A Review of the Use and Appeal of Flavored Electronic Cigarettes

  • Nicholas I. Goldenson
  • Adam M. Leventhal
  • Kelsey A. Simpson
  • Jessica L. Barrington-TrimisEmail author
Tobacco (K Garrison, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Tobacco


Purpose of Review

E-cigarettes are available in a variety of flavors not found in traditional tobacco products (i.e., “nontraditional flavors”), which is a commonly cited reason for e-cigarette use. This review examines the prevalence of nontraditional-flavored e-cigarette use, mechanisms through which flavorings enhance product appeal, use of nontraditional-flavored e-cigarettes for smoking cessation, and differences in these findings between youth and adults.

Recent Findings

Nontraditional-flavored e-cigarettes are used at e-cigarette initiation by the majority of youth. These flavors enhance the appeal of e-cigarettes by creating sensory perceptions of sweetness and coolness and masking the aversive taste of nicotine. Use of nontraditional-flavored e-cigarettes is higher among youth and young adults (vs. older adults) and among nonsmokers (vs. combustible cigarette smokers).


Nontraditional-flavored e-cigarettes are popular among youth, but may be less common among older adults and combustible cigarette smokers. Further research is needed to determine whether use of e-cigarettes in nontraditional flavors affects smoking cessation.


Electronic cigarette Vaping Flavored Flavor Appeal 


Compliance with Ethical Standards

Conflict of Interest

AL, KS, and JBT declare no conflicts of interest. NG accepted a job with JUUL Labs on February 10, 2019, and did not contribute to the paper after that date.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Lewis MJ, Wackowski O. Dealing with an innovative industry: a look at flavored cigarettes promoted by mainstream brands. Am J Public Health. 2006;96(2):244–51.Google Scholar
  2. 2.
    Feirman SP, Lock D, Cohen JE, Holtgrave DR, Li T. Flavored tobacco products in the United States: a systematic review assessing use and attitudes. Nicotine Tob Res. 2016;18(5):739–49.Google Scholar
  3. 3.
    Carpenter CM, Wayne GF, Connolly GN. The role of sensory perception in the development and targeting of tobacco products. Addiction. 2007;102(1):136–47.Google Scholar
  4. 4.
    Carpenter CM, Wayne GF, Pauly JL, Koh HK, Connolly GN. New cigarette brands with flavors that appeal to youth: tobacco marketing strategies. Health Aff (Millwood). 2005;24(6):1601–10.Google Scholar
  5. 5.
    Huang L-L, Baker HM, Meernik C, Ranney LM, Richardson A, Goldstein AO. Impact of non-menthol flavours in tobacco products on perceptions and use among youth, young adults and adults: a systematic review. Tob Control. 2017;26(6):709–19.Google Scholar
  6. 6.
    • Hoffman AC, Salgado RV, Dresler C, Faller RW, Bartlett C. Flavour preferences in youth versus adults: a review. Tob Control 2016;25(S2):ii32-ii39. This systematic review details the extant chemosensory science literature regarding flavorings used in tobacco products, finding that children and adolescents (vs. adults) prefer sweet flavorings (e.g., cherry, candy, strawberry).Google Scholar
  7. 7.
    Carvajal R, Clissold D, Shapiro J. Family smoking prevention and tobacco control act: an overview. The. Food & Drug LJ. 2009;64:717.Google Scholar
  8. 8.
    Wang TW, Gentzke A, Sharapova S, Cullen KA, Ambrose BK, Jamal A. Tobacco product use among middle and high school students—United States, 2011–2017. MMWR Morb Mortal Wkly Rep. 2018;67(22):629–33.Google Scholar
  9. 9.
    Murthy VH. E-cigarette use among youth and young adults: a major public health concern. JAMA Pediatr. 2017;171(3):209–10.Google Scholar
  10. 10.
