Flavored Tobacco Products in the United States: A Systematic Review Assessing Use and Attitudes

Nicotine Tob Res. 2016 May;18(5):739-49. doi: 10.1093/ntr/ntv176. Epub 2015 Aug 26.


Objectives: We systematically reviewed research examining use of and attitudes toward nonmenthol-flavored tobacco products to provide information relevant to a decision to regulate these products in the future.

Methods: To identify eligible studies, we searched PubMed, CINHAL, Embase, LILACS, and PsycINFO on September 19, 2013, without date restrictions. We obtained additional studies via gray literature searches, expert contacts, and hand-searching citations of included articles. We included participants of all ages. We conducted a qualitative synthesis for included studies.

Results: The 32 studies included in this review exhibited substantial heterogeneity and were of varied methodological quality. Findings from observational, experimental, and quasiexperimental studies suggest that flavored tobacco use is associated with young age and that consumers may perceive flavored products more favorably than nonflavored products. Evidence from qualitative studies indicates that flavoring in tobacco is viewed favorably by users and nonusers of these products.

Conclusions: The Food and Drug Administration has expressed interest in regulating flavored tobacco products. This systematic review strengthens the evidence base relating to this issue by synthesizing the literature from the United States on the use of and attitudes toward flavored tobacco. To address gaps in the literature, more research is needed to understand how flavoring impacts tobacco use over time. The evidence base would further be strengthened with the collection of brand-, flavor-, and product-specific data.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Attitude*
  • Flavoring Agents / administration & dosage*
  • Humans
  • Smoking / epidemiology
  • Smoking / legislation & jurisprudence
  • Smoking / psychology
  • Tobacco Products / legislation & jurisprudence
  • Tobacco Products / statistics & numerical data*
  • Tobacco Use / epidemiology*
  • Tobacco Use / legislation & jurisprudence
  • Tobacco Use / psychology
  • Tobacco, Smokeless / legislation & jurisprudence
  • Tobacco, Smokeless / statistics & numerical data
  • United States / epidemiology
  • United States Food and Drug Administration / legislation & jurisprudence


  • Flavoring Agents