ENDS Flavors: Difference between revisions

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It's usually necessary to view the PDF version to access the full study. If you'd like to contribute to this page, please see the instructions at the bottom of the page.
[[File:ENDS Flavors.jpg|center]]
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*''' This page will attempt to address the following questions:'''
<languages/>
: '''FAQ: Why are flavored ENDS products important to people who smoke?'''
<translate>
: '''FAQ: Why are flavored ENDS products important to people trying to prevent relapse to smoking?'''
<!--T:1-->
: '''FAQ: Do flavors entice youth to illegally use ENDS products?'''
It's often necessary to view the PDF version to access the full study. If you'd like to contribute to this page, please see the instructions at the bottom of the page.
: '''FAQ: When comparing continuum of risk, how do flavored ENDS products compare to smoking?'''
: '''FAQ: Are the flavors a threat to public health?'''
: '''FAQ: Are there any unintended consequences to banning flavored ENDS products?'''
: '''FAQ: Does diacetyl, a flavoring agent compound in ENDS products cause Popcorn Lung?'''


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Suggestions welcome!


=Personal Testimonies from people who used to smoke=


=Personal Testimonies from people who used to smoke & Blogs= <!--T:3-->


===All Years: Video Collection: [https://www.youtube.com/channel/UCY3vMuTdXfL7Z4PAsx7Q5nA/videos Golden Oldies Capitol Tours]===
===All Years: Video Collection: [https://www.youtube.com/channel/UCY3vMuTdXfL7Z4PAsx7Q5nA/videos Golden Oldies Capitol Tours]=== <!--T:4-->
 
<!--T:5-->
*People who used to smoke share how long they smoked and what flavors helped them to quit smoking.
*People who used to smoke share how long they smoked and what flavors helped them to quit smoking.


===All Years: Collection 13,000+ Testimonies: [https://casaa.org/_testimonials/ CASAA - REAL PEOPLE. REAL STORIES.]=== <!--T:6-->


===All Years: Collection 13,000+ Testimonies: [https://casaa.org/_testimonials/ CASAA - REAL PEOPLE. REAL STORIES.]===
<!--T:7-->
*Online submissions of personal testimonies by people who switched from smoking to harm reduction products.
*Online submissions of personal testimonies by people who switched from smoking to harm reduction products.


===2021: Letter: [https://clivebates.com/documents/CanadaFlavourBanSept2021.pdf Proposed vaping products’ flavour regulations – a response]===
*This submission responds to Health Canada’s Consultation on Proposed vaping products’ flavour regulations and order and related regulatory impact analysis.


===2915 Blog: [http://mommavape.blogspot.com/2017/05/cotton-candy-is-not-marketing-to-kids.html Cotton Candy is NOT Marketing To Kids]===
===2021: Letter: [https://clivebates.com/documents/NLFlavoursResponseJan2021.pdf Regulation of e-cigarette flavours – a response]===
*This document responds to the proposed Decree of the State Secretary for Health, Welfare and Sport on the regulation of e-cigarette flavours in the Netherlands. We provide a summary followed by a detailed discussion of each of the twelve sections in the summary.
 
===2021 Blog: [http://mommavape.blogspot.com/2021/06/gummy-bears-and-cotton-candy.html Gummy Bears and Cotton Candy]===
*The voice of consumers who are trying to quit smoking continues to be ignored. The use of flavored e-cigarettes was associated with more than twice the odds of smoking cessation among adult users compared to those using tobacco flavors. History demonstrates the adult love of all things candy. If something candy flavored is what helps someone stop smoking, who are we to tell them they can't quit that way?
 
===2019 Blog: [https://clivebates.com/the-us-vaping-flavour-ban-twenty-things-you-should-know/ The US vaping flavour ban: twenty things you should know]===
*What is the chance that this level of adult panic is, in fact, driving the very behaviour it is worrying about?
 
===2017 Blog: [http://mommavape.blogspot.com/2017/05/cotton-candy-is-not-marketing-to-kids.html Cotton Candy is NOT Marketing To Kids]=== <!--T:8-->
 
<!--T:9-->
*She says "honey, you need to get with the program, we were too poor when I was a kid to afford cotton candy, so now I'm having it whenever I want and any way I want it. Now give me the sweetest thing you got and I want cotton candy the next time I come here."  
*She says "honey, you need to get with the program, we were too poor when I was a kid to afford cotton candy, so now I'm having it whenever I want and any way I want it. Now give me the sweetest thing you got and I want cotton candy the next time I come here."  
*"Ma'am, if you don't mind me asking, how old are you?". She looks at me and says "82, I quit smoking 6 months ago and now I'm going to live to be 102."
*"Ma'am, if you don't mind me asking, how old are you?". She looks at me and says "82, I quit smoking 6 months ago and now I'm going to live to be 102."


===2017 Blog: [https://clivebates.com/flavors Are e-liquid flavours really “hooking another generation of kids”?]===
*To evaluate the demand to regulate these flavours (by which they mean ban them) you first need a framework for thinking about the issue – and that is not simple and may yield surprises.


=Abuse Liability - All THR Products=
=Abuse Liability - All THR Products= <!--T:10-->


===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-->


===2003: [https://pubmed.ncbi.nlm.nih.gov/12616334/ Subjective effects of the nicotine lozenge: assessment of abuse liability]===
<!--T:12-->
*Controlled use of JS (JUUL System) among adult smokers resulted in nicotine delivery, product liking, and satisfaction that were less than that of combustible cigarettes but generally greater than nicotine gum. These results support the conclusion that JS has lower abuse liability than combustible cigarettes, higher abuse liability than nicotine gum, and may provide sufficient nicotine delivery and satisfying effects to support substitution for combustible cigarettes among adult smokers.
*[https://www.sciencedirect.com/science/article/pii/S0376871620305603 PDF Version]
*Citation: Nicholas I. Goldenson, August R. Buchhalter, Erik M. Augustson, Mark L. Rubinstein, Jack E. Henningfield, 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, Drug and Alcohol Dependence, Volume 217, 2020, 108395, ISSN 0376-8716, doi:10.1016/j.drugalcdep.2020.108395.
 
===2003: [https://pubmed.ncbi.nlm.nih.gov/12616334/ Subjective effects of the nicotine lozenge: assessment of abuse liability]=== <!--T:13-->
 
<!--T:14-->
*In conclusion, results of the present study suggest that abuse liability of nicotine lozenges is low. Low abuse liability of the novel nicotine lozenges is in accordance with current knowledge of consumer use patterns of other, already marketed nicotine replacement therapies, which suggest little abuse of these products once they are marketed. Dose-dependent craving reduction by the lozenges in adults (22–50 years) but not young adults (18–21 years) suggests efficacy of the lozenge for adults, and reinforces the need for further studies of nicotine delivery systems as a treatment for nicotine dependence in younger adults and adolescents
*In conclusion, results of the present study suggest that abuse liability of nicotine lozenges is low. Low abuse liability of the novel nicotine lozenges is in accordance with current knowledge of consumer use patterns of other, already marketed nicotine replacement therapies, which suggest little abuse of these products once they are marketed. Dose-dependent craving reduction by the lozenges in adults (22–50 years) but not young adults (18–21 years) suggests efficacy of the lozenge for adults, and reinforces the need for further studies of nicotine delivery systems as a treatment for nicotine dependence in younger adults and adolescents
*[https://sci-hub.se/10.1007/s00213-002-1361-2 PDF Version]
*[https://sci-hub.se/10.1007/s00213-002-1361-2 PDF Version]
*Citation: Houtsmuller, E. J., Henningfield, J. E., & Stitzer, M. L. (2003). Subjective effects of the nicotine lozenge: assessment of abuse liability. Psychopharmacology, 167(1), 20–27. doi:10.1007/s00213-002-1361-2  
*Citation: Houtsmuller, E. J., Henningfield, J. E., & Stitzer, M. L. (2003). Subjective effects of the nicotine lozenge: assessment of abuse liability. Psychopharmacology, 167(1), 20–27. doi:10.1007/s00213-002-1361-2  
*Acknowledgement: This research was supported by SmithKline Beecham Consumer Healthcare.


===2002: [https://pubmed.ncbi.nlm.nih.gov/12175452/ Flavor improvement does not increase abuse liability of nicotine chewing gum]=== <!--T:15-->


===2002: [https://pubmed.ncbi.nlm.nih.gov/12175452/ Flavor improvement does not increase abuse liability of nicotine chewing gum]===
<!--T:16-->
*Improved flavor of nicotine gum does not increase abuse liability, but may be associated with enhanced craving reduction.
*Improved flavor of nicotine gum does not increase abuse liability, but may be associated with enhanced craving reduction.
*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.
*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]
*[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  
*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  
*Acknowledgement: This study was supported by SmithKline Beecham Consumer Healthcare.


=Public Health Advantages / Concerns of Public Health Harms=
= 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]===
*This 2022 updated review evaluates the use of flavours in THR products, specifically, nicotine vaping products. It highlights the link between (flavoured) vaping products and smoking cessation, and the potential benefits and risks of flavours and their availability for public health.


=Public Health Advantages / Concerns of Public Health Harms= <!--T:17-->


===2020: [https://pubmed.ncbi.nlm.nih.gov/32881666/ Investigation on the antibacterial activity of electronic cigarette liquids (ECLs): a proof of concept study]===
===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.
 
===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-->
 
<!--T:19-->
*Our results have shown that flavors considerably enhance antibacterial activity.
*Our results have shown that flavors considerably enhance antibacterial activity.
*This study provides important evidence that should be taken into consideration in further investigative approaches, to clarify the different sensitivity of the various bacterial species to e-liquids, including the respiratory microbiota, to highlight the possible role of flavors and nicotine.  
*This study provides important evidence that should be taken into consideration in further investigative approaches, to clarify the different sensitivity of the various bacterial species to e-liquids, including the respiratory microbiota, to highlight the possible role of flavors and nicotine.  
*Citation: Virginia Fuochi, Massimo Caruso , Rosalia Emma, Aldo Stivala, Riccardo Polosa, Alfio Distefano and Pio Maria Furneri *, “Investigation on the Antibacterial Activity of Electronic Cigarette Liquids (ECLs): A Proof of Concept Study”, Current Pharmaceutical Biotechnology (2020) 21: 1. doi:10.2174/1389201021666200903121624
*Citation: Virginia Fuochi, Massimo Caruso , Rosalia Emma, Aldo Stivala, Riccardo Polosa, Alfio Distefano and Pio Maria Furneri *, “Investigation on the Antibacterial Activity of Electronic Cigarette Liquids (ECLs): A Proof of Concept Study”, Current Pharmaceutical Biotechnology (2020) 21: 1. doi:10.2174/1389201021666200903121624


===2019: [https://www.cmaj.ca/content/re-vape-related-popcorn-lung-debunked-years-ago RE: Vape related "Popcorn Lung" debunked years ago]=== <!--T:20-->


===2019: [https://www.cmaj.ca/content/re-vape-related-popcorn-lung-debunked-years-ago RE: Vape related "Popcorn Lung" debunked years ago]===
<!--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]
*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]
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**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.
**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-->


===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:23-->
*Our results clearly show a lower toxicity of e-liquids, including flavoured e-liquids, when compared to [[Abbreviations|CSC]] (cigarette smoke condensate). Typically, more than 100 times higher concentrations of [[Abbreviations|CFs]] (commercial flavoured e-liquids) are required to elicit the same response as those observed for 3R4F CSC in specific endpoints.
*Our results clearly show a lower toxicity of e-liquids, including flavoured e-liquids, when compared to [[Special:MyLanguage/Abbreviations|CSC]] (cigarette smoke condensate). Typically, more than 100 times higher concentrations of [[Special:MyLanguage/Abbreviations|CFs]] (commercial flavoured e-liquids) are required to elicit the same response as those observed for 3R4F CSC in specific endpoints.
*Flavours play a critical role in attracting, and retaining smokers to e-cigarettes.
*Flavours play a critical role in attracting, and retaining smokers to e-cigarettes.
*[https://sci-hub.st/10.1016/j.tiv.2019.03.018 PDF Version]
*[https://sci-hub.st/10.1016/j.tiv.2019.03.018 PDF Version]
*Citation: Lukasz Czekala, Liam Simms, Matthew Stevenson, Edgar Trelles-Sticken, Paul Walker, Tanvir Walele, High Content Screening in NHBE cells shows significantly reduced biological activity of flavoured e-liquids, when compared to cigarette smoke condensate, Toxicology in Vitro, Volume 58, 2019, Pages 86-96, ISSN 0887-2333, doi:10.1016/j.tiv.2019.03.018.
*Citation: Lukasz Czekala, Liam Simms, Matthew Stevenson, Edgar Trelles-Sticken, Paul Walker, Tanvir Walele, High Content Screening in NHBE cells shows significantly reduced biological activity of flavoured e-liquids, when compared to cigarette smoke condensate, Toxicology in Vitro, Volume 58, 2019, Pages 86-96, ISSN 0887-2333, doi:10.1016/j.tiv.2019.03.018.
*Acknowledgements: This work was funded and supported by Fontem Ventures B.V., part of Imperial Brands Group PLC.
* Keywords: Flavours, In vitro, Normal Human Bronchial Epithelial cells, High Content Screening, E-liquids, Cigarette, flavor, flavoring, flavored


===2019: [https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-019-0318-2?optIn=false Toxicity classification of e-cigarette flavouring compounds based on European Union regulation: analysis of findings from a recent study]=== <!--T:24-->


===2019: [https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-019-0318-2?optIn=false Toxicity classification of e-cigarette flavouring compounds based on European Union regulation: analysis of findings from a recent study]===
<!--T:25-->
*The vast majority of flavouring (flavoring) compounds in e-cigarette liquids as reported in a recent study were present at levels far lower than needed to classify them as toxic.  
*The vast majority of flavouring (flavoring) compounds in e-cigarette liquids as reported in a recent study were present at levels far lower than needed to classify them as toxic.  
*[https://harmreductionjournal.biomedcentral.com/track/pdf/10.1186/s12954-019-0318-2.pdf PDF Version]
*[https://harmreductionjournal.biomedcentral.com/track/pdf/10.1186/s12954-019-0318-2.pdf PDF Version]
*Farsalinos, K., Lagoumintzis, G. Toxicity classification of e-cigarette flavouring compounds based on European Union regulation: analysis of findings from a recent study. Harm Reduct J 16, 48 (2019). doi: 10.1186/s12954-019-0318-2
*Farsalinos, K., Lagoumintzis, G. Toxicity classification of e-cigarette flavouring compounds based on European Union regulation: analysis of findings from a recent study. Harm Reduct J 16, 48 (2019). doi: 10.1186/s12954-019-0318-2
*Acknowledgements: The authors report no conflict of interest for the past 36 months. For the past 60 months, KF has published 2 studies funded by the non-profit association AEMSA and 1 study funded by the non-profit association Tennessee Smoke-Free Association.


===2019: [https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0222152&fbclid=IwAR1Rqtl6D0eLtqU0-pqJ5vlSlLK2xlJk8rs0djo90oeUAwIdX9IgmYgByZY Effects of flavoring compounds used in electronic cigarette refill liquids on endothelial and vascular function]=== <!--T:26-->


===2019: [https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0222152&fbclid=IwAR1Rqtl6D0eLtqU0-pqJ5vlSlLK2xlJk8rs0djo90oeUAwIdX9IgmYgByZY Effects of flavoring compounds used in electronic cigarette refill liquids on endothelial and vascular function]===
<!--T:27-->
*Our data indicate that flavorings typically present in e-cig refill liquids do not cause endothelial dysfunction that would result in impaired vasodilation upon acute exposure. In contrast, most of the tested compounds caused endothelium-independent vasorelaxation, albeit at fairly high concentrations that appear to exceed by far the plasma concentrations expected to occur upon vaping flavored liquids.
*Our data indicate that flavorings typically present in e-cig refill liquids do not cause endothelial dysfunction that would result in impaired vasodilation upon acute exposure. In contrast, most of the tested compounds caused endothelium-independent vasorelaxation, albeit at fairly high concentrations that appear to exceed by far the plasma concentrations expected to occur upon vaping flavored liquids.
*[https://storage.googleapis.com/plos-corpus-prod/10.1371/journal.pone.0222152/1/pone.0222152.pdf?X-Goog-Algorithm=GOOG4-RSA-SHA256&X-Goog-Credential=wombat-sa%40plos-prod.iam.gserviceaccount.com%2F20210106%2Fauto%2Fstorage%2Fgoog4_request&X-Goog-Date=20210106T115250Z&X-Goog-Expires=3600&X-Goog-SignedHeaders=host&X-Goog-Signature=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 PDF Version]
*[https://storage.googleapis.com/plos-corpus-prod/10.1371/journal.pone.0222152/1/pone.0222152.pdf?X-Goog-Algorithm=GOOG4-RSA-SHA256&X-Goog-Credential=wombat-sa%40plos-prod.iam.gserviceaccount.com%2F20210106%2Fauto%2Fstorage%2Fgoog4_request&X-Goog-Date=20210106T115250Z&X-Goog-Expires=3600&X-Goog-SignedHeaders=host&X-Goog-Signature=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 PDF Version]
*Citation: Wölkart G, Kollau A, Stessel H, Russwurm M, Koesling D, Schrammel A, et al. (2019) Effects of flavoring compounds used in electronic cigarette refill liquids on endothelial and vascular function. PLoS ONE 14(9): e0222152. https://doi.org/10.1371/journal.pone.0222152
*Citation: Wölkart G, Kollau A, Stessel H, Russwurm M, Koesling D, Schrammel A, et al. (2019) Effects of flavoring compounds used in electronic cigarette refill liquids on endothelial and vascular function. PLoS ONE 14(9): e0222152. https://doi.org/10.1371/journal.pone.0222152
*Acknowledgement: This work was supported by the Austrian Science Fund (FWF) grant [P24946] to BM.


===2018: [https://reason.org/wp-content/uploads/public-health-case-e-cigarette-flavors.pdf A QUESTION OF TASTE: THE PUBLIC HEALTH CASE FOR E-CIGARETTE FLAVORS]=== <!--T:28-->


===2018: [https://reason.org/wp-content/uploads/public-health-case-e-cigarette-flavors.pdf A QUESTION OF TASTE: THE PUBLIC HEALTH CASE FOR E-CIGARETTE FLAVORS]===
<!--T:29-->
*The available evidence on flavored e-cigarettes suggests that flavors in and of themselves are not especially appealing to non-smoking adults or adolescents. There is, however, a substantial and growing literature on how and why these products appeal to smoking adults and their potential to help consumers switch from smoking to less-harmful vaping.  
*The available evidence on flavored e-cigarettes suggests that flavors in and of themselves are not especially appealing to non-smoking adults or adolescents. There is, however, a substantial and growing literature on how and why these products appeal to smoking adults and their potential to help consumers switch from smoking to less-harmful vaping.  
*'''Any policy that harms the exclusive makers of reduced-risk products such as e-cigarettes more than the makers of traditional cigarettes is not in the interests of public health. '''
*'''Any policy that harms the exclusive makers of reduced-risk products such as e-cigarettes more than the makers of traditional cigarettes is not in the interests of public health. '''
*Report Author (55 pages): Guy Bentley
*Report Author (55 pages): Guy Bentley


===2018: [http://www.ecigarette-research.org/research/index.php/research/2018/262-flavors Paper: E-cigarette flavors and aldehyde emissions: another failure to verify findings from a previous study]=== <!--T:30-->


===2018: [http://www.ecigarette-research.org/research/index.php/research/2018/262-flavors Paper: E-cigarette flavors and aldehyde emissions: another failure to verify findings from a previous study]===
<!--T:31-->
**Our results were revealing in identifying a very small contribution of flavorings on aldehyde emissions. In fact, '''aldehyde levels were so low that consumption of 5 grams e-liquid per day would expose vapers to less formaldehyde and acetaldehyde than just staying at home and breathing air'''. For acrolein, exposure was orders of magnitude lower compared to NIOSH-defined recommended safety limits. To give you an idea of the differences in results, the authors of the original study found up to 7000 ug/g formaldehyde, while we found a maximum of 62 ug/g.
**Our results were revealing in identifying a very small contribution of flavorings on aldehyde emissions. In fact, '''aldehyde levels were so low that consumption of 5 grams e-liquid per day would expose vapers to less formaldehyde and acetaldehyde than just staying at home and breathing air'''. For acrolein, exposure was orders of magnitude lower compared to NIOSH-defined recommended safety limits. To give you an idea of the differences in results, the authors of the original study found up to 7000 ug/g formaldehyde, while we found a maximum of 62 ug/g.
*2017: Study: [https://www.sciencedirect.com/science/article/abs/pii/S0278691518301339?via%3Dihub Do flavouring compounds contribute to aldehyde emissions in e-cigarettes?]
*2017: Study: [https://www.sciencedirect.com/science/article/abs/pii/S0278691518301339?via%3Dihub Do flavouring compounds contribute to aldehyde emissions in e-cigarettes?]
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**[https://sci-hub.se/10.1016/j.fct.2018.02.059# PDF Version]
**[https://sci-hub.se/10.1016/j.fct.2018.02.059# PDF Version]
**Citation: Farsalinos, K. E., & Voudris, V. (2018). Do flavouring compounds contribute to aldehyde emissions in e-cigarettes? Food and Chemical Toxicology, 115, 212–217. doi:10.1016/j.fct.2018.02.059  
**Citation: Farsalinos, K. E., & Voudris, V. (2018). Do flavouring compounds contribute to aldehyde emissions in e-cigarettes? Food and Chemical Toxicology, 115, 212–217. doi:10.1016/j.fct.2018.02.059  
**Acknowledgement: The study was funded by Public Health England.
*2017: Follow Up: [https://pubs.acs.org/doi/10.1021/acs.est.6b06030 Comment on “Flavoring Compounds Dominate Toxic Aldehyde Production during E Cigarette Vaping”]
*2017: Follow Up: [https://pubs.acs.org/doi/10.1021/acs.est.6b06030 Comment on “Flavoring Compounds Dominate Toxic Aldehyde Production during E Cigarette Vaping”]
**We would like to point out that the finding is in a stark contrast to previous results.
**We would like to point out that the finding is in a stark contrast to previous results.
**The high levels only happen under dry puff conditions, something avoided by vapers as it is very unpleasant.
**The high levels only happen under dry puff conditions, something avoided by vapers as it is very unpleasant.


