Words matter: descriptors for nicotine that comes from tobacco and descriptors for synthetic nicotine that is created in a laboratory differentially impact understanding of nicotine source and risk perceptions.

BACKGROUND: Nicotine products increasingly contain synthetic nicotine made in a lab (NML), not from tobacco. 'Tobacco-free nicotine' is most often used to describe NML commercially, but other descriptors are emerging (eg, 'non-tobacco,' 'zero-tobacco'). We examined whether terms for NML differentially impact public understanding of nicotine source or risk perceptions relative to each other and to terms for describing nicotine from tobacco (NFT) as 'tobacco-derived.' METHODS: From December 2022 to April 2023, 1000 participants aged 13 and older completed an online survey (mean age: 33.02 (SD=18.15) years, 50.5% female, 16.6% Hispanic, 67.4% White and 79.8% with current tobacco use). Participants read 11 terms describing nicotine and reported on perceived nicotine source (ie, NML, NFT) and addictiveness. Rank-ordered harm was included as a sensitivity analysis. RESULTS: Significant differences were observed among terms (eg, 'zero tobacco nicotine' and 'no tobacco nicotine' were rated as least addictive overall). 'NML' and 'NFT' adequately conveyed nicotine source and were rated as conveying comparable, yet high addictiveness, making them the optimal terms. CONCLUSIONS: Many terms for NML and NFT are differentially related to understanding nicotine source and risk perceptions even though no existing research indicates that NML and NFT differ meaningfully from each other on characteristics like addictiveness. In the absence of prohibiting product differentiation by nicotine source, regulatory agencies should promote using the terms 'Nicotine from Tobacco' and 'Nicotine Made in a Lab' and investigate whether products using descriptors conveying reduced harm (eg, 'zero-tobacco,' 'no-tobacco,' 'non-tobacco') should require review as Modified Risk Tobacco Products.

Variability in Constituents of E-Cigarette Products Containing Nicotine Analogues.

This study characterizes and quantifies constituents in 2 e-cigarette products to assess product consistency and inform future risk assessments.

Psychometric evaluation of the Self-Report Habit Index for assessing habitual e-cigarette use behavior in high school adolescents.

Background: E-cigarettes are the most-used nicotine product among adolescents, but limited psychometrically-sound, e-cigarette-relevant measures exist for adolescents. We examined psychometric properties of the Self-Report Habit Index (SRHI) for assessing adolescents' habitual e-cigarette use. Methods: During Fall 2022, 4855 students from eight Connecticut high schools completed an anonymous survey. The analytic sample comprised 491 students who reported past-month e-cigarette use and completed the SRHI (Age M=15.94, SD=1.24 years, 56 % female, 37.1 % Hispanic, 57.6 % White). We examined the SRHI's latent factor structure; internal reliability; measurement invariance and between-groups differences (e.g., nicotine vs. nicotine-free vaping); and associations with total e-cigarette flavors used in the past month, past-30-day vaping frequency, and e-cigarette dependence. Results: The SRHI's 6-item, 1-factor structure was confirmed. Internal reliability was excellent. The SRHI was scalar invariant for all subgroups tested. Nicotine (vs. nicotine-free) and daily (vs. non-daily) e-cigarette use were associated with greater habitual e-cigarette use behavior. In adjusted models, habitual e-cigarette use was associated with using more e-cigarette flavors, vaping more frequently, and greater e-cigarette dependence. Habitual e-cigarette use incrementally accounted for variance in past-month flavors used and vaping frequency beyond dependence. Conclusions: The SRHI evidenced solid psychometric properties for assessing habitual e-cigarette use behavior among high school students. Relationships between habitual use and frequency of use, e-cigarette flavors, and dependence might be expected as these constructs are associated with the three characterizing features of habitual behaviors: frequent repetition, cue-driven elicitation, and automaticity. Future prospective research can clarify the temporal ordering of habitual e-cigarette use and dependence in adolescents.

