A flavored tobacco product is a tobacco product with added flavorings. Flavored tobacco products include types of cigarettes, cigarillos and cigars, hookah and hookah tobacco, and various types of smokeless tobacco. Flavored tobacco products are especially popular with youth and have therefore become targets of regulation in several countries.
According to a 2013 survey of internet tobacco retailers, the most common flavors are apple, cherry, chocolate, honey, grape, menthol, mint, peach, rum, strawberry, "sweet" (including bubble gum, candy, and toffee) and vanilla.
Cigarettes may be flavored to mask the taste or odor of the tobacco smoke, enhance the tobacco flavor, or decrease the social stigma associated with smoking. Flavors are generally added to the tobacco or rolling paper, although some cigarette brands have unconventional flavor delivery mechanisms such as inserting flavored pellets or rods into the cigarette filter. Cigarette flavors include anise, clove, cinnamon, spearmint, wintergreen, citrus, fruit, and alcohol (especially rum and cocktails). Flavors may be added to the tobacco, cigarette paper, filter, or even to the foil wrapper.:34 Some tobacco companies have developed unconventional flavor delivery systems, including polymer pellet technology, using a flavored filter pellet (polyethylene bead), flavor micro-encapsulation in the paper or packaging technology, flavor fibers inserted into the filter, and flavored tips.:34 Flavorings are typically added at the end of the cigarette manufacturing process.:25 Flavored cigarettes are heavily preferred by youth, with a 2008 study finding that adolescents and young adults ages 17–25 use flavored cigarettes at about twice the rate of adults age 25 and older, with 17- to 18-year-olds being the heaviest users of flavored cigarettes, using them three times as much as adults.
One common type of flavored cigarettes are beedis, a small, thin, hand-rolled cigarette originally from India, where they outsell regular cigarettes by a ratio of eight to one. Another is kretek, a cigarette made with a blend of tobacco and cloves that is popular in Indonesia. No flavored cigarettes, including menthol, beedis, and kreteks, are safe. Indeed, many flavorings produce increased levels of acetaldehyde when combusted, enhancing dependence and toxicity.:26 Additionally, some of the flavorings in cigarettes contain toxic compounds such as alkenylbenzenes.:37
The most popular cigarette flavor by far is menthol, which represents 10% of the global cigarette market and makes up more than 25% of the market in countries including the United States, Singapore, the Philippines, and Chile. Menthol is a chemical found in plants of the mint family that produces a cooling sensation in the throat. It is often used as a cigarette additive to mask the flavor and feel of the tobacco smoke or to improve the throat and mouth feel of the cigarette. Menthol increases the addictive properties of the nicotine in cigarettes, in part by increasing the density of nicotine receptors in the brain.
In the United States, menthol cigarettes are used disproportionately by African Americans: more than 70% of African-American smokers primarily use menthols, compared to approximately 30% of white smokers. This high use by African Americans is largely the result of deliberate marketing campaigns by tobacco companies, which exacerbated small racial differences in menthol cigarette preferences into large ones. Racial marketing strategies changed during the Fifties. The civil rights movement led to the rise of African-American publications, such as Ebony. This helped tobacco companies to target separate marketing messages by race.:57 Tobacco companies supported civil rights organizations, and advertised their support heavily. Industry motives were, according to their public statements, to support civil rights causes; according to an independent review of internal tobacco industry documents, they were "to increase African American tobacco use, to use African Americans as a frontline force to defend industry policy positions, and to defuse tobacco control efforts". There had been internal resistance to tobacco sponsorship, and some organizations are now rejecting nicotine funding as a matter of policy. Tobacco company Lorillard even gave out free menthol cigarette samples to children in black neighborhoods in the U.S. in the 1950s.
In addition to high use by African Americans, menthol cigarettes are used disproportionately by adolescents, women, and lesbian, gay, bisexual, and transgender (LGBT) Americans. LGBT Americans are twice as likely as straight ones to use menthol cigarettes, according to CDC research. Where these demographics overlap, menthol use is especially high: most female LGBT smokers use menthols, as do 80 percent of African American youth smokers and 70 percent of LGBT youth smokers. Tobacco companies have targeted the LGBT community with advertising for menthol cigarettes, most notably through Project SCUM.
Little cigars, both cigarette-sized ones as well as mid-sized cigarillos, are typically flavored, unlike full-size hand-wrapped cigars. Small cigars and cigarillos are disproportionately used by lower income and less educated people, young people, African Americans, Hispanics, LGBT people, and men. Usage of flavored cigarillos has grown explosively, with sales in U.S. convenience stores up 50% between 2008 and 2015, after tripling between 1997 and 2007. Among adult and youth cigar users, about 40 percent use flavored cigarillos. The most popular flavors for cigarillos are fruit (38.8 percent), sweet or candy (21.2 percent), and wine (17.0 percent). Flavored cigarillos are popular with lower income and younger people in part because they are inexpensive and are promoted by tobacco companies as affordable alternatives to cigarettes. Unlike cigarettes, cigarillos can be sold in small packs of one or two each for around 99¢ for two. In many jurisdictions, cigarillos and other cigars are taxed at lower rates than cigarettes, making them more appealing to low-income populations, including youth, young adults, and the unemployed.
E-liquid, the nicotine-containing liquid used in an electronic cigarette, is usually flavored. E-liquids come in a myriad of flavors, including mint, spice, fruit, and candy ones. A 2017 survey of internet e-cigarette retailers found 15,586 unique flavors of e-liquid and counting, up from the 7,764 found in a 2014 analysis. In surveys of regular e-cigarette users, the most popular e-liquid flavors are largely tobacco, mint and fruit, although candy and dessert flavors are also common. Mango is the most popular JUUL flavor. Fruit flavored e-liquid is the most commonly marketed e-liquid flavor on social media. Flavored e-liquids form a major part of the appeal for using e-cigarettes, especially for youth, for whom flavoring is cited as a major reason for using e-cigarettes.