===2017: [https://www.cdc.gov/niosh/hhe/reports/pdfs/2015-0107-3279.pdf?fbclid=IwAR37EOr5p5EwptMhuyrIwEDkfi4qbMh0nRwu6yz2VkY0Um-q138f3LfK64Y Evaluation of Chemical Exposures at a Vape Shop]=== <!--T:32-->


===2017: [https://www.cdc.gov/niosh/hhe/reports/pdfs/2015-0107-3279.pdf?fbclid=IwAR37EOr5p5EwptMhuyrIwEDkfi4qbMh0nRwu6yz2VkY0Um-q138f3LfK64Y Evaluation of Chemical Exposures at a Vape Shop]===
<!--T:33-->
*We collected air samples for flavoring chemicals (diacetyl, 2,3-pentanedione, 2,3-hexanedione, acetaldehyde, and acetoin), nicotine, formaldehyde, and propylene glycol.  
*We collected air samples for flavoring chemicals (diacetyl, 2,3-pentanedione, 2,3-hexanedione, acetaldehyde, and acetoin), nicotine, formaldehyde, and propylene glycol.  
*Concentrations of vaping-related chemicals in our air samples were below occupational exposure limits.
*Concentrations of vaping-related chemicals in our air samples were below occupational exposure limits.
*Citation: NIOSH 2017. Evaluation of chemical exposures at a vape shop. By Zwack LM, Stefaniak AB, LeBouf RF. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Health Hazard Evaluation Report 2015-0107-3279
*Citation: NIOSH 2017. Evaluation of chemical exposures at a vape shop. By Zwack LM, Stefaniak AB, LeBouf RF. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Health Hazard Evaluation Report 2015-0107-3279


===2016: [https://tobaccocontrol.bmj.com/content/25/Suppl_2/ii67 Cigarette smoking and electronic cigarette vaping patterns as a function of e-cigarette flavourings]=== <!--T:34-->


===2016: [https://tobaccocontrol.bmj.com/content/25/Suppl_2/ii67 Cigarette smoking and electronic cigarette vaping patterns as a function of e-cigarette flavourings]===
<!--T:35-->
*The findings suggest that adoption of e-cigarettes in smokers may influence smoking rates of people who smoke.
*The findings suggest that adoption of e-cigarettes in smokers may influence smoking rates of people who smoke.
*'''E-cigarette vaping rates are influenced by flavorings by people transitioning from smoking'''.
*'''E-cigarette vaping rates are influenced by flavorings by people transitioning from smoking'''.
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*[https://tobaccocontrol.bmj.com/content/tobaccocontrol/25/Suppl_2/ii67.full.pdf PDF Version]
*[https://tobaccocontrol.bmj.com/content/tobaccocontrol/25/Suppl_2/ii67.full.pdf PDF Version]
*Citation: Litt MD, Duffy V, Oncken C. Cigarette smoking and electronic cigarette vaping patterns as a function of e-cigarette flavourings, Tobacco Control 2016;25:ii67-ii72.
*Citation: Litt MD, Duffy V, Oncken C. Cigarette smoking and electronic cigarette vaping patterns as a function of e-cigarette flavourings, Tobacco Control 2016;25:ii67-ii72.
*Acknowledgement: Support for this project was provided by Grant 1 R01 DA036492 from the National Institute on Drug Abuse, and in part by General Clinical Research Center Grant M01-RR06192 from the National Institutes of Health.


===2015: [http://www.ecigarette-research.org/research/index.php/whats-new/whatsnew-2015/234-bo Medical journal misrepresents a case of hypersensitivity pneumonitis as popcorn lung disease caused by e-cigarette]=== <!--T:36-->


===2015: [http://www.ecigarette-research.org/research/index.php/whats-new/whatsnew-2015/234-bo Medical journal misrepresents a case of hypersensitivity pneumonitis as popcorn lung disease caused by e-cigarette]===
<!--T:37-->
*It was shocking to see a public statement reporting a case of popcorn lung disease in a patient using e-cigarettes. The title of the public release is: “Case report finds 'popcorn lung' in patient using e-cigarettes. Report points to possibility of diacetyl, a flavoring agent in e-cigarettes, to bronchiolitis obliterans syndrome”  
*It was shocking to see a public statement reporting a case of popcorn lung disease in a patient using e-cigarettes. The title of the public release is: “Case report finds 'popcorn lung' in patient using e-cigarettes. Report points to possibility of diacetyl, a flavoring agent in e-cigarettes, to bronchiolitis obliterans syndrome”  
*The case report is NOT about popcorn lung disease. The article then goes on to explain why it can’t be popcorn lung.
*The case report is NOT about popcorn lung disease. The article then goes on to explain why it can’t be popcorn lung.


===2015: [https://www.sciencedirect.com/science/article/pii/S0273230015001245?via%3Dihub An approach to ingredient screening and toxicological risk assessment of flavours in e-liquids]=== <!--T:38-->


===2015: [https://www.sciencedirect.com/science/article/pii/S0273230015001245?via%3Dihub An approach to ingredient screening and toxicological risk assessment of flavours in e-liquids]===
<!--T:39-->
*In vitro and Animal
*In vitro and Animal
*Individual flavours or groups of flavours were added to the tobacco rod and the resultant smoke was analysed for priority smoke constituents and tested in several in vitro tests as well as 90-day rat inhalation studies. In general, addition of the flavours had no effect on, or reduced the levels of most of the measured smoke constituents.”
*Individual flavours or groups of flavours were added to the tobacco rod and the resultant smoke was analysed for priority smoke constituents and tested in several in vitro tests as well as 90-day rat inhalation studies. In general, addition of the flavours had no effect on, or reduced the levels of most of the measured smoke constituents.”
*[https://sci-hub.se/10.1016/j.yrtph.2015.05.018 PDF Version]
*[https://sci-hub.se/10.1016/j.yrtph.2015.05.018 PDF Version]
*Citation: S. Costigan, C. Meredith, An approach to ingredient screening and toxicological risk assessment of flavours in e-liquids, Regulatory Toxicology and Pharmacology, Volume 72, Issue 2, 2015, Pages 361-369, ISSN 0273-2300, doi: 10.1016/j.yrtph.2015.05.018.
*Citation: S. Costigan, C. Meredith, An approach to ingredient screening and toxicological risk assessment of flavours in e-liquids, Regulatory Toxicology and Pharmacology, Volume 72, Issue 2, 2015, Pages 361-369, ISSN 0273-2300, doi: 10.1016/j.yrtph.2015.05.018..
*Acknowledgements: This work was joint funded by Nicoventures and British American Tobacco (BAT), and the authors are full time employees of Nicoventures and British American Tobacco (BAT).


===2013: [https://www.mdpi.com/1660-4601/10/10/5146/htm Comparison of the Cytotoxic Potential of Cigarette Smoke and Electronic Cigarette Vapour (Vapor) Extract on Cultured Myocardial Cells]=== <!--T:40-->


===2013: [https://www.mdpi.com/1660-4601/10/10/5146/htm Comparison of the Cytotoxic Potential of Cigarette Smoke and Electronic Cigarette Vapour (Vapor) Extract on Cultured Myocardial Cells]===
<!--T:41-->
*Smoking is an important risk factor for cardiovascular disease and cigarette smoke (CS) has well-established cytotoxic effects on myocardial cells. The purpose of this study was to evaluate the cytotoxic potential of the vapour of 20 EC (e-cigarette) liquid samples and a “base” liquid sample (50% glycerol and 50% propylene glycol, with no nicotine or flavourings) on cultured myocardial cells. Included were 4 samples produced by using cured tobacco leaves in order to extract the tobacco flavour. Methods: Cytotoxicity was tested according to the ISO 10993-5 standard.
*Smoking is an important risk factor for cardiovascular disease and cigarette smoke (CS) has well-established cytotoxic effects on myocardial cells. The purpose of this study was to evaluate the cytotoxic potential of the vapour of 20 EC (e-cigarette) liquid samples and a “base” liquid sample (50% glycerol and 50% propylene glycol, with no nicotine or flavourings) on cultured myocardial cells. Included were 4 samples produced by using cured tobacco leaves in order to extract the tobacco flavour. Methods: Cytotoxicity was tested according to the ISO 10993-5 standard.
*In conclusion, from 20 commercially-available EC liquids that were tested in vapour form, four were found to be cytotoxic on cultured cardiomyoblasts. Cytotoxicity was mainly observed in most (but not all) samples produced by using tobacco leaves, while one sample using food-approved flavoring was marginally cytotoxic. EC vapour production by using higher-voltage devices caused a decrease in cell survival. Overall, EC vapour extracts showed significantly higher cell viability compared to CS extract, based on a realistic-use rather than a standardized comparative level of exposure. This supports the concept that ECs may be useful as tobacco harm reduction products.
*In conclusion, from 20 commercially-available EC liquids that were tested in vapour form, four were found to be cytotoxic on cultured cardiomyoblasts. Cytotoxicity was mainly observed in most (but not all) samples produced by using tobacco leaves, while one sample using food-approved flavoring was marginally cytotoxic. EC vapour production by using higher-voltage devices caused a decrease in cell survival. Overall, EC vapour extracts showed significantly higher cell viability compared to CS extract, based on a realistic-use rather than a standardized comparative level of exposure. This supports the concept that ECs may be useful as tobacco harm reduction products.
*[https://sci-hub.do/10.3390/ijerph10105146 PDF Version]
*[https://sci-hub.do/10.3390/ijerph10105146 PDF Version]
*Citation: Farsalinos, K., Romagna, G., Allifranchini, E., Ripamonti, E., Bocchietto, E., Todeschi, S., … Voudris, V. (2013). Comparison of the Cytotoxic Potential of Cigarette Smoke and Electronic Cigarette Vapour Extract on Cultured Myocardial Cells. International Journal of Environmental Research and Public Health, 10(10), 5146–5162. doi:10.3390/ijerph10105146  
*Citation: Farsalinos, K., Romagna, G., Allifranchini, E., Ripamonti, E., Bocchietto, E., Todeschi, S., … Voudris, V. (2013). Comparison of the Cytotoxic Potential of Cigarette Smoke and Electronic Cigarette Vapour Extract on Cultured Myocardial Cells. International Journal of Environmental Research and Public Health, 10(10), 5146–5162. doi:10.3390/ijerph10105146  
*Acknowledgement: The study was funded in part by the Greek Association of E-cigarette Businesses (SEEHT).


=Regulations or Unintended Consequences= <!--T:42-->
===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
===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: 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]===
*[https://www.medrxiv.org/content/10.1101/2022.11.14.22282288v1.full.pdf PDF of full paper]


===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]===
*San Francisco’s ban on flavored tobacco product sales was associated with increased smoking among minor high school students relative to other school districts. While the policy applied to all tobacco products, its outcome was likely greater for youths who vaped than those who smoked due to higher rates of flavored tobacco use among those who vaped. This raises concerns that reducing access to flavored electronic nicotine delivery systems may motivate youths who would otherwise vape to substitute smoking. Indeed, analyses of how minimum legal sales ages for electronic nicotine delivery systems are associated with youth smoking also suggest such substitution.
*Citation: Friedman AS. A Difference-in-Differences Analysis of Youth Smoking and a Ban on Sales of Flavored Tobacco Products in San Francisco, California. JAMA Pediatr. 2021;175(8):863-865. doi:10.1001/jamapediatrics.2021.0922


=Regulations or Unintended Consequences=
===2021: [https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntab154/6332852?redirectedFrom=fulltext Reactions to sales restrictions on flavored vape products or all vape products among young adults in the US]=== <!--T:43-->


<!--T:44-->
*Young adult e-cigarette users indicate low support for e-cigarette sales restrictions (both for flavored products and complete restrictions). Moreover, if vape product sales were restricted to tobacco flavors, 39.1% of users reported being likely to continue using e-cigarettes but 33.2% were likely to switch to cigarettes. If vape product sales were entirely restricted, e-cigarette users were equally likely to switch to cigarettes versus not (~40%).
*Free version of full study or PDF not available
*Citation: Heather Posner, MPH, Katelyn F Romm, PhD, Lisa Henriksen, PhD, Debra Bernat, PhD, Carla J Berg, PhD, MBA, Reactions to Sales Restrictions on Flavored Vape Products or All Vape Products Among Young Adults in the United States, Nicotine & Tobacco Research, 2021;, ntab154, doi: 10.1093/ntr/ntab154


===2021: [https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntab154/6332852?redirectedFrom=fulltext Reactions to sales restrictions on flavored vape products or all vape products among young adults in the US]===
===2021: [https://f1000research.com/articles/10-619/v1 Vaping liquid flavour preferences, oral nicotine pouch and cannabis use: A survey of participants in the 2019 Oceania Vape Expo (version 1; peer review: awaiting peer review)]===
*
*In the event of a ban on other flavours, 20% of the NZ residents said they would probably go back to smoking (see Table 3). A majority (57%) indicated they intended to circumvent the ban, by mixing their own liquids and/or buying from overseas or the black market. Only 29% indicated they would change their vaping consumption to comply with the ban, as is typically implicitly assumed will happen. Nine percent would try to stop vaping and 35% would buy only the legal products (which includes the 18% who were already buying only products that would not be banned).
*[https://f1000research.com/articles/10-619/v1/pdf?article_uuid=853423ae-6086-4c13-a7bc-87b28d81a4a6 PDF Version]
*Citation: Glover M, Phillips CV, Selket K and Jeffares Y. Vaping liquid flavour preferences, oral nicotine pouch and cannabis use: A survey of participants in the 2019 Oceania Vape Expo [version 1; peer review: awaiting peer review]. F1000Research 2021, 10:619 doi:10.12688/f1000research.54582.1


===2021: Testimony in Netherlands pertaining to a potential flavour / flavor ban: [https://www.clivebates.com/documents/NLFlavoursResponseJan2021.pdf Regulation of e-cigarette flavours – a response]=== <!--T:45-->


===2021: Testimony in Netherlands pertaining to a potential flavour / flavor ban: [https://www.clivebates.com/documents/NLFlavoursResponseJan2021.pdf Regulation of e-cigarette flavours – a response]===
<!--T:46-->
*Signed by 24 experts from around the world
*Signed by 24 experts from around the world
*Covers 12 key points
*Covers 12 key points


===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-->


===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:48-->
*'''Policymakers should proceed with caution when considering bans on flavored nicotine e‐liquids''': restricting legal sales may push some vapers towards illicit sources, user‐modified e‐liquids (e.g. to add flavoring) or even conventional cigarette use. Given EVALI’s potential lethality and a myriad of work suggesting that conventional cigarette use is probably far more dangerous than vaping nicotine, these outcomes could be disastrous for public health. There is no link between nicotine liquids and EVALI. It appears to have come from illicit cannabis products.
*'''Policymakers should proceed with caution when considering bans on flavored nicotine e‐liquids''': restricting legal sales may push some vapers towards illicit sources, user‐modified e‐liquids (e.g. to add flavoring) or even conventional cigarette use. Given EVALI’s potential lethality and a myriad of work suggesting that conventional cigarette use is probably far more dangerous than vaping nicotine, these outcomes could be disastrous for public health. There is no link between nicotine liquids and EVALI. It appears to have come from illicit cannabis products.
*Link above is to the PDF version
*Link above is to the PDF version
*Citation: Friedman, A. S. (2020). Association of Vaping‐related Lung Injuries with Rates of E‐cigarette and Cannabis Use across US States. Addiction. doi:10.1111/add.15235  
*Citation: Friedman, A. S. (2020). Association of Vaping‐related Lung Injuries with Rates of E‐cigarette and Cannabis Use across US States. Addiction. doi:10.1111/add.15235  
*Acknowledgement: Research reported in this publication was supported by grant number 3U54DA036151‐08S2 from the National Institute On Drug Abuse of the National Institutes of Health and FDA Center for Tobacco Products (CTP).


===2020: [https://www.sciencedirect.com/science/article/pii/S2352853220300134 The impact of a comprehensive tobacco product flavor ban in San Francisco among young adults]=== <!--T:49-->


===2020: [https://www.sciencedirect.com/science/article/pii/S2352853220300134 The impact of a comprehensive tobacco product flavor ban in San Francisco among young adults]===
<!--T:50-->
*Among the 18–24 age group, there was a significant increase in cigarette smoking.
*Among the 18–24 age group, there was a significant increase in cigarette smoking.
*Cigarette smoking increased among 25–34 years old.
*Cigarette smoking increased among 25–34 years old.
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*[https://sci-hub.st/10.1016/j.abrep.2020.100273 PDF Version]
*[https://sci-hub.st/10.1016/j.abrep.2020.100273 PDF Version]
*Citation: Yang, Y., Lindblom, E. N., Salloum, R. G., & Ward, K. D. (2020). The impact of a comprehensive tobacco product flavor ban in San Francisco among young adults. Addictive Behaviors Reports, 11, 100273. doi:10.1016/j.abrep.2020.100273  
*Citation: Yang, Y., Lindblom, E. N., Salloum, R. G., & Ward, K. D. (2020). The impact of a comprehensive tobacco product flavor ban in San Francisco among young adults. Addictive Behaviors Reports, 11, 100273. doi:10.1016/j.abrep.2020.100273  
*Acknowledgement: This research was supported by the National Institute of Drug Abuse of the National Institutes of Health (R03DA048460).


===2020: Article: [https://www.realclearpolicy.com/articles/2020/10/01/yale_study_on_lung_disease_forecasts_dire_consequences_for_flavor_bans_579308.html Yale Study on Lung Disease Forecasts Dire Consequences for Flavor Bans]=== <!--T:51-->


===2020: Article: [https://www.realclearpolicy.com/articles/2020/10/01/yale_study_on_lung_disease_forecasts_dire_consequences_for_flavor_bans_579308.html Yale Study on Lung Disease Forecasts Dire Consequences for Flavor Bans]===
<!--T:52-->
*A new study from Yale School of Public Health should serve as a warning to e-cigarette opponents and public health officials pushing e-cigarette flavor bans and restrictions around the country.
*A new study from Yale School of Public Health should serve as a warning to e-cigarette opponents and public health officials pushing e-cigarette flavor bans and restrictions around the country.
*By pushing people into the black market for flavored products, they are increasing the risk that we will see another wave of consumers sickened by unregulated, illegal goods.  
*By pushing people into the black market for flavored products, they are increasing the risk that we will see another wave of consumers sickened by unregulated, illegal goods.  
*Citation: Elizabeth Sheld, Real Clear Policy, October 01, 2020.
*Citation: Elizabeth Sheld, Real Clear Policy, October 01, 2020.


===2019:  [https://www.atsjournals.org/doi/full/10.1513/AnnalsATS.201906-472OC Changes in Flavor Preference in a Cohort of Long-Term Electronic Cigarette Users]=== <!--T:53-->


===2019:  [https://www.atsjournals.org/doi/full/10.1513/AnnalsATS.201906-472OC Changes in Flavor Preference in a Cohort of Long-Term Electronic Cigarette Users]===
<!--T:54-->
*Our results regarding anticipated reactions to FDA e-cigarette flavor regulation suggest complexities such that the benefits and risks of flavor ban need to be carefully evaluated.
*Our results regarding anticipated reactions to FDA e-cigarette flavor regulation suggest complexities such that the benefits and risks of flavor ban need to be carefully evaluated.
*'''A majority anticipated that they would personally attempt to circumvent potential FDA regulations of e-cigarettes by obtaining e-cigarette flavors from various illicit sources''' (e.g., Internet orders from foreign countries) or even self-making flavors.
*'''A majority anticipated that they would personally attempt to circumvent potential FDA regulations of e-cigarettes by obtaining e-cigarette flavors from various illicit sources''' (e.g., Internet orders from foreign countries) or even self-making flavors.
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*[https://www.atsjournals.org/doi/pdf/10.1513/AnnalsATS.201906-472OC PDF Version]
*[https://www.atsjournals.org/doi/pdf/10.1513/AnnalsATS.201906-472OC PDF Version]
*Citation: Ann Am Thorac Soc Vol 17, No 5, pp 573–581, May 2020, Copyright © 2020 by the American Thoracic Society, DOI: 10.1513/AnnalsATS.201906-472OC
*Citation: Ann Am Thorac Soc Vol 17, No 5, pp 573–581, May 2020, Copyright © 2020 by the American Thoracic Society, DOI: 10.1513/AnnalsATS.201906-472OC
*Acknowledgement: Supported by the National Institute on Drug Abuse of the National Institutes of Health (NIH) and the Center for Tobacco Products of the U.S. Food and Drug Administration (FDA) (P50-DA-036107) for the Penn State Tobacco Center of Regulatory Science.


