Flavoured tobacco products in the USA: synthesis of recent multidiscipline studies with implications for advancing tobacco regulatory science

Stanton, Cassandra A.; Villanti, Andrea C.; Watson, Clifford H.; Delnevo, Cristine D.

doi:10.1136/tobaccocontrol-2016-053486

Cited by 23 publications

(14 citation statements)

References 20 publications

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“…Our analyses also revealed that females and racial and ethnic minorities (i.e., NH Blacks and Hispanics) were more likely than males and NH Whites, respectively, to perceive flavored e-cigarettes as easier to use. This finding is congruent with the high prevalence of flavored tobacco product use in females and racial and ethnic minority groups, partly due to the tobacco industry’s targeted marketing of flavored tobacco products [42]. Our results suggest that such targeted marketing may have led to these groups’ perceptions of the ease of using flavored e-cigarettes, although more research is needed to confirm these hypothesized associations.…”

Section: Discussionsupporting

confidence: 87%

Perceived ease of flavored e-cigarette use and e-cigarette use progression among youth never tobacco users

2019

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Background There is an increased need to understand how e-cigarette flavors may contribute to e-cigarette uptake and use among youth. We examined the relationship between perceived ease of flavored e-cigarette use and e-cigarette use susceptibility and progression among a nationally representative sample of U.S. youth never tobacco users. Methods The wave 1 (2013-2014) and wave 2 (2014-2015) surveys of PATH Study were used. Youth never tobacco users (ages 12-17) who reported whether flavored e-cigarettes were easier to use than unflavored e-cigarettes at wave 1 (n = 6,983) were included in the study. Multivariable logistic regressions were used to examine the associations between perceived ease of using flavored e-cigarettes (wave 1) and e-cigarette use outcomes including e-cigarette use susceptibility (wave 1) and e-cigarette initiation and past-30-day use (wave 2). Results Overall, 21.2% of the sample perceived flavored e-cigarettes easier to use than unflavored e-cigarettes; and 28.9% of the sample were susceptible to using e-cigarettes at wave 1, and 7.5% and 2.0% initiated e-cigarettes and used e-cigarettes in the past 30 days at wave 2, respectively. Among those who perceived flavored e-cigarettes easier to use, 41.0% were susceptible to using e-cigarettes at wave 1, and 10.6% and 3.4% initiated and used e-cigarettes in the past 30 days at wave 2, respectively. Perceiving flavored e-cigarettes as easier to use than unflavored e-cigarettes at wave 1 was positively associated with e-cigarette use susceptibility at wave 1 (

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Section: Discussionsupporting

confidence: 87%

Perceived ease of flavored e-cigarette use and e-cigarette use progression among youth never tobacco users

2019

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“…Evidence suggests that the variety of flavours available in these products also make them more appealing 9 11. Recent research reveals that youths are more likely to initiate e-cigarette use with non-tobacco flavoured products 12–14. JUULs, which are a single brand and type of e-cigarettes, come only in a handful of flavours, including Virginia tobacco, classic tobacco, fruit medley, mango, crème brûlée, menthol, mint and cool cucumber.…”

Section: Introductionmentioning

confidence: 99%

Do JUUL and e-cigarette flavours change risk perceptions of adolescents? Evidence from a national survey

Strombotne

Buckell

Sindelar³

2020

Tob Control

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IntroductionUse of JUULs and e-cigarettes is growing rapidly, particularly among adolescents. Research suggests that flavours may increase the appeal of these products, but little is known about how flavours influence perception. We examined whether youth perceptions about the health risks of JUULs and e-cigarettes vary with flavours.MethodsWe conducted a national survey in 2018 of 1610 high-school students aged 14–18 who had ever heard of either JUULs or e-cigarettes. Respondents were asked to rate the lung cancer risk, the harm of second-hand vapour, potential for addiction and healthiness of differently flavoured JUUL and e-cigarette products. We investigated the relationship among flavour, risk perception and socio-demographic information.ResultsWe found that risk perceptions for both JUULs and e-cigarettes differ significantly by flavour type. Youths perceive fruit flavours to be less likely to lead to lung cancer (−0.909 (0.065)), have harmful second-hand vapour (−0.933 (0.060)) and be more addictive (1.104 (0.094)) relative to tobacco flavours. Candy, menthol/mint and alcohol flavours show similar patterns of risk association, although the magnitude is slightly smaller than for fruit flavours.ConclusionsYouths believe that flavours are related to the health risks of both JUULs and e-cigarettes despite the fact that these differences in risk by flavour have not been scientifically or systematically established. A policy concern is that misperceptions based on flavour may result in increased vaping by youths. The findings from this study support the assertion that banning fruit, menthol or mint and sweet flavours could reduce the appeal of JUULs and e-cigarettes to youth, with concomitant health protections.

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“…Currently, the content of those disclosures is not released to the public or local jurisdictions that regulate tobacco products. In a recent editorial in this journal on flavoured tobacco products in the USA, Stanton et al 5 conclude that ‘ further data across disciplines with rigorous methods are needed to inform policy decisions regarding the regulation of flavours in tobacco products that can reduce initiation of tobacco products, promote cessation of tobacco products among users and ultimately reduce exposure to harmful products to protect population health ’.…”

Section: Introductionmentioning

confidence: 99%

Flavour chemicals in a sample of non-cigarette tobacco products without explicit flavour names sold in New York City in 2015

et al. 2017

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BackgroundYouth who experiment with tobacco often start with flavoured products. In New York City (NYC), local law restricts sales of all tobacco products with ‘characterising flavours’ except for ‘tobacco, menthol, mint and wintergreen’. Enforcement is based on packaging: explicit use of a flavour name (eg, ‘strawberry’) or image depicting a flavour (eg, a fruit) is presumptive evidence that a product is flavoured and therefore prohibited. However, a tobacco product may contain significant levels of added flavour chemicals even when the label does not explicitly use a flavour name.MethodsSixteen tobacco products were purchased within NYC in 2015 that did not have explicit flavour names, along with three with flavour names. These were analysed for 92 known flavour chemicals plus triacetin by gas chromatography/mass spectrometry.Results14 of the 16 products had total determined flavour chemical levels that were higher (>0.3 mg/g) than in previously studied flavour-labelled products and of a chemical profile indicating added flavour chemicals.ConclusionsThe results suggest that the tobacco industry has responded to sales restrictions by renaming flavoured products to avoid explicitly identifying them as flavoured. While chemical analysis is the most precise means of identifying flavours in tobacco products, federal tobacco laws pre-empt localities from basing regulations on that approach, limiting enforcement options. If the Food and Drug Administration would mandate that all tobacco products must indicate when flavourings are present above a specific level, local jurisdictions could enforce their sales restrictions. A level of 0.1 mg/g for total added flavour chemicals is suggested here as a relevant reference value for regulating added flavour chemicals in tobacco products.

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Flavoured tobacco products in the USA: synthesis of recent multidiscipline studies with implications for advancing tobacco regulatory science

Cited by 23 publications

References 20 publications

Perceived ease of flavored e-cigarette use and e-cigarette use progression among youth never tobacco users

Perceived ease of flavored e-cigarette use and e-cigarette use progression among youth never tobacco users

Do JUUL and e-cigarette flavours change risk perceptions of adolescents? Evidence from a national survey

Flavour chemicals in a sample of non-cigarette tobacco products without explicit flavour names sold in New York City in 2015

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