Some e-liquid flavorings are toxic. Cinnamaldehyde is a highly cytotoxic material in vitro used in cinnamon-flavored e-liquids. Cinnamaldehyde have been identified as cytotoxic at the amount of about 400 times less than those allowed for use by the US Environmental Protection Agency. A 2018 in vitro study found that exposing lung cells to liquid or vapor containing cinnamaldehyde causes significant and rapid damage to their cilia and mitochondria. This led the authors of the study to conclude that "inhalational exposures of cinnamaldehyde may increase the risk of respiratory infections in e-cigarette users." Some e-liquids containing cinnamaldehyde stimulate TRPA1, which might induce effects on the lung. E-liquids contain possibly toxic aldehydes and reactive oxygen species (ROS). Many flavors are known aldehydes, such as anisaldehyde, cinnamaldehyde, and isovaleraldehyde. A 2012 study found butterscotch flavor was highly toxic with one liquid and two others had a low toxicity. A 2014 in vitro study demonstrated that e-cigarette use of a "balsamic" flavor with no nicotine can activate the release of proinflammatory cytokine in lung epithelial cells and keratinocytes. Some additives may be added to reduce the irritation on the pharynx. The long-term toxicity is subject to the additives and contaminants in the e-liquid.
Certain e-liquid flavorings contain diacetyl and acetyl propionyl which give a buttery taste. Diacetyl and acetyl propionyl are associated with bronchiolitis obliterans ("popcorn lung"), a serious lung disease. A 2015 review recommended for specific regulation of diacetyl and acetyl propionyl in e-liquid, which are safe when ingested but have been associated with respiratory harm when inhaled. Both diacetyl and acetyl-propionyl have been found in concentrations above those recommended by the US National Institute for Occupational Safety and Health. Diacetyl is normally found at lower levels in e-cigarettes than in traditional cigarettes. Concerns exist that the flavors and additives in e-cigarettes might lead to diseases, including the popcorn lung. The cardiovascular effects, including a vast range of flavorings and fragrances, is unknown. The irritants butyl acetate, diethyl carbonate, benzoic acid, quinoline, bis(2-ethylhexyl) phthalate, and 2,6-dimethyl phenol were present as undeclared ingredients in the e-liquid. Hindering safety assessments of e-liquids is the fact that the precise ingredients of e-cigarettes and e-liquids are not known.
With the current popular trend of flavored e-cigarettes use among young generations, there is concern about the potential long-term health of the public.
Heated tobacco products
Mu'assel (also known as shisha), the tobacco used in a hookah, is almost always flavored: more than 85% of mu'assel sold in the United States is flavored. Typical flavors include apple, plum, coconut, mango, mint, strawberry and cola, with mint and double apple (Arabic: تفاحتين) being the most popular. Unusual flavors, including white gummy bear, blueberry muffin, spiced chai and Powerbull flavor (similar to the flavor of a Red Bull energy drink), have been introduced in recent years by modern tobacco companies. Heating these flavorings releases chemicals such as furans, phenols, aldehydes, and acids, in addition to nitrogenous carcinogens and alcohols, all of which are dangerous to human health. A comparison of 13 common hookah flavors found that melon flavors are the most dangerous, with their smoke containing four classes of hazards in high concentrations.
Many types of smokeless tobacco are flavored. Nasal snuff is typically flavored, with common flavors including coffee, chocolate, bordeaux, honey, vanilla, cherry, orange, apricot, plum, camphor, cinnamon, rose, spearmint, Bourbon, Cola, and whisky. Gutka, a chewing tobacco preparation commonly used in parts of India, is commonly flavored, as is naswar, a type of dipping tobacco common in Central and South Asia. Moist snuff (dip), snus, and dissolvables are also often flavored. Accounting for more than half of moist snuff and more than four-fifths of snus sold, flavored smokeless tobacco has been becoming very popular and driving the growth in smokeless tobacco usage in the United States.
Use by youth
Flavored tobacco products—particularly flavored cigarettes (including menthol), cigarillos, hookah, and electronic cigarettes—are disproportionately preferred by adolescents and young adults. Because of the high availability of these popular flavors, flavored tobacco products are widely used for at least 80% of youth tobacco users. According to the CDC, 67% of high school students and 49% of middle school students who used tobacco products in the past 30 days reported using a flavored tobacco product during that time.
Flavored tobacco products promote youth smoking initiation and help young occasional smokers to become daily smokers by reducing or masking the natural harshness and taste of tobacco smoke and increasing the social acceptability of the toxic tobacco product. Menthol appeals to younger or beginning smokers largely because the menthol masks the harshness and discomfort of inhaling smoke, making smoking more palatable. Trying menthols increases smoking initiation among youth and young adults, and menthols users face greater addiction and decreased success in quitting smoking. Young people who use menthol cigarettes are 80% more likely to become life-long smokers than those who use regular cigarettes. Likewise, studies associate youth hookah use with subsequent cigarette use, increased intensity of cigarette use, and decreased success in quitting. A 2016 study found 11- to 16-year-old English children exposed to e-cigarette advertisements highlighting flavored, in contrast to flavor-free e-cigarettes, increased e-cigarette appeal and usage. As such, adolescents were more likely to initiate vaping through flavored e-cigarettes than unflavored ones, and a majority of youth who used an e-cigarette first tried a flavored e-cigarette.