Unintended exposure to e-liquids and subsequent health outcomes among US youth and adults.

This study aimed to determine the prevalence and predictors of oral, ocular, or dermal e-liquid exposure and subsequent outcomes (becoming sick, going to the hospital) in the US. We examined survey data from the Population Assessment of Tobacco and Health Study Wave 5 (2018-2019). The analytic sample included US youth (aged 12-17 years), young adults (aged 18-24 years), and older adults (aged ≥ 25 years) who reported e-cigarette use in the past 12 months. We first determined the prevalence of self-reported e-liquid exposure (in the mouth, skin, or eyes), subsequently "becoming sick" from the exposure, and "going to the hospital" after the exposure. We also examined associations between these outcomes and the device type used (refillable tank /mod system, replaceable prefilled cartridges, disposable/ other device type). E-liquid exposure was reported by 25% of youth (aged 12-17 years), 25% of young adults (aged 18-24 years), and 19% of older adults (aged≥ 25 years). Among individuals reporting e-liquid exposure, subsequent sickness was reported by 10% of youth11% of young adults, and 14% of older adults, and "going to the hospital" was reported by 3.5% of youth, 2.7% of young adults, and 6.8% of older adults. Among young adults, the use of a refillable tank /mod system was associated with higher odds of e-liquid exposure (aOR = 2.2, 95% CI = 1.2, 4.1) than the use of other device types, including disposables. The findings suggest that, at a minimum, e-cigarettes/e-liquids may need warning labels that state the risks of e-liquid exposure and packaging regulations that promote device and bottle designs that minimize e-liquid spills.

Sex differences in appeal, reward, and sensory experience of E-cigarette flavors among adults who smoke cigarettes.

OBJECTIVE: Flavors enhance nicotine e-cigarette appeal by altering sensory experience. Females may be more sensitive to tobacco-associated cues and uniquely affected by flavor. The current study is an exploratory analysis to examine differences by sex on reward, appeal, and sensory experience of popular e-cigarette flavors. METHODS: Adults (N = 121) who use cigarettes (≥1 cigarette/day) were enrolled in a laboratory study in which they vaped four e-cigarette flavors (tobacco, cherry, menthol, vanilla; in separate lab sessions) in one of two freebase nicotine concentrations (6 mg/ml,18 mg/ml). Following exposures, participants rated e-cigarette reward using the Drug Effects Questionnaire (DEQ), flavor and overall e-cigarette appeal using Labeled Hedonic Scales (LHS), and intensity of flavor, irritation, coolness, fruitiness, and sweetness using Generalized Labeled Magnitude Scales (gLMS). Linear mixed models were conducted for outcomes to analyze effects of sex, flavor, and sex x flavor interaction. RESULTS: For DEQ ratings, there was a trend (p = .08) toward a sex x flavor interaction, in which menthol flavor produced more reward than other flavors for females, but not males. For LHS ratings, there was a significant sex x flavor interaction (p = .03) for overall e-cigarette experience with females but not males rating menthol higher than other flavors. All gLMS scales but irritation showed that females generally had greater differences between flavors compared to males (ps ≤ 0.03). CONCLUSION: Menthol in e-cigarettes may play an important role in mediating appeal and/or reward among females. This may be due in part to their ability to better detect sensory effects of e-cigarettes.

Development and Psychometric Evaluation of a Novel Measure of Nicotine E-cigarette Withdrawal for use with Adolescents and Young Adults.