===2019: Article: [https://www.detroitnews.com/story/opinion/2019/09/16/opinion-vape-flavor-ban-doesnt-help-kids-hurts-adults/2291817001/ Vape flavor ban doesn't help kids, hurts adults]=== <!--T:55-->


===2019: Article: [https://www.detroitnews.com/story/opinion/2019/09/16/opinion-vape-flavor-ban-doesnt-help-kids-hurts-adults/2291817001/ Vape flavor ban doesn't help kids, hurts adults]===
<!--T:56-->
*Tobacco users who switch from combustible cigarettes to e-cigarettes experience various improvements in health.
*Tobacco users who switch from combustible cigarettes to e-cigarettes experience various improvements in health.
*Using e-cigarettes also helps people quit smoking altogether, with twice the success rate of other quit methods.  
*Using e-cigarettes also helps people quit smoking altogether, with twice the success rate of other quit methods.  
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*Citation: Jesse Kelly & Carrie Wade, September 15, 2019, The Detroit News
*Citation: Jesse Kelly & Carrie Wade, September 15, 2019, The Detroit News


===2019: Article: [https://www.wwlp.com/news/state-politics/flavor-ban-will-feed-illegal-tobacco-sales-stores-say/ Flavor ban will feed illegal tobacco sales, stores say]=== <!--T:57-->


===2019: Article: [https://www.wwlp.com/news/state-politics/flavor-ban-will-feed-illegal-tobacco-sales-stores-say/ Flavor ban will feed illegal tobacco sales, stores say]===
<!--T:58-->
*A retired federal law enforcement officer cautioned against banning flavors.
*A retired federal law enforcement officer cautioned against banning flavors.
*“If this bill passes and we bring in prohibition, we’re going to bring crime into the city,” Marianos, who is now an adjunct faculty member at Georgetown University, said. “We’re going to replace store owners and manufacturers with people selling out of backpacks, people selling out of cars, and worst of all, people selling directly to the children we’re trying to protect.”
*“If this bill passes and we bring in prohibition, we’re going to bring crime into the city,” Marianos, who is now an adjunct faculty member at Georgetown University, said. “We’re going to replace store owners and manufacturers with people selling out of backpacks, people selling out of cars, and worst of all, people selling directly to the children we’re trying to protect.”
*Citation: Colin Young, November 04, 2019, 22 News WWLP
*Citation: Colin Young, November 04, 2019, 22 News WWLP


===2019: Article: [https://www.sun-sentinel.com/opinion/commentary/fl-op-com-minton-e-cigarette-ban-ineffective-dangerous-20190923-svobcmjbdjeptduwlqdx6blcii-story.html E-cigarette flavor ban — ineffective and dangerous]=== <!--T:59-->


===2019: Article: [https://www.sun-sentinel.com/opinion/commentary/fl-op-com-minton-e-cigarette-ban-ineffective-dangerous-20190923-svobcmjbdjeptduwlqdx6blcii-story.html E-cigarette flavor ban — ineffective and dangerous]===
<!--T:60-->
*Bans don’t work. Bans never work. All bans do is push consumers to make different, usually more risky, choices. In this case, the likely outcome of banning e-liquid flavors people want is that they will seek to obtain them through the black market or simply return to smoking cigarettes. As a result, many more will die of smoking-related diseases or tainted products.
*Bans don’t work. Bans never work. All bans do is push consumers to make different, usually more risky, choices. In this case, the likely outcome of banning e-liquid flavors people want is that they will seek to obtain them through the black market or simply return to smoking cigarettes. As a result, many more will die of smoking-related diseases or tainted products.
*The wide array of flavors, produced by thousands of vapor companies around the country — most of them small — appear to be critical in persuading smokers to try vaping and preventing e-cigarette users from returning to their deadly combustible cigarette habit.
*The wide array of flavors, produced by thousands of vapor companies around the country — most of them small — appear to be critical in persuading smokers to try vaping and preventing e-cigarette users from returning to their deadly combustible cigarette habit.
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*Citation: Michelle Minton, September 23, 2019, South Florida Sun Sentinel
*Citation: Michelle Minton, September 23, 2019, South Florida Sun Sentinel


===2019: Article: [https://www.kqed.org/science/1950849/vapers-turn-to-home-brew-as-flavored-nicotine-bans-mount Vapers Turn to Home Brew as Flavored Nicotine Bans Mount]=== <!--T:61-->


===2019: Article: [https://www.kqed.org/science/1950849/vapers-turn-to-home-brew-as-flavored-nicotine-bans-mount Vapers Turn to Home Brew as Flavored Nicotine Bans Mount]===
<!--T:62-->
*“Even though I haven’t touched a cigarette in five years, the pull is always there. It’s so easy to go and buy a pack. And I don’t want to do that,” Danielle Jones said. “The only route I can see going forward if there is a ban is to try to create the product myself at home.”
*“Even though I haven’t touched a cigarette in five years, the pull is always there. It’s so easy to go and buy a pack. And I don’t want to do that,” Danielle Jones said. “The only route I can see going forward if there is a ban is to try to create the product myself at home.”
*As more states, cities and even the federal government consider banning flavored nicotine, thousands of do-it-yourself vapers like Jones are flocking to social media groups and websites to learn how to make e-liquids at home.
*As more states, cities and even the federal government consider banning flavored nicotine, thousands of do-it-yourself vapers like Jones are flocking to social media groups and websites to learn how to make e-liquids at home.
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*Citation: Jenny Gold, November 12, 2019, Kaiser Health News KQED
*Citation: Jenny Gold, November 12, 2019, Kaiser Health News KQED


===2019: Article: [https://www.theatlantic.com/ideas/archive/2019/10/danger-vaping-bans/600451/ The Vaping Overreaction Politicians who ban flavors should brace for a surge in cigarette smoking and the use of questionable bootleg vaping products.]=== <!--T:63-->


===2019: Article: [https://www.theatlantic.com/ideas/archive/2019/10/danger-vaping-bans/600451/ The Vaping Overreaction Politicians who ban flavors should brace for a surge in cigarette smoking and the use of questionable bootleg vaping products.]===
<!--T:64-->
*The ethos of vaping is relative risk. E-cigarettes reduce harm, but can’t be called harmless. As a safer alternative than smoking for people addicted to nicotine, they are analogous to prescribing methadone for people addicted to opioids, a strategy called harm reduction. Other kinds of harm reduction, such as giving clean needles to injection-drug users and distributing condoms, pre-exposure prophylactic medication, and safe-sex information for populations at risk for HIV/AIDS, are widely endorsed by the public-health establishment.  
*The ethos of vaping is relative risk. E-cigarettes reduce harm, but can’t be called harmless. As a safer alternative than smoking for people addicted to nicotine, they are analogous to prescribing methadone for people addicted to opioids, a strategy called harm reduction. Other kinds of harm reduction, such as giving clean needles to injection-drug users and distributing condoms, pre-exposure prophylactic medication, and safe-sex information for populations at risk for HIV/AIDS, are widely endorsed by the public-health establishment.  
*In light of history, public-health advocates’ skepticism about e-cigarettes, at least when they first appeared, was understandable. But genuine advances really can occur, and the evidence suggests that the shift from smoking to vaping should be celebrated, not decried.
*In light of history, public-health advocates’ skepticism about e-cigarettes, at least when they first appeared, was understandable. But genuine advances really can occur, and the evidence suggests that the shift from smoking to vaping should be celebrated, not decried.
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*Unfortunately, the misconceptions surrounding vaping may be too well entrenched. A Kaiser poll conducted this month revealed that 49 percent of respondents support banning all e-cigarettes, not just flavored ones. That would be a deadly mistake. “If we lose this opportunity,” David S. Abrams, a professor at the New York University College of Global Public Health, told CBS Morning News last month, “we will have blown the single biggest public-health opportunity ever to get rid of cigarettes and replace them with a much safer form of nicotine for everybody.” With 35 million Americans still smoking, the stakes are high.
*Unfortunately, the misconceptions surrounding vaping may be too well entrenched. A Kaiser poll conducted this month revealed that 49 percent of respondents support banning all e-cigarettes, not just flavored ones. That would be a deadly mistake. “If we lose this opportunity,” David S. Abrams, a professor at the New York University College of Global Public Health, told CBS Morning News last month, “we will have blown the single biggest public-health opportunity ever to get rid of cigarettes and replace them with a much safer form of nicotine for everybody.” With 35 million Americans still smoking, the stakes are high.


===2019: [https://www.tandfonline.com/doi/abs/10.1080/10826084.2019.1626435?journalCode=isum20 Young adult dual combusted cigarette and e-cigarette users’ anticipated responses to hypothetical e-cigarette market restrictions]=== <!--T:65-->


===2019: [https://www.tandfonline.com/doi/abs/10.1080/10826084.2019.1626435?journalCode=isum20 Young adult dual combusted cigarette and e-cigarette users’ anticipated responses to hypothetical e-cigarette market restrictions]===
<!--T:66-->
*Hypothetical regulations resulted in reported intentions to reduce EC (e-cigarette) use and increase CC (combustible cigarette) use; the greatest impact was found for restrictions regarding e-liquid nicotine content, followed by flavor
*Hypothetical regulations resulted in reported intentions to reduce EC (e-cigarette) use and increase CC (combustible cigarette) use; the greatest impact was found for restrictions regarding e-liquid nicotine content, followed by flavor
*This work provides preliminary evidence that restrictive regulations regarding key EC characteristics may increase intentions to increase CC use among young adult dual EC and CC users.
*This work provides preliminary evidence that restrictive regulations regarding key EC characteristics may increase intentions to increase CC use among young adult dual EC and CC users.
*[https://sci-hub.se/10.1080/10826084.2019.1626435 PDF Version]
*[https://sci-hub.se/10.1080/10826084.2019.1626435 PDF Version]
*Citation:: Lauren R. Pacek, Olga Rass, Maggie M. Sweitzer, Jason A. Oliver & F. Joseph McClernon (2019): Young adult dual combusted cigarette and e-cigarette users’ anticipated responses to hypothetical e-cigarette market restrictions, Substance Use & Misuse, DOI:10.1080/10826084.2019.1626435
*Citation:: Lauren R. Pacek, Olga Rass, Maggie M. Sweitzer, Jason A. Oliver & F. Joseph McClernon (2019): Young adult dual combusted cigarette and e-cigarette users’ anticipated responses to hypothetical e-cigarette market restrictions, Substance Use & Misuse, DOI:10.1080/10826084.2019.1626435
*Acklnowledgement: This work was supported by the National Institutes of Health (K01DA043413, K23DA039294, and K23DA042898). The funding source had no other role other than financial support.


===2018: [https://www.regulations.gov/document?D=FDA-2017-N-6565-22941 Patterns of flavored e-cigarette use among adults vapers in the United States: an internet survey]=== <!--T:67-->


===2018: [https://www.regulations.gov/document?D=FDA-2017-N-6565-22941 Patterns of flavored e-cigarette use among adults vapers in the United States: an internet survey]===
<!--T:68-->
*Survey results submitted to the FDA
*Survey results submitted to the FDA
*In conclusion, this cross-sectional study of a very large sample of adult US e-cigarette users, most of which were former smokers, identified the importance of non-tobacco flavors in e-cigarette use initiation and sustained use, and their contribution to smoking cessation and relapse prevention. *'''This information should be considered by regulators in order to avoid unintentional adverse effects of over-restrictive regulation on e-cigarette flavors'''.
*In conclusion, this cross-sectional study of a very large sample of adult US e-cigarette users, most of which were former smokers, identified the importance of non-tobacco flavors in e-cigarette use initiation and sustained use, and their contribution to smoking cessation and relapse prevention. *'''This information should be considered by regulators in order to avoid unintentional adverse effects of over-restrictive regulation on e-cigarette flavors'''.
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*Citation: Konstantinos Farsalinos, MD, MPH, Christopher Russell, PhD, George Lagoumintzis, PhD, Konstantinos Poulas, Submitted to: Docket No. FDA-2017 N-6565 for “Regulation of Flavors in Tobacco Products.”
*Citation: Konstantinos Farsalinos, MD, MPH, Christopher Russell, PhD, George Lagoumintzis, PhD, Konstantinos Poulas, Submitted to: Docket No. FDA-2017 N-6565 for “Regulation of Flavors in Tobacco Products.”


===2018: [https://tobaccocontrol.bmj.com/content/28/2/168 Should flavours be banned in cigarettes and e-cigarettes? Evidence on adult smokers and recent quitters from a discrete choice experiment]=== <!--T:69-->


===2018: [https://tobaccocontrol.bmj.com/content/28/2/168 Should flavours be banned in cigarettes and e-cigarettes? Evidence on adult smokers and recent quitters from a discrete choice experiment]===
<!--T:70-->
*'''A ban on flavoured e-cigarettes would likely increase the choice of cigarettes in smokers, the more harmful way of obtaining nicotine.'''
*A ban on flavoured e-cigarettes would likely increase the choice of cigarettes in smokers, the more harmful way of obtaining nicotine.
*[https://tobaccocontrol.bmj.com/content/tobaccocontrol/28/2/168.full.pdf PDF Version]
*[https://tobaccocontrol.bmj.com/content/tobaccocontrol/28/2/168.full.pdf PDF Version]
*Citation:Buckell J, Marti J, Sindelar JLShould flavours be banned in cigarettes and e-cigarettes? Evidence on adult smokers and recent quitters from a discrete choice experimentTobacco Control 2019;28:168-175.
*Citation:Buckell J, Marti J, Sindelar JLShould flavours be banned in cigarettes and e-cigarettes? Evidence on adult smokers and recent quitters from a discrete choice experimentTobacco Control 2019;28:168-175.
*Acknowledgement: Research reported in this publication was supported by grant number P50DA036151 from the National Institute on Drug Abuse (NIDA) and FDA Center for Tobacco Products (CTP).


=Relapse Prevention or Long Term Abstinence=
=Relapse Prevention or Long Term Abstinence= <!--T:71-->


===2020: [https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-020-00418-8 Reported patterns of vaping to support long-term abstinence from smoking: a cross-sectional survey of a convenience sample of vapers]=== <!--T:72-->


===2020: [https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-020-00418-8 Reported patterns of vaping to support long-term abstinence from smoking: a cross-sectional survey of a convenience sample of vapers]===
<!--T:73-->
*Qualitative research suggests e-cigarettes can meet many of the needs of ex-smokers by substituting physical, psychological, social, cultural and identity-related aspects of tobacco addiction.  
*Qualitative research suggests e-cigarettes can meet many of the needs of ex-smokers by substituting physical, psychological, social, cultural and identity-related aspects of tobacco addiction.  
*According to a time-series analysis of data from the Smoking Toolkit study, in which repeated cross-sectional surveys are conducted with a representative sample of households in England, increasing prevalence of e-cigarette use in current smokers was predictive of higher success rates of quit attempts.
*According to a time-series analysis of data from the Smoking Toolkit study, in which repeated cross-sectional surveys are conducted with a representative sample of households in England, increasing prevalence of e-cigarette use in current smokers was predictive of higher success rates of quit attempts.
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*[https://sci-hub.st/10.1186/s12954-020-00418-8# PDF Version]
*[https://sci-hub.st/10.1186/s12954-020-00418-8# PDF Version]
*Citation: Gentry, S.V., Ward, E., Dawkins, L. et al. Reported patterns of vaping to support long-term abstinence from smoking: a cross-sectional survey of a convenience sample of vapers. Harm Reduct J 17, 70 (2020). doi:10.1186/s12954-020-00418-8
*Citation: Gentry, S.V., Ward, E., Dawkins, L. et al. Reported patterns of vaping to support long-term abstinence from smoking: a cross-sectional survey of a convenience sample of vapers. Harm Reduct J 17, 70 (2020). doi:10.1186/s12954-020-00418-8
*Acknowledgement: This research was funded by Cancer Research UK (CRUK), Grant Number C54889/A22732.


===2019: Article: [https://www.insidesources.com/e-cigarette-flavor-bans-will-drive-more-people-back-to-smoking/ E-Cigarette Flavor Bans Will Drive More People Back to Smoking]=== <!--T:74-->


===2019: Article: [https://www.insidesources.com/e-cigarette-flavor-bans-will-drive-more-people-back-to-smoking/ E-Cigarette Flavor Bans Will Drive More People Back to Smoking]===
<!--T:75-->
*These laws will result in thousands of ex-smokers returning to cigarette smoking because the e-cigarettes they rely upon are taken off the shelves, while tobacco cigarettes remain. The absurdity of these proposals is that they restrict the sale of e-cigarettes more severely than the sale of actual cigarettes, the ones that are killing more than 400,000 Americans each year. Why would regulators want to give a competitive advantage to cigarettes over the much safer alternative?
*These laws will result in thousands of ex-smokers returning to cigarette smoking because the e-cigarettes they rely upon are taken off the shelves, while tobacco cigarettes remain. The absurdity of these proposals is that they restrict the sale of e-cigarettes more severely than the sale of actual cigarettes, the ones that are killing more than 400,000 Americans each year. Why would regulators want to give a competitive advantage to cigarettes over the much safer alternative?
*By creating barriers to a much healthier product, these laws will simply force former smokers to return to cigarette smoking. Lawmakers are doing a huge favor not for the public’s health, but for Marlboro, which is going to see a windfall in the ex-smoker market as all of its competition from vaping products is eliminated.
*By creating barriers to a much healthier product, these laws will simply force former smokers to return to cigarette smoking. Lawmakers are doing a huge favor not for the public’s health, but for Marlboro, which is going to see a windfall in the ex-smoker market as all of its competition from vaping products is eliminated.
*Citation: Michael Siegel, February 19, 2019, Inside Sources
*Citation: Michael Siegel, February 19, 2019, Inside Sources


=Smoking Cessation= <!--T:76-->


===2021: [https://academic.oup.com/ntr/article-abstract/23/9/1490/6149939 How Does the Use of Flavored Nicotine Vaping Products Relate to Progression Toward Quitting Smoking? Findings From the 2016 and 2018 ITC 4CV Surveys]=== <!--T:77-->


=Smoking Cessation=
<!--T:78-->
 
 
===2021: [https://academic.oup.com/ntr/article-abstract/23/9/1490/6149939 How Does the Use of Flavored Nicotine Vaping Products Relate to Progression Toward Quitting Smoking? Findings From the 2016 and 2018 ITC 4CV Surveys]===
*Use of fruit and other sweet flavored e-liquids is positively related to smokers’ transition away from cigarettes.
*Use of fruit and other sweet flavored e-liquids is positively related to smokers’ transition away from cigarettes.
*Citation: Lin Li, PhD, Ron Borland, PhD, Kenneth Michael Cummings, PhD, Geoffrey T Fong, PhD, Shannon Gravely, PhD, Danielle M Smith, MPH, Maciej L Goniewicz, PhD, Richard J O’Connor, PhD, Mary E Thompson, PhD, Ann McNeill, PhD, How Does the Use of Flavored Nicotine Vaping Products Relate to Progression Toward Quitting Smoking? Findings From the 2016 and 2018 ITC 4CV Surveys, Nicotine & Tobacco Research, Volume 23, Issue 9, September 2021, Pages 1490–1497, doi: 10.1093/ntr/ntab033
*Citation: Lin Li, PhD, Ron Borland, PhD, Kenneth Michael Cummings, PhD, Geoffrey T Fong, PhD, Shannon Gravely, PhD, Danielle M Smith, MPH, Maciej L Goniewicz, PhD, Richard J O’Connor, PhD, Mary E Thompson, PhD, Ann McNeill, PhD, How Does the Use of Flavored Nicotine Vaping Products Relate to Progression Toward Quitting Smoking? Findings From the 2016 and 2018 ITC 4CV Surveys, Nicotine & Tobacco Research, Volume 23, Issue 9, September 2021, Pages 1490–1497, doi: 10.1093/ntr/ntab033


===2020: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7275248/ Associations of Flavored e-Cigarette Uptake With Subsequent Smoking Initiation and Cessation]=== <!--T:79-->


===2020: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7275248/ Associations of Flavored e-Cigarette Uptake With Subsequent Smoking Initiation and Cessation]===
<!--T:80-->
*'''Adults who began vaping nontobacco-flavored e-cigarettes were more likely to quit smoking than those who vaped tobacco flavors'''.
*'''Adults who began vaping nontobacco-flavored e-cigarettes were more likely to quit smoking than those who vaped tobacco flavors'''.
*Banning flavors altogether may be too blunt an instrument for the current problem (youth use of vapor products).
*Banning flavors altogether may be too blunt an instrument for the current problem (youth use of vapor products).
*[https://sci-hub.st/10.1001/jamanetworkopen.2020.3826# PDF Version]
*[https://sci-hub.st/10.1001/jamanetworkopen.2020.3826# PDF Version]
*Citation: Friedman, A. S., & Xu, S. (2020). Associations of Flavored e-Cigarette Uptake With Subsequent Smoking Initiation and Cessation. JAMA Network Open, 3(6), e203826. doi:10.1001/jamanetworkopen.2020.3826  
*Citation: Friedman, A. S., & Xu, S. (2020). Associations of Flavored e-Cigarette Uptake With Subsequent Smoking Initiation and Cessation. JAMA Network Open, 3(6), e203826. doi:10.1001/jamanetworkopen.2020.3826  
*Acknowledgment: : Ms Xu was supported by a T32 National Research Service Award from the Agency for Healthcare Research and Quality (HS017589).