The goal of tobacco companies also drives the widespread use of flavored tobacco products. According to a 2008 study, the internal tobacco company documents found that makers of the largest menthol cigarette brands in the United States—Kool, Newport, Salem, Marlboro, and Camel—formulated the menthol levels in their cigarettes, as well as their marketing strategies, to entice young people. Likewise, multiple reviews of internal tobacco company documents have found that flavored cigarettes are deliberately introduced to appeal to young people, with flavorings often being fine-tuned to best appeal to youth.
Furthermore, flavored tobacco products are often advertised to children and adolescents. Flavored cigarettes have been advertised in magazines frequently read by kids, such as Sports Illustrated, Cosmopolitan, and Rolling Stone and on television programs watched by adolescents. A majority of adolescents and young adults are exposed to cigarillo advertising in magazines and storefronts and on social media. Flavored e-cigarettes have been marketed extensively to youth in retail stores and on television and social media: 78.2 percent of American youth (20.5 million people). A 2018 analysis of the 2014, 2015, and 2016 NYTS data by the CDC found that retail stores were where most youth were exposed to e-cigarette advertisements, followed by online advertising, television advertising, and then newspaper and magazine advertising. About 24 million youth have been exposed to e-cigarette ads on cable TV, primarily due to an ad campaign for blu e-cigarettes. On social media, marketing includes images associated with youth culture, endorsements by celebrities and social media influencers popular with youth, and themes that have been found to strongly appeal to youth (such as freedom and rebellion). Ads for flavored e-cigarettes have been shown to cause children to be more interested in buying and trying e-cigarettes, as compared to ads for unflavored e-cigarettes.
Although a few countries have banned flavored cigarettes (except menthol), flavors in most tobacco products remain unregulated across the globe. The Family Smoking Prevention and Tobacco Control Act, passed by the United States Congress in October 2009, bans cigarettes with flavors other than menthol or tobacco. However, some tobacco companies have rebranded their flavored cigarettes as “little” or “filtered” cigars in order to circumvent this ban. In December 2016, the U.S. Food and Drug Administration (FDA) sent warning letters to four tobacco companies—Swisher International, Inc., Cheyenne International LLC, Prime Time International Co. and Southern Cross Tobacco Company Inc.—for marketing their fruit-flavored cigarettes as cigars to avoid the ban. A 2016 analysis of data from the 1999–2013 National Youth Tobacco Surveys suggests that the ban reduced adolescent cigarette use—both probability of smoking a cigarette and number of cigarettes used by smokers—although there was an increase in adolescent use of menthols, smokeless tobacco, flavored cigars, and pipes, suggesting substitution towards the remaining legal flavored tobacco products. That said, the ban was associated with a reduction in overall tobacco product use by youth of 6.1 percent.
Canada banned flavored additives in combustible tobacco products—cigarettes, little cigars, and rolling papers—in 2009, excluding menthol. Canada banned menthol cigarettes in 2017. Preliminary research in Ontario Province indicates that this ban increased the number of smokers who quit. Because the law only banned flavors in combustible tobacco products under 1.4 grams, some tobacco companies began producing flavored products slightly larger than 1.4 g.
In June 2018, San Francisco residents voted to outlaw the sale of flavored tobacco products, including e-liquids and menthol cigarettes, in the city. The measure, Proposition E, passed with 68.5 percent of the vote, in spite of Big Tobacco company R.J. Reynolds spending more than $12 million on ads against the measure. The ban was supported by groups including the American Cancer Society, the American Heart Association, the American Lung Association, African American American Tobacco Control Leadership Council, and Tobacco-Free Kids Action Fund. Similar bans have passed in California in the cities of Oakland and Sonoma as well as in San Mateo, Contra Costa and Yolo counties. As of January 2019[update], 180 localities in California, Illinois, Massachusetts, Minnesota, New York, and Rhode Island as well as two US states—Maine and New Jersey—restrict the sale of flavored tobacco products.
In June 2019, San Francisco became the first major U.S. city to put a ban on the sale and distribution of all e-cigarettes including flavored ones. The major e-cigarette company in San Francisco, JUUL spent over $18.6 million to the Proposition C campaign into a November ballot initiative in hopes to overturn the ban. This Proposition C would take launch starting early 2020 depending on the ballot results from San Francisco residents. It is based on the election results on November 5, 2019, the Proposition C was defeated. It shows that out of 201519 votes, nearly 82% of people were against Prop C. Which means that the citywide ban on e-cigarette products will be effective in 2020.
September 4, 2019, Michigan became the first state in the nation to ban flavored e-cigarettes.
In November 2018 the FDA announced its intention to outlaw menthol cigarettes and flavored cigars, and to limit sales of e-cigarettes with flavors other than mint, tobacco, and menthol to qualified adults-only stores and online.
- The Scientific Basis of Tobacco Product Regulation (PDF) (Technical report). Geneva: World Health Organization. 2007. ISBN 978 92 4 120945 8. ISSN 0512-3054. 945.
- Morris, Daniel S.; Fiala, Steven C. (January 2015). "Flavoured, non-cigarette tobacco for sale in the USA: an inventory analysis of Internet retailers". Tobacco Control. 24 (1): 101–102. doi:10.1136/tobaccocontrol-2013-051059. ISSN 1468-3318. PMID 23929812. Retrieved 2019-01-13.
- Carpenter, Carrie M.; Wayne, Geoffrey Ferris; Pauly, John L.; Koh, Howard K.; Connolly, Gregory N. (December 2005). "New cigarette brands with flavors that appeal to youth: tobacco marketing strategies". Health Affairs (Project Hope). 24 (6): 1601–1610. doi:10.1377/hlthaff.24.6.1601. ISSN 0278-2715. PMID 16284034.
- Simpson, David (2004-06-01). "USA/Brazil: the flavour of things to come". Tobacco Control. 13 (2): 105–106. ISSN 1468-3318. PMC 1747868. PMID 15175519.