INTRODUCTION: Nicotine withdrawal is a well-established construct that prompts continued nicotine product use and contributes to failed cessation efforts. Despite ongoing public health concerns about nicotine e-cigarette use in adolescents and young adults (AYAs), no psychometrically-sound measure of nicotine e-cigarette withdrawal exists for this population. METHODS: A mixed methods approach comprising a literature review to identify existing nicotine withdrawal items; subject matter expert feedback on existing items and novel item generation; cognitive interviews assessing the measure's instructions, items, and response options; and a large quantitative validation survey (N = 997) was employed to develop the novel retrospective measure of nicotine e-cigarette withdrawal. RESULTS: A 25-item solution comprising four subscales - Negative Affect, Negative Physical Symptoms, Craving, and Appetite/Food - and an Overall Withdrawal score was supported. Internal reliability was excellent (mean alpha = 0.91), and scalar measurement invariance was reached for all subgroups tested (e.g., sex, age, exclusive e-cigarette use versus dual tobacco product use, daily versus non-daily nicotine vaping). Overall Withdrawal and its subscales evidenced concurrent validity with time to first vape in the morning, e-cigarette dependence, and previous vaping cessation attempts, although not each subscale was associated with each outcome. Importantly, cross-sectional incremental validity analyses indicated that retrospective withdrawal accounted for variance in each outcome above and beyond e-cigarette dependence. CONCLUSIONS: The novel retrospective AYA Nicotine E-cigarette Withdrawal Scale (AYA NEWS) evidenced strong psychometric properties for use in this population. Future research can determine whether the AYA NEWS can be used to assess acute e-cigarette nicotine withdrawal. IMPLICATIONS: While e-cigarette use remains the most prevalent form of nicotine product use among adolescents and young adults, there are limited options for psychometrically-sound measures of e-cigarette-related constructs in this population. Withdrawal from nicotine is associated with failed cessation attempts and continued use of nicotine-containing products, making it a critical construct within tobacco-related research. This study outlines the development and preliminary psychometric evaluation of a novel, retrospective measure of nicotine e-cigarette withdrawal. Study findings support using the Adolescent and Young Adult Nicotine E-cigarette Withdrawal Scale (AYA NEWS) to assess retrospective withdrawal from nicotine e-cigarettes in young people.

Non-tobacco nicotine E-cigarette use and flavored E-cigarette use among young adults in the United States.

BACKGROUND: E-cigarette flavors can create sensations of sweetness and coolness while masking the aversiveness of nicotine. Recently, non-tobacco nicotine (NTN) products were introduced to the market, but little is known about flavors in NTN e-cigarette use. We examined associations between flavors (i.e., sweet, mint/menthol) and susceptibility to and use of NTN e-cigarettes. METHODS: 1239 US young adults (18-25 years) completed an anonymous, online survey in Fall 2021. The analytic sample included 520 participants who had used e-cigarettes and heard of NTN. Multinomial logistic regression models analyzed associations of flavored e-cigarette use (sweet and mint/menthol) with NTN e-cigarette use status (i.e., current [past-month] use, past [ever but not current] use, susceptible to use, and non-susceptible to use [reference]). RESULTS: Overall, 46.2% of participants reported current NTN use, 14.8% reported past use, 16.7% were susceptible to use, and 22.3% reported no susceptibility. Participants reported dual-use of sweet and mint/menthol NTN e-cigarette flavors (56.5%), sweet flavors use (24.8%), and mint/menthol flavor use (1.7%). Ever dual use of sweet and mint/menthol flavors was associated with current (OR = 9.64, 95%CI: 3.21-28.98) and past NTN e-cigarette use (8.30, [2.10-32.80]). Ever sweet flavor use was associated with current NTN use (3.80, 95%CI: 1.44-10.03) and susceptibility to future use (4.25, [1.53-11.81]). Similar findings were observed for mint/menthol flavors (current: 5.03, [1.41-17.99]; susceptible: 5.65, [1.64-19.51]). CONCLUSION: The use of sweet and mint/menthol flavors was significantly associated with NTN e-cigarette use among US young adults, highlighting the need for ongoing surveillance of flavored NTN e-cigarettes and appropriate regulations to discourage use.

High Variability in Nicotine Analog Contents, Misleading Labeling, and Artificial Sweetener in New E-Cigarette Products Marketed as "FDA-Exempt".