===2019: [https://www.sciencedirect.com/science/article/abs/pii/S0306460318311821 The role of flavors in vaping initiation and satisfaction among U.S. adults]=== <!--T:81-->


===2019: [https://www.sciencedirect.com/science/article/abs/pii/S0306460318311821 The role of flavors in vaping initiation and satisfaction among U.S. adults]===
<!--T:82-->
*Most common reasons for vaping initiation were as an alternative to cigarettes (43.7%) and because respondents viewed e-cigarettes as less harmful than other tobacco products (31.2%). Flavor was the third most commonly reported reason.
*Most common reasons for vaping initiation were as an alternative to cigarettes (43.7%) and because respondents viewed e-cigarettes as less harmful than other tobacco products (31.2%). Flavor was the third most commonly reported reason.
*'''Satisfaction among those who bought flavored e-liquid was higher than those who did not buy flavored e-liquid'''.
*'''Satisfaction among those who bought flavored e-liquid was higher than those who did not buy flavored e-liquid'''.
*[https://sci-hub.st/10.1016/j.addbeh.2019.106077# PDF Version]
*[https://sci-hub.st/10.1016/j.addbeh.2019.106077# PDF Version]
*Citation: Landry, R. L., Groom, A. L., Vu, T.-H. T., Stokes, A. C., Berry, K. M., Kesh, A., … Payne, T. J. (2019). The role of flavors in vaping initiation and satisfaction among U.S. adults. Addictive Behaviors, 106077. doi:10.1016/j.addbeh.2019.106077  
*Citation: Landry, R. L., Groom, A. L., Vu, T.-H. T., Stokes, A. C., Berry, K. M., Kesh, A., … Payne, T. J. (2019). The role of flavors in vaping initiation and satisfaction among U.S. adults. Addictive Behaviors, 106077. doi:10.1016/j.addbeh.2019.106077  
*This research was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) and the FDA Center for Tobacco Products (CTP) under Awards P50HL120163 and U54HL120163.


===2019: [https://pubmed.ncbi.nlm.nih.gov/31477072/ Vaping patterns, nicotine dependence and reasons for vaping among American Indian dual users of cigarettes and electronic cigarettes]=== <!--T:83-->


===2019: [https://pubmed.ncbi.nlm.nih.gov/31477072/ Vaping patterns, nicotine dependence and reasons for vaping among American Indian dual users of cigarettes and electronic cigarettes]===
<!--T:84-->
*The ten-item Penn State Dependence Index (PSDI) suggested greater dependence on smoking than vaping
*The ten-item Penn State Dependence Index (PSDI) suggested greater dependence on smoking than vaping
*'''The most common reasons for vaping were to reduce smoking (79%)''', enjoyment of flavors (78%), and ability to vape where smoking is not allowed (73%). Perceptions of less harm to others (69%) or to self were the next most common (65%). Fewer than half used ECs to reduce stress, for affordability, or because others used them.
*'''The most common reasons for vaping were to reduce smoking (79%)''', enjoyment of flavors (78%), and ability to vape where smoking is not allowed (73%). Perceptions of less harm to others (69%) or to self were the next most common (65%). Fewer than half used ECs to reduce stress, for affordability, or because others used them.
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6721166/pdf/12889_2019_Article_7523.pdf PDF Version]
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6721166/pdf/12889_2019_Article_7523.pdf PDF Version]
*Citation: Rhoades DA, Comiford AL, Dvorak JD, Ding K, Hopkins M, Spicer P, Wagener TL, Doescher MP. Vaping patterns, nicotine dependence and reasons for vaping among American Indian dual users of cigarettes and electronic cigarettes. BMC Public Health. 2019 Sep 2;19(1):1211. doi: 10.1186/s12889-019-7523-5. PMID: 31477072; PMCID: PMC6721166.
*Citation: Rhoades DA, Comiford AL, Dvorak JD, Ding K, Hopkins M, Spicer P, Wagener TL, Doescher MP. Vaping patterns, nicotine dependence and reasons for vaping among American Indian dual users of cigarettes and electronic cigarettes. BMC Public Health. 2019 Sep 2;19(1):1211. doi: 10.1186/s12889-019-7523-5. PMID: 31477072; PMCID: PMC6721166.
*Acknowledgement: Grants from the National Cancer Institute of the National Institutes of Health (P20CA202921 to University of Oklahoma, and 5P20CA202923 to Cherokee Nation) supported this study.


===2019: [https://www.youtube.com/watch?v=WqTdqLZQUCo Video: Can Flavors Help People Who Smoke Quit Smoking?]=== <!--T:85-->


===2019: [https://www.youtube.com/watch?v=WqTdqLZQUCo Video: Can Flavors Help People Who Smoke Quit Smoking?]===
<!--T:86-->
*Minnesota Smoke-Free Alliance
*Minnesota Smoke-Free Alliance
*Do flavors help adults quit smoking? Is there "right" flavored products and "wrong" flavored products? Do we have the right to tell people they have to quit smoking using a method we approve of? (English)
*Do flavors help adults quit smoking? Is there "right" flavored products and "wrong" flavored products? Do we have the right to tell people they have to quit smoking using a method we approve of? (English)


===2019: Article: [https://docs.google.com/document/d/18yNyRhNe0liQ_uP3tSEcaLV9JB-gLyMEnCuE8aLBtPc/edit?usp=sharing Flavors make vaping more palatable, help cigarette smokers kick the habit]=== <!--T:87-->


===2019: Article: [https://docs.google.com/document/d/18yNyRhNe0liQ_uP3tSEcaLV9JB-gLyMEnCuE8aLBtPc/edit?usp=sharing Flavors make vaping more palatable, help cigarette smokers kick the habit]===
<!--T:88-->
*Flavored e-cigarettes were not invented by “Big Tobacco,” nor are they an unscrupulous marketing plot from the thousands of small, independently owned vape companies in the United States to addict kids. Non-tobacco vape flavors are a user innovation.
*Flavored e-cigarettes were not invented by “Big Tobacco,” nor are they an unscrupulous marketing plot from the thousands of small, independently owned vape companies in the United States to addict kids. Non-tobacco vape flavors are a user innovation.
*Fruit, candy, bakery, mint, and beverage flavors were introduced to vaping in 2008 by pioneering users of the technology who were desperate to use e-cigarettes to replace smoking.
*Fruit, candy, bakery, mint, and beverage flavors were introduced to vaping in 2008 by pioneering users of the technology who were desperate to use e-cigarettes to replace smoking.
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*Citation: Amelia Howard, September 21, 2019, Pro/Con: As vaping-related illnesses rise, should flavored e-cigarettes be banned?, The Philadelphia Enquirer
*Citation: Amelia Howard, September 21, 2019, Pro/Con: As vaping-related illnesses rise, should flavored e-cigarettes be banned?, The Philadelphia Enquirer


===2019: Article: [https://web.archive.org/web/20191129093506/https://www.chieftain.com/opinion/20191128/banning-flavored-e-cigarettes-has-consequences Banning flavored e-cigarettes has consequences]=== <!--T:89-->


===2019: Article: [https://www.chieftain.com/opinion/20191128/banning-flavored-e-cigarettes-has-consequences Banning flavored e-cigarettes has consequences]===
<!--T:90-->
*Instead of clamping down on teen vaping or socking it to Juul, a total vape flavor ban would shut down more than 14,000 small businesses and put at least 166,000 people out of work, while denying millions of Americans access to the tools they used to quit smoking.
*Instead of clamping down on teen vaping or socking it to Juul, a total vape flavor ban would shut down more than 14,000 small businesses and put at least 166,000 people out of work, while denying millions of Americans access to the tools they used to quit smoking.
*E-cigarettes are known to be at least 95 percent safer than combustible cigarettes. If every smoker in America switched to vaping, as many as 6.6 million lives could be saved over the next decade.
*E-cigarettes are known to be at least 95 percent safer than combustible cigarettes. If every smoker in America switched to vaping, as many as 6.6 million lives could be saved over the next decade.
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*Citation: Guy Bentley, November 28, 2019, The Pueblo Chieftain
*Citation: Guy Bentley, November 28, 2019, The Pueblo Chieftain


===2018: [https://academic.oup.com/ntr/article-abstract/20/8/977/4061315?redirectedFrom=fulltext Advice From Former-Smoking E-Cigarette Users to Current Smokers on How to Use E-Cigarettes as Part of an Attempt to Quit Smoking]=== <!--T:91-->


===2018: [https://academic.oup.com/ntr/article-abstract/20/8/977/4061315?redirectedFrom=fulltext Advice From Former-Smoking E-Cigarette Users to Current Smokers on How to Use E-Cigarettes as Part of an Attempt to Quit Smoking]===
<!--T:92-->
*This study describes the advice that former-smokers who used e-cigarettes to quit smoking would offer to smokers who are considering using an e-cigarette to support an attempt to quit smoking. '''Vapers advised smokers to find the right combination of device, flavors and nicotine strength''', continue to smoke and vape for a while if they wished, not be deterred by past failed attempts to quit smoking, and expect health to improve after they have switched to vaping. Encouraging smokers to interact with vaping peers in vape shops and in online vaping-dedicated discussion forums may help significantly more smokers switch to vaping.
*This study describes the advice that former-smokers who used e-cigarettes to quit smoking would offer to smokers who are considering using an e-cigarette to support an attempt to quit smoking. '''Vapers advised smokers to find the right combination of device, flavors and nicotine strength''', continue to smoke and vape for a while if they wished, not be deterred by past failed attempts to quit smoking, and expect health to improve after they have switched to vaping. Encouraging smokers to interact with vaping peers in vape shops and in online vaping-dedicated discussion forums may help significantly more smokers switch to vaping.
*[https://sci-hub.do/10.1093/ntr/ntx176# PDF Version]
*[https://sci-hub.do/10.1093/ntr/ntx176# PDF Version]
*Citation: Christopher Russell, PhD, Tiffany Dickson, MSc, Neil McKeganey, PhD, Advice From Former-Smoking E-Cigarette Users to Current Smokers on How to Use E-Cigarettes as Part of an Attempt to Quit Smoking, Nicotine & Tobacco Research, Volume 20, Issue 8, August 2018, Pages 977–984, doi: 10.1093/ntr/ntx176
*Citation: Christopher Russell, PhD, Tiffany Dickson, MSc, Neil McKeganey, PhD, Advice From Former-Smoking E-Cigarette Users to Current Smokers on How to Use E-Cigarettes as Part of an Attempt to Quit Smoking, Nicotine & Tobacco Research, Volume 20, Issue 8, August 2018, Pages 977–984, doi: 10.1093/ntr/ntx176
*Acknowledgement: Funding for this study was provided by Nicoventures.


===2018: [https://bmjopen.bmj.com/content/8/3/e018329.full Motivation and main flavour of use, use with nicotine and dual use of electronic cigarettes in Barcelona, Spain: a cross-sectional study ]===
*The most prevalent motivation for using e-cigarettes was to reduce tobacco smoking 48%, followed by quitting smoking 39.2%, and to use e-cigarettes in places where tobacco smoking was prohibited 10.2%.
*Citation: Bunch K, Fu M, Ballbè M, et alMotivation and main flavour of use, use with nicotine and dual use of electronic cigarettes in Barcelona, Spain: a cross-sectional studyBMJ Open 2018;8:e018329. doi: 10.1136/bmjopen-2017-018329
===2017: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5800112/ Differences between Dual Users and Switchers Center around Vaping Behavior and Its Experiences Rather than Beliefs and Attitudes]=== <!--T:93-->


===2017: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5800112/ Differences between Dual Users and Switchers Center around Vaping Behavior and Its Experiences Rather than Beliefs and Attitudes]===
<!--T:94-->
*To the extent that dual users substantially lower the number of cigarettes, they will reduce health risks from smoking. However, from a medical point of view, exclusive vaping is preferable to dual use;
*To the extent that dual users substantially lower the number of cigarettes, they will reduce health risks from smoking. However, from a medical point of view, exclusive vaping is preferable to dual use;
*Differences between dual users and switchers center around variables proximal to the vaping behavior and its experienced effects rather than hinging on more general vaping-related beliefs and attitudes.
*Differences between dual users and switchers center around variables proximal to the vaping behavior and its experienced effects rather than hinging on more general vaping-related beliefs and attitudes.
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*Citation: Adriaens K, Van Gucht D, Baeyens F. Differences between Dual Users and Switchers Center around Vaping Behavior and Its Experiences Rather than Beliefs and Attitudes. Int J Environ Res Public Health. 2017 Dec 23;15(1):12. doi: 10.3390/ijerph15010012. PMID: 29295483; PMCID: PMC5800112.
*Citation: Adriaens K, Van Gucht D, Baeyens F. Differences between Dual Users and Switchers Center around Vaping Behavior and Its Experiences Rather than Beliefs and Attitudes. Int J Environ Res Public Health. 2017 Dec 23;15(1):12. doi: 10.3390/ijerph15010012. PMID: 29295483; PMCID: PMC5800112.


===2015: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4808473/ Preferred Flavors and Reasons for E-cigarette Use and Discontinued Use Among Never, Current, and Former Smokers]=== <!--T:95-->


===2015: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4808473/ Preferred Flavors and Reasons for E-cigarette Use and Discontinued Use Among Never, Current, and Former Smokers]===
<!--T:96-->
*Never users had significantly lower prevalence of use of alcohol, marijuana, and other tobacco products (take less risks).
*Never users had significantly lower prevalence of use of alcohol, marijuana, and other tobacco products (take less risks).
*The most commonly reported reasons for e-cigarette use were “they might be less harmful than cigarettes” (77%); “they don’t smell” (77%); “they help people quit smoking” (66%); and “they cost less than other forms of tobacco” (62%); these reasons were more frequently endorsed by former smokers.
*The most commonly reported reasons for e-cigarette use were “they might be less harmful than cigarettes” (77%); “they don’t smell” (77%); “they help people quit smoking” (66%); and “they cost less than other forms of tobacco” (62%); these reasons were more frequently endorsed by former smokers.
Line 340: Line 416:
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4808473/pdf/nihms739529.pdf PDF Version]
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4808473/pdf/nihms739529.pdf PDF Version]
*Citation: Berg CJ. Preferred flavors and reasons for e-cigarette use and discontinued use among never, current, and former smokers. Int J Public Health. 2016 Mar;61(2):225-36. doi: 10.1007/s00038-015-0764-x. Epub 2015 Nov 18. PMID: 26582009; PMCID: PMC4808473.
*Citation: Berg CJ. Preferred flavors and reasons for e-cigarette use and discontinued use among never, current, and former smokers. Int J Public Health. 2016 Mar;61(2):225-36. doi: 10.1007/s00038-015-0764-x. Epub 2015 Nov 18. PMID: 26582009; PMCID: PMC4808473.
*Acknowledgement: This research was supported by the National Cancer Institute (1K07CA139114-01A1; PI: Berg) and the Georgia Cancer Coalition (PI: Berg).


===2013: [https://www.mdpi.com/1660-4601/10/12/7272/htm Impact of Flavour Variability on Electronic Cigarette Use Experience: An Internet Survey]=== <!--T:97-->


===2013: [https://www.mdpi.com/1660-4601/10/12/7272/htm Impact of Flavour Variability on Electronic Cigarette Use Experience: An Internet Survey]===
<!--T:98-->
*4,618 participants were included in the analysis, with 4,515 reporting current smoking status (current vs. former smokers).
*4,618 participants were included in the analysis, with 4,515 reporting current smoking status (current vs. former smokers).
*More than 90% were former smokers. The mean age was 40 years
*More than 90% were former smokers. The mean age was 40 years
Line 351: Line 427:
*[https://sci-hub.st/10.3390/ijerph10127272# PDF Version]
*[https://sci-hub.st/10.3390/ijerph10127272# PDF Version]
*Citation: Farsalinos, K., Romagna, G., Tsiapras, D., Kyrzopoulos, S., Spyrou, A., & Voudris, V. (2013). Impact of Flavour Variability on Electronic Cigarette Use Experience: An Internet Survey. International Journal of Environmental Research and Public Health, 10(12), 7272–7282. doi:10.3390/ijerph10127272  
*Citation: Farsalinos, K., Romagna, G., Tsiapras, D., Kyrzopoulos, S., Spyrou, A., & Voudris, V. (2013). Impact of Flavour Variability on Electronic Cigarette Use Experience: An Internet Survey. International Journal of Environmental Research and Public Health, 10(12), 7272–7282. doi:10.3390/ijerph10127272  
*Acknowledgement: No funding was received for this study.


===2006: [https://nyaspubs.onlinelibrary.wiley.com/doi/abs/10.1111/j.1749-6632.2000.tb06686.x Tobacco Dependence: Global Public Health Potential for New Medications Development and Indications]=== <!--T:99-->


===2006: [https://nyaspubs.onlinelibrary.wiley.com/doi/abs/10.1111/j.1749-6632.2000.tb06686.x Tobacco Dependence: Global Public Health Potential for New Medications Development and Indications]===
<!--T:100-->
*The marketing of a mint-flavored form of nicotine gum in the United States increased the market for nicotine gum by more than 25% and contributed to increasing numbers of smokers finding a treatment that was acceptable and thereby successfully quitting smoking.  
*The marketing of a mint-flavored form of nicotine gum in the United States increased the market for nicotine gum by more than 25% and contributed to increasing numbers of smokers finding a treatment that was acceptable and thereby successfully quitting smoking.  
*There is clearly a need for increased forms of nicotine delivery, possibly including those that more closely mimic the pharmacokinetics of cigarettes.
*There is clearly a need for increased forms of nicotine delivery, possibly including those that more closely mimic the pharmacokinetics of cigarettes.
*PDF Version
*PDF Version
*Citation: HENNINGFIELD, J. E., FANT, R. V., GITCHELL, J., & SHIFFMAN, S. (2006). Tobacco Dependence: Global Public Health Potential for New Medications Development and Indications. Annals of the New York Academy of Sciences, 909(1), 247–256. doi:10.1111/j.1749-6632.2000.tb06686.x  
*Citation: HENNINGFIELD, J. E., FANT, R. V., GITCHELL, J., & SHIFFMAN, S. (2006). Tobacco Dependence: Global Public Health Potential for New Medications Development and Indications. Annals of the New York Academy of Sciences, 909(1), 247–256. doi:10.1111/j.1749-6632.2000.tb06686.x  
*Acknowledgement: Portions of this paper were adapted from a paper submitted by these authors to The Economics of Neuroscience. 37 The preparation of this paper was partially supported by unrestricted funding by SmithKline Beecham Consumer Healthcare for which the authors also provide consulting services.


=Use of Flavors (Youth to Sr. Citizens)=
=Use of Flavors (Youth to Sr. Citizens)= <!--T:101-->


===2021: [https://thr.ams3.cdn.digitaloceanspaces.com/strapi/0cbd3b34cef86dad0032528c324d2f7b.pdf THE CASE FOR FLAVOURS IN TOBACCO HARM REDUCTION, TO SAVE LIVES]===
*Unfortunately, several governments are contemplating banning flavours in ENDS, apparently to prevent youth initiation. This review argues for the responsible and regulated use of flavours, to maximise the harm reduction effect of ENDS and its role in smoking cessation.
*Report by: Konstantinos Farsalinos, MD, MPH
*[https://www.youtube.com/watch?v=BwlJVEBk1o8&t=121s Webinar]
**This webinar discussed the above flavors report and took place on 15 December 2021, and featured Dr Konstantinos Farsalinos, Dr Delon Human, Dr Kgosi Letlape, Prof Heino Stöver, and Charles A. Gardner, PhD.


===2020: [https://watermark.silverchair.com/ntaa248.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAArMwggKvBgkqhkiG9w0BBwagggKgMIICnAIBADCCApUGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMsUiST8f8L3FvTG8YAgEQgIICZovK-OLqdbWKZq6cNuR5I_O_F6n4jTn_zmdWXkUjuET2EhmXwOWOGA7cwe83Fv5fmid7AedenbSLbSVtclpW8RrIR4V7ryYBS24TsSwe81TvK8SfXkmfbkfOMIDjxP5PrWg0Jkg6TfKU4YIINWJXoztK7QQY1KQVrdL8-D0e2mZpmmhPZl7Al66TDYMEY4xHUH2YQFzA1dh_Ik5kGaeOAtFV4UCduk8XDkkkMM1ZnRBCh_osDkIQRdp8fG6zfo78xe-lsXPNXhblbQw5XpvVAofzq7KE51_5AOdtl3r32zfN4kzqiqpbXYezBO25ZzIKp-i_AMgiftBgMFXUKMhq5d_JkKt9chy346mGFWUdbNDhp0ZT8i3k1QUY8he8TNV9bW6JPhncLSYVwRjMo_qua9XafPJrK7W-hMhOv5HqLwhUHI5ygs8osaJ2ALOtDNxuwLwp4kdGBe47WnJnZ1Q3e-D3Q0D0NWOp8ZK2VkyNk-vfr3y-SvsMEkvP4TlR9_tZmRPOONSLD_3T0YzCUvPsb_NwA_nle2JG2DXz_9OfUpGJh6R_OgFPnWVfGFHHS6KepCRRFvepW0QuH_Co7MMa8kOjNh3xUqOY4Nh7Q7DksrtwNPBumBI-fymemyOpyVH3RHh96mOnLm4IETRej_Ipj9u65ybFA7PeibYj4vBHRxIWvK6qUv7pva7aWJm9krekq_Vnhh2WtNdyIt6TGjkjRH6Bkoy7_-zGdi7Nbh_wggvmjT4lRiEDVYUE0C5fLcjFlH4gLnwj6Ng-LSF-KSejsjfPQyRq2D73oZknV3nCRMw0K06X0IZC Choice and variety-seeking of e-liquids and flavour (flavor) categories by New Zealand smokers using an electronic cigarette: a longitudinal study]===
===2020: [https://pubmed.ncbi.nlm.nih.gov/33748862/ Choice and variety-seeking of e-liquids and flavour (flavor) categories by New Zealand smokers using an electronic cigarette: a longitudinal study]=== <!--T:102-->
 
<!--T:103-->
*'''Variety-seeking behaviour (behavior) was common and typically reported within the first 12 weeks of participants’ e-cigarette-assisted attempt to transition away from smoking.'''  
*'''Variety-seeking behaviour (behavior) was common and typically reported within the first 12 weeks of participants’ e-cigarette-assisted attempt to transition away from smoking.'''  
*Policies allowing diverse e-liquid flavours at specialist stores could support users’ variety-seeking and potentially create opportunities to couple e-liquid purchasing occasions with cessation advice during the first months of a transition attempt.
*Policies allowing diverse e-liquid flavours at specialist stores could support users’ variety-seeking and potentially create opportunities to couple e-liquid purchasing occasions with cessation advice during the first months of a transition attempt.
*(Link above is to the PDF version)
*Citation: Mei-Ling Blank, MPH, Janet Hoek, PhD, Choice and variety-seeking of e-liquids and flavour categories by New Zealand smokers using an electronic cigarette: a longitudinal study, Nicotine & Tobacco Research, , ntaa248, doi:10.1093/ntr/ntaa248
*Citation: Mei-Ling Blank, MPH, Janet Hoek, PhD, Choice and variety-seeking of e-liquids and flavour categories by New Zealand smokers using an electronic cigarette: a longitudinal study, Nicotine & Tobacco Research, , ntaa248, doi:10.1093/ntr/ntaa248
*Acknowledgement: Royal Society of New Zealand Marsden Fund Grant (17-UOO-129) to Janet Hoek (PI), Mei-Ling Blank (AI), Tamlin Conner (AI), Shelagh Ferguson (AI), and Lee Thompson (AI). Both authors are members of ASPIRE 2025, a research collaboration working to achieve the New Zealand Government's Smokefree 2025 goal.


