Flavoured e-cigarette use among youth after comprehensive regulations and market entry of new vapes

Abstract Background In Finland, other than tobacco flavours have been prohibited in nicotine-containing and nicotine-free e-cigarettes since 2016, combined with other strict regulations such as retail licensing, distance sales ban, taxation, advertising and display ban and inclusion to smoking bans. Around 2021, new attractive “vapes” that partially circumvent these regulations became available. We examine the use of flavoured e-cigarettes among Finnish youth. Methods Biennial National School Health Promotion study data from years 2015-2023 with students on 8th-9th grades in comprehensive schools (N = 390004), 1st-2nd year in general upper secondary schools (N = 210150) and 1st-2nd year in vocational institutions (N = 122334) was utilized. Changes in tobacco-flavoured and other-flavoured (e.g., fruit) e-cigarette use were assessed with cross-tabulations and logistic regression models adjusted for age, gender, school type, smoking and snus use. Results Overall, daily e-cigarette use declined between 2015-2021 but increased between 2021-2023 both among girls and boys. In 2023, 5% of girls and 6% of boys used e-cigarettes daily. Use of tobacco-flavoured e-cigarettes was consistently less common than use of e-cigarettes with other flavours. Compared to 2017, when data was available for all e-cigarette flavours, current use of tobacco-flavoured e-cigarette became less likely in 2019 (OR 0.75, 95% CI 0.72-0.78) and remained on similar level in 2021 (OR 0.74; 0.71-0.78), but became more likely in 2023 (OR 1.60; 1.53-1.66). Current use of other than tobacco flavours became less likely in 2019 (OR 0.73; 0.71-0.75) and in 2021 (0.53; 0.51-0.55), but became more likely in 2023 (OR 2.26; 2.19-2.32). Conclusions Comprehensive e-cigarette regulations were associated with reduced e-cigarette use among youth, but the use increased when new products targeting regulatory loopholes became available. The increase was driven by use of other than tobacco flavours. Key messages • Regulation of flavours and other attractive elements in e-cigarettes is essential to prevent use among youth. • Yet, regulations need to be future proofed for new product developments.