The recent introduction of electronic cigarette products containing a synthetic nicotine analog, 6-methyl nicotine (6MN), challenges FDA's tobacco regulatory authority. A similar strategy is pursued by vendors of recently introduced e-cigarette liquids containing nicotinamide (NA), marketed as 'Nixotine' or 'Nixamide'. Compared to nicotine, 6MN is pharmacologically more potent at nicotinic receptors, and more toxic, raising concerns about increased addictiveness and adverse effects. Here, combinations of gas chromatography, high performance liquid chromatography and mass spectrometry were used to determine nicotine analogs, flavor and sweetener contents of e-cigarette liquids of the brands "SpreeBar" and ECBlend "Nixotine" products. All SpreeBar products, labelled as containing 5% 6-methyl nicotine, contained only 0.61-0.64% 6-methylnicotine, while "Nixotine" samples contained 7-46% less of the declared nicotinamide contents. Although "Nixotine" product labels did not list 6MN as an ingredient, small amounts of 6-methyl nicotine were detected. All 'SpreeBar' samples contained the artificial sweetener neotame (0.20-0.86µg/mg). Results identified significant discrepancies between declared and measured constituents of e-cigarette products containing nicotine alternatives. The discrepancy is misleading for consumers and raises concerns about production errors. 'SpreeBar' products also contained neotame, a high-intensity sweetener with high heat stability, likely increasing appeal to young and first-time users. Novel e-cigarette products with misleading labels containing nicotine analogs instead of nicotine on the US market is concerning and should be urgently addressed by lawmakers and regulators.

How healthcare providers and the right information may play a critical role in quitting success among smokers interested in using e-cigarettes for quitting: Results from a survey of U.S adults.

INTRODUCTION: Promoting smoking cessation is a global public health priority. E-cigarettes are increasingly being used by individuals to try quitting smoking. Identifying sources and types of information available to adults who are trying to quit, and the impact of this information during a quit attempt, is critical to augment the potential public health benefit of e-cigarettes for reducing cigarette smoking. METHODS: US adults (N = 857) who reported using e-cigarettes in a recent smoking cessation attempt completed an anonymous, cross sectional, online survey. We examined sources of information and type of information received when using e-cigarettes to quit smoking and their associations with the duration of abstinence achieved. RESULTS: The two most commonly reported information sources were friends (43.9%) and the internet (35.2%), while 14.0% received information from a healthcare provider. People received information on type of device (48.5%), flavor (46.3%), and nicotine concentration (43.6%). More people received information about gradually switching from smoking to vaping (46.7%) than abruptly switching (30.2%). Obtaining information from healthcare providers (ß (SE) = 0.16 (0.08), p = 0.04), getting information about abruptly switching to e-cigarettes (ß (SE) = 0.14 (0.06), p = 0.01) and what nicotine concentrations to use (ß (SE) = 0.18 (0.05), p = 0.03) were associated with longer quit durations. CONCLUSIONS: Amidst the growing popularity of e-cigarettes use for quitting smoking, our results highlight common sources of information and types of information received by individuals. Few people received information from healthcare providers indicating a gap in cessation support that can be filled. Providing information about immediate switching to e-cigarettes and nicotine concentrations to use may help in increasing quit rates and duration.

E-cigarette dependence and cooling flavor use are linked among youth.

