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12 <br />there could be independent reasons for these trends, or a common factor driving them. Nor is it <br />sufficient to show that a person used e-cigarettes first and then took up smoking – in the absence of <br />e-cigarettes they may have simply started to smoke anyway. It is also possible that e-cigarette use in <br />adolescents is protective – preventing or diverting the onset of a consolidated cigarette smoking <br />habit. Some care is required in drawing causal conclusions from observational data on e-cigarette <br />use but every claim for detecting a gateway effect fails to address these issues. <br />3.2.5 Kiddie flavours to appeal to children <br />It is often asserted, as if it is obvious, that flavours with childish characteristics will appeal to <br />adolescents. There is no evidence for this, just assertion, and it is actually counter-intuitive: most <br />adolescents are imitating adult behaviour, not reinforcing their status as children. The one study that <br />has looked at the preferences of young people for e-cigarette flavours found extremely low interest. <br />Teenagers were asked to rate their interest on a scale of 0-10 in using e-cigarettes and were offered <br />a list of flavours. They reported minimal interest (average =0.41 out of 10), much less than adult <br />smokers (1.73 out of 10) and interest did not vary much across flavours 47. To the extent that any <br />preferences were revealed among teens, ‘Single Malt Scotch” and ‘Classic Tobacco’ were top. <br /> <br />Other studies confirm that adults are attracted to supposedly juvenile flavours like cherry crush, or <br />fruit loop. For example a survey of users of the world’s largest user forum found fruit to be the most <br />popular flavour category 48. A similar survey of over 4,519 users found 44% used tobacco, 32% <br />menthol/mint, 61% sweet, 15% nuts, 69% fruit, 37% drink, and 22% other 49. Non-users should <br />understand that flavours are an important aspect of vaping and integral to the experience. They are <br />also part of a migration away from tobacco. Initial switchers tend to favour tobacco flavours but <br />gradually move on to non-tobacco flavours often as part of a permanent switch from smoking. <br /> <br />47 Shiffman S, Sembower MA, Pillitteri JL, Gerlach KK, Gitchell JG. The impact of flavor descriptors on nonsmoking teens’ <br />and adult smokers' interest in electronic cigarettes. Nicotine Tob Res 2015; published online Jan 7 [link][release]. <br />48 E-cigarette forum, Survey of users. Big survey 2014 - initial findings eliquid , 17 July 2014. [link] <br />49 Farsalinos KE, Romagna G, Tsiapras D, Kyrzopoulos S, Spyrou A, Voudris V. Impact of flavour variability on electronic <br />cigarette use experience: an internet survey. Int J Environ Res Public Health 2013; 10: 7272–82.[link]