ENDS Flavors: Difference between revisions

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=Abuse Liability - All THR Products=

===See Also: [https://safernicotine.wiki/mediawiki/index.php/Nicotine_-_Addiction/Dependence Nicotine - Addiction/Dependence]===

===2022: [https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-14166-w E-cigarette addiction and harm perception: Does initiation flavor choice matter?]===

*"Traditionally flavored e-cigarette initiation produces similar risk for addiction and harm perceptions as non-traditionally flavored initiation. These findings suggest that banning non-traditional flavors alone may be ineffective in curbing e-cigarette addiction and harm perception. Additional research is needed to better understand which e-cigarette product characteristics and behaviors may be associated with greater addiction and reduced harm perceptions."

**Hung, M., Spencer, A., Hon, E.S. et al. E-cigarette addiction and harm perception: Does initiation flavor choice matter?. BMC Public Health 22, 1780 (2022). https://doi.org/10.1186/s12889-022-14166-w

===2022: [https://academic.oup.com/ntr/article/24/9/1332/6550857 The Role of Nicotine and Flavor in the Abuse Potential and Appeal of Electronic Cigarettes for Adult Current and Former Cigarette and Electronic Cigarette Users: A Systematic Review]===

*"E-cigarettes may provide a reduced-harm alternative to cigarettes for smokers unwilling/unable to quit or serve as a path for quitting all nicotine products. Higher nicotine concentrations and flavor variety are associated with higher abuse potential and appeal of e-cigarettes. Higher abuse potential and appeal products may help facilitate complete switching from cigarettes to e-cigarettes. Regulation of nicotine concentration and flavors aimed at decreasing naïve uptake may inadvertently decrease uptake and complete switching among smokers, reducing the harm reduction potential of e-cigarettes. Evidence-based effects of regulating nicotine concentration and flavors must be considered for the population as a whole, including smokers."

**Citation: Mari S Gades, Aleksandra Alcheva, Amy L Riegelman, Dorothy K Hatsukami, The Role of Nicotine and Flavor in the Abuse Potential and Appeal of Electronic Cigarettes for Adult Current and Former Cigarette and Electronic Cigarette Users: A Systematic Review, Nicotine & Tobacco Research, Volume 24, Issue 9, September 2022, Pages 1332–1343, https://doi.org/10.1093/ntr/ntac073

***Acknowledgment: This work was supported by the National Institute of Drug Abuse (T32 DA007097 and R36 DA050000 to MSG); and the National Institutes of Health (P01 CA217806 to DKH).

===2020: [https://pubmed.ncbi.nlm.nih.gov/33176942/ Abuse liability assessment of the JUUL system in four flavors relative to combustible cigarette, nicotine gum and a comparator electronic nicotine delivery system among adult smokers]===

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*mint-flavored nicotine gum was rated as more palatable than the original nicotine gum, but the improvement in flavor did not increase abuse liability in adults (22 – 50 years old) or young adults (18 –21 years old). Since the aversive taste of the original nicotine gum was an important impediment to compliance (Rose, 1996) and treatment initiation, the availability of nicotine gum in different flavors and the development of alternative oral nicotine replacement products with appealing flavors may improve compliance and expand the range of options for those attempting to quit smoking, without posing an increased risk of abuse.

*[https://sci-hub.se/10.1016/s0091-3057(02)00723-2 PDF Version]

*Citation: Houtsmuller, E. J., Fant, R. V., Eissenberg, T. E., Henningfield, J. E., & Stitzer, M. L. (2002). Flavor improvement does not increase abuse liability of nicotine chewing gum. Pharmacology Biochemistry and Behavior, 72(3), 559–568. doi:10.1016/s0091-3057(02)00723-2

= Multiple Points=

=Marketing/Advertising/Packaging=

===2024: [https://www.tandfonline.com/doi/full/10.1080/10826084.2024.2374973 Associations Between Noticing E-Cigarette Advertising Features and E-Cigarette Appeal and Switching Interest Among Young Adult Dual Users]===

*Results: "Noticing fruit flavors (AOR = 1.67 and 1.28) and fruit images (AOR = 1.53 and 1.21) was positively associated with having any e-cigarette product appeal and switching interest. Noticing price promotions (AOR = 1.23) was positively associated with product appeal. In contrast, noticing nicotine warnings (AOR = 0.74 and 0.86), smoker-targeted claims (AOR = 0.78 and 0.89), and tobacco flavors (AOR = 0.92 and 0.90) was negatively associated with product appeal and switching interest."

=Multiple Points=

===2022: [https://media.thr.net/strapi/34d52398d9056adece15e8bda5172870.pdf?updated_at=2023-08-29T12:28:33.423Z THE CASE FOR FLAVOURS IN TOBACCO HARM REDUCTION, TO SAVE LIVES]===

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===2023: [https://www.sciencedirect.com/science/article/abs/pii/S0378427423001091 A contextualised e-cigarette testing strategy shows flavourings do not impact lung toxicity in vitro]===

*"We show that the tested flavours do not increase overall toxicity levels in a flavour or concentration-dependent manner. In fact, we demonstrate that the toxicity of e-cigarette aerosols in vitro derived from all the analysed flavour variants were > 95% reduced when compared to cigarette smoke toxicity."

*Citation: Bishop E, East N, Miazzi F, Fiebelkorn S, Breheny D, Gaca M, Thorne D. A contextualised e-cigarette testing strategy shows flavourings do not impact lung toxicity in vitro. Toxicol Lett. 2023 May 1;380:1-11. doi: 10.1016/j.toxlet.2023.03.006. Epub 2023 Mar 17. PMID: 36935081.

**Citation: Bishop E, East N, Miazzi F, Fiebelkorn S, Breheny D, Gaca M, Thorne D. A contextualised e-cigarette testing strategy shows flavourings do not impact lung toxicity in vitro. Toxicol Lett. 2023 May 1;380:1-11. doi: 10.1016/j.toxlet.2023.03.006. Epub 2023 Mar 17. PMID: 36935081.

===2022: [https://pubmed.ncbi.nlm.nih.gov/36250607/ Associations between e-cigarette use and e-cigarette flavors with cigarette smoking quit attempts and quit success: Evidence from a US large, nationally representative 2018-2019 survey]===

*E-cigarette use is positively associated with both making a quit attempt and quit success, and those using flavored e-cigarettes are more likely to successfully quit smoking, with no statistically significant differences between the use of menthol or mint-flavored e-cigarettes versus the use of other nontobacco flavored products.

**Citation: Mok Y, Jeon J, Levy DT, Meza R. Associations Between E-cigarette Use and E-cigarette Flavors With Cigarette Smoking Quit Attempts and Quit Success: Evidence From a U.S. Large, Nationally Representative 2018-2019 Survey. Nicotine Tob Res. 2023 Feb 9;25(3):541-552. doi: 10.1093/ntr/ntac241. PMID: 36250607; PMCID: PMC9910159.

