Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Mar 16:7:100143.
doi: 10.1016/j.dadr.2023.100143. eCollection 2023 Jun.

The role of flavored electronic nicotine delivery systems in smoking cessation: A systematic review

Alex C Liber  1 , Marie Knoll  1 , Christopher J Cadham  2 , Mona Issabakhsh  1 , Hayoung Oh  1 , Steve Cook  3 , Kenneth E Warner  2 , Ritesh Mistry  4 , David T Levy  1
Affiliations
Review

The role of flavored electronic nicotine delivery systems in smoking cessation: A systematic review

Alex C Liber et al. Drug Alcohol Depend Rep. .

Abstract

Background: Electronic nicotine delivery systems (ENDS) come in numerous flavors and may aid smoking cessation. This systematic review examines evidence on the role of ENDS flavors in smoking cessation.

Methods: We searched EMBASE OVID, PsychInfo, and Medline databases for studies that: 1) examined cigarette cessation outcomes for persons using ENDS (intent, attempts, and success) and 2) reported results separated by respondent's ENDS flavor used. We extracted crude and adjusted odds ratios for associations between cessation outcomes and types of ENDS flavors used (nontobacco vs. tobacco/unflavored; nontobacco and nonmenthol vs. tobacco/unflavored and menthol). We did not consider cessation outcomes among people not using ENDS. We evaluated the evidence using the GRADE approach, focusing on consistency and reliability of findings across studies.

Results: 29 studies met inclusion criteria, producing 36 odds ratios (ORs) comparing cessation outcomes across ENDS flavor groups. Three ORs examined quit intent, five examined quit attempts, and 28 examined quit success. Using GRADE, we reached Low levels of certainty that there was not an association between ENDS flavor use and intention to quit smoking or making a quit attempt. There were Very Low levels of certainty that nontobacco flavored versus tobacco/unflavored ENDS use was not associated with smoking cessation success, with similar findings for nonmenthol and nontobacco compared to tobacco and menthol flavored ENDS.

Conclusion: The evidence about the role of different flavored ENDS use and smoking cessation outcomes is inconclusive, reflecting highly heterogeneous study definitions and methodological limitations. More high-quality evidence, ideally from randomized controlled trials, is required.

Keywords: Electronic nicotine delivery systems; Flavored tobacco; Smoking cessation; Systematic review.

PubMed Disclaimer

Conflict of interest statement

Mr. Cadham receives research funding from imvaria, Inc. for unrelated work. The remaining authors report no conflicts of interest.

Figures

Fig 1
Fig. 1
PRISMA Diagram
See this image and copyright information in PMC

References

    1. 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;15:E12. doi: 10.3390/ijerph15010012. - DOI - PMC - PubMed
    1. Alzahrani Z., Zaidi S.F., Alsolami H., Bashrahil B., Alghamdi N., Nooh M., Khan M.A., Alshanberi A.M., Qanash S. Electronic cigarettes consumption and associated factors among general population in Western Saudi Arabia. J. Public Health Res. 2021;11 doi: 10.4081/jphr.2021.2346. - DOI - PMC - PubMed
    1. Bach L. States & localities that have restricted the sale of flavored tobacco products [WWW Document] Campaign Tob.-Free Kids. 2021 https://www.tobaccofreekids.org/assets/factsheets/0398.pdf URL. (accessed 8.13.21)
    1. Benowitz N.L., Bernert J.T., Foulds J., Hecht S.S., Jacob P., Jarvis M.J., Joseph A., Oncken C., Piper M.E. Biochemical verification of tobacco use and abstinence: 2019 update. Nicotine Tob. Res. Off. J. Soc. Res. Nicotine Tob. 2020;22:1086–1097. doi: 10.1093/ntr/ntz132. - DOI - PMC - PubMed
    1. Berg C.J. Preferred flavors and reasons for e-cigarette use and discontinued use among never, current, and former smokers. Int. J. Public Health, Soz. Pravent. 2016;61:225–236. doi: 10.1007/s00038-015-0764-x. - DOI - PMC - PubMed

LinkOut - more resources