- Klein, Sarah M.; Giovino, Gary A.; Barker, Dianne C.; Tworek, Cindy; Cummings, K. Michael; O'Connor, Richard J. (July 2008). "Use of flavored cigarettes among older adolescent and adult smokers: United States, 2004--2005". Nicotine & Tobacco Research. 10 (7): 1209–1214. doi:10.1080/14622200802163159. ISSN 1462-2203. PMID 18629731.
- "Smoking and Tobacco Use; Fact Sheet; Bidis and Kreteks". CDC's Office on Smoking and Health. Centers for Disease Control and Prevention. 14 August 2018. Retrieved 4 February 2019.
- "Bidis: An Overview" (PDF). Campaign for Tobacco-Free Kids. Archived from the original (PDF) on 16 April 2016. Retrieved 4 February 2019.
- Hanusz, Mark. Smoke; A Century of Kretek.
- Bach, Laura (September 13, 2018). "Flavored Tobacco Products Attract Kids" (PDF). Campaign for Tobacco-Free Kids. Retrieved October 13, 2018.
- Case studies for regulatory approaches to tobacco products: Menthol in tobacco products (Report). Geneva: World Health Organization. 2018. WHO/NMH/PND/18.1. Retrieved February 5, 2019.
- Biswas, L.; Harrison, E.; Gong, Y.; Avusula, R.; Lee, J.; Zhang, M.; Rousselle, T.; Lage, J.; Liu, X. (2016). "Enhancing effect of menthol on nicotine self-administration in rats". Psychopharmacology. 233 (18): 3417–3427. doi:10.1007/s00213-016-4391-x. PMC 4990499. PMID 27473365.
- Wickham, R. J. (2015). "How Menthol Alters Tobacco-Smoking Behavior: A Biological Perspective". Yale J. Biol. Med. 88 (3): 279–287. PMC 4553648. PMID 26339211.
- Kabbani, Nadine (2013-07-23). "Not so Cool? Menthol's discovered actions on the nicotinic receptor and its implications for nicotine addiction". Frontiers in Pharmacology. 4: 95. doi:10.3389/fphar.2013.00095. ISSN 1663-9812. PMC 3720998. PMID 23898298.
- "Harvard Researchers Gather More Evidence Implicating Menthol in Health Disparities Between White and Black Smokers". Harvard School of Public Health. August 18, 2005.
- Gardiner, Phillip S. (February 2004). "The African Americanization of menthol cigarette use in the United States". Nicotine & Tobacco Research. 6 Suppl 1: 55–65. doi:10.1080/14622200310001649478. ISSN 1462-2203. PMID 14982709. S2CID 1486105.
- Edwards, Jim (January 5, 2011). "Why Big Tobacco Targeted Blacks With Ads for Menthol Cigarettes". Retrieved 2018-05-24.
- Davis, Ronald M.; Gilpin, Elizabeth A.; Loken, Barbara; Viswanath, K.; Wakefield, Melanie A. (2008). The role of the media in promoting and reducing tobacco use (PDF). National Cancer Institute tobacco control monograph series. U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute. p. 684.
- Yerger, V. B.; Malone, R. E. (2002-12-01). "African American leadership groups: smoking with the enemy". Tobacco Control. 11 (4): 336–345. doi:10.1136/tc.11.4.336. PMC 1747674. PMID 12432159.
- Press, The Associated (2004-06-27). "Cigarette Suit Says Maker Gave Samples To Children". The New York Times. Retrieved 2018-05-24.
- "Evans v. Lorillard: A Bittersweet Victory Against the Tobacco Industry" (PDF). Tobacco Control Legal Consortium. Mitchell Hamline School of Law. August 2016. Retrieved 20 December 2018.
- Rose, Shyanika W; Jo, Catherine L; Binns, Steven; Buenger, Melissa; Emery, Sherry; Ribisl, Kurt M (2017-02-27). "Perceptions of Menthol Cigarettes Among Twitter Users: Content and Sentiment Analysis". Journal of Medical Internet Research. 19 (2): e56. doi:10.2196/jmir.5694. ISSN 1439-4456. PMC 5348619. PMID 28242592.
- Fallin, Amanda; Goodin, Amie J.; King, Brian A. (January 2015). "Menthol Cigarette Smoking among Lesbian, Gay, Bisexual, and Transgender Adults". American Journal of Preventive Medicine. 48 (1): 93–97. doi:10.1016/j.amepre.2014.07.044. ISSN 0749-3797. PMC 4454462. PMID 25245795.
- Moodie-Mills, Aisha (May 12, 2011). "Flavored Disease and Death for Minorities". Center for American Progress. Retrieved 4 October 2018.
- King, Brian A.; Dube, Shanta R.; Tynan, Michael A. (February 2013). "Flavored Cigar Smoking Among U.S. Adults: Findings From the 2009–2010 National Adult Tobacco Survey". Nicotine & Tobacco Research. 15 (2): 608–614. doi:10.1093/ntr/nts178. ISSN 1462-2203. PMID 22927687.
- Corey, C. G.; King, B. A.; Coleman, B. N.; Delnevo, C. D.; Husten, C. G.; Ambrose, B. K.; Apelberg, B. J. (August 2014). "Little filtered cigar, cigarillo, and premium cigar smoking among adults--United States, 2012-2013". MMWR. Morbidity and Mortality Weekly Report. 63 (30): 650–654. ISSN 0149-2195. PMC 4584787. PMID 25078654.
- King, Brian A.; Tynan, Michael A.; Dube, Shanta R.; Arrazola, Rene (January 2014). "Flavored-Little-Cigar and Flavored-Cigarette Use Among U.S. Middle and High School Students". The Journal of Adolescent Health. 54 (1): 40–46. doi:10.1016/j.jadohealth.2013.07.033. ISSN 1054-139X. PMC 4572463. PMID 24161587.