===2022: [https://tobaccocontrol.bmj.com/content/31/e1/e10 Association of device type, flavours and vaping behaviour with tobacco product transitions among adult electronic cigarette users in the USA]===

*Non-tobacco flavours, daily vaping and modifiable e-cigarette devices may help some smokers abstain from cigarette smoking via transitioning to exclusive e-cigarette use, but are also associated with ongoing exclusive e-cigarette use.

**Citation: Harlow AF, Fetterman JL, Ross CS, et alAssociation of device type, flavours and vaping behaviour with tobacco product transitions among adult electronic cigarette users in the USATobacco Control 2022;31:e10-e17.

===2020: [https://pubmed.ncbi.nlm.nih.gov/32881666/ Investigation on the antibacterial activity of electronic cigarette liquids (ECLs): a proof of concept study]===

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**There is 750x more diacetyl in a pack of cigarettes than there is in a days worth of vaping nicotine fluid, and to date we have no confirmation that smokers are getting popcorn lung.

*There is 750x more diacetyl in a pack of cigarettes than there is in a days worth of vaping nicotine fluid, and to date we have no confirmation that smokers are getting popcorn lung.

*2015 [http://tobaccoanalysis.blogspot.com/2015/12/new-study-finds-that-average-diacetyl.html New Study Finds that Average Diacetyl Exposure from Vaping is 750 Times Lower than from Smoking]

**There's just one minor fact that is omitted completely in the article, as well as in all the media coverage.

=== 2015 [http://tobaccoanalysis.blogspot.com/2015/12/new-study-finds-that-average-diacetyl.html New Study Finds that Average Diacetyl Exposure from Vaping is 750 Times Lower than from Smoking] ===

**That fact: All conventional cigarettes produce tobacco smoke that contains diacetyl, and the levels of diacetyl in cigarettes are a lot higher than those produced by e-cigarettes.

*There's just one minor fact that is omitted completely in the article, as well as in all the media coverage.

*That fact: All conventional cigarettes produce tobacco smoke that contains diacetyl, and the levels of diacetyl in cigarettes are a lot higher than those produced by e-cigarettes.

===2019: [https://www.sciencedirect.com/science/article/pii/S0887233318307768?via%3Dihub High Content Screening in NHBE cells shows significantly reduced biological activity of flavoured e-liquids, when compared to cigarette smoke condensate]===

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=Regulations or Unintended Consequences=

===2024: [https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-024-01003-z Exploring the opinions and potential impact of unflavoured e-liquid on smoking cessation among people who smoke and smoking relapse among people who previously smoked and now use e-cigarettes: findings from a UK-based mixed methods study]===

*"The findings highlight that people who smoke and vape could be impacted by flavour restrictions in a range of ways, some of which could have a potential adverse impact on harm reduction efforts in the UK (e.g., by making smoking more appealing than vaping)."

**Citation: Khouja, J.N., Dyer, M.L., Havill, M.A. et al. Exploring the opinions and potential impact of unflavoured e-liquid on smoking cessation among people who smoke and smoking relapse among people who previously smoked and now use e-cigarettes: findings from a UK-based mixed methods study. Harm Reduct J 21, 90 (2024). https://doi.org/10.1186/s12954-024-01003-z

===2024: [https://www.nber.org/papers/w32534 Comprehensive E-cigarette Flavor Bans and Tobacco Use among Youth and Adults]===

*"The vast majority of youth e-cigarette users consume flavored e-cigarettes, raising concerns from public health advocates that flavors may drive youth initiation into and continued use of e-cigarettes...Our findings suggest that statewide comprehensive flavor bans may have generated an unintended consequence by encouraging substitution towards traditional smoking in some populations."

**Citation: Comprehensive E-cigarette Flavor Bans and Tobacco Use among Youth and Adults, Henry Saffer, Selen Ozdogan, Michael Grossman, Daniel L. Dench, and Dhaval M. Dave, NBER Working Paper No. 32534, June 2024, JEL No. H07,I12,I18,J13

===2024: [https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntae151/7697906?login=false The Impact of New Jersey’s 2020 E-cigarette Flavor Ban on E-cigarette, Cigarette, and Cigar Sales in New Jersey]===

*"Flavored e-cigarette sales were declining prior to the ban but the pace of the decline accelerated following federal and state restrictions on flavored e-cigarette sales, then slowed by the second half of 2020, with a brief period of increased cigarette and cigar sales immediately following the ban."

**Citation: Mary Hrywna, Arjun Teotia, Erin Miller Lo, Daniel P Giovenco, Cristine D Delnevo, The Impact of New Jersey’s 2020 E-cigarette Flavor Ban on E-cigarette, Cigarette, and Cigar Sales in New Jersey, Nicotine & Tobacco Research, 2024;, ntae151, https://doi.org/10.1093/ntr/ntae151

===2023: [https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4586701 E-cigarette Flavor Restrictions’ Effects on Tobacco Product Sales]===

*"Over 375 US localities and 7 states have adopted permanent restrictions on sales of flavored electronic nicotine delivery systems (“ENDS”). These policies’ effects on combustible cigarette use, a more harmful habit, remain unclear. Matching new flavor policy data to retail sales data, we find a tradeoff of 12 additional cigarettes for every 1 less 0.7 mL ENDS pod sold due to ENDS flavor restrictions. Further, cigarette sales increase even among brands disproportionately used by underage youth. Thus, any public health benefits of reducing ENDS sales via flavor restrictions may be offset by public health costs from increased cigarette sales."

*Citation: Friedman, Abigail and Liber, Alex C. and Crippen, Alyssa and Pesko, Michael, E-cigarette Flavor Restrictions’ Effects on Tobacco Product Sales (September 26, 2023). Available at SSRN: https://ssrn.com/abstract=4586701 or http://dx.doi.org/10.2139/ssrn.4586701

**Citation: Friedman, Abigail and Liber, Alex C. and Crippen, Alyssa and Pesko, Michael, E-cigarette Flavor Restrictions’ Effects on Tobacco Product Sales (September 26, 2023). Available at SSRN: https://ssrn.com/abstract=4586701 or http://dx.doi.org/10.2139/ssrn.4586701

===2023: [https://academic.oup.com/ntr/advance-article/doi/10.1093/ntr/ntad258/7492743 Responses to real-world and hypothetical e-cigarette flavor bans among US young adults who use flavored e-cigarettes]===

*"Young adults who vape flavored e-cigarettes have mixed responses to e-cigarette flavor bans. Under both real-world and hypothetical e-cigarette flavor bans, most who use flavored e-cigarettes continue vaping. Under a real-world ban, the second most common response among those who exclusively vape is to switch to smoking; under a hypothetical federal ban, it is to quit all tobacco."