    Drazen JM, Morrissey S, Campion EW. The dangerous flavors of E-cigarettes. N Engl J Med. 2019;380:679–80. Scholar
  11. 11.
    Zhu S-H, Sun JY, Bonnevie E, Cummins SE, Gamst A, Yin L, et al. Four hundred and sixty brands of e-cigarettes and counting: implications for product regulation. Tob Control. 2014;23(S3):iii3–9.Google Scholar
  12. 12.
    Johnston LD, Miech RA, O’Malley PM, Bachman JG, Schulenberg JE, Patrick ME. Monitoring the future national survey results on drug use: 1975–2017: overview, key findings on adolescent drug use. Ann Arbor: Institute for Social Research, The University of Michigan; 2018.Google Scholar
  13. 13.
    Hong H, McConnell R, Liu F, Urman R, Barrington-Trimis JL. The impact of local regulation on reasons for electronic cigarette use among Southern California young adults. Addict Behav. 2019 Apr;91:253–8.Google Scholar
  14. 14.
    Kong G, Morean ME, Cavallo DA, Camenga DR, Krishnan-Sarin S. Reasons for electronic cigarette experimentation and discontinuation among adolescents and young adults. Nicotine Tob Res. 2014;17(7):847–54.Google Scholar
  15. 15.
    Barrington-Trimis JL, Samet JM, McConnell R. Flavorings in electronic cigarettes: an unrecognized respiratory health hazard? JAMA. 2014;312(23):2493–4.Google Scholar
  16. 16.
    .National Academies of Sciences E, and Medicine. Public health consequences of e- cigarettes. Washington, DC: 2018.Google Scholar
  17. 17.
    Goniewicz ML, Knysak J, Gawron M, Kosmider L, Sobczak A, Kurek J, et al. Levels of selected carcinogens and toxicants in vapour from electronic cigarettes. Tob Control. 2014;23(2):133–9.Google Scholar
  18. 18.
    Goniewicz ML, Gawron M, Smith DM, Peng M, Jacob P 3rd, Benowitz NL. Exposure to nicotine and selected toxicants in cigarette smokers who switched to electronic cigarettes: a longitudinal within-subjects observational study. Nicotine Tob Res. 2017;19(2):160–7.Google Scholar
  19. 19.
    Abrams DB, Glasser AM, Pearson JL, Villanti AC, Collins LK, Niaura RS. Harm minimization and tobacco control: reframing societal views of nicotine use to rapidly save lives. Annu Rev Public Health. 2018;39:193–213.Google Scholar
  20. 20.
    Nutt DJ, Phillips LD, Balfour D, Curran HV, Dockrell M, Foulds J, et al. Estimating the harms of nicotine-containing products using the MCDA approach. Eur Addict Res. 2014;20(5):218–25.Google Scholar
  21. 21.
    Hajek P, Phillips-Waller A, Przulj D, Pesola F, Myers Smith K, Bisal N, et al. A randomized trial of e-cigarettes versus nicotine-replacement therapy. N Engl J Med. 2019;380:629–37. Scholar
  22. 22.
    Hartmann-Boyce J, McRobbie H, Bullen C, Begh R, Stead LF, Hajek P. Electronic cigarettes for smoking cessation. Cochrane Libr. 2016.Google Scholar
  23. 23.
    Kalkhoran S, Glantz SA. E-cigarettes and smoking cessation in real-world and clinical settings: a systematic review and meta-analysis. Lancet Respir Med. 2016;4(2):116–28.Google Scholar
  24. 24.
    Russell C, Dickson T, McKeganey N. Advice from former-smoking e-cigarette users to current smokers on how to use e-cigarettes as part of an attempt to quit smoking. Nicotine Tob Res. 2018;20(8):977–84.Google Scholar
  25. 25.
    Gottlieb S, Zeller M. A nicotine-focused framework for public health. N Engl J Med. 2017;377(12):1111–4.Google Scholar
  26. 26.
    Food, Drug Administration H. Deeming Tobacco Products To Be Subject to the Federal Food. Drug, and cosmetic act, as amended by the family smoking prevention and tobacco control act; restrictions on the Sale and distribution of tobacco products and required warning statements for tobacco products. Final rule. Fed Regist. 2016;81(90):28973.Google Scholar
  27. 27.
    Polosa R, Rodu B, Caponnetto P, Maglia M, Raciti C. A fresh look at tobacco harm reduction: the case for the electronic cigarette. Harm Reduct J. 2013;10(1):1.Google Scholar