BACKGROUND: E-cigarette flavors that produce cooling sensations may reduce nicotine harshness and enhance appeal among youth. While previous research has shown that use of cooling flavors is associated with more frequent vaping among youth, it is unknown whether the same holds true for e-cigarette dependence. This study examines the relationship between cooling flavor use and e-cigarette dependence among youth accounting for vaping frequency. METHODS: In Fall 2022, a survey was conducted among Connecticut high school students to assess past-month nicotine e-cigarette use, ever use of cooling flavors, cooling flavor types (e.g., fruit-cooling), and e-cigarette dependence. Analyses were restricted to those with past-month nicotine and nicotine-free e-cigarette use and complete data (n=204). Multivariable linear regressions were run to examine the association between cooling flavor use and e-cigarette dependence, adjusting for demographics, e-cigarette use characteristics, and other tobacco product use. RESULTS: 78.4% of the sample used cooling e-cigarette flavors, with 55.0% using mint-cooling flavors and 52.5% using fruit-cooling flavors. Regression results observed that cooling flavor use was associated with higher e-cigarette dependence (ꞵ=1.53, SE=0.63, p=0.017), with those who used cooling flavors having higher e-cigarette dependence than those who did not (M=5.78 [SD=5.33] vs. 2.84 [3.19]). CONCLUSIONS: Our results suggest that cooling flavor use is significantly associated with e-cigarette dependence among youth. While regulations often target menthol flavor, tobacco control agencies should consider restricting any flavor that can produce cooling sensations, even if they are not traditional menthol products, as cooling flavors is associated with youth e-cigarette dependence.

Sources of exposure to non-tobacco nicotine electronic nicotine delivery systems and associations with susceptibility to use and use behaviors among young adults in the United States.

INTRODUCTION: The Electronic Nicotine Delivery Systems (ENDS) industry recently introduced non-tobacco nicotine (NTN), which is not tobacco-derived and is often marketed as "tobacco-free nicotine." Given its novelty, it is important to understand where young adults learn about NTN ENDS. This study examined sources of exposure to NTN ENDS and relationships with NTN ENDS use and susceptibility. METHODS: We analyzed online survey data collected in Fall 2021 from 642 young adults (18-25 years) who had heard of NTN ENDS. We assessed 9 sources of NTN ENDS exposure (e.g., retail stores, social media) and examined associations between sources of exposure and NTN current (past-month) use, lifetime (non-current) use, and susceptibility to use, adjusting for demographics and other tobacco product use. RESULTS: Participants reported current NTN ENDS use (37.4%), lifetime use (12.0%), susceptibility (18.5%), or no susceptibility to use (32.1%). The most common sources of NTN ENDS exposure were retail stores (87.7%) and social media (81.0%). Exposure to NTN ENDS via social media was associated with greater odds of current NTN ENDS use (vs. no susceptibility) (aOR = 1.83, 95%CI: 1.02-3.28). Exposure via online streaming platforms was associated with greater odds of current (aOR = 1.75, 95%CI: 1.08-2.82) and lifetime NTN ENDS use (aOR = 2.42, 95%CI: 1.25-4.68). CONCLUSIONS: Young adults were exposed to and learned about NTN ENDS from diverse sources, primarily retail shops and social media. Further, exposure via social media and streaming platforms were associated with NTN ENDS use. Future studies should explore the content of NTN information from various sources to inform prevention efforts.

Cardiovascular Health Effects and Synthetic Cooling Agents in E-cigarettes Labeled as 'clear' Marketed in Massachusetts After the Tobacco Product Flavoring Ban.

Introduction: Massachusetts (MA) enacted statewide regulation on all flavored tobacco products in June 2020. Thereafter, electronic cigarettes (e-cigarettes) labeled 'clear' emerged on the market. We aimed to combine cardiovascular health effects with chemical analysis of 'clear' e-cigarettes. Methods: We measured acute changes in blood pressure and heart rate following a 10-minute structured use of participants' own e-cigarette, comparing 'clear' e-cigarette users with other flavored e-cigarette users and non-users. Chemical characterization and quantification of relevant flavorings and cooling agents (WS-3, WS-23) of 19 'clear'-labeled disposable e-cigarette liquids was carried out by GC/MS. Results: After the ban, participants that used 'clear' labeled e-cigarettes increased from 0% to 21%. Increase in diastolic blood pressure and heart rate was significantly greater in 'clear' e-cigarettes users (n=22) compared to both non-'clear' flavored e-cigarette users (n=114) and non-users (n=72). We saw similar results in heart rate when comparing Juul e-cigarette and 'clear' users; Juul was used as a reference as synthetic coolants WS-3 or WS-23 were not detected in these.All (19/19) 'clear' e-liquids were found to contain synthetic cooling agents WS-23 and/or WS-3, menthol (18/19), as well as other flavorings (12/19). Discussion: The detected presence of menthol alongside other flavorings in tested 'clear' products is a direct violation of the MA flavored tobacco product regulation, warranting stricter monitoring for new products and constituents. 'clear' e-cigarette use led to greater hemodynamic effects compared to other flavored e-cigarettes and Juul, which raises questions about the effect of cooling agents on users.