*Citation: Jamie Tam, Evelyn Jimenez-Mendoza, John Buckell, Jody Sindelar, Rafael Meza, Responses to Real-World and Hypothetical E-Cigarette Flavor Bans Among US Young Adults Who Use Flavored E-Cigarettes, Nicotine & Tobacco Research, 2023;, ntad258, https://doi.org/10.1093/ntr/ntad258

===2022: [https://www.sciencedirect.com/science/article/abs/pii/S0091743522001116 Effect of flavored E-cigarette bans in the United States: What does the evidence show?]===

*However, in this paper, we propose an evidence-based version of this model based on several years' worth of longitudinal and econometric research, which suggests that youth e-cigarette use has instead worked to replace a culture of youth smoking. From this analysis, we propose a re-evaluation of current policies surrounding e-cigarette sales so that declines in e-cigarette use will not come at the cost of increasing cigarette use among youth and adults.

**Citation: Siegel M, Katchmar A. Effect of flavored E-cigarette bans in the United States: What does the evidence show? Prev Med. 2022 Dec;165(Pt B):107063. doi: 10.1016/j.ypmed.2022.107063. Epub 2022 Apr 20. PMID: 35452711.

===2022: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9287473/ Impact of existing and potential e-cigarette flavor restrictions on e-cigarette use among young adult e-cigarette users in 6 US metropolitan areas]===

*Results from this study highlight heterogeneity in young adult e-cigarette users’ reactions to existing flavored e-cigarette sales restrictions and hypothetical restrictions. Some reduced e-cigarette use, but many reported intentions to continue e-cigarette use, by using tank-based e-cigarettes, available flavors, or flavors accessed through alternative sources. More concerning, some switched to cigarettes. Similarly, in response to future restrictions of all flavored e-liquids, young adult e-cigarette users largely indicated that they would either quit vaping – the ideal scenario – or switch to cigarettes – the least desirable scenario. Another major concern highlighted was access to flavored e-cigarettes despite restrictions (e.g., online, across state lines). Collectively, findings suggest that implications of flavored e-cigarette sales restrictions are complex, with the potential for both reductions in e-cigarette use and unintended consequences among young adults, including continued use of flavored e-cigarettes or switching to cigarettes, and retail and consumer circumvention of restrictions.

**Citation: Romm KF, Henriksen L, Huang J, Le D, Clausen M, Duan Z, Fuss C, Bennett B, Berg CJ. Impact of existing and potential e-cigarette flavor restrictions on e-cigarette use among young adult e-cigarette users in 6 US metropolitan areas. Prev Med Rep. 2022 Jul 9;28:101901. doi: 10.1016/j.pmedr.2022.101901. PMID: 35855926; PMCID: PMC9287473.

===2022: [https://academic.oup.com/ntr/article/24/9/1332/6550857 The Role of Nicotine and Flavor in the Abuse Potential and Appeal of Electronic Cigarettes for Adult Current and Former Cigarette and Electronic Cigarette Users: A Systematic Review]===

*"E-cigarettes may provide a reduced-harm alternative to cigarettes for smokers unwilling/unable to quit or serve as a path for quitting all nicotine products. Higher nicotine concentrations and flavor variety are associated with higher abuse potential and appeal of e-cigarettes. Higher abuse potential and appeal products may help facilitate complete switching from cigarettes to e-cigarettes. Regulation of nicotine concentration and flavors aimed at decreasing naïve uptake may inadvertently decrease uptake and complete switching among smokers, reducing the harm reduction potential of e-cigarettes. Evidence-based effects of regulating nicotine concentration and flavors must be considered for the population as a whole, including smokers."

**Citation: Mari S Gades, Aleksandra Alcheva, Amy L Riegelman, Dorothy K Hatsukami, The Role of Nicotine and Flavor in the Abuse Potential and Appeal of Electronic Cigarettes for Adult Current and Former Cigarette and Electronic Cigarette Users: A Systematic Review, Nicotine & Tobacco Research, Volume 24, Issue 9, September 2022, Pages 1332–1343, https://doi.org/10.1093/ntr/ntac073

***Acknowledgment: This work was supported by the National Institute of Drug Abuse (T32 DA007097 and R36 DA050000 to MSG); and the National Institutes of Health (P01 CA217806 to DKH).

===2022: PREPRINT: [https://www.medrxiv.org/content/10.1101/2022.11.14.22282288v1 A decision aid for policymakers to estimate the impact of e-cigarette flavour restrictions on population smoking and e-cigarette use prevalence among youth versus smoking prevalence among adults]===

*"We demonstrated the value of this decision aid using data from various sources to estimate the impact of a flavour ban in three populations: the general UK population, low-socioeconomic position UK population, and the general US population. All three examples suggested a negative net population impact of a ban. These reports were then presented to the all-party parliamentary group for vaping."

*[https://www.medrxiv.org/content/10.1101/2022.11.14.22282288v1.full.pdf PDF of full paper]

**Citation: A decision aid for policymakers to estimate the impact of e-cigarette flavour restrictions on population smoking and e-cigarette use prevalence among youth versus smoking prevalence among adults Mark J Gibson, Marcus R Munafò, Angela S. Attwood, Martin J. Dockrell, Michelle A. Havill, Jasmine N Khouja medRxiv 2022.11.14.22282288; doi: https://doi.org/10.1101/2022.11.14.22282288

===2022: [https://pubmed.ncbi.nlm.nih.gov/36328469/ Removal of mango-flavoured Juul pods created opportunity for adulterated mango Juul-compatible pods with altered chemical constituents]===

*"Adulterated Juul-compatible products may expose e-cigarette consumers to more chemical constituents at higher concentrations than previously found in the original product, despite similarity in product design."

**Citation: Dell LG, Page MK, Leigh NJ, Goniewicz ML. Removal of mango-flavoured Juul pods created opportunity for adulterated mango Juul-compatible pods with altered chemical constituents. Tob Control. 2022 Nov;31(Suppl 3):s230-s233. doi: 10.1136/tc-2022-057476. PMID: 36328469; PMCID: PMC9664127.

===2021: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8145156/ A Difference-in-Differences Analysis of Youth Smoking and a Ban on Sales of Flavored Tobacco Products in San Francisco, California]===

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*Signed by 24 experts from around the world

*Covers 12 key points

===2021: [https://www.sciencedirect.com/science/article/pii/S0306460321003373 Responses to potential nicotine vaping product flavor restrictions among regular vapers using non-tobacco flavors: Findings from the 2020 ITC Smoking and Vaping Survey in Canada, England and the United States]===

*Conclusion: "At this time, it is not yet clear exactly how NVP flavor bans will play out as they are implemented across national and sub-national jurisdictions. However, by extrapolating from this study, and the other limited studies available, it appears that the outcomes will be mixed and complex. While our study suggests most vapers are opposed to a ban, and some vapers indicated that such a ban would lead to unintended consequences (e.g., taking up cigarette smoking again, or turning to illicit channels), many vapers said that they would be willing to vape available flavors. Thus, it is important for policy makers to weigh the potential for public health consequences, as well as possible benefits."