===2018: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6022703/ Changing patterns of first e-cigarette flavor used and current flavors used by 20,836 adult frequent e-cigarette users in the USA]=== <!--T:104-->


===2018: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6022703/ Changing patterns of first e-cigarette flavor used and current flavors used by 20,836 adult frequent e-cigarette users in the USA]===
<!--T:105-->
*Adult frequent e-cigarette users in the USA who have completely switched from smoking cigarettes to using e-cigarettes are increasingly likely to have initiated e-cigarette use with non-tobacco flavors and to have transitioned from tobacco to non-tobacco flavors over time. '''Restricting access to non-tobacco e-cigarette flavors may discourage smokers from attempting to switch to e-cigarettes'''.
*Adult frequent e-cigarette users in the USA who have completely switched from smoking cigarettes to using e-cigarettes are increasingly likely to have initiated e-cigarette use with non-tobacco flavors and to have transitioned from tobacco to non-tobacco flavors over time. '''Restricting access to non-tobacco e-cigarette flavors may discourage smokers from attempting to switch to e-cigarettes'''.
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6022703/pdf/12954_2018_Article_238.pdf PDF Version]
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6022703/pdf/12954_2018_Article_238.pdf PDF Version]
*Citation: Russell C, McKeganey N, Dickson T, Nides M. Changing patterns of first e-cigarette flavor used and current flavors used by 20,836 adult frequent e-cigarette users in the USA. Harm Reduct J. 2018 Jun 28;15(1):33. doi: 10.1186/s12954-018-0238-6. PMID: 29954412; PMCID: PMC6022703.
*Citation: Russell C, McKeganey N, Dickson T, Nides M. Changing patterns of first e-cigarette flavor used and current flavors used by 20,836 adult frequent e-cigarette users in the USA. Harm Reduct J. 2018 Jun 28;15(1):33. doi: 10.1186/s12954-018-0238-6. PMID: 29954412; PMCID: PMC6022703.
*Acknowledgements: The authors are grateful to Julie Woessner and Alex Clark (Consumer Advocates for Smoke-free Alternatives Association), Stefan Didak and Danielle Bloss (Not Blowing Smoke), Gregory Conley (American Vaping Association), Cynthia Cabrera (Cating Group), and the Board of the Smoke-Free Alternatives Trade Association, without whose assistance this study would not have been possible. Fontem Ventures, a company that makes e-cigarettes, and a wholly owned subsidiary of Imperial Brands PLC provided funding for this study.


===2015: [https://academic.oup.com/ntr/article-abstract/17/10/1255/1028251?redirectedFrom=fulltext The Impact of Flavor Descriptors on Nonsmoking Teens’ and Adult Smokers’ Interest in Electronic Cigarettes]=== <!--T:106-->


===2015: [https://academic.oup.com/ntr/article-abstract/17/10/1255/1028251?redirectedFrom=fulltext The Impact of Flavor Descriptors on Nonsmoking Teens’ and Adult Smokers’ Interest in Electronic Cigarettes]===
<!--T:107-->
*Nonsmoking teens’ interest in e-cigarettes was very low.  
*Nonsmoking teens’ interest in e-cigarettes was very low.  
*Adult smokers’ interest was significantly higher overall and for each flavor.  
*Adult smokers’ interest was significantly higher overall and for each flavor.  
Line 387: Line 469:
*[https://www.casaa.org/wp-content/uploads/Shiffman-on-flavors-1255-62.pdf PDF Version]
*[https://www.casaa.org/wp-content/uploads/Shiffman-on-flavors-1255-62.pdf PDF Version]
*Citation: Saul Shiffman, PhD, Mark A Sembower, MS, Janine L Pillitteri, PhD, Karen K Gerlach, PhD, MPH, Joseph G Gitchell, BA, The Impact of Flavor Descriptors on Nonsmoking Teens’ and Adult Smokers’ Interest in Electronic Cigarettes, Nicotine & Tobacco Research, Volume 17, Issue 10, October 2015, Pages 1255–1262, doi: 10.1093/ntr/ntu333
*Citation: Saul Shiffman, PhD, Mark A Sembower, MS, Janine L Pillitteri, PhD, Karen K Gerlach, PhD, MPH, Joseph G Gitchell, BA, The Impact of Flavor Descriptors on Nonsmoking Teens’ and Adult Smokers’ Interest in Electronic Cigarettes, Nicotine & Tobacco Research, Volume 17, Issue 10, October 2015, Pages 1255–1262, doi: 10.1093/ntr/ntu333
*Acknowledgement: This work was supported by NJOY, a company that markets electronic cigarettes, but does not make or sell any combustible tobacco products. All authors work for Pinney Associates and provide consulting services to GlaxoSmithKline Consumer Healthcare on their stop-smoking medications and to NJOY, Inc. on electronic nicotine delivery systems (ENDS). SS and JGG also own an interest in a novel nicotine medication in development. The study sponsor was involved in discussion of the study design, but had no role in study execution, data collection, data analysis, or writing of the manuscript, nor did the sponsor review the manuscript prior to submission.


===2013: [https://www.sciencedirect.com/science/article/abs/pii/S1054139X12004090 Adolescent Males' Awareness of and Willingness to Try Electronic Cigarettes]=== <!--T:108-->


===2013: [https://www.sciencedirect.com/science/article/abs/pii/S1054139X12004090 Adolescent Males' Awareness of and Willingness to Try Electronic Cigarettes]===
<!--T:109-->
*Only two participants (< 1%) had previously tried e-cigarettes.  
*Only two participants (< 1%) had previously tried e-cigarettes.  
*Among those who had not tried e-cigarettes, most (67%) had heard of them. Awareness was higher among older and non-Hispanic adolescents.  
*Among those who had not tried e-cigarettes, most (67%) had heard of them. Awareness was higher among older and non-Hispanic adolescents.  
Line 398: Line 480:
*[https://sci-hub.st/10.1016/j.jadohealth.2012.09.014# PDF Version]
*[https://sci-hub.st/10.1016/j.jadohealth.2012.09.014# PDF Version]
*Citation: Pepper, J. K., Reiter, P. L., McRee, A.-L., Cameron, L. D., Gilkey, M. B., & Brewer, N. T. (2013). Adolescent Males’ Awareness of and Willingness to Try Electronic Cigarettes. Journal of Adolescent Health, 52(2), 144–150. doi:10.1016/j.jadohealth.2012.09.014  
*Citation: Pepper, J. K., Reiter, P. L., McRee, A.-L., Cameron, L. D., Gilkey, M. B., & Brewer, N. T. (2013). Adolescent Males’ Awareness of and Willingness to Try Electronic Cigarettes. Journal of Adolescent Health, 52(2), 144–150. doi:10.1016/j.jadohealth.2012.09.014  
*Acknowledgement: : Support for this study was provided by the American Cancer Society (MSRG-06-259-01-CPPB), the Cancer Control Education Program at UNC Lineberger Comprehensive Cancer Center (R25 CA57726), the National Institutes of Health (P50CA105632 and P30CA016058), and a NRSA in Primary Medical Care at the University of Minnesota (T32HP22239).


=Youth= <!--T:110-->


===2020: [https://cei.org/issue_analysis/perverse-psychology/ Report Summary: Perverse Psychology How Anti-Vaping Campaigners Created the Youth Vaping “Epidemic”]=== <!--T:111-->


=Youth=
<!--T:112-->
 
 
===2020: [https://cei.org/issue_analysis/perverse-psychology/ Report Summary: Perverse Psychology How Anti-Vaping Campaigners Created the Youth Vaping “Epidemic”]===
*It is reasonable for anti-tobacco advocates to worry about youth experimentation with nicotine, but the evidence is clear that their interventions have backfired and made the problem worse. Their attempts to dissuade teenagers from vaping increased their awareness of the behavior, made it more attractive, and convinced them that everyone around them was doing it.
*It is reasonable for anti-tobacco advocates to worry about youth experimentation with nicotine, but the evidence is clear that their interventions have backfired and made the problem worse. Their attempts to dissuade teenagers from vaping increased their awareness of the behavior, made it more attractive, and convinced them that everyone around them was doing it.
*Anti-tobacco advocates argue that the government can end the “epidemic” by raising the minimum tobacco age to 21, '''banning non-tobacco e-cigarette flavors''', and increasing funding for anti-vaping education. But, as this paper has demonstrated, '''these measures will not only fail, they will actually make matters worse by increasing the coolness of vaping and youth attraction to it'''.
*Anti-tobacco advocates argue that the government can end the “epidemic” by raising the minimum tobacco age to 21, '''banning non-tobacco e-cigarette flavors''', and increasing funding for anti-vaping education. But, as this paper has demonstrated, '''these measures will not only fail, they will actually make matters worse by increasing the coolness of vaping and youth attraction to it'''.
Line 411: Line 491:
*[https://cei.org/sites/default/files/Michelle%20Minton%20-%20Perverse%20Psychology.pdf PDF of Full report]
*[https://cei.org/sites/default/files/Michelle%20Minton%20-%20Perverse%20Psychology.pdf PDF of Full report]


===2020: [https://www.nber.org/papers/w26811 Paper: Intended and Unintended Effects of Banning Menthol Cigarettes]=== <!--T:113-->


===2020: [https://www.nber.org/papers/w26811 Paper: Intended and Unintended Effects of Banning Menthol Cigarettes]===
<!--T:114-->
*'''Menthol bans significantly increased non-menthol cigarette smoking among youths, resulting in no overall net change in youth smoking rates'''.
*'''Menthol bans significantly increased non-menthol cigarette smoking among youths, resulting in no overall net change in youth smoking rates'''.
*Menthol bans shifted smokers’ cigarette purchases away from grocery stores and gas stations to First Nations reserves (where the menthol bans do not bind).
*Menthol bans shifted smokers’ cigarette purchases away from grocery stores and gas stations to First Nations reserves (where the menthol bans do not bind).
*[https://sci-hub.st/10.3386/w26811# PDF Full Paper]
*[https://sci-hub.st/10.3386/w26811# PDF Full Paper]


===2020: [https://www.youtube.com/watch?v=O4_l-klxqCQ Video: Vaping: what people are getting wrong]=== <!--T:115-->


===2020: [https://www.youtube.com/watch?v=O4_l-klxqCQ Video: Vaping: what people are getting wrong]===
<!--T:116-->
*The Economist
*The Economist
*A youth vaping “epidemic” and a mysterious outbreak of lung disease in America has led to curbs on e-cigarette flavours. A backlash against vaping is perpetuating myths about nicotine-based e-cigarette products that are not backed up by scientific research.  (UK / English)
*A youth vaping “epidemic” and a mysterious outbreak of lung disease in America has led to curbs on e-cigarette flavours. A backlash against vaping is perpetuating myths about nicotine-based e-cigarette products that are not backed up by scientific research.  (UK / English)


===2019: Article: [https://www.clivebates.com/the-us-vaping-flavour-ban-twenty-things-you-should-know/ The US vaping flavour (flavor) ban: twenty things you should know]=== <!--T:117-->


===2019: Article: [https://www.clivebates.com/the-us-vaping-flavour-ban-twenty-things-you-should-know/ The US vaping flavour (flavor) ban: twenty things you should know]===
<!--T:118-->
*A well researched article that touches on many of the myths and fears about youth use of flavored vapor products.
*A well researched article that touches on many of the myths and fears about youth use of flavored vapor products.
*[https://www.clivebates.com/documents/Flavours20Nov2019.pdf PDF Version]
*[https://www.clivebates.com/documents/Flavours20Nov2019.pdf PDF Version]


===2017: Blog: [http://mommavape.blogspot.com/2017/12/paint-me-green-and-hear-me-roar.html Confessions of an e-liquid mixologist]=== <!--T:119-->


===2017: Blog: [http://mommavape.blogspot.com/2017/12/paint-me-green-and-hear-me-roar.html Confessions of an e-liquid mixologist]===
<!--T:120-->
*Certain things really bother me. Like when anti-tobacco activists do things to destroy my pride in being an ex-smoker and helping other people quit smoking. The most hurtful thing of all, is to pervert the effort I put into creating flavors of e-liquids to appeal to adult smokers and accuse me of marketing to children, of trying to addict the next generation of kids on nicotine.
*Certain things really bother me. Like when anti-tobacco activists do things to destroy my pride in being an ex-smoker and helping other people quit smoking. The most hurtful thing of all, is to pervert the effort I put into creating flavors of e-liquids to appeal to adult smokers and accuse me of marketing to children, of trying to addict the next generation of kids on nicotine.
*Not once did I create a flavor and go “hmmmm, I bet a 12 year old would like this”. Not once. I’m not a monster, I’m a mom, an aunt, a grandma, and a great grandma. All I wanted to do is help people quit smoking so they could live long enough to enjoy their extended families. I wanted to help people quit smoking so kids would no longer be exposed to 2nd hand smoke. I wanted to make the world a better place.  
*Not once did I create a flavor and go “hmmmm, I bet a 12 year old would like this”. Not once. I’m not a monster, I’m a mom, an aunt, a grandma, and a great grandma. All I wanted to do is help people quit smoking so they could live long enough to enjoy their extended families. I wanted to help people quit smoking so kids would no longer be exposed to 2nd hand smoke. I wanted to make the world a better place.  


=Addressing Myths About Flavors= <!--T:121-->


===2020: Article: [https://vaping360.com/learn/popcorn-lung-diacetyl/ Does Diacetyl in Vaping Cause Popcorn Lung?]=== <!--T:122-->


=Addressing Myths About Flavors=
<!--T:123-->
 
 
===2020: Article: [https://vaping360.com/learn/popcorn-lung-diacetyl/ Does Diacetyl in Vaping Cause Popcorn Lung?]===
*While almost anything is possible, there’s simply no evidence that vaping causes popcorn lung.
*While almost anything is possible, there’s simply no evidence that vaping causes popcorn lung.


===2019: Cancer Research UK: [https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/does-vaping-cause-popcorn-lung Does vaping cause popcorn lung?]=== <!--T:124-->


===2019: Cancer Research UK: [https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/does-vaping-cause-popcorn-lung Does vaping cause popcorn lung?]===
<!--T:125-->
*No. There’s no good evidence that e-cigarettes could cause the lung condition called popcorn lung. There’s been no confirmed cases of popcorn lung reported in people who use e-cigarettes.
*No. There’s no good evidence that e-cigarettes could cause the lung condition called popcorn lung. There’s been no confirmed cases of popcorn lung reported in people who use e-cigarettes.


===2019: [https://www.cmaj.ca/content/re-vape-related-popcorn-lung-debunked-years-ago RE: Vape related "Popcorn Lung" debunked years ago]=== <!--T:126-->


===2019: [https://www.cmaj.ca/content/re-vape-related-popcorn-lung-debunked-years-ago RE: Vape related "Popcorn Lung" debunked years ago]===
<!--T:127-->
*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.


===2018: [http://www.ecigarette-research.org/research/index.php/research/2018/262-flavors Paper: E-cigarette flavors and aldehyde emissions: another failure to verify findings from a previous study]=== <!--T:128-->


===2018: [http://www.ecigarette-research.org/research/index.php/research/2018/262-flavors Paper: E-cigarette flavors and aldehyde emissions: another failure to verify findings from a previous study]===
<!--T:129-->
: Our results were revealing in identifying a very small contribution of flavorings on aldehyde emissions. In fact, aldehyde levels were so low that consumption of 5 grams liquid per day would expose vapers to less formaldehyde and acetaldehyde than just staying at home and breathing air. For acrolein, exposure was orders of magnitude lower compared to NIOSH-defined recommended safety limits. To give you an idea of the differences in results, the authors of the original study found up to 7000 ug/g formaldehyde, while we found a maximum of 62 ug/g.
: Our results were revealing in identifying a very small contribution of flavorings on aldehyde emissions. In fact, aldehyde levels were so low that consumption of 5 grams liquid per day would expose vapers to less formaldehyde and acetaldehyde than just staying at home and breathing air. For acrolein, exposure was orders of magnitude lower compared to NIOSH-defined recommended safety limits. To give you an idea of the differences in results, the authors of the original study found up to 7000 ug/g formaldehyde, while we found a maximum of 62 ug/g.
*2017: [https://sci-hub.se/10.1016/j.fct.2018.02.059 Do flavouring compounds contribute to aldehyde emissions in e-cigarettes?]
*2017: [https://sci-hub.se/10.1016/j.fct.2018.02.059 Do flavouring compounds contribute to aldehyde emissions in e-cigarettes?]
: In conclusion, we confirmed that flavouring compounds can contribute to aldehyde emissions from ECs, but such contribution, detected in only 3 liquids and two flavours herein, was minimal.  
: In conclusion, we confirmed that flavouring compounds can contribute to aldehyde emissions from ECs, but such contribution, detected in only 3 liquids and two flavours herein, was minimal.  


===2017: [https://pubs.acs.org/doi/10.1021/acs.est.6b06030 Comment on “Flavoring Compounds Dominate Toxic Aldehyde Production during E Cigarette Vaping”]=== <!--T:130-->


===2017: [https://pubs.acs.org/doi/10.1021/acs.est.6b06030 Comment on “Flavoring Compounds Dominate Toxic Aldehyde Production during E Cigarette Vaping”]===
<!--T:131-->
*We would like to point out that the finding is in a stark contrast to previous results.
*We would like to point out that the finding is in a stark contrast to previous results.
*The high levels only happen under dry puff conditions, something avoided by vapers as it is very unpleasant.
*The high levels only happen under dry puff conditions, something avoided by vapers as it is very unpleasant.


===2015: [http://www.ecigarette-research.org/research/index.php/whats-new/whatsnew-2015/234-bo Medical journal MISPRESENTS a case of hypersensitivity pneumonitis as popcorn lung disease caused by e-cigarette]=== <!--T:132-->


===2015: [http://www.ecigarette-research.org/research/index.php/whats-new/whatsnew-2015/234-bo Medical journal MISPRESENTS a case of hypersensitivity pneumonitis as popcorn lung disease caused by e-cigarette]===
<!--T:133-->
*It was shocking to see a public statement reporting a case of popcorn lung disease in a patient using e-cigarettes. The title of the public release is: “Case report finds 'popcorn lung' in patient using e-cigarettes. Report points to possibility of diacetyl, a flavoring agent in e-cigarettes, to bronchiolitis obliterans syndrome”  
*It was shocking to see a public statement reporting a case of popcorn lung disease in a patient using e-cigarettes. The title of the public release is: “Case report finds 'popcorn lung' in patient using e-cigarettes. Report points to possibility of diacetyl, a flavoring agent in e-cigarettes, to bronchiolitis obliterans syndrome”  
*The article then goes on to explain why it can’t be popcorn lung and calls for the retraction of the study.
*The article then goes on to explain why it can’t be popcorn lung and calls for the retraction of the study.


===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]=== <!--T:134-->


 
<!--T:135-->
===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.
*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.
*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.


=Quotes / Graphics= <!--T:136-->




=Quotes / Graphics=
===Scott Gottlieb, MD - Former USA FDA Commissioner=== <!--T:137-->
 
[https://www.fda.gov/news-events/press-announcements/statement-fda-commissioner-scott-gottlieb-md-efforts-reduce-tobacco-use-especially-among-youth Source]


===Scott Gottlieb, MD - Former USA FDA Commissioner===
<!--T:138-->
[[File:GottliebFlavors.jpg|Scott Gottlieb on Flavors]]
[[File:GottliebFlavors.jpg|Scott Gottlieb on Flavors]]
<br>


===American Association of Public Health Physicians=== <!--T:139-->


<!--T:140-->
[[File:AAPHP.jpg|AAPHP flavor statement]] 




===American Association of Public Health Physicians===
[[File:AAPHP.jpg|AAPHP flavor statement]] 






===Observation on the variety of flavored products used=== <!--T:141-->


===Observation on the variety of flavored products used=== 
 
<!--T:142-->
[[File:Flavors_for_smoking_cessation.jpg|NRT vs. ENDS: Does it matter?]]
[[File:Flavors_for_smoking_cessation.jpg|NRT vs. ENDS: Does it matter?]]


