As the Food and Drug Administration announced a crackdown on e-cigarettes, describing their use among teens as reaching “an epidemic proportion,” a new study from the UMD School of Public Health found which groups are most likely to use flavored e-cigarettes: adults ages 18–24, women and those who have never smoked.

Of the 8 percent of American young adults who said they used e-cigarettes in the preceding month, about 69 percent chose flavors such as fruit and candy rather than traditional tobacco and menthol flavors, according to the study published in the October issue of the journal Drug and Alcohol Dependence.

Young women with a high school diploma or GED and higher were more likely to choose fruit and candy flavors. People who had used marijuana but hadn’t smoked cigarettes were also more likely to choose sweet e-cigarette flavors.

“We know that when trying out e-cigarettes, youth start off with flavors,” said Dina Borzekowski, a research professor of behavioral and community health and a co-author of the study. “Public health interventionists need to know more about those using flavors to better affect policies around e-cig marketing and distribution."

The FDA on Wednesday announced what it called the “single-largest enforcement action in agency history,” targeting sellers and buyers. It includes ordering manufacturers to produce plans within 60 days to prevent youths from buying their products, as well as investigating their marketing and sales practices. The agency is also warning 1,100 stores and online retailers to stop selling e-cigarettes to minors.

Flavors play an important role in attracting teen users, and flavored e-cigarettes have been found to increase nicotine addiction and act as a gateway to other tobacco products. “At the same time that fruit- and candy-flavored e-cigarettes are rising in popularity, there is an unclear media portrayal of the negative health consequences of vaping,” lead researcher Julia Chen Ph.D. ’18 said.

The researchers called for more regulations and restrictions on the tobacco industry’s marketing tactics for selling and promoting flavored e-cigarettes, as well as initiatives to prevent and reduce flavored e-cigarette use.

“With the knowledge from this study, we can target the most high-risk groups with public health programs and mass media campaigns showing the harmful effects of flavored e-cigarettes and flavored tobacco products,” said Chen. “We can also provide cessation aids to those who develop a nicotine dependence.”