**Citation: Gravely S, Smith DM, Liber AC, Cummings KM, East KA, Hammond D, Hyland A, O'Connor RJ, Kasza KA, Quah ACK, Loewen R, Martin N, Meng G, Ouimet J, Thompson ME, Boudreau C, McNeill A, Sweanor DT, Fong GT. Responses to potential nicotine vaping product flavor restrictions among regular vapers using non-tobacco flavors: Findings from the 2020 ITC Smoking and Vaping Survey in Canada, England and the United States. Addict Behav. 2022 Feb;125:107152. doi: 10.1016/j.addbeh.2021.107152. Epub 2021 Oct 14. PMID: 34695685; PMCID: PMC9094050.

***Acknowledgment: This study was supported by grants from the US National Cancer Institute (P01 CA200512), the Canadian Institutes of Health Research (FDN-148477), the National Health and Medical Research Council of Australia (APP 1106451). GTF was supported by a Senior Investigator Award from the Ontario Institute for Cancer Research (IA-004) and the Canadian Cancer Society 2020 O. Harold Warwick Prize. AH and RJO are supported by a Tobacco Centers of Regulatory Science US National Cancer Institute grant (U54 CA238110). AL is supported by the Center for the Assessment of Tobacco Regulations (U54CA229974). AM is a National Institute for Health Research (NIHR) Senior Investigator. These funders/supporting agencies had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication. Declarations of interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. KMC has served as paid expert witness in litigation filed against cigarette manufacturers. GTF and DH have served as expert witnesses on behalf of governments in litigation involving the tobacco industry. AM is a UK National Institute for Health Research (NIHR) Senior Investigator. The views expressed in this article are those of the authors and not necessarily those of the NIHR, or the UK Department of Health and Social Care.

===2020: [https://sci-hub.st/https://onlinelibrary.wiley.com/doi/10.1111/add.15235# Association of vaping‐related lung injuries with rates of e‐cigarette and cannabis use across US states]===

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=Further Reading=

===2023: Yale School of Public Health: [https://ysph.yale.edu/news-article/tobacco-purchases-rise-following-restrictions-on-e-cigarette-sales/ Tobacco purchases rise following restrictions on e-cigarette sales]===

===2021: Policy Analyst Testimony: [https://www.cga.ct.gov/2021/PHdata/Tmy/2021SB-00326-R000208-Stroud,%20Lindsey,%20Policy%20Analyst-Taxpayers%20Protection%20Alliance-TMY.PDF Testimony before the Connecticut Public Health Committee Regarding Prohibiting the Sale of Flavored Tobacco and Vapor Products]===

===2021: Commentary: [https://www.myjournalcourier.com/opinion/article/Commentary-Lindsey-Stroud-Want-fewer-teen-16184278.php Want fewer teen smokers? Stop all the bans]===

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*If you prefer not to add information to this page yourself, drop the links here and one of our editors will do it for you

===~~2022~~: [https://pubmed.ncbi.nlm.nih.gov/~~36328469~~/ ~~Removal~~ of ~~mango~~-~~flavoured Juul pods created opportunity for adulterated mango Juul-compatible pods with altered chemical constituents]===~~

===2024: [https://pubmed.ncbi.nlm.nih.gov/39787830/ The impact of non-tobacco e-cigarette flavoring on e-cigarette uptake, cigarette smoking reduction, and cessation: A secondary analysis of a nationwide clinical trial]===

~~===2022: [https://pubmed.ncbi.nlm.nih.gov/36250607/ Associations between~~ e-cigarette ~~use and~~ e-cigarette ~~flavors with cigarette smoking quit attempts and quit success: Evidence from a US large~~, ~~nationally representative 2018-2019 survey]===~~

*E-cigarette ~~use is positively associated with both making a quit attempt and quit success, and those using flavored e-cigarettes are more likely to successfully quit~~ smoking, ~~with no statistically significant differences between the use of menthol or mint-flavored e-cigarettes versus the use of other nontobacco flavored products.~~

~~===2022: [https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-14166-w E-cigarette addiction~~ and ~~harm perception: Does initiation flavor choice matter?]===~~

~~===2022: [https~~:~~//tobaccocontrol.bmj.com/content/31/e1/e10 Association~~ of ~~device type, flavours and vaping behaviour with tobacco product transitions among adult electronic cigarette users in the USA~~]===

*Non-tobacco flavours, daily vaping and modifiable e-cigarette devices may help some smokers abstain from cigarette smoking via transitioning to exclusive e-cigarette use, but are also associated with ongoing exclusive e-cigarette use.

===~~2022~~: [https://~~www.sciencedirect~~.com/~~science~~/~~article/abs~~/~~pii~~/~~S0091743522001116 Effect of flavored~~ E-~~cigarette bans in the United States: What does the evidence show?]===~~

===2024: [https://jamanetwork.com/journals/jama-health-forum/fullarticle/2828404 Flavored E-Cigarette Sales Restrictions and Young Adult Tobacco Use]===

*However, in this paper, we propose an evidence-based version of this model based on several years' worth of longitudinal and econometric research, which suggests that youth e-cigarette use has instead worked to replace a culture of youth smoking. From this analysis, we propose a re-evaluation of current policies surrounding e-cigarette sales so that declines in e-cigarette use will not come at the cost of increasing cigarette use among youth and adults.

~~===2022: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9287473/ Impact of existing~~ and ~~potential e-cigarette flavor restrictions on e-cigarette use among young adult e-cigarette users in 6 US metropolitan areas~~]===

*Results from this study highlight heterogeneity in young adult e-cigarette users’ reactions to existing flavored e-cigarette sales restrictions and hypothetical restrictions. Some reduced e-cigarette use, but many reported intentions to continue e-cigarette use, by using tank-based e-cigarettes, available flavors, or flavors accessed through alternative sources. More concerning, some switched to cigarettes. Similarly, in response to future restrictions of all flavored e-liquids, young adult e-cigarette users largely indicated that they would either quit vaping – the ideal scenario – or switch to cigarettes – the least desirable scenario. Another major concern highlighted was access to flavored e-cigarettes despite restrictions (e.g., online, across state lines). Collectively, findings suggest that implications of flavored e-cigarette sales restrictions are complex, with the potential for both reductions in e-cigarette use and unintended consequences among young adults, including continued use of flavored e-cigarettes or switching to cigarettes, and retail and consumer circumvention of restrictions.

