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Impact of non-menthol flavours in tobacco products on perceptions and use among youth, young adults and adults: a systematic review
  1. Li-Ling Huang1,
  2. Hannah M Baker2,
  3. Clare Meernik2,
  4. Leah M Ranney1,2,
  5. Amanda Richardson1,
  6. Adam O Goldstein1,2
  1. 1 Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
  2. 2 Department of Family Medicine, Tobacco Prevention and Evaluation Program, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
  1. Correspondence to Dr Li-Ling Huang, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, Chapel Hill, NC 27599, USA; huangl{at}


Objective This systematic review examines the impact of non-menthol flavours in tobacco products on tobacco use perceptions and behaviours among youth, young adults and adults.

Data sources English-language peer-reviewed publications indexed in 4 databases were searched through April 2016.

Study selection A search strategy was developed related to tobacco products and flavours. Of 1688 articles identified, we excluded articles that were not English-language, were not peer-reviewed, were qualitative, assessed menthol-flavoured tobacco products only and did not contain original data on outcomes that assessed the impact of flavours in tobacco products on perceptions and use behaviour.

Data extraction Outcome measures were identified and tabulated. 2 researchers extracted the data independently and used a validated quality assessment tool to assess study quality.

Data synthesis 40 studies met the inclusion criteria. Data showed that tobacco product packaging with flavour descriptors tended to be rated as more appealing and as less harmful by tobacco users and non-users. Many tobacco product users, especially adolescents, reported experimenting, initiating and continuing to use flavoured products because of the taste and variety of the flavours. Users of many flavoured tobacco products also showed decreased likelihood of intentions to quit compared with non-flavoured tobacco product users.

Conclusions Flavours in most tobacco products appear to play a key role in how users and non-users, especially youth, perceive, initiate, progress and continue using tobacco products. Banning non-menthol flavours from tobacco products may ultimately protect public health by reducing tobacco use, particularly among youth.

  • Global health
  • Prevention
  • Public policy

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Contributors L-LH and AOG conceptualised and designed the study. L-LH, CM, HMB and LMR conducted the data screening, extraction and analyses. L-LH led and oversaw the writing of the manuscript, with contributions from CM, HMB, LMR and AR. AOG contributed to the manuscript by providing key information on the study context, suggestions about the analysis approach and interpretation of results. All authors read, provided comments and approved the final manuscript.

  • Funding Research reported in this publication was supported by grant number P50CA180907 from the National Cancer Institute and the FDA Center for Tobacco Products (CTP).

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the Food and Drug Administration.

  • Competing interests None declared.

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

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