  28. 28.
    Yingst JM, Veldheer S, Hammett E, Hrabovsky S, Foulds J. A method for classifying user- reported electronic cigarette liquid flavors. Nicotine Tob Res. 2017;19(11):1381–5.Google Scholar
  29. 29.
    Krüsemann EJZ, Boesveldt S, de Graaf K, Talhout R. An E-liquid flavor wheel: a shared vocabulary based on systematically reviewing E-liquid flavor classifications in literature. Nicotine Tob Res. 2018.
  30. 30.
    Ambrose BK, Day HR, Rostron B, Conway KP, Borek N, Hyland A, et al. Flavored tobacco product use among us youth aged 12-17 years, 2013-2014. JAMA. 2015;314(17):1871–3.Google Scholar
  31. 31.
    •• Bold KW, Kong G, Cavallo DA, Camenga DR, Krishnan-Sarin S. Reasons for trying e- cigarettes and risk of continued use. Pediatrics. 2016;138(3):e20160895 This prospective study presents novel longitudinal evidence that preference for flavored e- cigarettes may be associated with persistent e-cigarette use following initiation among youth.Google Scholar
  32. 32.
    • Chen JC, Das B, Mead EL, Borzekowski DL. Flavored e-cigarette use and cigarette smoking susceptibility among youth. Tob Regul Sci. 2017;3(1):68–80 This cross-sectional survey suggests that use of flavored e-cigarettes among nonsmoking youth is associated with increased susceptibility to cigarette smoking.Google Scholar
  33. 33.
    Corey CG, Ambrose BK, Apelberg BJ, King BA. Flavored tobacco product use among middle and high school students—United States, 2014. MMWR Morb Mortal Wkly Rep. 2014;64(38):1066–70.Google Scholar
  34. 34.
    •• Dai H, Hao J. Flavored electronic cigarette use and smoking among youth. Pediatrics. 2016;138(6) This important cross-sectional survey suggests that use of flavored e-cigarettes among nonsmoking youth is associated with intentions to initiate smoking, and among smokers, youth who use flavored e-cigarettes were less likely to report intentions to quit smoking.Google Scholar
  35. 35.
    •• Harrell M, Weaver S, Loukas A, Creamer M, Marti C, Jackson C, et al. Flavored e- cigarette use: characterizing youth, young adult, and adult users. Prev Med Rep. 2016;5:33–40 This important cross-sectional survey demonstrates that flavored e- cigarettes are widely used by youth at e-cigarette initiation and during regular use. The prevalence of flavored e-cigarette use is markedly lower among adult vapers.Google Scholar
  36. 36.
    •• Morean M, Butler E, Bold K, Kong G, Camenga D, Cavallo D, et al. Preferring more e- cigarette flavors is associated with e-cigarette use frequency among adolescents but not adults. PloS one. 2018;13(1):e0189015-e This cross-sectional study presents some of the first data that suggests that use of flavored e-cigarettes and a greater total number of e- cigarette flavorings is associated with increased frequency of past 30-day vaping among youth.Google Scholar
  37. 37.
    Schneller LM, Bansal-Travers M, Goniewicz ML, McIntosh S, Ossip D, O’Connor RJ. Use of flavored electronic cigarette refill liquids among adults and youth in the US—results from wave 2 of the population assessment of tobacco and health study (2014–2015). PLoS One. 2018;13(8):e0202744.Google Scholar
  38. 38.
    •• Villanti AC, Johnson AL, Ambrose BK, Cummings KM, Stanton CA, Rose SW, et al. Flavored tobacco product use in youth and adults: findings from the First Wave of the PATH Study (2013–2014). Am J Prev Med. 2017;53(2):139–51 This is an important epidemiological study that suggests that there is an inverse relation between sweet-flavored e-cigarette use (vs. tobacco and menthol flavors) and age, with younger age associated with greater rates of sweet-flavored e-cigarette use.Google Scholar
  39. 39.