=Page Editor Instructions=

@@ Line 45: / Line 45: @@
 =Abuse Liability - All THR Products= <!--T:10-->
+===See Also: [https://safernicotine.wiki/mediawiki/index.php/Nicotine_-_Addiction/Dependence Nicotine - Addiction/Dependence]===
+===2022: [https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-14166-w E-cigarette addiction and harm perception: Does initiation flavor choice matter?]===
+*"Traditionally flavored e-cigarette initiation produces similar risk for addiction and harm perceptions as non-traditionally flavored initiation. These findings suggest that banning non-traditional flavors alone may be ineffective in curbing e-cigarette addiction and harm perception. Additional research is needed to better understand which e-cigarette product characteristics and behaviors may be associated with greater addiction and reduced harm perceptions."
+**Hung, M., Spencer, A., Hon, E.S. et al. E-cigarette addiction and harm perception: Does initiation flavor choice matter?. BMC Public Health 22, 1780 (2022). https://doi.org/10.1186/s12889-022-14166-w
+===2022: [https://academic.oup.com/ntr/article/24/9/1332/6550857 The Role of Nicotine and Flavor in the Abuse Potential and Appeal of Electronic Cigarettes for Adult Current and Former Cigarette and Electronic Cigarette Users: A Systematic Review]===
+*"E-cigarettes may provide a reduced-harm alternative to cigarettes for smokers unwilling/unable to quit or serve as a path for quitting all nicotine products. Higher nicotine concentrations and flavor variety are associated with higher abuse potential and appeal of e-cigarettes. Higher abuse potential and appeal products may help facilitate complete switching from cigarettes to e-cigarettes. Regulation of nicotine concentration and flavors aimed at decreasing naïve uptake may inadvertently decrease uptake and complete switching among smokers, reducing the harm reduction potential of e-cigarettes. Evidence-based effects of regulating nicotine concentration and flavors must be considered for the population as a whole, including smokers."
+**Citation: Mari S Gades, Aleksandra Alcheva, Amy L Riegelman, Dorothy K Hatsukami, The Role of Nicotine and Flavor in the Abuse Potential and Appeal of Electronic Cigarettes for Adult Current and Former Cigarette and Electronic Cigarette Users: A Systematic Review, Nicotine & Tobacco Research, Volume 24, Issue 9, September 2022, Pages 1332–1343, https://doi.org/10.1093/ntr/ntac073
+***Acknowledgment: This work was supported by the National Institute of Drug Abuse (T32 DA007097 and R36 DA050000 to MSG); and the National Institutes of Health (P01 CA217806 to DKH).
 ===2020: [https://pubmed.ncbi.nlm.nih.gov/33176942/ Abuse liability assessment of the JUUL system in four flavors relative to combustible cigarette, nicotine gum and a comparator electronic nicotine delivery system among adult smokers]=== <!--T:11-->
@@ Line 66: / Line 77: @@
 *mint-flavored nicotine gum was rated as more palatable than the original nicotine gum, but the improvement in flavor did not increase abuse liability in adults (22 – 50 years old) or young adults (18 –21 years old). Since the aversive taste of the original nicotine gum was an important impediment to compliance (Rose, 1996) and treatment initiation, the availability of nicotine gum in different flavors and the development of alternative oral nicotine replacement products with appealing flavors may improve compliance and expand the range of options for those attempting to quit smoking, without posing an increased risk of abuse.
 *[https://sci-hub.se/10.1016/s0091-3057(02)00723-2 PDF Version]
 *Citation: Houtsmuller, E. J., Fant, R. V., Eissenberg, T. E., Henningfield, J. E., & Stitzer, M. L. (2002). Flavor improvement does not increase abuse liability of nicotine chewing gum. Pharmacology Biochemistry and Behavior, 72(3), 559–568. doi:10.1016/s0091-3057(02)00723-2
-= Multiple Points=
+=Marketing/Advertising/Packaging=
+===2024: [https://www.tandfonline.com/doi/full/10.1080/10826084.2024.2374973 Associations Between Noticing E-Cigarette Advertising Features and E-Cigarette Appeal and Switching Interest Among Young Adult Dual Users]===
+*Results: "Noticing fruit flavors (AOR = 1.67 and 1.28) and fruit images (AOR = 1.53 and 1.21) was positively associated with having any e-cigarette product appeal and switching interest. Noticing price promotions (AOR = 1.23) was positively associated with product appeal. In contrast, noticing nicotine warnings (AOR = 0.74 and 0.86), smoker-targeted claims (AOR = 0.78 and 0.89), and tobacco flavors (AOR = 0.92 and 0.90) was negatively associated with product appeal and switching interest."
+=Multiple Points=
 ===2022: [https://media.thr.net/strapi/34d52398d9056adece15e8bda5172870.pdf?updated_at=2023-08-29T12:28:33.423Z THE CASE FOR FLAVOURS IN TOBACCO HARM REDUCTION, TO SAVE LIVES]===
@@ Line 77: / Line 93: @@
 ===2023: [https://www.sciencedirect.com/science/article/abs/pii/S0378427423001091 A contextualised e-cigarette testing strategy shows flavourings do not impact lung toxicity in vitro]===
 *"We show that the tested flavours do not increase overall toxicity levels in a flavour or concentration-dependent manner. In fact, we demonstrate that the toxicity of e-cigarette aerosols in vitro derived from all the analysed flavour variants were > 95% reduced when compared to cigarette smoke toxicity."
-*Citation: Bishop E, East N, Miazzi F, Fiebelkorn S, Breheny D, Gaca M, Thorne D. A contextualised e-cigarette testing strategy shows flavourings do not impact lung toxicity in vitro. Toxicol Lett. 2023 May 1;380:1-11. doi: 10.1016/j.toxlet.2023.03.006. Epub 2023 Mar 17. PMID: 36935081.
+**Citation: Bishop E, East N, Miazzi F, Fiebelkorn S, Breheny D, Gaca M, Thorne D. A contextualised e-cigarette testing strategy shows flavourings do not impact lung toxicity in vitro. Toxicol Lett. 2023 May 1;380:1-11. doi: 10.1016/j.toxlet.2023.03.006. Epub 2023 Mar 17. PMID: 36935081.
+===2022: [https://pubmed.ncbi.nlm.nih.gov/36250607/ Associations between e-cigarette use and e-cigarette flavors with cigarette smoking quit attempts and quit success: Evidence from a US large, nationally representative 2018-2019 survey]===
+*E-cigarette use is positively associated with both making a quit attempt and quit success, and those using flavored e-cigarettes are more likely to successfully quit smoking, with no statistically significant differences between the use of menthol or mint-flavored e-cigarettes versus the use of other nontobacco flavored products.
+**Citation: Mok Y, Jeon J, Levy DT, Meza R. Associations Between E-cigarette Use and E-cigarette Flavors With Cigarette Smoking Quit Attempts and Quit Success: Evidence From a U.S. Large, Nationally Representative 2018-2019 Survey. Nicotine Tob Res. 2023 Feb 9;25(3):541-552. doi: 10.1093/ntr/ntac241. PMID: 36250607; PMCID: PMC9910159.
+===2022: [https://tobaccocontrol.bmj.com/content/31/e1/e10 Association of device type, flavours and vaping behaviour with tobacco product transitions among adult electronic cigarette users in the USA]===
