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Impact of non-menthol flavours in e-cigarettes on perceptions and use: an updated systematic review
  1. Clare Meernik1,
  2. Hannah M Baker2,3,
  3. Sarah D Kowitt3,
  4. Leah M Ranney3,
  5. Adam O Goldstein2,3
  1. 1 Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  2. 2 Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  3. 3 Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  1. Correspondence to Dr Adam O Goldstein; adam_goldstein{at}


Objectives Given the exponential increase in the use of e-cigarettes among younger age groups and in the growth in research on e-cigarette flavours, we conducted a systematic review examining the impact of non-menthol flavoured e-cigarettes on e-cigarette perceptions and use among youth and adults.

Design PubMed, Embase, PyscINFO and CINAHL were systematically searched for studies published and indexed through March 2018.

Eligibility criteria Quantitative observational and experimental studies that assessed the effect of non-menthol flavours in e-cigarettes on perceptions and use behaviours were included. Specific outcome measures assessed are appeal, reasons for use, risk perceptions, susceptibility, intention to try, initiation, preference, current use, quit intentions and cessation.

Data extraction and synthesis Three authors independently extracted data related to the impact of flavours in tobacco products. Data from a previous review were then combined with those from the updated review for final analysis. Results were then grouped and analysed by outcome measure.

Results The review included 51 articles for synthesis, including 17 published up to 2016 and an additional 34 published between 2016 and 2018. Results indicate that non-menthol flavours in e-cigarettes decrease harm perceptions (five studies) and increase willingness to try and initiation of e-cigarettes (six studies). Among adults, e-cigarette flavours increase product appeal (seven studies) and are a primary reason many adults use the product (five studies). The role of flavoured e-cigarettes on smoking cessation remains unclear (six studies).

Conclusion This review provides summary data on the role of non-menthol flavours in e-cigarette perceptions and use. Consistent evidence shows that flavours attract both youth and adults to use e-cigarettes. Given the clear findings that such flavours increase product appeal, willingness to try and initiation among youth, banning non-menthol flavours in e-cigarettes may reduce youth e-cigarette use. Longitudinal research is needed to examine any role flavours may play in quit behaviours among adults.

  • public health
  • tobacco control
  • electronic cigarettes

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  • CM and HMB are joint first authors.

  • Contributors CM and HMB contributed equally to this paper as joint first authors. CM, HMB and SK conducted data review and analysis, drafted the initial manuscript and revised and reviewed the full manuscript. LR and AOG conceptualised the study and provided critical feedback to the intellectual content during drafting and revisions of the manuscript, as well as to the interpretation of data analyses.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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