E-cigarette flavor and device preferences among US pregnant women who smoke: A latent class analysis

Little is known about e-cigarette device and flavor preferences among pregnant women. The purpose of this study was to identify classes of e-cigarette use based on device and flavor preferences among pregnant women who report dual use of e-cigarettes and cigarettes.

A sample of pregnant women (n=118), aged 18-40 years, living in the US, with dual cigarette and e-cigarette use, completed a cross-sectional online survey. Participants reported e-cigarette characteristics including past 30-day e-cigarette device (cartridge-based, JUUL, tank, and disposable) and flavor use (tobacco, mint, spice, sweet, alcohol, combined), and use of e-cigarettes containing delta-9-tetrahydrocannabinol (THC) in pregnancy. We used latent class analysis to classify subgroups based on e-cigarette preferences in pregnancy and examined the association of sociodemographic variables and cigarette smoking frequency with class membership.

We found four distinct classes of e-cigarette preferences: Class 1) tobacco, mint, and sweet JUUL (50.4%); Class 2) THC, all flavors, and JUUL (28.1%); Class 3) THC, all flavors, and all device (12.4%); and Class 4) THC, tobacco, mint, sweet, and tank device (9.1%). Pregnant women who smoked ≥11 cigarettes per day, compared to those who smoked 1-10 per day, were 5.22 (95% CI: 1.85-14.70) and 5.55 times (95% CI: 1.49-20.61) as likely to use THC, all flavors, and JUUL and all devices, respectively, compared with those who used tobacco, mint, and sweet flavors with JUUL.

Pregnant dual users of cigarettes and e-cigarettes are a heterogenous group. Device and flavor differences should be considered when developing targeted messaging campaigns and prevention strategies.