+*Non-tobacco flavours, daily vaping and modifiable e-cigarette devices may help some smokers abstain from cigarette smoking via transitioning to exclusive e-cigarette use, but are also associated with ongoing exclusive e-cigarette use.
+**Citation: Harlow AF, Fetterman JL, Ross CS, et alAssociation of device type, flavours and vaping behaviour with tobacco product transitions among adult electronic cigarette users in the USATobacco Control 2022;31:e10-e17.
 ===2020: [https://pubmed.ncbi.nlm.nih.gov/32881666/ Investigation on the antibacterial activity of electronic cigarette liquids (ECLs): a proof of concept study]=== <!--T:18-->
@@ Line 89: / Line 113: @@
 <!--T:21-->
-**There is 750x more diacetyl in a pack of cigarettes than there is in a days worth of vaping nicotine fluid, and to date we have no confirmation that smokers are getting popcorn lung.
+*There is 750x more diacetyl in a pack of cigarettes than there is in a days worth of vaping nicotine fluid, and to date we have no confirmation that smokers are getting popcorn lung.
-*2015 [http://tobaccoanalysis.blogspot.com/2015/12/new-study-finds-that-average-diacetyl.html New Study Finds that Average Diacetyl Exposure from Vaping is 750 Times Lower than from Smoking]
-**There's just one minor fact that is omitted completely in the article, as well as in all the media coverage.
+=== 2015 [http://tobaccoanalysis.blogspot.com/2015/12/new-study-finds-that-average-diacetyl.html New Study Finds that Average Diacetyl Exposure from Vaping is 750 Times Lower than from Smoking] ===
-**That fact: All conventional cigarettes produce tobacco smoke that contains diacetyl, and the levels of diacetyl in cigarettes are a lot higher than those produced by e-cigarettes.
+*There's just one minor fact that is omitted completely in the article, as well as in all the media coverage.
+*That fact: All conventional cigarettes produce tobacco smoke that contains diacetyl, and the levels of diacetyl in cigarettes are a lot higher than those produced by e-cigarettes.
 ===2019: [https://www.sciencedirect.com/science/article/pii/S0887233318307768?via%3Dihub High Content Screening in NHBE cells shows significantly reduced biological activity of flavoured e-liquids, when compared to cigarette smoke condensate]=== <!--T:22-->
@@ Line 174: / Line 199: @@
 =Regulations or Unintended Consequences= <!--T:42-->
+===2024: [https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-024-01003-z Exploring the opinions and potential impact of unflavoured e-liquid on smoking cessation among people who smoke and smoking relapse among people who previously smoked and now use e-cigarettes: findings from a UK-based mixed methods study]===
+*"The findings highlight that people who smoke and vape could be impacted by flavour restrictions in a range of ways, some of which could have a potential adverse impact on harm reduction efforts in the UK (e.g., by making smoking more appealing than vaping)."
+**Citation: Khouja, J.N., Dyer, M.L., Havill, M.A. et al. Exploring the opinions and potential impact of unflavoured e-liquid on smoking cessation among people who smoke and smoking relapse among people who previously smoked and now use e-cigarettes: findings from a UK-based mixed methods study. Harm Reduct J 21, 90 (2024). https://doi.org/10.1186/s12954-024-01003-z
+===2024: [https://www.nber.org/papers/w32534 Comprehensive E-cigarette Flavor Bans and Tobacco Use among Youth and Adults]===
+*"The vast majority of youth e-cigarette users consume flavored e-cigarettes, raising concerns from public health advocates that flavors may drive youth initiation into and continued use of e-cigarettes...Our findings suggest that statewide comprehensive flavor bans may have generated an unintended consequence by encouraging substitution towards traditional smoking in some populations."
+**Citation: Comprehensive E-cigarette Flavor Bans and Tobacco Use among Youth and Adults, Henry Saffer, Selen Ozdogan, Michael Grossman, Daniel L. Dench, and Dhaval M. Dave, NBER Working Paper No. 32534, June 2024, JEL No. H07,I12,I18,J13
+===2024: [https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntae151/7697906?login=false The Impact of New Jersey’s 2020 E-cigarette Flavor Ban on E-cigarette, Cigarette, and Cigar Sales in New Jersey]===
+*"Flavored e-cigarette sales were declining prior to the ban but the pace of the decline accelerated following federal and state restrictions on flavored e-cigarette sales, then slowed by the second half of 2020, with a brief period of increased cigarette and cigar sales immediately following the ban."
+**Citation: Mary Hrywna, Arjun Teotia, Erin Miller Lo, Daniel P Giovenco, Cristine D Delnevo, The Impact of New Jersey’s 2020 E-cigarette Flavor Ban on E-cigarette, Cigarette, and Cigar Sales in New Jersey, Nicotine & Tobacco Research, 2024;, ntae151, https://doi.org/10.1093/ntr/ntae151
 ===2023: [https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4586701 E-cigarette Flavor Restrictions’ Effects on Tobacco Product Sales]===
 *"Over 375 US localities and 7 states have adopted permanent restrictions on sales of flavored electronic nicotine delivery systems (“ENDS”). These policies’ effects on combustible cigarette use, a more harmful habit, remain unclear. Matching new flavor policy data to retail sales data, we find a tradeoff of 12 additional cigarettes for every 1 less 0.7 mL ENDS pod sold due to ENDS flavor restrictions. Further, cigarette sales increase even among brands disproportionately used by underage youth. Thus, any public health benefits of reducing ENDS sales via flavor restrictions may be offset by public health costs from increased cigarette sales."
-*Citation: Friedman, Abigail and Liber, Alex C. and Crippen, Alyssa and Pesko, Michael, E-cigarette Flavor Restrictions’ Effects on Tobacco Product Sales (September 26, 2023). Available at SSRN: https://ssrn.com/abstract=4586701 or http://dx.doi.org/10.2139/ssrn.4586701
+**Citation: Friedman, Abigail and Liber, Alex C. and Crippen, Alyssa and Pesko, Michael, E-cigarette Flavor Restrictions’ Effects on Tobacco Product Sales (September 26, 2023). Available at SSRN: https://ssrn.com/abstract=4586701 or http://dx.doi.org/10.2139/ssrn.4586701
 ===2023: [https://academic.oup.com/ntr/advance-article/doi/10.1093/ntr/ntad258/7492743 Responses to real-world and hypothetical e-cigarette flavor bans among US young adults who use flavored e-cigarettes]===
 *"Young adults who vape flavored e-cigarettes have mixed responses to e-cigarette flavor bans. Under both real-world and hypothetical e-cigarette flavor bans, most who use flavored e-cigarettes continue vaping. Under a real-world ban, the second most common response among those who exclusively vape is to switch to smoking; under a hypothetical federal ban, it is to quit all tobacco."
 *Citation: Jamie Tam, Evelyn Jimenez-Mendoza, John Buckell, Jody Sindelar, Rafael Meza, Responses to Real-World and Hypothetical E-Cigarette Flavor Bans Among US Young Adults Who Use Flavored E-Cigarettes, Nicotine & Tobacco Research, 2023;, ntad258, https://doi.org/10.1093/ntr/ntad258
