Flavored tobacco products — with added flavorings — include types of , and , and hookah tobacco, various types of smokeless tobacco, and more recently electronic cigarettes. Flavored tobacco products are especially popular with youth and have therefore become targets of regulation in several countries.
According to a 2013 survey of internet tobacco retailers, the most common flavors are apple, cherry, chocolate, honey, grape, menthol, Lamiaceae, peach, rum, strawberry, "sweet" (including bubble gum, candy, mango, blueberry, strawberry, orange, gum mint, and toffee) and vanilla.
In the United States, menthol cigarettes are used disproportionately by African Americans: more than 70% of African-American smokers primarily use menthols, compared to approximately 30% of White Americans smokers. In fact, menthol tobacco marketing is specifically targeted to African Americans; it is a subject of research and it has been a subject of litigation on discrimination grounds. This high use by African Americans is largely the result of deliberate marketing campaigns by tobacco companies, which exacerbated small racial differences in menthol cigarette preferences into large ones. Racial marketing strategies changed during the Fifties. The civil rights movement led to the rise of African-American publications, such as Ebony. This helped tobacco companies to target separate marketing messages by race. Tobacco companies supported civil rights organizations, and advertised their support heavily. Industry motives were, according to their public statements, to support civil rights causes; according to an independent review of internal tobacco industry documents, they were "to increase African American tobacco use, to use African Americans as a frontline force to defend industry policy positions, and to defuse tobacco control efforts". There had been internal resistance to tobacco sponsorship, and some organizations are now rejecting nicotine funding as a matter of policy. Tobacco company Lorillard even gave out free menthol cigarette samples to children in black neighborhoods in the U.S. in the 1950s.
In addition to high use by African Americans, menthol cigarettes are used disproportionately by adolescents, women, and lesbian, gay, bisexual, and transgender (LGBT) Americans. LGBT Americans are twice as likely as straight ones to use menthol cigarettes, according to CDC research. Where these demographics overlap, menthol use is especially high: most female LGBT smokers use menthols, as do 80 percent of African American youth smokers and 70 percent of LGBT youth smokers. Tobacco companies have targeted the LGBT community with advertising for menthol cigarettes, most notably through Project SCUM.
Some e-liquid flavorings are toxic. Cinnamaldehyde is a highly cytotoxic material in vitro used in cinnamon-flavored e-liquids. Cinnamaldehyde have been identified as cytotoxic at the amount of about 400 times less than those allowed for use by the US Environmental Protection Agency. A 2018 in vitro study found that exposing lung cells to liquid or vapor containing cinnamaldehyde causes significant and rapid damage to their cilia and mitochondria. This led the authors of the study to conclude that "inhalational exposures of cinnamaldehyde may increase the risk of respiratory infections in e-cigarette users." Some e-liquids containing cinnamaldehyde stimulate TRPA1, which might induce effects on the lung. E-liquids contain possibly toxic and reactive oxygen species (ROS). Many flavors are known aldehydes, such as anisaldehyde, cinnamaldehyde, and isovaleraldehyde. A 2012 study found butterscotch flavor was highly toxic with one liquid and two others had a low toxicity. A 2014 in vitro study demonstrated that e-cigarette use of a "balsamic" flavor with no nicotine can activate the release of proinflammatory cytokine in lung epithelial cells and . Some additives may be added to reduce the irritation on the pharynx. The long-term toxicity is subject to the additives and contaminants in the e-liquid.
Certain e-liquid flavorings contain diacetyl and acetylpropionyl which give a buttery taste. Diacetyl and acetyl propionyl are associated with bronchiolitis obliterans ("popcorn lung"), a serious lung disease. A 2015 review recommended for specific regulation of diacetyl and acetyl propionyl in e-liquid, which are safe when ingested but have been associated with respiratory harm when inhaled. Both diacetyl and acetyl-propionyl have been found in concentrations above those recommended by the US National Institute for Occupational Safety and Health. Diacetyl is normally found at lower levels in e-cigarettes than in traditional cigarettes. Concerns exist that the flavors and additives in e-cigarettes might lead to diseases, including the popcorn lung. The cardiovascular effects, including a vast range of flavorings and fragrances, is unknown. The irritants butyl acetate, diethyl carbonate, benzoic acid, quinoline, bis(2-ethylhexyl) phthalate, and 2,6-dimethyl phenol were present as undeclared ingredients in the e-liquid. Hindering safety assessments of e-liquids is the fact that the precise ingredients of e-cigarettes and e-liquids are not known.
With the current popular trend of flavored e-cigarettes use among young generations, there is concern about the potential long-term health of the public.