    Berg CJ. Preferred flavors and reasons for e-cigarette use and discontinued use among never, current, and former smokers. Int J Public Health. 2016;61(2):225–36.Google Scholar
  40. 40.
    Bonhomme MG, Holder-Hayes E, Ambrose BK, Tworek C, Feirman SP, King BA, et al. Flavoured non-cigarette tobacco product use among US adults: 2013–2014. Tob Control. 2016;25(S2):ii4–ii13.Google Scholar
  41. 41.
    Chen JC, Green KM, Arria AM, Borzekowski DLG. Prospective predictors of flavored e- cigarette use: a one-year longitudinal study of young adults in the U.S. Drug Alcohol Depend. 2018;191:279–85.Google Scholar
  42. 42.
    Dawkins L, Turner J, Roberts A, Soar K. ‘Vaping’ profiles and preferences: an online survey of electronic cigarette users. Addiction. 2013;108(6):1115–25.Google Scholar
  43. 43.
    Etter JF. Characteristics of users and usage of different types of electronic cigarettes: findings from an online survey. Addiction. 2016;111(4):724–33.Google Scholar
  44. 44.
    Etter JF, Bullen C. Electronic cigarette: users profile, utilization, satisfaction and perceived efficacy. Addiction. 2011;106(11):2017–28.Google Scholar
  45. 45.
    Farsalinos KE, Romagna G, Tsiapras D, Kyrzopoulos S, Spyrou A, Voudris V. Impact of flavour variability on electronic cigarette use experience: an internet survey. Int J Environ Res Public Health. 2013;10(12):7272–82.Google Scholar
  46. 46.
    McQueen A, Tower S, Sumner W. Interviews with “vapers”: implications for future research with electronic cigarettes. Nicotine Tob Res. 2011;13(9):860–7.Google Scholar
  47. 47.
    Nonnemaker J, Kim AE, Lee YO, MacMonegle A. Quantifying how smokers value attributes of electronic cigarettes. Tob Control. 2016;25(e1):e37–43.Google Scholar
  48. 48.
    Russell C, McKeganey N, Dickson T, Nides M. Changing patterns of first e-cigarette flavor used and current flavors used by 20,836 adult frequent e-cigarette users in the USA. Harm Reduct J. 2018;15(1):33.Google Scholar
  49. 49.
    Smith DM, Bansal-Travers M, Huang J, Barker D, Hyland AJ, Chaloupka F. Association between use of flavoured tobacco products and quit behaviours: findings from a cross- sectional survey of US adult tobacco users. Tob Control. 2016;25(S2):ii73–80.Google Scholar
  50. 50.
    Tackett AP, Lechner WV, Meier E, Grant DM, Driskill LM, Tahirkheli NN, et al. Biochemically verified smoking cessation and vaping beliefs among vape store customers. Addiction. 2015;110(5):868–74.Google Scholar
  51. 51.
    Villanti AC, Richardson A, Vallone DM, Rath JM. Flavored tobacco product use among US young adults. Am J Prev Med. 2013;44(4):388–91.Google Scholar
  52. 52.
    Yingst JM, Veldheer S, Hrabovsky S, Nichols TT, Wilson SJ, Foulds J. Factors associated with electronic cigarette users’ device preferences and transition from first generation to advanced generation devices. Nicotine Tob Res. 2015;17(10):1242–6.Google Scholar
  53. 53.
    Cooper M, Harrell MB, Pérez A, Delk J, Perry CL. Flavorings and perceived harm and addictiveness of E-cigarettes among youth. Tob Regul Sci. 2016;2(3):278–89.Google Scholar
  54. 54.
    •• Harrell MB, Loukas A, Jackson CD, Marti CN, Perry CL. Flavored tobacco product use among youth and young adults: what if flavors didn't exist? Tob Regul Sci. 2017;3(2):168–73 In this survey, 78% of adolescent vapers reported that they would no longer use e- cigarettes if they were not available in flavored varieties; this data suggests that the availability of flavored e-cigarettes may be an important factor that contributes to youth vaping.Google Scholar
  55. 55.
    • Krishnan-Sarin S, Green BG, Kong G, Cavallo DA, Jatlow P, Gueorguieva R, et al. Studying the interactive effects of menthol and nicotine among youth: an examination using e-cigarettes. Drug Alcohol Depend. 2017;180:193–9 This is one of the few laboratory experiments to assess the effects of flavored e-cigarettes among youth. E-cigarettes with high concentrations of menthol (3.5%) were found to increase product appeal and enhance taste and sensory coolness.Google Scholar