- Milam, Adam J.; Bone, Lee R.; Byron, M. Justin; Hoke, Kathleen; Williams, Carla D.; Furr-Holden, C. Debra; Stillman, Frances A. (November 2013). "Cigarillo use among High-Risk Urban Young Adults". Journal of Health Care for the Poor and Underserved. 24 (4): 1657–1665. doi:10.1353/hpu.2013.0173. ISSN 1049-2089. PMC 3988125. PMID 24185161.
- Cohn, Amy; Cobb, Caroline O.; Niaura, Raymond S.; Richardson, Amanda (2015-12-01). "The Other Combustible Products: Prevalence and Correlates of Little Cigar/Cigarillo Use Among Cigarette Smokers". Nicotine & Tobacco Research. 17 (12): 1473–1481. CiteSeerX 10.1.1.855.9741. doi:10.1093/ntr/ntv022. ISSN 1462-2203. PMID 25634932.
- Hsu, Greta; Sun, Jessica Y; Zhu, Shu-Hong (12 March 2018). "Evolution of Electronic Cigarette Brands From 2013-2014 to 2016-2017: Analysis of Brand Websites". Journal of Medical Internet Research. 20 (3): e80. doi:10.2196/jmir.8550. ISSN 1439-4456. PMC 5869180. PMID 29530840.
- Hajek, P; Etter, JF; Benowitz, N; Eissenberg, T; McRobbie, H (31 July 2014). "Electronic cigarettes: review of use, content, safety, effects on smokers and potential for harm and benefit" (PDF). Addiction. 109 (11): 1801–10. doi:10.1111/add.12659. PMC 4487785. PMID 25078252.
- Teitell, Beth (November 16, 2017). "'Juuling': The most widespread phenomenon you've never heard of". The Boston Globe.
- Liang, Yunji; Zheng, Xiaolong; Dajun Zheng, Daniel; Zhou, Xingshe (22 January 2016). Zheng, Xiaolong; Dajun Zeng, Daniel; Chen, Hsinchun; Leischow, Scott J. (eds.). Impact of Flavor on Electronic Cigarette Marketing in Social Media. Smart Health: International Conference, ICSH 2015. Phoenix, AZ, USA: Springer. p. 283. ISBN 978-3-319-29175-8.
- Hefner, Kathryn; Valentine, Gerald; Sofuoglu, Mehmet (2017). "Electronic cigarettes and mental illness: Reviewing the evidence for help and harm among those with psychiatric and substance use disorders". The American Journal on Addictions. 26 (4): 306–315. doi:10.1111/ajad.12504. ISSN 1055-0496. PMID 28152247. S2CID 24298173.
- Kong, G.; Morean, M.E.; Cavallo, D.A.; Camenga, D.R.; Krishnan-Sarin, S. (2014). "Reasons for Electronic Cigarette Experimentation and Discontinuation Among Adolescents and Young Adults". Nicotine & Tobacco Research. 17 (7): 847–54. doi:10.1093/ntr/ntu257. ISSN 1462-2203. PMC 4674436. PMID 25481917.
- "Heart and Stroke Foundation: E-cigarettes in Canada". Heart and Stroke Foundation. September 2014. Archived from the original on 6 October 2014.
- "E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General" (PDF). Surgeon General of the United States. 2016. pp. 1–298.
- Ebbert, Jon O.; Agunwamba, Amenah A.; Rutten, Lila J. (2015). "Counseling Patients on the Use of Electronic Cigarettes". Mayo Clinic Proceedings. 90 (1): 128–134. doi:10.1016/j.mayocp.2014.11.004. ISSN 0025-6196. PMID 25572196.
- Farsalinos, K. E.; Polosa, R. (2014). "Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: a systematic review". Therapeutic Advances in Drug Safety. 5 (2): 67–86. doi:10.1177/2042098614524430. ISSN 2042-0986. PMC 4110871. PMID 25083263.
- Clapp, P.; Lavrich, K. (May 23, 2018). The E-Cigarette Flavoring Cinnamaldehyde Suppresses Mitochondrial Function and Transiently Impairs Cilia Beat Frequency in Human Bronchial Epithelial Cells. American Thoracic Society 2018 International Conference. San Diego, CA.
- Rowell, Temperance R; Tarran, Robert (2015). "Will Chronic E-Cigarette Use Cause Lung Disease?". American Journal of Physiology. Lung Cellular and Molecular Physiology. 309 (12): L1398–L1409. doi:10.1152/ajplung.00272.2015. ISSN 1040-0605. PMC 4683316. PMID 26408554.
- Bhatnagar, A.; Whitsel, L. P.; Ribisl, K. M.; Bullen, C.; Chaloupka, F.; Piano, M. R.; Robertson, R. M.; McAuley, T.; Goff, D.; Benowitz, N. (24 August 2014). "Electronic Cigarettes: A Policy Statement From the American Heart Association" (PDF). Circulation. 130 (16): 1418–1436. doi:10.1161/CIR.0000000000000107. PMC 7643636. PMID 25156991.
- Rom, Oren; Pecorelli, Alessandra; Valacchi, Giuseppe; Reznick, Abraham Z. (2014). "Are E-cigarettes a safe and good alternative to cigarette smoking?". Annals of the New York Academy of Sciences. 1340 (1): 65–74. Bibcode:2015NYASA1340...65R. doi:10.1111/nyas.12609. ISSN 0077-8923. PMID 25557889. S2CID 26187171.