+===2022: [https://www.sciencedirect.com/science/article/abs/pii/S0091743522001116 Effect of flavored E-cigarette bans in the United States: What does the evidence show?]===
+*However, in this paper, we propose an evidence-based version of this model based on several years' worth of longitudinal and econometric research, which suggests that youth e-cigarette use has instead worked to replace a culture of youth smoking. From this analysis, we propose a re-evaluation of current policies surrounding e-cigarette sales so that declines in e-cigarette use will not come at the cost of increasing cigarette use among youth and adults.
+**Citation: Siegel M, Katchmar A. Effect of flavored E-cigarette bans in the United States: What does the evidence show? Prev Med. 2022 Dec;165(Pt B):107063. doi: 10.1016/j.ypmed.2022.107063. Epub 2022 Apr 20. PMID: 35452711.
+===2022: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9287473/ Impact of existing and potential e-cigarette flavor restrictions on e-cigarette use among young adult e-cigarette users in 6 US metropolitan areas]===
+*Results from this study highlight heterogeneity in young adult e-cigarette users’ reactions to existing flavored e-cigarette sales restrictions and hypothetical restrictions. Some reduced e-cigarette use, but many reported intentions to continue e-cigarette use, by using tank-based e-cigarettes, available flavors, or flavors accessed through alternative sources. More concerning, some switched to cigarettes. Similarly, in response to future restrictions of all flavored e-liquids, young adult e-cigarette users largely indicated that they would either quit vaping – the ideal scenario – or switch to cigarettes – the least desirable scenario. Another major concern highlighted was access to flavored e-cigarettes despite restrictions (e.g., online, across state lines). Collectively, findings suggest that implications of flavored e-cigarette sales restrictions are complex, with the potential for both reductions in e-cigarette use and unintended consequences among young adults, including continued use of flavored e-cigarettes or switching to cigarettes, and retail and consumer circumvention of restrictions.
+**Citation: Romm KF, Henriksen L, Huang J, Le D, Clausen M, Duan Z, Fuss C, Bennett B, Berg CJ. Impact of existing and potential e-cigarette flavor restrictions on e-cigarette use among young adult e-cigarette users in 6 US metropolitan areas. Prev Med Rep. 2022 Jul 9;28:101901. doi: 10.1016/j.pmedr.2022.101901. PMID: 35855926; PMCID: PMC9287473.
+===2022: [https://academic.oup.com/ntr/article/24/9/1332/6550857 The Role of Nicotine and Flavor in the Abuse Potential and Appeal of Electronic Cigarettes for Adult Current and Former Cigarette and Electronic Cigarette Users: A Systematic Review]===
+*"E-cigarettes may provide a reduced-harm alternative to cigarettes for smokers unwilling/unable to quit or serve as a path for quitting all nicotine products. Higher nicotine concentrations and flavor variety are associated with higher abuse potential and appeal of e-cigarettes. Higher abuse potential and appeal products may help facilitate complete switching from cigarettes to e-cigarettes. Regulation of nicotine concentration and flavors aimed at decreasing naïve uptake may inadvertently decrease uptake and complete switching among smokers, reducing the harm reduction potential of e-cigarettes. Evidence-based effects of regulating nicotine concentration and flavors must be considered for the population as a whole, including smokers."
+**Citation: Mari S Gades, Aleksandra Alcheva, Amy L Riegelman, Dorothy K Hatsukami, The Role of Nicotine and Flavor in the Abuse Potential and Appeal of Electronic Cigarettes for Adult Current and Former Cigarette and Electronic Cigarette Users: A Systematic Review, Nicotine & Tobacco Research, Volume 24, Issue 9, September 2022, Pages 1332–1343, https://doi.org/10.1093/ntr/ntac073
+***Acknowledgment: This work was supported by the National Institute of Drug Abuse (T32 DA007097 and R36 DA050000 to MSG); and the National Institutes of Health (P01 CA217806 to DKH).
+===2022: PREPRINT: [https://www.medrxiv.org/content/10.1101/2022.11.14.22282288v1 A decision aid for policymakers to estimate the impact of e-cigarette flavour restrictions on population smoking and e-cigarette use prevalence among youth versus smoking prevalence among adults]===
+*"We demonstrated the value of this decision aid using data from various sources to estimate the impact of a flavour ban in three populations: the general UK population, low-socioeconomic position UK population, and the general US population. All three examples suggested a negative net population impact of a ban. These reports were then presented to the all-party parliamentary group for vaping."
+*[https://www.medrxiv.org/content/10.1101/2022.11.14.22282288v1.full.pdf PDF of full paper]
+**Citation: A decision aid for policymakers to estimate the impact of e-cigarette flavour restrictions on population smoking and e-cigarette use prevalence among youth versus smoking prevalence among adults Mark J Gibson, Marcus R Munafò, Angela S. Attwood, Martin J. Dockrell, Michelle A. Havill, Jasmine N Khouja medRxiv 2022.11.14.22282288; doi: https://doi.org/10.1101/2022.11.14.22282288
+===2022: [https://pubmed.ncbi.nlm.nih.gov/36328469/ Removal of mango-flavoured Juul pods created opportunity for adulterated mango Juul-compatible pods with altered chemical constituents]===
+*"Adulterated Juul-compatible products may expose e-cigarette consumers to more chemical constituents at higher concentrations than previously found in the original product, despite similarity in product design."
+**Citation: Dell LG, Page MK, Leigh NJ, Goniewicz ML. Removal of mango-flavoured Juul pods created opportunity for adulterated mango Juul-compatible pods with altered chemical constituents. Tob Control. 2022 Nov;31(Suppl 3):s230-s233. doi: 10.1136/tc-2022-057476. PMID: 36328469; PMCID: PMC9664127.
 ===2021: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8145156/ A Difference-in-Differences Analysis of Youth Smoking and a Ban on Sales of Flavored Tobacco Products in San Francisco, California]===
@@ Line 204: / Line 263: @@
 *Signed by 24 experts from around the world
 *Covers 12 key points
+===2021: [https://www.sciencedirect.com/science/article/pii/S0306460321003373 Responses to potential nicotine vaping product flavor restrictions among regular vapers using non-tobacco flavors: Findings from the 2020 ITC Smoking and Vaping Survey in Canada, England and the United States]===
+*Conclusion: "At this time, it is not yet clear exactly how NVP flavor bans will play out as they are implemented across national and sub-national jurisdictions. However, by extrapolating from this study, and the other limited studies available, it appears that the outcomes will be mixed and complex. While our study suggests most vapers are opposed to a ban, and some vapers indicated that such a ban would lead to unintended consequences (e.g., taking up cigarette smoking again, or turning to illicit channels), many vapers said that they would be willing to vape available flavors. Thus, it is important for policy makers to weigh the potential for public health consequences, as well as possible benefits."
