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Flavoured tobacco products in the USA: synthesis of recent multidiscipline studies with implications for advancing tobacco regulatory science
  1. Cassandra A Stanton1,2,
  2. Andrea C Villanti3,
  3. Clifford Watson4,
  4. Cristine D Delnevo5
  1. 1Westat Inc, Rockville, Maryland, USA
  2. 2Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington DC, USA
  3. 3Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington DC, USA
  4. 4National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  5. 5Center for Tobacco Studies, School of Public Health, Rutgers, the State University, New Brunswick, New Jersey, USA
  1. Correspondence to Dr Cassandra A Stanton, Westat Inc, Rockville, MD, 20850, USA; cassandrastanton{at}westat.com

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Almost all tobacco products include flavour additives. As of 2014, over 1300 flavouring ingredients had been identified in cigarettes, smokeless and roll-your-own tobacco products.1 The 2009 Family Smoking Prevention and Tobacco Control Act—which gave the US Food and Drug Administration (FDA) authority to regulate tobacco products in the USA—banned the inclusion of characterising flavours (eg, candy, fruit) other than tobacco and menthol in cigarettes, but not other tobacco products.2 Additionally the FDA's Center for Tobacco Products (CTP) has conducted reviews3–5 and requested information on the impact of menthol cigarettes on population health through the Federal Register and meetings of the Tobacco Product Scientific Advisory Committee.

While the US FDA has not yet asserted its authority to regulate flavours in non-cigarette tobacco products (eg, smokeless tobacco, cigars, hookah) or e-cigarettes to date, the FDA signalled in materials accompanying the May 2016 deeming regulations its intent to issue a product standard that would ban characterising flavours in cigars, cigarillos and little cigars.6 Meanwhile, other countries are enacting more robust regulations regarding flavoured tobacco products, with bans on menthol flavoured products proposed and being passed in countries such as Brazil, Turkey, Germany and Ethiopia.7

Flavoured tobacco products are widely considered to be ‘starter’ products for young users and may encourage experimentation or reduce ‘harshness’ associated with more established products. Flavoured tobacco products are often perceived as less harmful than other products, facilitating tobacco use habits that can lead to a lifetime of addiction.8 Like all tobacco products, flavoured tobacco products can have serious health risks in addition to those normally associated with tobacco use and should not be considered or perceived as less harmful than non-flavoured products. Little is known about the health consequences and patterns of initiation/use among emerging tobacco products many of which are marketed …

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