- Jimenez Ruiz, CA; Solano Reina, S; de Granda Orive, JI; Signes-Costa Minaya, J; de Higes Martinez, E; Riesco Miranda, JA; Altet Gómez, N; Lorza Blasco, JJ; Barrueco Ferrero, M; de Lucas Ramos, P (August 2014). "The electronic cigarette. Official statement of the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) on the efficacy, safety and regulation of electronic cigarettes". Archivos de Bronconeumologia. 50 (8): 362–7. doi:10.1016/j.arbres.2014.02.006. PMID 24684764.
- Bertholon, J.F.; Becquemin, M.H.; Annesi-Maesano, I.; Dautzenberg, B. (2013). "Electronic Cigarettes: A Short Review". Respiration. 86 (5): 433–8. doi:10.1159/000353253. ISSN 1423-0356. PMID 24080743.
- Hildick-Smith, Gordon J.; Pesko, Michael F.; Shearer, Lee; Hughes, Jenna M.; Chang, Jane; Loughlin, Gerald M.; Ipp, Lisa S. (2015). "A Practitioner's Guide to Electronic Cigarettes in the Adolescent Population". Journal of Adolescent Health. 57 (6): 574–9. doi:10.1016/j.jadohealth.2015.07.020. ISSN 1054-139X. PMID 26422289.
- Farsalinos, Konstantinos; LeHouezec, Jacques (2015). "Regulation in the face of uncertainty: the evidence on electronic nicotine delivery systems (e-cigarettes)". Risk Management and Healthcare Policy. 8: 157–67. doi:10.2147/RMHP.S62116. ISSN 1179-1594. PMC 4598199. PMID 26457058.
- Bhatnagar, Aruni (2016). "Cardiovascular Perspective of the Promises and Perils of E-Cigarettes". Circulation Research. 118 (12): 1872–1875. doi:10.1161/CIRCRESAHA.116.308723. ISSN 0009-7330. PMC 5505630. PMID 27283531.
- Benowitz, Neal L.; Burbank, Andrea D. (2016). "Cardiovascular toxicity of nicotine: Implications for electronic cigarette use". Trends in Cardiovascular Medicine. 26 (6): 515–23. doi:10.1016/j.tcm.2016.03.001. ISSN 1050-1738. PMC 4958544. PMID 27079891.
- Sanford Z, Goebel L (2014). "E-cigarettes: an up to date review and discussion of the controversy". W V Med J. 110 (4): 10–5. PMID 25322582.CS1 maint: uses authors parameter (link)
- Schraufnagel, Dean E.; Blasi, Francesco; Drummond, M. Bradley; Lam, David C. L.; Latif, Ehsan; Rosen, Mark J.; Sansores, Raul; Van Zyl-Smit, Richard (2014). "Electronic Cigarettes. A Position Statement of the Forum of International Respiratory Societies". American Journal of Respiratory and Critical Care Medicine. 190 (6): 611–618. doi:10.1164/rccm.201407-1198PP. ISSN 1073-449X. PMID 25006874. S2CID 43763340.
- Drazen, Jeffrey M.; Morrissey, Stephen; Campion, Edward W. (2019-02-14). "The Dangerous Flavors of E-Cigarettes". New England Journal of Medicine. 380 (7): 679–680. doi:10.1056/NEJMe1900484. ISSN 0028-4793. PMID 30699053.
- "Heated tobacco products (HTPs) information sheet". World Health Organization. May 2018.
- "Alternatieve tabaksproducten: harm reduction?" [Alternative tobacco products: harm reduction?] (PDF). Netherlands National Institute for Public Health and the Environment. 2016. p. 36.
- "Shisha". British Heart Foundation. Retrieved 16 January 2019.
- "Listing the Most Popular Shisha Flavors -". Rad Hookah Pipes. 11 March 2016. Retrieved 4 February 2019.
- "Our Range". الفاخر. شركة الفاخر لتجارة التبغ. Retrieved 27 June 2018.
- Farag, Mohamed A.; Elmassry, Moamen M.; El-Ahmady, Sherweit H. (2018-11-19). "The characterization of flavored hookahs aroma profile and in response to heating as analyzed via headspace solid-phase microextraction (SPME) and chemometrics". Scientific Reports. 8 (1): 17028. Bibcode:2018NatSR...817028F. doi:10.1038/s41598-018-35368-6. ISSN 2045-2322. PMC 6242864. PMID 30451904.
- The Old Snuff House of Fribourg & Treyer at the Sign of the Rasp & Crown, No.34 St. James's Haymarket, London, S.W., 1720, 1920. Author: George Evens and Fribourg & Treyer. Publisher: Nabu Press, London, England. Reproduced 5 August 2010, ISBN 978-1176904705
- "CPAA: Quit Smoking Campaign, Anti Tobacco & Quit Smoking Campaign". Archived from the original on 17 May 2015. Retrieved 30 May 2015.
- Sajid, Faiza; Bano, Samina (2015-09-20). "Effects of smokeless dipping tobacco (Naswar) consumption on antioxidant enzymes and lipid profile in its users". Pakistan Journal of Pharmaceutical Sciences. 28 (5 Suppl): 1829–1833. PMID 26525023.
- Kuiper, Nicole M; Gammon, Doris; Loomis, Brett; Falvey, Kyle; Wang, Teresa W.; King, Brian A.; Rogers, Todd (3 May 2018). "Trends in Sales of Flavored and Menthol Tobacco Products in the United States during 2011–2015". Nicotine & Tobacco Research. 20 (6): 698–706. doi:10.1093/ntr/ntx123. ISSN 1462-2203. PMC 5711620. PMID 28575408.
- Lewis, M. Jane; Wackowski, Olivia (February 2006). "Dealing With an Innovative Industry: A Look at Flavored Cigarettes Promoted by Mainstream Brands". American Journal of Public Health. 96 (2): 244–251. doi:10.2105/AJPH.2004.061200. ISSN 0090-0036. PMC 1470487. PMID 16380563.