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===American Academy of Pediatricts===
 
===American Academy of Pediatricts=== <!--T:143-->
 
<!--T:144-->
[[File:Flavored_NRT.jpg|Flavored NRT ]]
[[File:Flavored_NRT.jpg|Flavored NRT ]]


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===FDA approved manufacturers of Nicotine Replacement Therapy understand the importance of flavors===
 
===FDA approved manufacturers of Nicotine Replacement Therapy understand the importance of flavors=== <!--T:145-->
 
<!--T:146-->
[[File:Nicorette_flavors.jpg|FDA approved NRT comes in flavors]]
[[File:Nicorette_flavors.jpg|FDA approved NRT comes in flavors]]


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===Age demographics of people who eat cotton candy===
[[File:Cotton_candy.png|Cotton Candy]]


===Age demographics of people who eat cotton candy=== <!--T:147-->


<!--T:148-->
[[File:Cotton_candy.png|Cotton Candy]]




===Senator Dick Durbin endorses banning flavors (1)===
[[File:Senator_Durbin_Ice_Cream.jpg|Senator Durbin Ice Cream ]]






===Senator Dick Durbin endorses banning flavors (1)=== <!--T:149-->


===Senator Dick Durbin endorses banning flavors (2)===
<!--T:150-->
[[File:Senator_Durbin_Candy.png|Senator Durbin Candy]]
[[File:Senator_Durbin_Ice_Cream.jpg|Senator Durbin Ice Cream ]]


=Suggested Studies, Papers, Surveys, and Articles to Add to This Page=
*If you prefer to not add information to this page yourself, drop the links here and one of our editors will do it for you




===2021: Survey: [https://f1000research.com/articles/10-619/v1 Vaping liquid flavour preferences, oral nicotine pouch and cannabis use: A survey of participants in the 2019 Oceania Vape Expo]===


===2021: Blog: [https://www.theamericanconsumer.org/2021/01/banning-flavored-tobacco-products-is-just-blowing-smoke/ Banning Flavored Tobacco Products is Just Blowing Smoke]===


===Senator Dick Durbin endorses banning flavors (2)=== <!--T:151-->


===2020: Policy Paper: [https://241yjo5ffc43s84vz4462arn-wpengine.netdna-ssl.com/wp-content/uploads/2020/09/WHY-VAPE-FLAVORS-MATTER-POLICY-PAPER.pdf Why Vape Flavors Matter]===
<!--T:152-->
[[File:Senator_Durbin_Candy.png|Senator Durbin Candy]]




=Further Reading=
===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]===
===2020: Policy Paper: [https://241yjo5ffc43s84vz4462arn-wpengine.netdna-ssl.com/wp-content/uploads/2020/09/WHY-VAPE-FLAVORS-MATTER-POLICY-PAPER.pdf Why Vape Flavors Matter]===
===2020: Policy Blog: [https://vaping.org/yale-study-finds-that-vaping-flavors-help-adults-quit/ YALE STUDY FINDS THAT VAPING FLAVORS HELP ADULTS QUIT]===
===2020: Policy Blog: [https://reason.org/commentary/montana-should-reject-proposed-ban-on-flavored-vaping-products/ Montana Should Reject Proposed Ban on Flavored Vaping Products]===
===2020: Policy Blog: [https://reason.org/commentary/montana-should-reject-proposed-ban-on-flavored-vaping-products/ Montana Should Reject Proposed Ban on Flavored Vaping Products]===
 
===2020: Opinion: [https://insidesources.com/flavors-arent-main-driver-of-youth-e-cigarette-use/ Flavors Aren’t Main Driver of Youth E-Cigarette Use]===
 
===2020: Policy Blog: [https://reason.org/commentary/how-californias-flavored-tobacco-ban-will-hurt-communities-and-budgets/ How California’s Flavored Tobacco Ban Will Hurt Communities and Budgets]===
===2020: Policy Blog: [https://reason.org/commentary/how-californias-flavored-tobacco-ban-will-hurt-communities-and-budgets/ How California’s Flavored Tobacco Ban Will Hurt Communities and Budgets]===
 
===2020: Policy analyst Testimony: [https://www.house.leg.state.mn.us/comm/docs/3437294b-d481-4a34-b22c-887092b85054.pdf Testimony before the Minnesota House Committee on Commerce]===
 
===2020: Flavor Ban Letter: [https://vaping.org/ava-urges-florida-governor-to-veto-backdoor-flavor-ban-bill/ AVA URGES FLORIDA GOVERNOR TO VETO BACKDOOR FLAVOR BAN BILL]===
===2020: Policy Blog: [https://reason.org/events/the-costs-and-unintended-consequences-of-tobacco-and-vaping-flavor-bans/ The Costs and Unintended Consequences of Tobacco and Vaping Flavor Bans]===
===2020: Policy Blog: [https://reason.org/events/the-costs-and-unintended-consequences-of-tobacco-and-vaping-flavor-bans/ The Costs and Unintended Consequences of Tobacco and Vaping Flavor Bans]===  
 
===2020: Policy Blog: [https://reason.org/commentary/in-2020-congress-replaced-war-on-marijuana-with-a-war-on-flavored-tobacco-products/ In 2020, Congress Replaced the War on Marijuana With a War on Flavored Tobacco Products]===  
 
===2020: Policy Blog: [https://reason.org/commentary/in-2020-congress-replaced-war-on-marijuana-with-a-war-on-flavored-tobacco-products/ In 2020, Congress Replaced the War on Marijuana With a War on Flavored Tobacco Products]===
 
 
===2020: Policy Blog: [https://reason.org/commentary/cdc-survey-shows-flavors-arent-driving-youth-vaping/ CDC Survey Shows Flavors Aren’t Driving Youth Vaping]===
===2020: Policy Blog: [https://reason.org/commentary/cdc-survey-shows-flavors-arent-driving-youth-vaping/ CDC Survey Shows Flavors Aren’t Driving Youth Vaping]===
===2020: Policy Blog: [https://reason.org/commentary/the-negative-impacts-of-massachusetts-flavored-tobacco-ban/ The Negative Impacts of Massachusetts’ Flavored Tobacco Ban]===
===2020: Policy Blog: [https://reason.org/commentary/the-negative-impacts-of-massachusetts-flavored-tobacco-ban/ The Negative Impacts of Massachusetts’ Flavored Tobacco Ban]===
===2019: Policy Paper: [https://www.heartland.org/_template-assets/documents/Tobacco%20Harm%20Reduction%20pdf.pdf TOBACCO HARM REDUCTION 101: A GUIDEBOOK FOR POLICYMAKERS]===
===2019: Policy Paper: [https://www.heartland.org/_template-assets/documents/Tobacco%20Harm%20Reduction%20pdf.pdf TOBACCO HARM REDUCTION 101: A GUIDEBOOK FOR POLICYMAKERS]===
===2019: Article: [https://dailygazette.com/2019/07/08/editorial-vote-no-on-flavored-vaping-ban/?fbclid=IwAR1zS8EeRnRi8ItYlqDa68emLywJpHUcccRRT1SOPdZoGROzk7Taea8XkqA EDITORIAL: Vote no on flavored vaping ban]===
===2019: Article: [https://dailygazette.com/2019/07/08/editorial-vote-no-on-flavored-vaping-ban/?fbclid=IwAR1zS8EeRnRi8ItYlqDa68emLywJpHUcccRRT1SOPdZoGROzk7Taea8XkqA EDITORIAL: Vote no on flavored vaping ban]===
 
===2019: [https://vaportechnology.org/wp-content/uploads/2019/11/Dunham-Economic-Impact-of-Flavor-Ban-11-21-19.pdf The Economic Impact of a Ban on Flavored Vapor Products ]===  
 
===2019: [https://vaportechnology.org/wp-content/uploads/2019/11/Dunham-Economic-Impact-of-Flavor-Ban-11-21-19.pdf The Economic Impact of a Ban on Flavored Vapor Products ]===
*[https://vaportechnology.org/wp-content/uploads/2019/11/New-Economic-Analysis-Demonstrates-Significant-Negative-Impact-of-a-National-Flavor-Ban50808.pdf NEW ECONOMIC ANALYSIS DEMONSTRATES SIGNIFICANT NEGATIVE IMPACT OF A NATIONAL FLAVOR BAN ]
*[https://vaportechnology.org/wp-content/uploads/2019/11/New-Economic-Analysis-Demonstrates-Significant-Negative-Impact-of-a-National-Flavor-Ban50808.pdf NEW ECONOMIC ANALYSIS DEMONSTRATES SIGNIFICANT NEGATIVE IMPACT OF A NATIONAL FLAVOR BAN ]
===2019: Policy Blog: [https://reason.org/commentary/albanys-proposed-flavored-tobacco-ban-misses-the-mark/ Albany’s Proposed Flavored Tobacco Ban Misses the Mark]===
===2019: Policy Blog: [https://reason.org/commentary/albanys-proposed-flavored-tobacco-ban-misses-the-mark/ Albany’s Proposed Flavored Tobacco Ban Misses the Mark]===
===2019: Policy Blog: [https://reason.org/commentary/the-public-health-case-for-e-cigarette-flavors/ The Public Health Case for E-Cigarette Flavors]===
===2019: Policy Blog: [https://reason.org/wp-content/uploads/michigan-e-cigarette-flavors-explainer.pdf E-Cigarette Flavor Ban Creates Public Health Problems]===
===2018: Testimony to FDA: [https://reason.org/commentary/comments-on-fdas-advance-notice-of-proposed-rulemaking-on-flavored-tobacco-products/ Comments on FDA's Advance Notice of Proposed Rulemaking on Flavored Tobacco Products]===
===2018: Policy Blog: [https://reason.org/commentary/san-francisco-flavored-vapes-and-the-next-prohibition-disaster/ San Francisco, Flavored Vapes, and the Next Prohibition Disaster]===
===2018: Policy Blog: [https://reason.org/commentary/californias-plan-to-ban-vaping-flavors-would-hurt-public-health/ California’s Plan to Ban Vaping Flavors would Hurt Public Health]===
===2017: Blog: [http://tobaccoanalysis.blogspot.com/2017/05/vape-shop-air-sampling-by-california.html Vape Shop Air Sampling by California State Health Department Suggests that Secondhand Vape Exposure is Minimal]===
===2017: Blog: [https://www.clivebates.com/flavors Are e-liquid flavours really 'hooking another generation of kids'?]===


=Other Resources=


===2019: Policy Blog: [https://reason.org/commentary/the-public-health-case-for-e-cigarette-flavors/ The Public Health Case for E-Cigarette Flavors]===
===[https://docs.google.com/document/d/1CWfu0QLj347Ud07tb9NdNWESXZRqAzW9MX_VbU_NAss/edit?usp=sharing Document of pre-written tweets about flavors]===
 
 
===2019: Policy Blog: [https://reason.org/wp-content/uploads/michigan-e-cigarette-flavors-explainer.pdf E-Cigarette Flavor Ban Creates Public Health Problems]===
 
 
===2018: Testimony to FDA: [https://reason.org/commentary/comments-on-fdas-advance-notice-of-proposed-rulemaking-on-flavored-tobacco-products/ Comments on FDA's Advance Notice of Proposed Rulemaking on Flavored Tobacco Products]===
*Reason Foundation / Guy Bentley
 


===2018: Policy Blog: [https://reason.org/commentary/san-francisco-flavored-vapes-and-the-next-prohibition-disaster/ San Francisco, Flavored Vapes, and the Next Prohibition Disaster]===
=Suggested Studies, Papers, Surveys, and Articles to Add to This Page= <!--T:153-->
*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]===


===2018: Policy Blog: [https://reason.org/commentary/californias-plan-to-ban-vaping-flavors-would-hurt-public-health/ California’s Plan to Ban Vaping Flavors would Hurt Public Health]===
===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?]===


===2017: Blog: [http://tobaccoanalysis.blogspot.com/2017/05/vape-shop-air-sampling-by-california.html Vape Shop Air Sampling by California State Health Department Suggests that Secondhand Vape Exposure is Minimal]===
===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?]===
*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.


===2017: Blog: [https://www.clivebates.com/flavors Are e-liquid flavours really 'hooking another generation of kids'?]===
===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.


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[[Category:Studies, Surveys, and Papers]]
[[Category:Media - Movies, Videos, Vlogs, Blogs, OpEds, News, etc.]] [[Category: FAQ Question]]
[[Category:Media - Movies, Videos, Vlogs, Blogs, OpEds, News, etc.]] [[Category: FAQ Question]]
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Personal Testimonies from people who used to smoke & Blogs

All Years: Video Collection: Golden Oldies Capitol Tours

  • People who used to smoke share how long they smoked and what flavors helped them to quit smoking.

All Years: Collection 13,000+ Testimonies: CASAA - REAL PEOPLE. REAL STORIES.

  • Online submissions of personal testimonies by people who switched from smoking to harm reduction products.

2021: Letter: Proposed vaping products’ flavour regulations – a response

  • This submission responds to Health Canada’s Consultation on Proposed vaping products’ flavour regulations and order and related regulatory impact analysis.

2021: Letter: Regulation of e-cigarette flavours – a response

  • This document responds to the proposed Decree of the State Secretary for Health, Welfare and Sport on the regulation of e-cigarette flavours in the Netherlands. We provide a summary followed by a detailed discussion of each of the twelve sections in the summary.

2021 Blog: Gummy Bears and Cotton Candy

  • The voice of consumers who are trying to quit smoking continues to be ignored. The use of flavored e-cigarettes was associated with more than twice the odds of smoking cessation among adult users compared to those using tobacco flavors. History demonstrates the adult love of all things candy. If something candy flavored is what helps someone stop smoking, who are we to tell them they can't quit that way?

2019 Blog: The US vaping flavour ban: twenty things you should know

  • What is the chance that this level of adult panic is, in fact, driving the very behaviour it is worrying about?

2017 Blog: Cotton Candy is NOT Marketing To Kids

  • She says "honey, you need to get with the program, we were too poor when I was a kid to afford cotton candy, so now I'm having it whenever I want and any way I want it. Now give me the sweetest thing you got and I want cotton candy the next time I come here."
  • "Ma'am, if you don't mind me asking, how old are you?". She looks at me and says "82, I quit smoking 6 months ago and now I'm going to live to be 102."

2017 Blog: Are e-liquid flavours really “hooking another generation of kids”?

  • To evaluate the demand to regulate these flavours (by which they mean ban them) you first need a framework for thinking about the issue – and that is not simple and may yield surprises.

Abuse Liability - All THR Products

2020: 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

  • Controlled use of JS (JUUL System) among adult smokers resulted in nicotine delivery, product liking, and satisfaction that were less than that of combustible cigarettes but generally greater than nicotine gum. These results support the conclusion that JS has lower abuse liability than combustible cigarettes, higher abuse liability than nicotine gum, and may provide sufficient nicotine delivery and satisfying effects to support substitution for combustible cigarettes among adult smokers.
  • PDF Version
  • Citation: Nicholas I. Goldenson, August R. Buchhalter, Erik M. Augustson, Mark L. Rubinstein, Jack E. Henningfield, 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, Drug and Alcohol Dependence, Volume 217, 2020, 108395, ISSN 0376-8716, doi:10.1016/j.drugalcdep.2020.108395.

2003: Subjective effects of the nicotine lozenge: assessment of abuse liability

  • In conclusion, results of the present study suggest that abuse liability of nicotine lozenges is low. Low abuse liability of the novel nicotine lozenges is in accordance with current knowledge of consumer use patterns of other, already marketed nicotine replacement therapies, which suggest little abuse of these products once they are marketed. Dose-dependent craving reduction by the lozenges in adults (22–50 years) but not young adults (18–21 years) suggests efficacy of the lozenge for adults, and reinforces the need for further studies of nicotine delivery systems as a treatment for nicotine dependence in younger adults and adolescents
  • PDF Version
  • Citation: Houtsmuller, E. J., Henningfield, J. E., & Stitzer, M. L. (2003). Subjective effects of the nicotine lozenge: assessment of abuse liability. Psychopharmacology, 167(1), 20–27. doi:10.1007/s00213-002-1361-2

2002: Flavor improvement does not increase abuse liability of nicotine chewing gum

  • Improved flavor of nicotine gum does not increase abuse liability, but may be associated with enhanced craving reduction.
  • 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.
  • 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

2022: THE CASE FOR FLAVOURS IN TOBACCO HARM REDUCTION, TO SAVE LIVES

  • This 2022 updated review evaluates the use of flavours in THR products, specifically, nicotine vaping products. It highlights the link between (flavoured) vaping products and smoking cessation, and the potential benefits and risks of flavours and their availability for public health.

Public Health Advantages / Concerns of Public Health Harms

2023: 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.

2020: Investigation on the antibacterial activity of electronic cigarette liquids (ECLs): a proof of concept study

  • Our results have shown that flavors considerably enhance antibacterial activity.
  • This study provides important evidence that should be taken into consideration in further investigative approaches, to clarify the different sensitivity of the various bacterial species to e-liquids, including the respiratory microbiota, to highlight the possible role of flavors and nicotine.
  • Citation: Virginia Fuochi, Massimo Caruso , Rosalia Emma, Aldo Stivala, Riccardo Polosa, Alfio Distefano and Pio Maria Furneri *, “Investigation on the Antibacterial Activity of Electronic Cigarette Liquids (ECLs): A Proof of Concept Study”, Current Pharmaceutical Biotechnology (2020) 21: 1. doi:10.2174/1389201021666200903121624

2019: RE: Vape related "Popcorn Lung" debunked years ago

    • 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 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.
    • 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: High Content Screening in NHBE cells shows significantly reduced biological activity of flavoured e-liquids, when compared to cigarette smoke condensate

  • Our results clearly show a lower toxicity of e-liquids, including flavoured e-liquids, when compared to CSC (cigarette smoke condensate). Typically, more than 100 times higher concentrations of CFs (commercial flavoured e-liquids) are required to elicit the same response as those observed for 3R4F CSC in specific endpoints.
  • Flavours play a critical role in attracting, and retaining smokers to e-cigarettes.
  • PDF Version
  • Citation: Lukasz Czekala, Liam Simms, Matthew Stevenson, Edgar Trelles-Sticken, Paul Walker, Tanvir Walele, High Content Screening in NHBE cells shows significantly reduced biological activity of flavoured e-liquids, when compared to cigarette smoke condensate, Toxicology in Vitro, Volume 58, 2019, Pages 86-96, ISSN 0887-2333, doi:10.1016/j.tiv.2019.03.018.

2019: Toxicity classification of e-cigarette flavouring compounds based on European Union regulation: analysis of findings from a recent study

  • The vast majority of flavouring (flavoring) compounds in e-cigarette liquids as reported in a recent study were present at levels far lower than needed to classify them as toxic.
  • PDF Version
  • Farsalinos, K., Lagoumintzis, G. Toxicity classification of e-cigarette flavouring compounds based on European Union regulation: analysis of findings from a recent study. Harm Reduct J 16, 48 (2019). doi: 10.1186/s12954-019-0318-2

2019: Effects of flavoring compounds used in electronic cigarette refill liquids on endothelial and vascular function

  • Our data indicate that flavorings typically present in e-cig refill liquids do not cause endothelial dysfunction that would result in impaired vasodilation upon acute exposure. In contrast, most of the tested compounds caused endothelium-independent vasorelaxation, albeit at fairly high concentrations that appear to exceed by far the plasma concentrations expected to occur upon vaping flavored liquids.
  • PDF Version
  • Citation: Wölkart G, Kollau A, Stessel H, Russwurm M, Koesling D, Schrammel A, et al. (2019) Effects of flavoring compounds used in electronic cigarette refill liquids on endothelial and vascular function. PLoS ONE 14(9): e0222152. https://doi.org/10.1371/journal.pone.0222152

2018: A QUESTION OF TASTE: THE PUBLIC HEALTH CASE FOR E-CIGARETTE FLAVORS

  • The available evidence on flavored e-cigarettes suggests that flavors in and of themselves are not especially appealing to non-smoking adults or adolescents. There is, however, a substantial and growing literature on how and why these products appeal to smoking adults and their potential to help consumers switch from smoking to less-harmful vaping.
  • Any policy that harms the exclusive makers of reduced-risk products such as e-cigarettes more than the makers of traditional cigarettes is not in the interests of public health.
  • Report Author (55 pages): Guy Bentley

2018: Paper: E-cigarette flavors and aldehyde emissions: another failure to verify findings from a previous study

    • Our results were revealing in identifying a very small contribution of flavorings on aldehyde emissions. In fact, aldehyde levels were so low that consumption of 5 grams e-liquid per day would expose vapers to less formaldehyde and acetaldehyde than just staying at home and breathing air. For acrolein, exposure was orders of magnitude lower compared to NIOSH-defined recommended safety limits. To give you an idea of the differences in results, the authors of the original study found up to 7000 ug/g formaldehyde, while we found a maximum of 62 ug/g.
  • 2017: Study: Do flavouring compounds contribute to aldehyde emissions in e-cigarettes?
    • In conclusion, we confirmed that flavouring compounds can contribute to aldehyde emissions from ECs, but such contribution, detected in only 3 liquids and two flavours herein, was minimal. (flavor, flavors, flavoring, flavorings)
    • PDF Version
    • Citation: Farsalinos, K. E., & Voudris, V. (2018). Do flavouring compounds contribute to aldehyde emissions in e-cigarettes? Food and Chemical Toxicology, 115, 212–217. doi:10.1016/j.fct.2018.02.059
  • 2017: Follow Up: Comment on “Flavoring Compounds Dominate Toxic Aldehyde Production during E Cigarette Vaping”
    • We would like to point out that the finding is in a stark contrast to previous results.
    • The high levels only happen under dry puff conditions, something avoided by vapers as it is very unpleasant.

