Impact of non-menthol flavours in e-cigarettes on perceptions and use: an updated systematic review

Abstract

ObjectivesGiven the exponential increase in the use of e-cigarettes among younger age groups and in the growth in research on e-cigarette flavours, we conducted a systematic review examining the impact of non-menthol flavoured e-cigarettes on e-cigarette perceptions and use among youth and adults.DesignPubMed, Embase, PyscINFO and CINAHL were systematically searched for studies published and indexed through March 2018.Eligibility criteriaQuantitative observational and experimental studies that assessed the effect of non-menthol flavours in e-cigarettes on perceptions and use behaviours were included. Specific outcome measures assessed are appeal, reasons for use, risk perceptions, susceptibility, intention to try, initiation, preference, current use, quit intentions and cessation.Data extraction and synthesisThree authors independently extracted data related to the impact of flavours in tobacco products. Data from a previous review were then combined with those from the updated review for final analysis. Results were then grouped and analysed by outcome measure.ResultsThe review included 51 articles for synthesis, including 17 published up to 2016 and an additional 34 published between 2016 and 2018. Results indicate that non-menthol flavours in e-cigarettes decrease harm perceptions (five studies) and increase willingness to try and initiation of e-cigarettes (six studies). Among adults, e-cigarette flavours increase product appeal (seven studies) and are a primary reason many adults use the product (five studies). The role of flavoured e-cigarettes on smoking cessation remains unclear (six studies).ConclusionThis review provides summary data on the role of non-menthol flavours in e-cigarette perceptions and use. Consistent evidence shows that flavours attract both youth and adults to use e-cigarettes. Given the clear findings that such flavours increase product appeal, willingness to try and initiation among youth, banning non-menthol flavours in e-cigarettes may reduce youth e-cigarette use. Longitudinal research is needed to examine any role flavours may play in quit behaviours among adults.

Trends in youth e-cigarette and cigarette use between 2013 and 2019: insights from repeat cross-sectional data from the COMPASS study

“…A variety of intervention strategies may help to reduce the availability and appeal of e-cigarettes among youth. For example, given that the appealing flavours are an important reason for youth use of e-cigarettes (Meernik et al 2019), limiting the number and types of e-cigarette flavours available may help to reduce their appeal and use among youth. Data from clinical trials suggest that lowering the nicotine content of cigarettes reduces cigarette consumption among adults (Benowitz et al 2012;Donny et al 2015); it is possible that a similar approach to limiting the amount of nicotine that is permitted in pods and e-liquid may help to reduce e-cigarette use among youth.…”

Youth source of acquisition for E-Cigarettes

“…Food and Drug Administration, 2019). The wide variety of flavors available in e-cigarettes (which are no longer available in cigarettes) may be particularly appealing to youth, and are cited as a primary reason for use among youth in many studies (Huang et al, 2017, Meernik et al, 2019). In fact, one study showed that 78% of youth reported that they would not use an e-cigarette if it were not flavored.…”

ENDS Flavor Preference by Menthol Cigarette Smoking Status among US Adults, 2018–2019

“…Study participants also cited flavors as a reason for tobacco product experimentation and use. Meernik et al subsequently produced an updated review that looked specifically at nonmenthol-flavored ENDS and found that flavors increased product appeal and willingness to try and use ENDS and decreased harm perceptions of ENDS use among youth [ 20 ]. They also found among adults that flavors increased product appeal and were cited as a reason for ENDS use but that the effects of flavors on smoking cessation were not clear.…”