+**Citation: Gravely S, Smith DM, Liber AC, Cummings KM, East KA, Hammond D, Hyland A, O'Connor RJ, Kasza KA, Quah ACK, Loewen R, Martin N, Meng G, Ouimet J, Thompson ME, Boudreau C, McNeill A, Sweanor DT, Fong GT. Responses to potential nicotine vaping product flavor restrictions among regular vapers using non-tobacco flavors: Findings from the 2020 ITC Smoking and Vaping Survey in Canada, England and the United States. Addict Behav. 2022 Feb;125:107152. doi: 10.1016/j.addbeh.2021.107152. Epub 2021 Oct 14. PMID: 34695685; PMCID: PMC9094050.
+***Acknowledgment: This study was supported by grants from the US National Cancer Institute (P01 CA200512), the Canadian Institutes of Health Research (FDN-148477), the National Health and Medical Research Council of Australia (APP 1106451). GTF was supported by a Senior Investigator Award from the Ontario Institute for Cancer Research (IA-004) and the Canadian Cancer Society 2020 O. Harold Warwick Prize. AH and RJO are supported by a Tobacco Centers of Regulatory Science US National Cancer Institute grant (U54 CA238110). AL is supported by the Center for the Assessment of Tobacco Regulations (U54CA229974). AM is a National Institute for Health Research (NIHR) Senior Investigator. These funders/supporting agencies had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication. Declarations of interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. KMC has served as paid expert witness in litigation filed against cigarette manufacturers. GTF and DH have served as expert witnesses on behalf of governments in litigation involving the tobacco industry. AM is a UK National Institute for Health Research (NIHR) Senior Investigator. The views expressed in this article are those of the authors and not necessarily those of the NIHR, or the UK Department of Health and Social Care.
 ===2020: [https://sci-hub.st/https://onlinelibrary.wiley.com/doi/10.1111/add.15235# Association of vaping‐related lung injuries with rates of e‐cigarette and cannabis use across US states]=== <!--T:47-->
@@ Line 628: / Line 692: @@
 =Further Reading=
+===2023: Yale School of Public Health: [https://ysph.yale.edu/news-article/tobacco-purchases-rise-following-restrictions-on-e-cigarette-sales/ Tobacco purchases rise following restrictions on e-cigarette sales]===
 ===2021: Policy Analyst Testimony: [https://www.cga.ct.gov/2021/PHdata/Tmy/2021SB-00326-R000208-Stroud,%20Lindsey,%20Policy%20Analyst-Taxpayers%20Protection%20Alliance-TMY.PDF Testimony before the Connecticut Public Health Committee Regarding Prohibiting the Sale of Flavored Tobacco and Vapor Products]===
 ===2021: Commentary: [https://www.myjournalcourier.com/opinion/article/Commentary-Lindsey-Stroud-Want-fewer-teen-16184278.php Want fewer teen smokers? Stop all the bans]===
@@ Line 661: / Line 726: @@
 *If you prefer not to add information to this page yourself, drop the links here and one of our editors will do it for you
-===2022: [https://pubmed.ncbi.nlm.nih.gov/36328469/ Removal of mango-flavoured Juul pods created opportunity for adulterated mango Juul-compatible pods with altered chemical constituents]===
+===2024: [https://pubmed.ncbi.nlm.nih.gov/39787830/ The impact of non-tobacco e-cigarette flavoring on e-cigarette uptake, cigarette smoking reduction, and cessation: A secondary analysis of a nationwide clinical trial]===
-===2022: [https://pubmed.ncbi.nlm.nih.gov/36250607/ Associations between e-cigarette use and e-cigarette flavors with cigarette smoking quit attempts and quit success: Evidence from a US large, nationally representative 2018-2019 survey]===
-*E-cigarette use is positively associated with both making a quit attempt and quit success, and those using flavored e-cigarettes are more likely to successfully quit smoking, with no statistically significant differences between the use of menthol or mint-flavored e-cigarettes versus the use of other nontobacco flavored products.
-===2022: [https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-14166-w E-cigarette addiction and harm perception: Does initiation flavor choice matter?]===
-===2022: [https://tobaccocontrol.bmj.com/content/31/e1/e10 Association of device type, flavours and vaping behaviour with tobacco product transitions among adult electronic cigarette users in the USA]===
-*Non-tobacco flavours, daily vaping and modifiable e-cigarette devices may help some smokers abstain from cigarette smoking via transitioning to exclusive e-cigarette use, but are also associated with ongoing exclusive e-cigarette use.
-===2022: [https://www.sciencedirect.com/science/article/abs/pii/S0091743522001116 Effect of flavored E-cigarette bans in the United States: What does the evidence show?]===
+===2024: [https://jamanetwork.com/journals/jama-health-forum/fullarticle/2828404 Flavored E-Cigarette Sales Restrictions and Young Adult Tobacco Use]===
-*However, in this paper, we propose an evidence-based version of this model based on several years' worth of longitudinal and econometric research, which suggests that youth e-cigarette use has instead worked to replace a culture of youth smoking. From this analysis, we propose a re-evaluation of current policies surrounding e-cigarette sales so that declines in e-cigarette use will not come at the cost of increasing cigarette use among youth and adults.
-===2022: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9287473/ Impact of existing and potential e-cigarette flavor restrictions on e-cigarette use among young adult e-cigarette users in 6 US metropolitan areas]===
-*Results from this study highlight heterogeneity in young adult e-cigarette users’ reactions to existing flavored e-cigarette sales restrictions and hypothetical restrictions. Some reduced e-cigarette use, but many reported intentions to continue e-cigarette use, by using tank-based e-cigarettes, available flavors, or flavors accessed through alternative sources. More concerning, some switched to cigarettes. Similarly, in response to future restrictions of all flavored e-liquids, young adult e-cigarette users largely indicated that they would either quit vaping – the ideal scenario – or switch to cigarettes – the least desirable scenario. Another major concern highlighted was access to flavored e-cigarettes despite restrictions (e.g., online, across state lines). Collectively, findings suggest that implications of flavored e-cigarette sales restrictions are complex, with the potential for both reductions in e-cigarette use and unintended consequences among young adults, including continued use of flavored e-cigarettes or switching to cigarettes, and retail and consumer circumvention of restrictions.
 =Page Editor Instructions= <!--T:176-->