- Connolly, G. N. (2004-09-01). "Sweet and spicy flavours: new brands for minorities and youth". Tobacco Control. 13 (3): 211–212. doi:10.1136/tc.2004.009191. ISSN 1468-3318. PMC 1747891. PMID 15333865.
- Bach, Laura (May 10, 2016). "Hookah is not Harmless" (PDF). Campaign for Tobacco-Free Kids. Retrieved January 16, 2019.
- Wang, Teresa W. (June 7, 2018). "Tobacco Product Use Among Middle and High School Students — United States, 2011–2017". MMWR. Morbidity and Mortality Weekly Report. 67 (22): 629–633. doi:10.15585/mmwr.mm6722a3. PMC 5991815. PMID 29879097.
- E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General (PDF) (Report). Rockville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. 2016. p. 40. Retrieved 1 November 2018.
- Ambrose, Bridget K.; Day, Hannah R.; Rostron, Brian; Conway, Kevin P.; Borek, Nicolette; Hyland, Andrew; Villanti, Andrea C. (3 November 2015). "Flavored Tobacco Product Use Among US Youth Aged 12-17 Years, 2013-2014". JAMA. 314 (17): 1871–1873. doi:10.1001/jama.2015.13802. ISSN 0098-7484. PMC 6467270. PMID 26502219.
- "Youth and Tobacco Use". 2019-12-10.
- Wayne, G. Ferris; Connolly, G. N. (March 2002). "How cigarette design can affect youth initiation into smoking: Camel cigarettes 1983-93". Tobacco Control. 11 (suppl 1): i32–i39. doi:10.1136/tc.11.suppl_1.i32. ISSN 1468-3318. PMC 1766065. PMID 11893812.
- Kreslake, Jennifer M.; Wayne, Geoffrey Ferris; Alpert, Hillel R.; Koh, Howard K.; Connolly, Gregory N. (2008-09-01). "Tobacco Industry Control of Menthol in Cigarettes and Targeting of Adolescents and Young Adults". American Journal of Public Health. 98 (9): 1685–1692. doi:10.2105/AJPH.2007.125542. ISSN 0090-0036. PMC 2509610. PMID 18633084.
- Preliminary Scientific Evaluation of the Possible Public Health Effects of Menthol versus Nonmenthol Cigarettes (PDF) (Report). Food and Drug Administration. 2013. Retrieved 13 January 2019.
- Peterson, Lisa A.; Hecht, Stephen S. (2017). "Tobacco, e-cigarettes, and child health". Current Opinion in Pediatrics. 29 (2): 225–230. doi:10.1097/MOP.0000000000000456. ISSN 1040-8703. PMC 5598780. PMID 28059903.
- Cormet-Boyaka, Estelle; Zare, Samane; Nemati, Mehdi; Zheng, Yuqing (2018). "A systematic review of consumer preference for e-cigarette attributes: Flavor, nicotine strength, and type". PLOS ONE. 13 (3): e0194145. Bibcode:2018PLoSO..1394145Z. doi:10.1371/journal.pone.0194145. ISSN 1932-6203. PMC 5854347. PMID 29543907.
- Cummings, K. M.; Morley, C. P.; Horan, J. K.; Steger, C.; Leavell, N.-R. (March 2002). "Marketing to America's youth: evidence from corporate documents". Tobacco Control. 11 Suppl 1: –5–17. doi:10.1136/tc.11.suppl_1.i5. ISSN 0964-4563. PMC 1766057. PMID 11893810.
- "Get the Facts on E-cigarettes". Know the Risks: E-Cigarettes and Young People. U.S. Surgeon General. Retrieved 2018-11-08.
- Duke, Jennifer C.; Lee, Youn O.; Kim, Annice E.; Watson, Kimberly A.; Arnold, Kristin Y.; Nonnemaker, James M.; Porter, Lauren (July 2014). "Exposure to Electronic Cigarette Television Advertisements Among Youth and Young Adults". Pediatrics. 134 (1): –29–e36. doi:10.1542/peds.2014-0269. ISSN 1098-4275. PMID 24918224. Retrieved 2019-01-16.
- Franck, Caroline; Filion, Kristian B.; Kimmelman, Jonathan; Grad, Roland; Eisenberg, Mark J. (2016). "Ethical considerations of e-cigarette use for tobacco harm reduction". Respiratory Research. 17 (1): 53. doi:10.1186/s12931-016-0370-3. ISSN 1465-9921. PMC 4869264. PMID 27184265.
However, the relative absence of restrictions to date in the US has led e-cigarette marketing to permeate most media outlets through the likes of celebrity endorsements, images associated with youth culture, and statements encouraging consumers to reclaim lost freedoms
- Vasiljevic, Milica; Petrescu, Dragos C.; Marteau, Theresa M. (December 2016). "Impact of advertisements promoting candy-like flavoured e-cigarettes on appeal of tobacco smoking among children: an experimental study". Tobacco Control. 25 (e2): e107–e112. doi:10.1136/tobaccocontrol-2015-052593. ISSN 1468-3318. PMC 5284337. PMID 26781305.
- Vasiljevic, Milica; Petrescu, Dragos C; Marteau, Theresa M (December 2016). "Impact of advertisements promoting candy-like flavoured e-cigarettes on appeal of tobacco smoking among children: an experimental study". Tobacco Control. 25 (e2): –107–e112. doi:10.1136/tobaccocontrol-2015-052593. ISSN 0964-4563. PMC 5284337. PMID 26781305.