Socioecological factors associated with multiple nicotine product use among U.S. youth: Findings from the population assessment of tobacco and health (PATH) study 2013-2018.

OBJECTIVE: This study utilized a socioecological approach to prospectively identify intrapersonal, familial, and environmental factors associated with single nicotine product use (NPU) and multiple NPU among U.S. youth. METHODS: Participants were 10,029 youths (ages 12-17 years) who had completed the Population Assessment of Tobacco Health study's Wave 1 (2013-2014) and Wave 4 (2016-2018) assessments and data on past 30-day nicotine product use. Multinomial logistic regression was fit for the 3-level outcome (no use, single NPU, multiple NPU) to estimate adjusted associations between the predictors and the outcome. RESULTS: The current study found that intrapersonal (sex, age, race/ethnicity, internalizing symptoms, sensation seeking, harm perceptions, lifetime history of using two or more tobacco products), familial (parental discussion about not using tobacco and living with someone who uses tobacco products) and environmental factors (exposure to tobacco advertising) commonly associated with tobacco use differentiated between individuals who later reported past 30-day NPU (either multiple or single NPU) from those who did not report past 30-day NPU. One familial factor only differentiated between lifetime users who were single NPUs from those who reported no NPU: non-combustible tobacco product use allowed anywhere in the home. Intrapersonal factors differentiated multiple NPU from single NPU: older age, being male, lifetime history of using nicotine product and less harm perceptions. CONCLUSIONS: This study identified factors that may be studied to prevent any NPU, along with factors that may be studied to promote harm reduction by preventing escalation of single NPU to problematic patterns of multiple NPU.

A randomized controlled trial of potential tobacco policies prohibiting menthol flavor in cigarettes and e-cigarettes: a study protocol.

BACKGROUND: Menthol cigarette use remains a large public health problem and disproportionately affects Black adults in the United States. The Food and Drug Administration has proposed prohibiting menthol flavor in cigarettes to protect public health. However, e-cigarettes are available in menthol flavor and are a popular alternative product adults might switch to if menthol is prohibited in cigarettes. Research is needed to understand how availability of menthol (vs. tobacco) flavored e-cigarettes could impact cigarette use among adults who smoke menthol cigarettes. METHODS: We will recruit 150 adults who currently smoke menthol cigarettes and will randomize them to 1 of 3 conditions modeling different regulatory scenarios. We will recruit equal numbers of participants identifying as Black vs. non-Black and will stratify randomization by race. To promote standardization and adherence, cigarette and e-cigarette products will be provided for 8 weeks based on the assigned condition: (A) no menthol restriction (menthol cigarette and menthol flavored e-cigarette), (B) menthol prohibited in cigarettes only (non-menthol cigarette and menthol flavored e-cigarette), (C) menthol prohibited in both cigarettes and e-cigarettes (non-menthol cigarette and tobacco flavored e-cigarette). A follow-up visit will occur at week 12 to assess tobacco use status. The study aims are to (1) examine the impact of prohibiting menthol flavor in cigarettes and e-cigarettes on smoking behavior and (2) investigate whether outcomes differ by race to understand the impact of menthol policies on Black (vs. non-Black) individuals given high rates of menthol cigarette use in this population. The primary outcome will evaluate changes in the number of cigarettes smoked per day during the 8-week study period and will examine differences by regulatory scenario. Secondary outcomes will compare percent days smoke-free, changes in nicotine dependence, and motivation, confidence, and intentions to quit smoking by the regulatory scenarios. We will examine whether changes in the outcomes differ by Black vs. non-Black participants to compare the magnitude of the effect of the various menthol policy scenarios by race. DISCUSSION: Results will contribute critical information regarding menthol in cigarettes and e-cigarettes to inform regulatory policies that maximize reductions in cigarette smoking and reduce tobacco-related health disparities. TRIAL REGISTRATION: NCT05259566. Yale IRB protocol #2000032211, last approved 12/8/2023.