2017: Evaluation of Chemical Exposures at a Vape Shop

  • We collected air samples for flavoring chemicals (diacetyl, 2,3-pentanedione, 2,3-hexanedione, acetaldehyde, and acetoin), nicotine, formaldehyde, and propylene glycol.
  • Concentrations of vaping-related chemicals in our air samples were below occupational exposure limits.
  • Citation: NIOSH 2017. Evaluation of chemical exposures at a vape shop. By Zwack LM, Stefaniak AB, LeBouf RF. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Health Hazard Evaluation Report 2015-0107-3279

2016: Cigarette smoking and electronic cigarette vaping patterns as a function of e-cigarette flavourings

  • The findings suggest that adoption of e-cigarettes in smokers may influence smoking rates of people who smoke.
  • E-cigarette vaping rates are influenced by flavorings by people transitioning from smoking.
  • These findings have implications for the utility of e-cigarettes as a nicotine replacement device and for the regulation of e-cigarettes for harm reduction.
  • PDF Version
  • Citation: Litt MD, Duffy V, Oncken C. Cigarette smoking and electronic cigarette vaping patterns as a function of e-cigarette flavourings, Tobacco Control 2016;25:ii67-ii72.

2015: Medical journal misrepresents a case of hypersensitivity pneumonitis as popcorn lung disease caused by e-cigarette

  • It was shocking to see a public statement reporting a case of popcorn lung disease in a patient using e-cigarettes. The title of the public release is: “Case report finds 'popcorn lung' in patient using e-cigarettes. Report points to possibility of diacetyl, a flavoring agent in e-cigarettes, to bronchiolitis obliterans syndrome”
  • The case report is NOT about popcorn lung disease. The article then goes on to explain why it can’t be popcorn lung.

2015: An approach to ingredient screening and toxicological risk assessment of flavours in e-liquids

  • In vitro and Animal
  • Individual flavours or groups of flavours were added to the tobacco rod and the resultant smoke was analysed for priority smoke constituents and tested in several in vitro tests as well as 90-day rat inhalation studies. In general, addition of the flavours had no effect on, or reduced the levels of most of the measured smoke constituents.”
  • PDF Version
  • Citation: S. Costigan, C. Meredith, An approach to ingredient screening and toxicological risk assessment of flavours in e-liquids, Regulatory Toxicology and Pharmacology, Volume 72, Issue 2, 2015, Pages 361-369, ISSN 0273-2300, doi: 10.1016/j.yrtph.2015.05.018..

2013: Comparison of the Cytotoxic Potential of Cigarette Smoke and Electronic Cigarette Vapour (Vapor) Extract on Cultured Myocardial Cells

  • Smoking is an important risk factor for cardiovascular disease and cigarette smoke (CS) has well-established cytotoxic effects on myocardial cells. The purpose of this study was to evaluate the cytotoxic potential of the vapour of 20 EC (e-cigarette) liquid samples and a “base” liquid sample (50% glycerol and 50% propylene glycol, with no nicotine or flavourings) on cultured myocardial cells. Included were 4 samples produced by using cured tobacco leaves in order to extract the tobacco flavour. Methods: Cytotoxicity was tested according to the ISO 10993-5 standard.
  • In conclusion, from 20 commercially-available EC liquids that were tested in vapour form, four were found to be cytotoxic on cultured cardiomyoblasts. Cytotoxicity was mainly observed in most (but not all) samples produced by using tobacco leaves, while one sample using food-approved flavoring was marginally cytotoxic. EC vapour production by using higher-voltage devices caused a decrease in cell survival. Overall, EC vapour extracts showed significantly higher cell viability compared to CS extract, based on a realistic-use rather than a standardized comparative level of exposure. This supports the concept that ECs may be useful as tobacco harm reduction products.
  • PDF Version
  • Citation: Farsalinos, K., Romagna, G., Allifranchini, E., Ripamonti, E., Bocchietto, E., Todeschi, S., … Voudris, V. (2013). Comparison of the Cytotoxic Potential of Cigarette Smoke and Electronic Cigarette Vapour Extract on Cultured Myocardial Cells. International Journal of Environmental Research and Public Health, 10(10), 5146–5162. doi:10.3390/ijerph10105146

Regulations or Unintended Consequences

2023: 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

2023: 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: PREPRINT: 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

2021: A Difference-in-Differences Analysis of Youth Smoking and a Ban on Sales of Flavored Tobacco Products in San Francisco, California

  • San Francisco’s ban on flavored tobacco product sales was associated with increased smoking among minor high school students relative to other school districts. While the policy applied to all tobacco products, its outcome was likely greater for youths who vaped than those who smoked due to higher rates of flavored tobacco use among those who vaped. This raises concerns that reducing access to flavored electronic nicotine delivery systems may motivate youths who would otherwise vape to substitute smoking. Indeed, analyses of how minimum legal sales ages for electronic nicotine delivery systems are associated with youth smoking also suggest such substitution.
  • Citation: Friedman AS. A Difference-in-Differences Analysis of Youth Smoking and a Ban on Sales of Flavored Tobacco Products in San Francisco, California. JAMA Pediatr. 2021;175(8):863-865. doi:10.1001/jamapediatrics.2021.0922

2021: Reactions to sales restrictions on flavored vape products or all vape products among young adults in the US

  • Young adult e-cigarette users indicate low support for e-cigarette sales restrictions (both for flavored products and complete restrictions). Moreover, if vape product sales were restricted to tobacco flavors, 39.1% of users reported being likely to continue using e-cigarettes but 33.2% were likely to switch to cigarettes. If vape product sales were entirely restricted, e-cigarette users were equally likely to switch to cigarettes versus not (~40%).
  • Free version of full study or PDF not available
  • Citation: Heather Posner, MPH, Katelyn F Romm, PhD, Lisa Henriksen, PhD, Debra Bernat, PhD, Carla J Berg, PhD, MBA, Reactions to Sales Restrictions on Flavored Vape Products or All Vape Products Among Young Adults in the United States, Nicotine & Tobacco Research, 2021;, ntab154, doi: 10.1093/ntr/ntab154

2021: Vaping liquid flavour preferences, oral nicotine pouch and cannabis use: A survey of participants in the 2019 Oceania Vape Expo (version 1; peer review: awaiting peer review)

  • In the event of a ban on other flavours, 20% of the NZ residents said they would probably go back to smoking (see Table 3). A majority (57%) indicated they intended to circumvent the ban, by mixing their own liquids and/or buying from overseas or the black market. Only 29% indicated they would change their vaping consumption to comply with the ban, as is typically implicitly assumed will happen. Nine percent would try to stop vaping and 35% would buy only the legal products (which includes the 18% who were already buying only products that would not be banned).
  • PDF Version
  • Citation: Glover M, Phillips CV, Selket K and Jeffares Y. Vaping liquid flavour preferences, oral nicotine pouch and cannabis use: A survey of participants in the 2019 Oceania Vape Expo [version 1; peer review: awaiting peer review]. F1000Research 2021, 10:619 doi:10.12688/f1000research.54582.1

2021: Testimony in Netherlands pertaining to a potential flavour / flavor ban: Regulation of e-cigarette flavours – a response

  • Signed by 24 experts from around the world
  • Covers 12 key points

2020: Association of vaping‐related lung injuries with rates of e‐cigarette and cannabis use across US states

  • Policymakers should proceed with caution when considering bans on flavored nicotine e‐liquids: restricting legal sales may push some vapers towards illicit sources, user‐modified e‐liquids (e.g. to add flavoring) or even conventional cigarette use. Given EVALI’s potential lethality and a myriad of work suggesting that conventional cigarette use is probably far more dangerous than vaping nicotine, these outcomes could be disastrous for public health. There is no link between nicotine liquids and EVALI. It appears to have come from illicit cannabis products.
  • Link above is to the PDF version
  • Citation: Friedman, A. S. (2020). Association of Vaping‐related Lung Injuries with Rates of E‐cigarette and Cannabis Use across US States. Addiction. doi:10.1111/add.15235

2020: The impact of a comprehensive tobacco product flavor ban in San Francisco among young adults

  • Among the 18–24 age group, there was a significant increase in cigarette smoking.
  • Cigarette smoking increased among 25–34 years old.
  • Banning flavors in e-cigarettes can push some e-cigarette users to turn to cigarette smoking and could prompt some youth to initiate into smoking instead of e-cigarette use.
  • The proportions of e-cigarettes, cigarettes, and cigars obtained over the internet increased after the ban, and the proportions obtained from retailers outside of San Francisco also increased overall.
  • PDF Version
  • Citation: Yang, Y., Lindblom, E. N., Salloum, R. G., & Ward, K. D. (2020). The impact of a comprehensive tobacco product flavor ban in San Francisco among young adults. Addictive Behaviors Reports, 11, 100273. doi:10.1016/j.abrep.2020.100273

2020: Article: Yale Study on Lung Disease Forecasts Dire Consequences for Flavor Bans

  • A new study from Yale School of Public Health should serve as a warning to e-cigarette opponents and public health officials pushing e-cigarette flavor bans and restrictions around the country.
  • By pushing people into the black market for flavored products, they are increasing the risk that we will see another wave of consumers sickened by unregulated, illegal goods.
  • Citation: Elizabeth Sheld, Real Clear Policy, October 01, 2020.

2019: Changes in Flavor Preference in a Cohort of Long-Term Electronic Cigarette Users

  • Our results regarding anticipated reactions to FDA e-cigarette flavor regulation suggest complexities such that the benefits and risks of flavor ban need to be carefully evaluated.
  • A majority anticipated that they would personally attempt to circumvent potential FDA regulations of e-cigarettes by obtaining e-cigarette flavors from various illicit sources (e.g., Internet orders from foreign countries) or even self-making flavors.
  • The use of flavoring agents purchased from unregulated sources could lead to additional unanticipated toxicities.
  • It is also concerning that some established e-cigarette users believed that they would return to cigarette smoking if nontobacco e-cigarette flavors were banned. Thus, for adult e-cigarette users who use certain flavors to facilitate smoking cessation or reduction, banning all nontobacco flavors could precipitate relapse to smoking.
  • PDF Version
  • Citation: Ann Am Thorac Soc Vol 17, No 5, pp 573–581, May 2020, Copyright © 2020 by the American Thoracic Society, DOI: 10.1513/AnnalsATS.201906-472OC

2019: Article: Vape flavor ban doesn't help kids, hurts adults

  • Tobacco users who switch from combustible cigarettes to e-cigarettes experience various improvements in health.
  • Using e-cigarettes also helps people quit smoking altogether, with twice the success rate of other quit methods.
  • Researchers have yet to demonstrate that an e-cigarette flavor ban will prevent minors from obtaining and experimenting with tobacco products.
  • The ban creates a greater opportunity for people — including adolescents — to interact with law enforcement, putting them at increased risk of becoming involved with the criminal justice system.
  • Citation: Jesse Kelly & Carrie Wade, September 15, 2019, The Detroit News

2019: Article: Flavor ban will feed illegal tobacco sales, stores say

  • A retired federal law enforcement officer cautioned against banning flavors.
  • “If this bill passes and we bring in prohibition, we’re going to bring crime into the city,” Marianos, who is now an adjunct faculty member at Georgetown University, said. “We’re going to replace store owners and manufacturers with people selling out of backpacks, people selling out of cars, and worst of all, people selling directly to the children we’re trying to protect.”
  • Citation: Colin Young, November 04, 2019, 22 News WWLP

2019: Article: E-cigarette flavor ban — ineffective and dangerous

  • Bans don’t work. Bans never work. All bans do is push consumers to make different, usually more risky, choices. In this case, the likely outcome of banning e-liquid flavors people want is that they will seek to obtain them through the black market or simply return to smoking cigarettes. As a result, many more will die of smoking-related diseases or tainted products.
  • The wide array of flavors, produced by thousands of vapor companies around the country — most of them small — appear to be critical in persuading smokers to try vaping and preventing e-cigarette users from returning to their deadly combustible cigarette habit.
  • As a society, we have found satisfactory ways to address youth access to many adult products, like alcohol and marijuana. Given that e-cigarettes have the potential to save lives, regulators have a responsibility to find a similarly sophisticated solution to the youth vaping problem. Or, they can follow Michigan’s lead and learn the same lesson repeated throughout history: prohibition always causes more problems than it solves.
  • Citation: Michelle Minton, September 23, 2019, South Florida Sun Sentinel

2019: Article: Vapers Turn to Home Brew as Flavored Nicotine Bans Mount

  • “Even though I haven’t touched a cigarette in five years, the pull is always there. It’s so easy to go and buy a pack. And I don’t want to do that,” Danielle Jones said. “The only route I can see going forward if there is a ban is to try to create the product myself at home.”
  • As more states, cities and even the federal government consider banning flavored nicotine, thousands of do-it-yourself vapers like Jones are flocking to social media groups and websites to learn how to make e-liquids at home.
  • “To have people mixing their own e-cigarette liquid is crazy.” said Stanton Glantz, a professor of medicine and the director of the Center for Tobacco Control Research and Education at the University of California-San Francisco.
  • Dr. Michael Siegel, a professor of community health sciences at Boston University, worries about the risk of contaminated products as some people use the bans as an opportunity to make their own concoctions cheaply and sell them on the black market. “Who knows what they’re going to put in there?” Siegel said. “This is just what happens when you use prohibition as a regulatory approach.
  • Alex Clark, CEO of the Consumer Advocates for Smoke-Free Alternatives Association (CASAA), said he plans to warn the nonprofit’s more than 200,000 members about the dangers of making e-liquid at home. Clark notes that people should not use flavors found in the baking aisle of a grocery store.
  • Citation: Jenny Gold, November 12, 2019, Kaiser Health News KQED

2019: Article: The Vaping Overreaction Politicians who ban flavors should brace for a surge in cigarette smoking and the use of questionable bootleg vaping products.

  • The ethos of vaping is relative risk. E-cigarettes reduce harm, but can’t be called harmless. As a safer alternative than smoking for people addicted to nicotine, they are analogous to prescribing methadone for people addicted to opioids, a strategy called harm reduction. Other kinds of harm reduction, such as giving clean needles to injection-drug users and distributing condoms, pre-exposure prophylactic medication, and safe-sex information for populations at risk for HIV/AIDS, are widely endorsed by the public-health establishment.
  • In light of history, public-health advocates’ skepticism about e-cigarettes, at least when they first appeared, was understandable. But genuine advances really can occur, and the evidence suggests that the shift from smoking to vaping should be celebrated, not decried.
  • Claims that nicotine alone leads to brain damage in youth have limited empirical support; most of the relevant literature involves studies of teens exposed to the substance via smoking. I mention this not to dismiss the problem of teen vaping—the FDA and other agencies are rightly trying to curb teen access—but merely to warn against rash, misdirected responses that will prevent today’s smokers from quitting.
  • Unfortunately, the misconceptions surrounding vaping may be too well entrenched. A Kaiser poll conducted this month revealed that 49 percent of respondents support banning all e-cigarettes, not just flavored ones. That would be a deadly mistake. “If we lose this opportunity,” David S. Abrams, a professor at the New York University College of Global Public Health, told CBS Morning News last month, “we will have blown the single biggest public-health opportunity ever to get rid of cigarettes and replace them with a much safer form of nicotine for everybody.” With 35 million Americans still smoking, the stakes are high.

2019: Young adult dual combusted cigarette and e-cigarette users’ anticipated responses to hypothetical e-cigarette market restrictions

  • Hypothetical regulations resulted in reported intentions to reduce EC (e-cigarette) use and increase CC (combustible cigarette) use; the greatest impact was found for restrictions regarding e-liquid nicotine content, followed by flavor
  • This work provides preliminary evidence that restrictive regulations regarding key EC characteristics may increase intentions to increase CC use among young adult dual EC and CC users.
  • PDF Version
  • Citation:: Lauren R. Pacek, Olga Rass, Maggie M. Sweitzer, Jason A. Oliver & F. Joseph McClernon (2019): Young adult dual combusted cigarette and e-cigarette users’ anticipated responses to hypothetical e-cigarette market restrictions, Substance Use & Misuse, DOI:10.1080/10826084.2019.1626435

2018: Patterns of flavored e-cigarette use among adults vapers in the United States: an internet survey

  • Survey results submitted to the FDA
  • In conclusion, this cross-sectional study of a very large sample of adult US e-cigarette users, most of which were former smokers, identified the importance of non-tobacco flavors in e-cigarette use initiation and sustained use, and their contribution to smoking cessation and relapse prevention. *This information should be considered by regulators in order to avoid unintentional adverse effects of over-restrictive regulation on e-cigarette flavors.
  • PDF Version
  • Citation: Konstantinos Farsalinos, MD, MPH, Christopher Russell, PhD, George Lagoumintzis, PhD, Konstantinos Poulas, Submitted to: Docket No. FDA-2017 N-6565 for “Regulation of Flavors in Tobacco Products.”

2018: Should flavours be banned in cigarettes and e-cigarettes? Evidence on adult smokers and recent quitters from a discrete choice experiment

  • A ban on flavoured e-cigarettes would likely increase the choice of cigarettes in smokers, the more harmful way of obtaining nicotine.
  • PDF Version
  • Citation:Buckell J, Marti J, Sindelar JLShould flavours be banned in cigarettes and e-cigarettes? Evidence on adult smokers and recent quitters from a discrete choice experimentTobacco Control 2019;28:168-175.

Relapse Prevention or Long Term Abstinence

2020: Reported patterns of vaping to support long-term abstinence from smoking: a cross-sectional survey of a convenience sample of vapers

  • Qualitative research suggests e-cigarettes can meet many of the needs of ex-smokers by substituting physical, psychological, social, cultural and identity-related aspects of tobacco addiction.
  • According to a time-series analysis of data from the Smoking Toolkit study, in which repeated cross-sectional surveys are conducted with a representative sample of households in England, increasing prevalence of e-cigarette use in current smokers was predictive of higher success rates of quit attempts.
  • Most participants were self-reported long-term abstinent smokers (86.3%).
  • Those who start on a low self-reported nicotine e-liquid concentration (strength) will be more likely to relapse to tobacco smoking than those starting on a higher nicotine e-liquid, after controlling for cigarettes per day (CPD) before cessation.
  • Results suggest a change in flavor choices over the course of vaping initiation and uptake. There was a reduction in the proportion of people using a tobacco flavor, and increase in the proportion using a fruit/sweet/food flavor, from initial to current flavor choice
  • According to the 2017 ASH-A survey, among current users, fruit flavors were the most popular.
  • PDF Version
  • Citation: Gentry, S.V., Ward, E., Dawkins, L. et al. Reported patterns of vaping to support long-term abstinence from smoking: a cross-sectional survey of a convenience sample of vapers. Harm Reduct J 17, 70 (2020). doi:10.1186/s12954-020-00418-8

2019: Article: E-Cigarette Flavor Bans Will Drive More People Back to Smoking

  • These laws will result in thousands of ex-smokers returning to cigarette smoking because the e-cigarettes they rely upon are taken off the shelves, while tobacco cigarettes remain. The absurdity of these proposals is that they restrict the sale of e-cigarettes more severely than the sale of actual cigarettes, the ones that are killing more than 400,000 Americans each year. Why would regulators want to give a competitive advantage to cigarettes over the much safer alternative?
  • By creating barriers to a much healthier product, these laws will simply force former smokers to return to cigarette smoking. Lawmakers are doing a huge favor not for the public’s health, but for Marlboro, which is going to see a windfall in the ex-smoker market as all of its competition from vaping products is eliminated.
  • Citation: Michael Siegel, February 19, 2019, Inside Sources

Smoking Cessation

2021: How Does the Use of Flavored Nicotine Vaping Products Relate to Progression Toward Quitting Smoking? Findings From the 2016 and 2018 ITC 4CV Surveys

  • Use of fruit and other sweet flavored e-liquids is positively related to smokers’ transition away from cigarettes.
  • Citation: Lin Li, PhD, Ron Borland, PhD, Kenneth Michael Cummings, PhD, Geoffrey T Fong, PhD, Shannon Gravely, PhD, Danielle M Smith, MPH, Maciej L Goniewicz, PhD, Richard J O’Connor, PhD, Mary E Thompson, PhD, Ann McNeill, PhD, How Does the Use of Flavored Nicotine Vaping Products Relate to Progression Toward Quitting Smoking? Findings From the 2016 and 2018 ITC 4CV Surveys, Nicotine & Tobacco Research, Volume 23, Issue 9, September 2021, Pages 1490–1497, doi: 10.1093/ntr/ntab033

2020: Associations of Flavored e-Cigarette Uptake With Subsequent Smoking Initiation and Cessation

  • Adults who began vaping nontobacco-flavored e-cigarettes were more likely to quit smoking than those who vaped tobacco flavors.
  • Banning flavors altogether may be too blunt an instrument for the current problem (youth use of vapor products).
  • PDF Version
  • Citation: Friedman, A. S., & Xu, S. (2020). Associations of Flavored e-Cigarette Uptake With Subsequent Smoking Initiation and Cessation. JAMA Network Open, 3(6), e203826. doi:10.1001/jamanetworkopen.2020.3826

2019: The role of flavors in vaping initiation and satisfaction among U.S. adults

  • Most common reasons for vaping initiation were as an alternative to cigarettes (43.7%) and because respondents viewed e-cigarettes as less harmful than other tobacco products (31.2%). Flavor was the third most commonly reported reason.
  • Satisfaction among those who bought flavored e-liquid was higher than those who did not buy flavored e-liquid.
  • PDF Version
  • Citation: Landry, R. L., Groom, A. L., Vu, T.-H. T., Stokes, A. C., Berry, K. M., Kesh, A., … Payne, T. J. (2019). The role of flavors in vaping initiation and satisfaction among U.S. adults. Addictive Behaviors, 106077. doi:10.1016/j.addbeh.2019.106077

2019: Vaping patterns, nicotine dependence and reasons for vaping among American Indian dual users of cigarettes and electronic cigarettes

  • The ten-item Penn State Dependence Index (PSDI) suggested greater dependence on smoking than vaping
  • The most common reasons for vaping were to reduce smoking (79%), enjoyment of flavors (78%), and ability to vape where smoking is not allowed (73%). Perceptions of less harm to others (69%) or to self were the next most common (65%). Fewer than half used ECs to reduce stress, for affordability, or because others used them.
  • PDF Version
  • Citation: Rhoades DA, Comiford AL, Dvorak JD, Ding K, Hopkins M, Spicer P, Wagener TL, Doescher MP. Vaping patterns, nicotine dependence and reasons for vaping among American Indian dual users of cigarettes and electronic cigarettes. BMC Public Health. 2019 Sep 2;19(1):1211. doi: 10.1186/s12889-019-7523-5. PMID: 31477072; PMCID: PMC6721166.