  56. 56.
    Patrick ME, Miech RA, Carlier C, O'Malley PM, Johnston LD, Schulenberg JE. Self- reported reasons for vaping among 8th, 10th, and 12th graders in the US: nationally- representative results. Drug Alcohol Depend. 2016;165:275–8.Google Scholar
  57. 57.
    Pepper J, Ribisl K, Brewer N. Adolescents’ interest in trying flavoured e-cigarettes. Tob Control. 2016;25(S2):ii62–6.Google Scholar
  58. 58.
    Tsai J, Walton K, Coleman BN, Sharapova SR, Johnson SE, Kennedy SM, et al. Reasons for electronic cigarette use among middle and high school students—National Youth Tobacco Survey, United States, 2016. MMWR Morb Mortal Wkly Rep. 2018;67(6):196–200.Google Scholar
  59. 59.
    Wagoner KG, Cornacchione J, Wiseman KD, Teal R, Moracco KE, Sutfin E. E-cigarettes, hookah pens and vapes: adolescent and young adult perceptions of electronic nicotine delivery systems. Nicotine Tob Res. 2016;18(10):2006–12.Google Scholar
  60. 60.
    Amato MS, Boyle RG, Levy D. How to define e-cigarette prevalence? Finding clues in the use frequency distribution. Tob Control. 2016;25(e1):e24–9.Google Scholar
  61. 61.
    Audrain-McGovern J, Strasser AA, Wileyto EP. The impact of flavoring on the rewarding and reinforcing value of e-cigarettes with nicotine among young adult smokers. Drug Alcohol Depend. 2016;166:263–7.Google Scholar
  62. 62.
    Berg CJ, Barr DB, Stratton E, Escoffery C, Kegler M. Attitudes toward e-cigarettes, reasons for initiating e-cigarette use, and changes in smoking behavior after initiation: a pilot longitudinal study of regular cigarette smokers. Open J Prev Med. 2014;4(10):789–800.Google Scholar
  63. 63.
    Cheney MK, Gowin M, Wann TF. Electronic cigarette use in straight-to-work young adults. Am J Health Behav. 2016;40(2):268–79.Google Scholar
  64. 64.
    Farsalinos KE, Romagna G, Voudris V. Factors associated with dual use of tobacco and electronic cigarettes: a case control study. Int J Drug Policy. 2015;26(6):595–600.Google Scholar
  65. 65.
    Goldenson NI, Kirkpatrick MG, Barrington-Trimis JL, Pang RD, McBeth JF, Pentz MA, et al. Effects of sweet flavorings and nicotine on the appeal and sensory properties of e- cigarettes among young adult vapers: application of a novel methodology. Drug Alcohol Depend. 2016;168:176–80.Google Scholar
  66. 66.
    • St Helen G, Shahid M, Chu S, Benowitz NL. Impact of e-liquid flavors on e-cigarette vaping behavior. Drug Alcohol Depend. 2018;189:42–8 This laboratory study suggests that flavored e-cigarettes may affect vaping topography, as participants demonstrated increased puff volume when using sweet-flavored (vs. tobacco-flavored) e-cigarettes.Google Scholar
  67. 67.
    Kim H, Lim J, Buehler SS, Brinkman MC, Johnson NM, Wilson L, et al. Role of sweet and other flavours in liking and disliking of electronic cigarettes. Tob Control. 2016;25(Suppl 2):ii55–61.Google Scholar
  68. 68.
    •• Litt MD, Duffy V, Oncken C. Cigarette smoking and electronic cigarette vaping patterns as a function of e-cigarette flavourings. Tob Control. 2016;25(Suppl 2):ii67–72 This is an important smoking reduction trial that assessed the efficacy of flavored e-cigarettes among adult smokers. Menthol-flavored e-cigarettes were more effective than sweet- and tobacco-flavored e-cigarettes at reducing cigarette smoking.Google Scholar
  69. 69.
    McDonald EA, Ling PM. One of several ‘toys’ for smoking: young adult experiences with electronic cigarettes in New York City. Tob Control. 2015;24(6):588–93.Google Scholar
  70. 70.