Why young adults use tobacco-free nicotine E-cigarettes: An analysis of qualitative data.

BACKGROUND: Tobacco-free nicotine (TFN) is often marketed as being better tasting and healthier than tobacco-derived nicotine (TDN). Studies have yet to systematically characterize subjective experiences using TFN e-cigarettes. This qualitative study explored young adults' reasons for using TFN e-cigarettes and perceptions of differences between using TFN and TDN e-cigarettes. METHOD: We conducted a national online Qualtrics survey of U.S. young adults aged 18-25 years in October 2021. Respondents who reported lifetime TFN e-cigarette use (n = 317, mean age: 20.8 (SD:2.2), 53.9 % female) provided write-in responses to open-ended questions assessing reasons for using TFN e-cigarettes and perceptions of differences between TFN and TDN e-cigarettes. Responses from participants were thematically analyzed by independent raters. RESULTS: Reasons for using TFN e-cigarettes included product taste/flavor, health reasons (e.g. believing TFN was healthy), and product accessibility. Perceptions of differences between TFN and TDN e-cigarettes included differences in taste/ flavor and acute psychoactive and physical effects (e.g., nicotine buzz, throat hit), with TFN e-cigarettes being described as generally stronger and superior relative to TDN e-cigarettes. CONCLUSION: These qualitative data suggest that taste and perceived health benefits are primary reasons that young adults try TFN e-cigarettes. Compared to TDN, young adults perceive TFN as better tasting with different psychoactive and less aversive effects. Determining if these perceived reasons for use and differences occur in blinded human experimental studies is a necessary next step to understanding TFN e-cigarette use. Additionally, understanding why young adults use TFN e-cigarettes is important in the development of prevention communication about these products.

Psychometric evaluation of the sensory e-cigarette expectancies scale for use with adolescents.

BACKGROUND: The Sensory E-cigarette Expectancies Scale (SEES) has demonstrated solid psychometric properties for use with adults. It assesses expectancies for enjoying the taste and smell of vaping, experiencing pleasurable physical sensations, and enjoying creating vapor clouds. We evaluated psychometric properties of the SEES for use with adolescents. METHODS: In Fall 2022, 4,855 students from eight Connecticut high schools completed an anonymous, cross-sectional, online survey. Our analytic sample (n = 724) endorsed lifetime e-cigarette use and completed the SEES. Psychometric analyses included factor analyses, internal reliability, measurement invariance, between-groups differences, and relationships with vaping outcomes. RESULTS: The three-factor SEES structure was confirmed. Internal reliability of each subscale was excellent (range: 0.88-0.95). The SEES was invariant by sex (male/female), race (Black/White/Other), Hispanic ethnicity (no/yes), nicotine e-cigarette use (no/yes), any past-month vaping (no/yes), daily vaping (no/yes), and vaping status (a variable created based on the distribution of past-month vaping frequency [0; 1-4; 5-20; 21+ days]). Those who reported using nicotine e-cigarettes, past-month vaping, daily vaping, and vaping on 21+ days in the past month reported stronger scores on each subscale compared to their respective counterparts. In adjusted models, expecting Pleasurable Physical Sensations was associated with total flavors used, past-month vaping frequency, and e-cigarette dependence. Enjoyment of Taste and Smell was positively associated with total flavors used and e-cigarette dependence. Enjoyment of Vapor Clouds was positively associated with total flavors used and past-month vaping frequency. CONCLUSIONS: Given its strong psychometric properties, the SEES can be used in future research to assess sensory-related vaping expectancies in youth.