The study, conducted by researchers at the University of North Carolina at Chapel Hill and published in the British Medical Journal Open, is a systematic review of all peer-reviewed scientific literature published on e-cigarette use behaviors and perceptions through March 2018. First author Ms. Clare Meernik is a doctoral student of epidemiology at the University of North Carolina Gillings School of Global Public Health.

The researchers found several key takeaways:

• Five studies indicate that non-menthol flavors — particularly fruit and candy flavors — decrease the perception that e-cigarettes are harmful.
• Six studies indicate that flavors make youth and young adults more willing to try e-cigarettes.
• Seven studies showed that flavors increase product appeal among adults.
• Six studies showed that the role of flavored e-cigarettes in stopping traditional cigarette smoking among adults is unclear.
• One study showed that youth who use flavored e-cigarettes were less likely to quit tobacco products.

Most e-cigarettes contain nicotine, and most include at least one of about 7,000 e-cigarette flavors available for purchase, such as blueberry cheesecake, mango, cinnamon, sweet milk and lemon crumble cake. Many flavors are named for candy or sweets — such as gummy bear, cookies ‘n cream and cotton candy — that appeal more to younger e-cigarette users.

Studies over the past five years have shown a steady rise in vaping among youth, with a 2019 study finding that about 28 percent of young people in the United States currently use e-cigarettes.