"Ice" flavor elements in E-cigarette images: Influence on liking and intention to use among youth who are at risk of E-cigarette use.

Introduction: "Ice"-flavored e-liquids and e-cigarettes, marketed as both sweet and cooling recently entered the US marketplace and are popular among youth. Advertisements featuring attractive product images and descriptions are one of the first exposures to these products for youth. This study examines the appeal of e-cigarette images, with and without a cooling "ice" imagery, among youth who have limited e-cigarette use or who are at risk of future use.

Methods: We conducted two online, within-subject experimental studies with 71 Connecticut youth at risk of e-cigarette use, using a Qualtrics survey. Participants viewed 34 images of sweet-flavored e-liquids with and without cooling imagery (e.g., mango vs. mango-ice) and 28 sweet-flavored disposables devices with (e.g., watermelon-ice) and without names indicating cooling (e.g., strawberry). Images were presented in randomized order and participants rated overall liking and intention to use on four-point scales. Linear mixed-effects models were used to analyze outcomes, reporting least-squares means (M) and standard errors (SE).

Results: The sample was 59.2 % female with an average age of 16.5 years. No significant differences were observed for liking and intention to use between sweet-flavored e-liquids with and without cooling imagery (ps > 0.05). For disposable e-cigarette images, participants reported significantly higher overall liking (M = 1.72, [SE = 0.07] vs. 1.62 [0.07], p = 0.002) and intention to use (1.52 [0.06] vs. 1.46 [0.06]; p = 0.037) in response to images without descriptions of "ice" compared to those with "ice".

Conclusions: Adding cooling images or descriptors did not increase appeal or use intentions of sweet-flavored e-liquids or disposable e-cigarettes among youth with limited e-cigarette experience.