Abstract
Although a few countries have banned flavored cigarettes (except menthol), flavors in most tobacco products remain unregulated across the globe. We conducted a systematic review of qualitative studies examining perceptions of and experiences with flavored non-menthol tobacco products. Of 20 studies on flavored tobacco products included in our qualitative systematic review, 10 examined hookah, six examined e-cigarettes, two examined little cigars and cigarillos (LCCs), and three examined other tobacco products, including cigarettes. The majority of studies, regardless of product type, reported positive perceptions of flavored tobacco products, particularly among young adults and adolescents. In six studies that assessed perceptions of harm (including hookah, LCCs, and other flavored tobacco products), participants believed flavored tobacco products to be less harmful than cigarettes. In studies that examined the role of flavors in experimentation and/or initiation (including three studies on e-cigarettes, one hookah study and one LCC study), participants mentioned flavors as specifically leading to their experimentation and/or initiation of flavored tobacco products. Given that many countries have not yet banned flavors in tobacco products, these findings add to existing research on why individuals use flavored tobacco products and how they perceive harm in flavored tobacco products, providing further support for banning non-menthol flavors in most tobacco products.
Highlights
Flavored tobacco product use among youth and young adults is high, with prevalence rates for current use of any flavored tobacco product ranging from 12% among youth to18.5% among young adults in the United States (U.S.) [1,2]
Of 20 studies on flavored tobacco products included in our qualitative systematic review, 10 examined hookah, six examined e-cigarettes, two examined little cigars and cigarillos (LCCs), and three examined other tobacco products, including cigarettes
Supporting previous quantitative research on the appeal of flavored tobacco products [1,2,3], we found that most 20 studies included in our review reported positive perceptions of flavored tobacco products
Summary
Flavored tobacco product use among youth and young adults is high, with prevalence rates for current use (i.e., past 30 days) of any flavored tobacco product ranging from 12% among youth to18.5% among young adults in the United States (U.S.) [1,2]. Flavored tobacco product use among youth and young adults is high, with prevalence rates for current use (i.e., past 30 days) of any flavored tobacco product ranging from 12% among youth to. When examined by product type for young adults, use of any flavored tobacco product ranged from 3% for cigarettes (excluding menthol), to 13% for e-cigarettes, 35% for little cigars/cigarillos or bidis, and 50% for hookah. Many adolescents initiate tobacco use with flavored products [3], and flavors are one of the main reasons why youth continue to use tobacco products [3]. Act authorized the U.S Food and Drug Administration (FDA) to ban cigarettes with characterizing flavors (except for menthol) [4], but flavors in other non-cigarette tobacco products remain legal [5]. Public Health 2017, 14, 338; doi:10.3390/ijerph14040338 www.mdpi.com/journal/ijerph
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