- Ford, Allison; MacKintosh, Anne Marie; Bauld, Linda; Moodie, Crawford; Hastings, Gerard (2016). "Adolescents' responses to the promotion and flavouring of e-cigarettes". International Journal of Public Health. 61 (2): 215–224. doi:10.1007/s00038-015-0769-5. ISSN 1661-8556. PMC 4819499. PMID 26650455.
- Kowitt, Sarah; Meernik, Clare; Baker, Hannah; Osman, Amira; Huang, Li-Ling; Goldstein, Adam (2017). "Perceptions and Experiences with Flavored Non-Menthol Tobacco Products: A Systematic Review of Qualitative Studies". International Journal of Environmental Research and Public Health. 14 (4): 338. doi:10.3390/ijerph14040338. ISSN 1660-4601. PMC 5409539. PMID 28333107. This article incorporates text by Sarah D. Kowitt, Clare Meernik, Hannah M. Baker, Amira Osman, Li-Ling Huang, and Adam O. Goldstein available under the CC BY 4.0 license.
- "Compliance, Enforcement & Training - Family Smoking Prevention and Tobacco Control Act - An Overview". FDA Center for Tobacco Products. U.S. Food and Drug Administration. 31 October 2018. Retrieved 20 December 2018.
- Courtemanche, Charles J.; Palmer, Makayla K.; Pesko, Michael F. (1 May 2017). "Influence of the Flavored Cigarette Ban on Adolescent Tobacco Use". American Journal of Preventive Medicine. 52 (5): –139–e146. doi:10.1016/j.amepre.2016.11.019. ISSN 0749-3797. PMC 5401634. PMID 28081999.
- Lencucha, Raphael; Ruckert, Arne; Labonte, Ronald; Drope, Jeffrey (2018-11-28). "Opening windows and closing gaps: a case analysis of Canada's 2009 tobacco additives ban and its policy lessons". BMC Public Health. 18 (1): 1321. doi:10.1186/s12889-018-6157-3. ISSN 1471-2458. PMC 6260734. PMID 30486817.
- Weinstock, Cheryl Platzman (March 8, 2018). "A menthol cigarette ban may influence smokers to quit". Reuters. Retrieved October 18, 2018.
- Chaiton, Michael; Schwartz, Robert; Cohen, Joanna E.; Soule, Eric; Eissenberg, Thomas (2018-05-01). "Association of Ontario's Ban on Menthol Cigarettes With Smoking Behavior 1 Month After Implementation". JAMA Internal Medicine. 178 (5): 710–711. doi:10.1001/jamainternmed.2017.8650. PMC 5876835. PMID 29507934.
- "An Act to amend the Tobacco Act". Section 5.1, 5.2, 7.1 and 23.1, Act No. C-32 of 8 October 2009. p. 41.
- "Brazil bans flavored tobacco". WHO Framework Convention on Tobacco Control.
- Brooks-Pollock, Tom (19 May 2016). "The EU is banning menthol cigarettes". The Independent. Retrieved 19 October 2018.
- "How Other Countries Regulate Flavored Tobacco Products" (PDF). Tobacco Control Legal Consortium. 2015. Retrieved 5 February 2019.
- Almukhtar, Sarah; Bloch, Matthew; Lee, Jasmine C. (2018-06-05). "California Primary Election Results". The New York Times. ISSN 0362-4331. Retrieved 2018-10-17.
- Hoffman, Jan (June 6, 2018). "San Francisco Voters Uphold Ban on Flavored Vaping Products". The New York Times. Retrieved 17 October 2018.
- Tadayon, Ali (20 September 2017). "Oakland bans flavored tobacco products". East Bay Times. Retrieved 17 October 2018.
- Green, Jason (2018-06-06). "Supervisors vote to ban flavored tobacco in San Mateo County". San Jose Mercury News. Retrieved 2018-10-17.
- Bach, Laura (January 22, 2019). "States & localities that have restricted the sale of flavored tobacco products" (PDF). Campaign for Tobacco-Free Kids. Retrieved February 4, 2019.
- "7 States Have Moved to Ban Vapes. Is the Rest of America Next?". 2019-10-14.
- "Juul ends support for Prop. C, SF measure to overturn e-cigarette sales ban". October 2019.
- Kaplan, Sheila; Hoffman, Jan (2018-11-16). "F.D.A. Seeks Restrictions on Teens' Access to Flavored E-Cigarettes and a Ban on Menthol Cigarettes". The New York Times. ISSN 0362-4331. Retrieved 2018-12-20.
- "6 takeaways from the FDA's e-cigarette and flavored tobacco plan". Truth Initiative. 21 November 2018. Retrieved 4 February 2019.
- The Scientific Basis of Tobacco Product Regulation (2007). World Health Organization
- Trapl, Erika S.; O’Rourke-Suchoff, Danielle; Yoder, Laura D.; Cofie, Leslie E.; Frank, Jean L.; Fryer, Craig S. (January 2017). "Youth Acquisition and Situational Use of Cigars, Cigarillos, and Little Cigars: A Cross-sectional Study". American Journal of Preventive Medicine. 52 (1): –9–e16. doi:10.1016/j.amepre.2016.08.011. ISSN 0749-3797. PMC 5704971. PMID 27717517.
- Morean, Meghan E.; Butler, Ellyn R.; Bold, Krysten W.; Kong, Grace; Camenga, Deepa R.; Cavallo, Dana A.; Simon, Patricia; O’Malley, Stephanie S.; Krishnan-Sarin, Suchitra (January 2018). "Preferring more e-cigarette flavors is associated with e-cigarette use frequency among adolescents but not adults". PLOS ONE. 13 (1): e0189015. Bibcode:2018PLoSO..1389015M. doi:10.1371/journal.pone.0189015. ISSN 1932-6203. PMC 5754053. PMID 29300749.