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
. 2024 May 27:16:e51991.
doi: 10.2196/51991.

e-Cigarette Tobacco Flavors, Public Health, and Toxicity: Narrative Review

Yehao Sun  1 , Prital Prabhu  1 , Ryan Rahman  1 , Dongmei Li  2 , Scott McIntosh  3 , Irfan Rahman #  1
Affiliations
Review

e-Cigarette Tobacco Flavors, Public Health, and Toxicity: Narrative Review

Yehao Sun et al. Online J Public Health Inform. .

Abstract

Background: Recently, the US Food and Drug Administration implemented enforcement priorities against all flavored, cartridge-based e-cigarettes other than menthol and tobacco flavors. This ban undermined the products' appeal to vapers, so e-cigarette manufacturers added flavorants of other attractive flavors into tobacco-flavored e-cigarettes and reestablished appeal.

Objective: This review aims to analyze the impact of the addition of other flavorants in tobacco-flavored e-cigarettes on both human and public health issues and to propose further research as well as potential interventions.

Methods: Searches for relevant literature published between 2018 and 2023 were performed. Cited articles about the toxicity of e-cigarette chemicals included those published before 2018, and governmental websites and documents were also included for crucial information.

Results: Both the sales of e-cigarettes and posts on social media suggested that the manufacturers' strategy was successful. The reestablished appeal causes not only a public health issue but also threats to the health of individual vapers. Research has shown an increase in toxicity associated with the flavorants commonly used in flavored e-cigarettes, which are likely added to tobacco-flavored e-cigarettes based on tobacco-derived and synthetic tobacco-free nicotine, and these other flavors are associated with higher clinical symptoms not often induced solely by natural, traditional tobacco flavors.

Conclusions: The additional health risks posed by the flavorants are pronounced even without considering the toxicological interactions of the different tobacco flavorants, and more research should be done to understand the health risks thoroughly and to take proper actions accordingly for the regulation of these emerging products.

Keywords: e-cigarettes; health risk; menthol; nicotine; public health; regulation; risk; risks; smoking; social media; symptom; symptoms; tobacco; tobacco flavors; toxicity; toxicology; vaping.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
A schematic of the discussion of new tobacco-flavored e-cigarettes and their associated problems. FDA: Food and Drug Administration.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Leventhal AM, Dai H. Prevalence of flavored e-cigarette use among subpopulations of adults in the United States. J Natl Cancer Inst. 2021 Apr 06;113(4):418–424. doi: 10.1093/jnci/djaa118. https://europepmc.org/abstract/MED/32785659 5891665 - DOI - PMC - PubMed
    1. Zavala-Arciniega L, Hirschtick JL, Meza R, Fleischer NL. e-Cigarette characteristics and cigarette smoking cessation behaviors among U.S. adult dual users of cigarettes and e-cigarettes. Prev Med Rep. 2022 Apr;26:101748. doi: 10.1016/j.pmedr.2022.101748. https://linkinghub.elsevier.com/retrieve/pii/S2211-3355(22)00055-9 S2211-3355(22)00055-9 - DOI - PMC - PubMed
    1. Bold K, O'Malley S, Krishnan-Sarin S, Morean M. e-Cigarette use patterns, flavors, and device characteristics associated with quitting smoking among a U.S. sample of adults using e-cigarettes in a smoking cessation attempt. Nicotine Tob Res. 2023 Apr 06;25(5):954–961. doi: 10.1093/ntr/ntac276. https://europepmc.org/abstract/MED/36462196 6871065 - DOI - PMC - PubMed
    1. Jordt SE. Synthetic nicotine has arrived. Tob Control. 2023 Apr 07;32(e1):e113–e117. doi: 10.1136/tobaccocontrol-2021-056626. http://tobaccocontrol.bmj.com/lookup/pmidlookup?view=long&pmid=34493630 tobaccocontrol-2021-056626 - DOI - PMC - PubMed
    1. Stephenson J. FDA gains power to regulate synthetic nicotine in e-cigarettes. JAMA Health Forum. 2022 Apr 01;3(4):e221140. doi: 10.1001/jamahealthforum.2022.1140. https://jamanetwork.com/article.aspx?doi=10.1001/jamahealthforum.2022.1140 2790958 - DOI - PubMed

LinkOut - more resources