Flavouring chemicals are added to most tobacco products, as described above in Section 12.6.3.1. Flavourings can enhance the taste of the product and mask harshness, affecting consumer perceptions of tobacco products. Some products have an abundance of a specific flavour, known as a characterising flavour. These ‘flavoured’ products have been banned in a number of countries. For instance, fruit and/or sweet flavoured cigarettes are banned under state laws or regulation in Australia. In the US, flavoured cigarettes (with the exception of menthol cigarettes) have been banned but other tobacco products may be flavoured. Popular flavoured products in the US include flavoured cigars, bidis and waterpipe tobacco.1 See Section 12.6.12 for the regulation of flavourings and flavoured products. Section 10.8.4 contains more details about the types of flavoured products sold by the tobacco industry and Section 5.13.2 describes their influence on new users.
This section, as well as Sections 12.6.10 and 12.6.11 describes ‘flavoured’ tobacco products; those with a discernible characteristic flavour, as opposed to those that having any flavouring additives.
A large US cohort study found that one of the top reasons for choosing a tobacco product was ‘comes in flavors that I like’. This was the top reason for adolescents (14 to 17 years) who chose filtered cigars and cigarillos (after the flavoured cigarette ban in 2009).2 The use of flavoured tobacco products is also perceived by young people to be associated with peer approval and acceptance.3
Flavours are often perceived as being associated with lower harm from tobacco. A number of studies have shown that people believe that flavoured tobacco products are less harmful than non-flavoured cigarettes.4,5 Users of flavoured little cigars, cigarillos, and filtered cigars were more likely to perceive them as ‘not at all risky’ or ‘a little risky’6 and to perceive themselves as not addicted,7 compared to users of non-flavoured products.
Most waterpipe tobacco contains sweet flavours from added molasses or honey and fruit-based additives (see Section 12.2.5).8 A systematic review concluded that flavourings are the primary aspect that makes waterpipe use attractive.9 Waterpipe users of flavoured products were more likely than non-flavoured users to describe the experience as tasty and satisfying, less irritating and as producing an enjoyable sensation in the throat and chest.8 Most women (82%) who used waterpipes preferred flavoured tobacco in a study of US women of reproductive age. Sweet flavours (fruits, candy or other sweets, chocolate) were preferred over other flavours (menthol/mint, clove/spice, alcohol, other beverages, tobacco/unflavoured).10 Fruity flavours and pleasant odours underpinned perceptions of reduced harm from waterpipe use in a UK study of young people aged 20 to 30 years.11
People who use cigars of various types rather than cigarettes reported that enjoying flavour/taste was the main reason for their choice.12
References
1. Cullen KA, Liu ST, Bernat JK, Slavit WI, Tynan MA, et al. Flavored tobacco product use among middle and high school students - United States, 2014-2018. The Morbidity and Mortality Weekly Report, 2019; 68(39):839-44. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31581163
2. Villanti AC, Johnson AL, Ambrose BK, Cummings KM, Stanton CA, et al. Flavored tobacco product use in youth and adults: Findings from the first wave of the PATH study (2013-2014). American Journal of Preventive Medicine, 2017; 53(2):139-51. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28318902
3. Camenga DR, Fiellin LE, Pendergrass T, Miller E, Pentz MA, et al. Adolescents' perceptions of flavored tobacco products, including e-cigarettes: A qualitative study to inform fda tobacco education efforts through videogames. Addictive Behaviors, 2018; 82:189-94. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29573891
4. Kowitt SD, Meernik C, Baker HM, Osman A, Huang LL, et al. Perceptions and experiences with flavored non-menthol tobacco products: A systematic review of qualitative studies. International Journal of Environmental Research and Public Health, 2017; 14(4). Available from: https://www.ncbi.nlm.nih.gov/pubmed/28333107
5. Stanton CA, Villanti AC, Watson C, and Delnevo CD. Flavoured tobacco products in the USA: Synthesis of recent multidiscipline studies with implications for advancing tobacco regulatory science. Tobacco Control, 2016; 25(Suppl 2):ii1-ii3. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27856996
6. Nyman AL, Sterling KL, Majeed BA, Jones DM, and Eriksen MP. Flavors and risk: Perceptions of flavors in little cigars and cigarillos among U.S. Adults, 2015. Nicotine & Tobacco Research, 2018; 20(9):1055-61. Available from: https://pubmed.ncbi.nlm.nih.gov/28666353/
7. Nyman AL, Sterling KL, Weaver SR, Majeed BA, and Eriksen MP. Little cigars and cigarillos: Users, perceptions, and reasons for use. Tobacco Regulatory Science, 2016; 2(3):239-51. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27413772
8. Ben Taleb Z, Vargas M, Ebrahimi Kalan M, Breland A, Eissenberg T, et al. The effect of flavoured and non-flavoured tobacco on subjective experience, topography and toxicant exposure among waterpipe smokers. Tobacco Control, 2020; 29(Suppl 2):s72-s9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31767788
9. Kienhuis AS and Talhout R. Options for waterpipe product regulation: A systematic review on product characteristics that affect attractiveness, addictiveness and toxicity of waterpipe use. Tobacco Induced Diseases, 2020; 18:69. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32934615
10. Scott-Sheldon LAJ and Stroud LR. Preferences and perceptions of flavored hookah tobacco among us women. American Journal of Health Behavior, 2018; 42(3):37-46. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29663979
11. Dhillon AZ, Doran T, and Aggarwal VR. Perceptions of waterpipe smoking among young adults: A phenomenological study. Dentistry journal, 2020; 8(4). Available from: https://www.ncbi.nlm.nih.gov/pubmed/33321834
12. Campbell BK, Le T, Gubner NR, and Guydish J. Health risk perceptions and reasons for use of tobacco products among clients in addictions treatment. Addictive Behaviors, 2019; 91:149-55. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30206006