2019: Video: Can Flavors Help People Who Smoke Quit Smoking?

  • Minnesota Smoke-Free Alliance
  • Do flavors help adults quit smoking? Is there "right" flavored products and "wrong" flavored products? Do we have the right to tell people they have to quit smoking using a method we approve of? (English)

2019: Article: Flavors make vaping more palatable, help cigarette smokers kick the habit

  • Flavored e-cigarettes were not invented by “Big Tobacco,” nor are they an unscrupulous marketing plot from the thousands of small, independently owned vape companies in the United States to addict kids. Non-tobacco vape flavors are a user innovation.
  • Fruit, candy, bakery, mint, and beverage flavors were introduced to vaping in 2008 by pioneering users of the technology who were desperate to use e-cigarettes to replace smoking.
  • Flavors like cotton candy, bubble gum, and the many other examples opponents claim are obviously targeted to youth are in fact flavors someone trying to quit smoking wanted to vape and mixed themselves. These innovations in home-mixing resulted in the commercial market about to be banned today.
  • The preponderance of evidence indicates that non-tobacco flavors, including fruit, dessert, and candy, are essential to vaping as an effective way to quit smoking and avoid relapse.
  • Citation: Amelia Howard, September 21, 2019, Pro/Con: As vaping-related illnesses rise, should flavored e-cigarettes be banned?, The Philadelphia Enquirer

2019: Article: Banning flavored e-cigarettes has consequences

  • Instead of clamping down on teen vaping or socking it to Juul, a total vape flavor ban would shut down more than 14,000 small businesses and put at least 166,000 people out of work, while denying millions of Americans access to the tools they used to quit smoking.
  • E-cigarettes are known to be at least 95 percent safer than combustible cigarettes. If every smoker in America switched to vaping, as many as 6.6 million lives could be saved over the next decade.
  • Additionally, a study published in the New England Journal of Medicine found e-cigarettes to be almost twice as effective as traditional nicotine replacement therapies at helping smokers quit.
  • The consequences of banning flavors are as obvious as they are tragic. Analyzing the potential effects of different tobacco flavor bans, researchers at the Yale School of Public Health concluded that banning e-cigarette flavors would result in more smoking.
  • Citation: Guy Bentley, November 28, 2019, The Pueblo Chieftain

2018: Advice From Former-Smoking E-Cigarette Users to Current Smokers on How to Use E-Cigarettes as Part of an Attempt to Quit Smoking

  • This study describes the advice that former-smokers who used e-cigarettes to quit smoking would offer to smokers who are considering using an e-cigarette to support an attempt to quit smoking. Vapers advised smokers to find the right combination of device, flavors and nicotine strength, continue to smoke and vape for a while if they wished, not be deterred by past failed attempts to quit smoking, and expect health to improve after they have switched to vaping. Encouraging smokers to interact with vaping peers in vape shops and in online vaping-dedicated discussion forums may help significantly more smokers switch to vaping.
  • PDF Version
  • Citation: Christopher Russell, PhD, Tiffany Dickson, MSc, Neil McKeganey, PhD, Advice From Former-Smoking E-Cigarette Users to Current Smokers on How to Use E-Cigarettes as Part of an Attempt to Quit Smoking, Nicotine & Tobacco Research, Volume 20, Issue 8, August 2018, Pages 977–984, doi: 10.1093/ntr/ntx176

2018: Motivation and main flavour of use, use with nicotine and dual use of electronic cigarettes in Barcelona, Spain: a cross-sectional study

  • The most prevalent motivation for using e-cigarettes was to reduce tobacco smoking 48%, followed by quitting smoking 39.2%, and to use e-cigarettes in places where tobacco smoking was prohibited 10.2%.
  • Citation: Bunch K, Fu M, Ballbè M, et alMotivation and main flavour of use, use with nicotine and dual use of electronic cigarettes in Barcelona, Spain: a cross-sectional studyBMJ Open 2018;8:e018329. doi: 10.1136/bmjopen-2017-018329

2017: Differences between Dual Users and Switchers Center around Vaping Behavior and Its Experiences Rather than Beliefs and Attitudes

  • To the extent that dual users substantially lower the number of cigarettes, they will reduce health risks from smoking. However, from a medical point of view, exclusive vaping is preferable to dual use;
  • Differences between dual users and switchers center around variables proximal to the vaping behavior and its experienced effects rather than hinging on more general vaping-related beliefs and attitudes.
  • After e-cig initiation, dual users decreased tobacco consumption by 82% and were low-to-moderately cigarette dependent.
  • The two groups (dual users and switchers) reported mostly using a flavor other than tobacco.
  • PDF Version
  • Citation: Adriaens K, Van Gucht D, Baeyens F. Differences between Dual Users and Switchers Center around Vaping Behavior and Its Experiences Rather than Beliefs and Attitudes. Int J Environ Res Public Health. 2017 Dec 23;15(1):12. doi: 10.3390/ijerph15010012. PMID: 29295483; PMCID: PMC5800112.

2015: Preferred Flavors and Reasons for E-cigarette Use and Discontinued Use Among Never, Current, and Former Smokers

  • Never users had significantly lower prevalence of use of alcohol, marijuana, and other tobacco products (take less risks).
  • The most commonly reported reasons for e-cigarette use were “they might be less harmful than cigarettes” (77%); “they don’t smell” (77%); “they help people quit smoking” (66%); and “they cost less than other forms of tobacco” (62%); these reasons were more frequently endorsed by former smokers.
  • Among current e-cigarette users, the most commonly used flavor was fruit flavors (67%)
  • Over 90% of former cigarette smokers who were current e-cigarette users reported using e-cigarettes to quit smoking.
  • Over half of never smokers who are former e-cigarette users said they did not recently use e-cigarettes because they “just don’t think about it”, possibly indicating that addiction did not play a role in their use.
  • PDF Version
  • Citation: Berg CJ. Preferred flavors and reasons for e-cigarette use and discontinued use among never, current, and former smokers. Int J Public Health. 2016 Mar;61(2):225-36. doi: 10.1007/s00038-015-0764-x. Epub 2015 Nov 18. PMID: 26582009; PMCID: PMC4808473.

2013: Impact of Flavour Variability on Electronic Cigarette Use Experience: An Internet Survey

  • 4,618 participants were included in the analysis, with 4,515 reporting current smoking status (current vs. former smokers).
  • More than 90% were former smokers. The mean age was 40 years
  • At the time of participation, most commonly used flavors were fruits, followed by sweets.
  • Most participants (68.3%) were switching between flavours on a daily basis or within the day, with former smokers switching more frequently. More than half of the study sample mentioned that they like the variety of flavours and that the taste gets blunt from long-term use of the same flavour. The average score for importance of flavours variability in reducing or quitting smoking was 4 (“very important”). Finally, the majority of participants stated that restricting variability of flavours would make the EC experience less enjoyable while almost half of them answered that it would increase craving for tobacco cigarettes and would make reducing or completely substituting smoking less likely.
  • The results of this survey indicate that EC liquid flavourings play a major role in the overall experience of dedicated users and support the hypothesis that they are important contributors in reducing or eliminating smoking consumption.
  • PDF Version
  • Citation: Farsalinos, K., Romagna, G., Tsiapras, D., Kyrzopoulos, S., Spyrou, A., & Voudris, V. (2013). Impact of Flavour Variability on Electronic Cigarette Use Experience: An Internet Survey. International Journal of Environmental Research and Public Health, 10(12), 7272–7282. doi:10.3390/ijerph10127272

2006: Tobacco Dependence: Global Public Health Potential for New Medications Development and Indications

  • The marketing of a mint-flavored form of nicotine gum in the United States increased the market for nicotine gum by more than 25% and contributed to increasing numbers of smokers finding a treatment that was acceptable and thereby successfully quitting smoking.
  • There is clearly a need for increased forms of nicotine delivery, possibly including those that more closely mimic the pharmacokinetics of cigarettes.
  • PDF Version
  • Citation: HENNINGFIELD, J. E., FANT, R. V., GITCHELL, J., & SHIFFMAN, S. (2006). Tobacco Dependence: Global Public Health Potential for New Medications Development and Indications. Annals of the New York Academy of Sciences, 909(1), 247–256. doi:10.1111/j.1749-6632.2000.tb06686.x

Use of Flavors (Youth to Sr. Citizens)

2021: THE CASE FOR FLAVOURS IN TOBACCO HARM REDUCTION, TO SAVE LIVES

  • Unfortunately, several governments are contemplating banning flavours in ENDS, apparently to prevent youth initiation. This review argues for the responsible and regulated use of flavours, to maximise the harm reduction effect of ENDS and its role in smoking cessation.
  • Report by: Konstantinos Farsalinos, MD, MPH
  • Webinar
    • This webinar discussed the above flavors report and took place on 15 December 2021, and featured Dr Konstantinos Farsalinos, Dr Delon Human, Dr Kgosi Letlape, Prof Heino Stöver, and Charles A. Gardner, PhD.

2020: Choice and variety-seeking of e-liquids and flavour (flavor) categories by New Zealand smokers using an electronic cigarette: a longitudinal study

  • Variety-seeking behaviour (behavior) was common and typically reported within the first 12 weeks of participants’ e-cigarette-assisted attempt to transition away from smoking.
  • Policies allowing diverse e-liquid flavours at specialist stores could support users’ variety-seeking and potentially create opportunities to couple e-liquid purchasing occasions with cessation advice during the first months of a transition attempt.
  • Citation: Mei-Ling Blank, MPH, Janet Hoek, PhD, Choice and variety-seeking of e-liquids and flavour categories by New Zealand smokers using an electronic cigarette: a longitudinal study, Nicotine & Tobacco Research, , ntaa248, doi:10.1093/ntr/ntaa248

2018: Changing patterns of first e-cigarette flavor used and current flavors used by 20,836 adult frequent e-cigarette users in the USA

  • Adult frequent e-cigarette users in the USA who have completely switched from smoking cigarettes to using e-cigarettes are increasingly likely to have initiated e-cigarette use with non-tobacco flavors and to have transitioned from tobacco to non-tobacco flavors over time. Restricting access to non-tobacco e-cigarette flavors may discourage smokers from attempting to switch to e-cigarettes.
  • PDF Version
  • Citation: Russell C, McKeganey N, Dickson T, Nides M. Changing patterns of first e-cigarette flavor used and current flavors used by 20,836 adult frequent e-cigarette users in the USA. Harm Reduct J. 2018 Jun 28;15(1):33. doi: 10.1186/s12954-018-0238-6. PMID: 29954412; PMCID: PMC6022703.

2015: The Impact of Flavor Descriptors on Nonsmoking Teens’ and Adult Smokers’ Interest in Electronic Cigarettes

  • Nonsmoking teens’ interest in e-cigarettes was very low.
  • Adult smokers’ interest was significantly higher overall and for each flavor.
  • Teen interest did not vary by flavor, but adult interest did.
  • Past-30-day adult e-cigarette users had the greatest interest in e-cigarettes, and their interest was most affected by flavor.
  • Nonsmoking teens who had never tried e-cigarettes had the lowest interest in flavors, followed by adults who had never tried e-cigarettes
  • PDF Version
  • Citation: Saul Shiffman, PhD, Mark A Sembower, MS, Janine L Pillitteri, PhD, Karen K Gerlach, PhD, MPH, Joseph G Gitchell, BA, The Impact of Flavor Descriptors on Nonsmoking Teens’ and Adult Smokers’ Interest in Electronic Cigarettes, Nicotine & Tobacco Research, Volume 17, Issue 10, October 2015, Pages 1255–1262, doi: 10.1093/ntr/ntu333

2013: Adolescent Males' Awareness of and Willingness to Try Electronic Cigarettes

  • Only two participants (< 1%) had previously tried e-cigarettes.
  • Among those who had not tried e-cigarettes, most (67%) had heard of them. Awareness was higher among older and non-Hispanic adolescents.
  • Nearly 1 in 5 (18%) participants were willing to try either a plain or flavored e-cigarette, but willingness to try plain versus flavored varieties did not differ.
  • Smokers were more willing to try any e-cigarette than nonsmokers.
  • Nonsmokers who had more negative beliefs about the typical smoker were less willing to try e-cigarettes.
  • PDF Version
  • Citation: Pepper, J. K., Reiter, P. L., McRee, A.-L., Cameron, L. D., Gilkey, M. B., & Brewer, N. T. (2013). Adolescent Males’ Awareness of and Willingness to Try Electronic Cigarettes. Journal of Adolescent Health, 52(2), 144–150. doi:10.1016/j.jadohealth.2012.09.014

Youth

2020: Report Summary: Perverse Psychology How Anti-Vaping Campaigners Created the Youth Vaping “Epidemic”

  • It is reasonable for anti-tobacco advocates to worry about youth experimentation with nicotine, but the evidence is clear that their interventions have backfired and made the problem worse. Their attempts to dissuade teenagers from vaping increased their awareness of the behavior, made it more attractive, and convinced them that everyone around them was doing it.
  • Anti-tobacco advocates argue that the government can end the “epidemic” by raising the minimum tobacco age to 21, banning non-tobacco e-cigarette flavors, and increasing funding for anti-vaping education. But, as this paper has demonstrated, these measures will not only fail, they will actually make matters worse by increasing the coolness of vaping and youth attraction to it.
  • Teen vaping did not escalate despite the increased anti-vaping messaging. Adolescents’ curiosity and subsequent experimentation with vaping rose because of anti-vaping messaging.
  • PDF of Full report

2020: Paper: Intended and Unintended Effects of Banning Menthol Cigarettes

  • Menthol bans significantly increased non-menthol cigarette smoking among youths, resulting in no overall net change in youth smoking rates.
  • Menthol bans shifted smokers’ cigarette purchases away from grocery stores and gas stations to First Nations reserves (where the menthol bans do not bind).
  • PDF Full Paper

2020: Video: Vaping: what people are getting wrong

  • The Economist
  • A youth vaping “epidemic” and a mysterious outbreak of lung disease in America has led to curbs on e-cigarette flavours. A backlash against vaping is perpetuating myths about nicotine-based e-cigarette products that are not backed up by scientific research. (UK / English)

2019: Article: The US vaping flavour (flavor) ban: twenty things you should know

  • A well researched article that touches on many of the myths and fears about youth use of flavored vapor products.
  • PDF Version

2017: Blog: Confessions of an e-liquid mixologist

  • Certain things really bother me. Like when anti-tobacco activists do things to destroy my pride in being an ex-smoker and helping other people quit smoking. The most hurtful thing of all, is to pervert the effort I put into creating flavors of e-liquids to appeal to adult smokers and accuse me of marketing to children, of trying to addict the next generation of kids on nicotine.
  • Not once did I create a flavor and go “hmmmm, I bet a 12 year old would like this”. Not once. I’m not a monster, I’m a mom, an aunt, a grandma, and a great grandma. All I wanted to do is help people quit smoking so they could live long enough to enjoy their extended families. I wanted to help people quit smoking so kids would no longer be exposed to 2nd hand smoke. I wanted to make the world a better place.

Addressing Myths About Flavors

2020: Article: Does Diacetyl in Vaping Cause Popcorn Lung?

  • While almost anything is possible, there’s simply no evidence that vaping causes popcorn lung.

2019: Cancer Research UK: Does vaping cause popcorn lung?

  • No. There’s no good evidence that e-cigarettes could cause the lung condition called popcorn lung. There’s been no confirmed cases of popcorn lung reported in people who use e-cigarettes.

2019: RE: Vape related "Popcorn Lung" debunked years ago

  • 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.

2018: Paper: E-cigarette flavors and aldehyde emissions: another failure to verify findings from a previous study

Our results were revealing in identifying a very small contribution of flavorings on aldehyde emissions. In fact, aldehyde levels were so low that consumption of 5 grams liquid per day would expose vapers to less formaldehyde and acetaldehyde than just staying at home and breathing air. For acrolein, exposure was orders of magnitude lower compared to NIOSH-defined recommended safety limits. To give you an idea of the differences in results, the authors of the original study found up to 7000 ug/g formaldehyde, while we found a maximum of 62 ug/g.
In conclusion, we confirmed that flavouring compounds can contribute to aldehyde emissions from ECs, but such contribution, detected in only 3 liquids and two flavours herein, was minimal.

2017: Comment on “Flavoring Compounds Dominate Toxic Aldehyde Production during E Cigarette Vaping”

  • We would like to point out that the finding is in a stark contrast to previous results.
  • The high levels only happen under dry puff conditions, something avoided by vapers as it is very unpleasant.

2015: Medical journal MISPRESENTS a case of hypersensitivity pneumonitis as popcorn lung disease caused by e-cigarette

  • It was shocking to see a public statement reporting a case of popcorn lung disease in a patient using e-cigarettes. The title of the public release is: “Case report finds 'popcorn lung' in patient using e-cigarettes. Report points to possibility of diacetyl, a flavoring agent in e-cigarettes, to bronchiolitis obliterans syndrome”
  • The article then goes on to explain why it can’t be popcorn lung and calls for the retraction of the study.

2015 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.
  • 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.

Quotes / Graphics

Scott Gottlieb, MD - Former USA FDA Commissioner

Source


Scott Gottlieb on Flavors

American Association of Public Health Physicians

AAPHP flavor statement



Observation on the variety of flavored products used

NRT vs. ENDS: Does it matter?



American Academy of Pediatricts

Flavored NRT



FDA approved manufacturers of Nicotine Replacement Therapy understand the importance of flavors

FDA approved NRT comes in flavors



Age demographics of people who eat cotton candy

Cotton Candy



Senator Dick Durbin endorses banning flavors (1)

Senator Durbin Ice Cream



Senator Dick Durbin endorses banning flavors (2)

Senator Durbin Candy


Further Reading

2021: Policy Analyst Testimony: Testimony before the Connecticut Public Health Committee Regarding Prohibiting the Sale of Flavored Tobacco and Vapor Products

2021: Commentary: Want fewer teen smokers? Stop all the bans

2020: Policy Paper: Why Vape Flavors Matter

2020: Policy Blog: YALE STUDY FINDS THAT VAPING FLAVORS HELP ADULTS QUIT

2020: Policy Blog: Montana Should Reject Proposed Ban on Flavored Vaping Products

2020: Opinion: Flavors Aren’t Main Driver of Youth E-Cigarette Use

2020: Policy Blog: How California’s Flavored Tobacco Ban Will Hurt Communities and Budgets

2020: Policy analyst Testimony: Testimony before the Minnesota House Committee on Commerce

2020: Flavor Ban Letter: AVA URGES FLORIDA GOVERNOR TO VETO BACKDOOR FLAVOR BAN BILL

2020: Policy Blog: The Costs and Unintended Consequences of Tobacco and Vaping Flavor Bans

2020: Policy Blog: In 2020, Congress Replaced the War on Marijuana With a War on Flavored Tobacco Products

2020: Policy Blog: CDC Survey Shows Flavors Aren’t Driving Youth Vaping

2020: Policy Blog: The Negative Impacts of Massachusetts’ Flavored Tobacco Ban

2019: Policy Paper: TOBACCO HARM REDUCTION 101: A GUIDEBOOK FOR POLICYMAKERS

2019: Article: EDITORIAL: Vote no on flavored vaping ban

2019: The Economic Impact of a Ban on Flavored Vapor Products

2019: Policy Blog: Albany’s Proposed Flavored Tobacco Ban Misses the Mark

2019: Policy Blog: The Public Health Case for E-Cigarette Flavors

2019: Policy Blog: E-Cigarette Flavor Ban Creates Public Health Problems

2018: Testimony to FDA: Comments on FDA's Advance Notice of Proposed Rulemaking on Flavored Tobacco Products

2018: Policy Blog: San Francisco, Flavored Vapes, and the Next Prohibition Disaster

2018: Policy Blog: California’s Plan to Ban Vaping Flavors would Hurt Public Health

2017: Blog: Vape Shop Air Sampling by California State Health Department Suggests that Secondhand Vape Exposure is Minimal

2017: Blog: Are e-liquid flavours really 'hooking another generation of kids'?

Other Resources

Document of pre-written tweets about flavors

Suggested Studies, Papers, Surveys, and Articles to Add to This Page

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2022: Removal of mango-flavoured Juul pods created opportunity for adulterated mango Juul-compatible pods with altered chemical constituents

2022: 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: E-cigarette addiction and harm perception: Does initiation flavor choice matter?

2022: 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: 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.

2022: 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.

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