicotine 36mg/mlReinforcing Efficacy: Difference Score in Drug Effects of Each E-cigarette Condition35.18 score on a scaleStandard Error 3.01
Comparison: Outcome analyses will be intent-to-treat and using mixed-effects models with flavor as a within-subject factor. A significant main effect of flavor with greater liking of sweet plus cooling flavor than sweet minus cooling flavor will be considered supportive of our hypotheses.p-value: 0.187t-test, 2 sided

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026