    Pokhrel P, Herzog TA, Muranaka N, Fagan P. Young adult e-cigarette users’ reasons for liking and not liking e-cigarettes: a qualitative study. Psychol Health. 2015;30(12):1450–69.Google Scholar
  71. 71.
    Rosbrook K, Green BG. Sensory effects of menthol and nicotine in an E-cigarette. Nicotine Tob Res. 2016;18(7):1588–95.Google Scholar
  72. 72.
    Soule EK, Rosas SR, Nasim A. Reasons for electronic cigarette use beyond cigarette smoking cessation: a concept mapping approach. Addict Behav. 2016;56:41–50.Google Scholar
  73. 73.
    Kim H, Davis AH, Dohack JL, Clark PI. E-cigarettes use behavior and experience of adults: qualitative research findings to inform E-cigarette use measure development. Nicotine Tob Res. 2016;19(2):190–6.Google Scholar
  74. 74.
    Barbeau AM, Burda J, Siegel M. Perceived efficacy of e-cigarettes versus nicotine replacement therapy among successful e-cigarette users: a qualitative approach. Addict Sci Clin Pract. 2013;8(1):5.Google Scholar
  75. 75.
    Buu A, Hu YH, Piper ME, Lin HC. The association between e-cigarette use characteristics and combustible cigarette consumption and dependence symptoms: results from a national longitudinal study. Addict Behav. 2018;84:69–74.Google Scholar
  76. 76.
    •• Chen JC. Flavored E-cigarette use and cigarette smoking reduction and cessation-a large national study among young adult smokers. Subst Use Misuse. 2018;53(12):2017–31 Data presented in this U.S. longitudinal study suggest that smoking reduction and cessation may be associated with use of flavored e-cigarettes among young adults. Google Scholar
  77. 77.
    Krishnan-Sarin S, Morean M, Camenga D, Cavallo DA, Kong G. E-cigarette use among high school and middle school adolescents in Connecticut. Nicotine Tob Res. 2014;17(7):810–8.Google Scholar
  78. 78.
    Patel D, Davis KC, Cox S, Bradfield B, King BA, Shafer P, et al. Reasons for current E- cigarette use among US adults. Prev Med. 2016;93:14–20.Google Scholar
  79. 79.
    Baumann AW, Kohler C, Kim Y-i, Cheong J, Hendricks P, Bailey WC, et al. Differences in electronic cigarette awareness, use history, and advertisement exposure between black and white hospitalized cigarette smokers. J Cancer Educ. 2015;30(4):648–54.Google Scholar
  80. 80.
    Kistler CE, Crutchfield TM, Sutfin EL, Ranney LM, Berman ML, Zarkin GA, et al. Consumers’ preferences for electronic nicotine delivery system product features: a structured content analysis. Int J Environ Res Public Health. 2017;14(6):613.Google Scholar
  81. 81.
    Oncken CA, Litt MD, McLaughlin LD, Burki NA. Nicotine concentrations with electronic cigarette use: effects of sex and flavor. Nicotine Tob Res. 2015;17(4):473–8.Google Scholar
  82. 82.
    Piñeiro B, Correa JB, Simmons VN, Harrell PT, Menzie NS, Unrod M, et al. Gender differences in use and expectancies of e-cigarettes: online survey results. Addict Behav. 2016;52:91–7.Google Scholar
  83. 83.
    •• Courtemanche CJ, Palmer MK, Pesko MF. Influence of the flavored cigarette ban on adolescent tobacco use. Am J Prev Med. 2017;52(5):e139–e46 The results of this observational study suggest that the restriction of flavored combustible cigarettes in the U.S. may have reduced the prevalence of youth tobacco use.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Nicholas I. Goldenson
    • 1
  • Adam M. Leventhal
    • 1
    • 2
  • Kelsey A. Simpson
    • 1
  • Jessica L. Barrington-Trimis
    • 3
    Email author
  1. 1.Department of Preventive MedicineUniversity of Southern California Keck School of MedicineLos AngelesUSA
  2. 2.Department of PsychologyUniversity of Southern CaliforniaLos AngelesUSA
  3. 3.Department of Preventive MedicineUniversity of Southern California Keck School of MedicineLos AngelesUSA

Personalised recommendations