Flavored tobacco products promote youth smoking initiation and help young occasional smokers to become daily smokers by reducing or masking the natural harshness and taste of tobacco smoke and increasing the social acceptability of the toxic tobacco product. Menthol appeals to younger or beginning smokers largely because the menthol masks the harshness and discomfort of inhaling smoke, making smoking more palatable. Trying menthols increases smoking initiation among youth and young adults, and menthols users face greater addiction and decreased success in quitting smoking. Young people who use menthol cigarettes are 80% more likely to become life-long smokers than those who use regular cigarettes. Likewise, studies associate youth hookah use with subsequent cigarette use, increased intensity of cigarette use, and decreased success in quitting. A 2016 study found 11- to 16-year-old English children exposed to e-cigarette advertisements highlighting flavored, in contrast to flavor-free e-cigarettes, increased e-cigarette appeal and usage. As such, adolescents were more likely to initiate vaping through flavored e-cigarettes than unflavored ones, and a majority of youth who used an e-cigarette first tried a flavored e-cigarette.
The goal of tobacco companies also drives the widespread use of flavored tobacco products. According to a 2008 study, the internal tobacco company documents found that makers of the largest menthol cigarette brands in the United States—Kool, Newport, Salem, Marlboro, and Camel—formulated the menthol levels in their cigarettes, as well as their marketing strategies, to entice young people. Likewise, multiple reviews of internal tobacco company documents have found that flavored cigarettes are deliberately introduced to appeal to young people, with flavorings often being fine-tuned to best appeal to youth.
Furthermore, flavored tobacco products are often advertised to children and adolescents. Flavored cigarettes have been advertised in magazines frequently read by kids, such as Sports Illustrated, Cosmopolitan, and Rolling Stone and on television programs watched by adolescents. A majority of adolescents and young adults are exposed to cigarillo advertising in magazines and storefronts and on social media. Flavored e-cigarettes have been marketed extensively to youth in retail stores and on television and social media: 78.2 percent of American youth (20.5 million people). A 2018 analysis of the 2014, 2015, and 2016 NYTS data by the CDC found that retail stores were where most youth were exposed to e-cigarette advertisements, followed by online advertising, television advertising, and then newspaper and magazine advertising. About 24 million youth have been exposed to e-cigarette ads on cable TV, primarily due to an ad campaign for blu e-cigarettes. On social media, marketing includes images associated with youth culture, endorsements by celebrities and social media popular with youth, and themes that have been found to strongly appeal to youth (such as freedom and rebellion). Ads for flavored e-cigarettes have been shown to cause children to be more interested in buying and trying e-cigarettes, as compared to ads for unflavored e-cigarettes.
Canada banned flavored additives in combustible tobacco products—cigarettes, little cigars, and rolling papers—in 2009, excluding menthol. Canada banned menthol cigarettes in 2017. Preliminary research in Ontario Province indicates that this ban increased the number of smokers who quit. Because the law only banned flavors in combustible tobacco products under 1.4 grams, some tobacco companies began producing flavored products slightly larger than 1.4 g.
In March 2012, Brazil became the first country to outlaw all flavored cigarettes, including menthol cigarettes. The policy has yet to be implemented.
In May 2016, the European Union banned flavored cigarettes including menthols. The ban took effect in 2020.
In 2015, Ethiopia, Moldova, and Chile have passed legislation banning flavored tobacco products. Turkey also implemented the world's first ban on menthol in all tobacco products in that year.
In June 2018, San Francisco residents voted to outlaw the sale of flavored tobacco products, including e-liquids and menthol cigarettes, in the city. The measure, Proposition E, passed with 68.5 percent of the vote, in spite of Big Tobacco company R.J. Reynolds spending more than $12 million on ads against the measure. The ban was supported by groups including the American Cancer Society, the American Heart Association, the American Lung Association, African American American Tobacco Control Leadership Council, and Tobacco-Free Kids Action Fund. Similar bans have passed in California in the cities of Oakland and Sonoma as well as in San Mateo, Contra Costa and Yolo County counties. , 180 localities in California, Illinois, Massachusetts, Minnesota, New York, and Rhode Island as well as two US states—Maine and New Jersey—restrict the sale of flavored tobacco products.
In June 2019, San Francisco became the first major U.S. city to put a ban on the sale and distribution of all e-cigarettes including flavored ones. The major e-cigarette company in San Francisco, JUUL spent over $18.6 million to the Proposition C campaign into a November ballot initiative in hopes to overturn the ban. This Proposition C would take launch starting early 2020 depending on the ballot results from San Francisco residents. It is based on the election results on November 5, 2019, the Proposition C was defeated. It shows that out of 201519 votes, nearly 82% of people were against Prop C. Which means that the citywide ban on e-cigarette products will be effective in 2020.
September 4, 2019, Michigan became the first state in the nation to ban flavored e-cigarettes.[1]
In November 2018 the FDA announced its intention to outlaw menthol cigarettes and flavored cigars, and to limit sales of e-cigarettes with flavors other than mint, tobacco, and menthol to qualified adults-only stores and online.
Heated tobacco products
Hookah
Smokeless tobacco
Use by youth
Regulation
Further reading
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