The role of sweet/fruit-flavored disposable electronic cigarettes on early nicotine initiation - a systematic review

Abstract

Abstract Background Sweet/fruit disposable e-cigarettes (ECs) are cheap, easy to use, and look like inconspicuous colored markers, which encourages young people and young adults to use them. This work attempts to summarize current knowledge about the effect of sweet/fruit-flavor disposable ECs on early nicotine initiation. Methods The literature search was performed in June 2024 in Pub Med, Scopus, Web of Science and Science Direct databases by the terms ‘ends’, ‘electronic nicotine delivery system’, ‘disposable electronic cigarette’, ‘disposable e-cigarette’, ‘cig-a-like e-cigarette’, ‘cig-a-like electronic cigarette’, ‘nicotine initiation’. Results This systematic review analyzes findings from four heterogenous US studies. All analyzed studies highlighted that sweet/fruit-flavored ECs, compared to mint/menthol- or tobacco-flavors, were the most commonly chosen by youths and young adults during initiation and progression of vaping, regardless of the device type. Furthermore, two studies determined that never-smokers mostly start vaping by using modifiable ECs compared to disposable EC devices. Moreover, all studies showed that initiation by using disposable ECs was lower in people who had never previously vaped or smoked compared to current/former ECs users and former tobacco cigarettes (TCs) smokers or dual users. Conclusions Due to limited number of studies, their limited location, scope (mostly ever users aged ≥ 18), and moderate quality of the studies, it is difficult to clearly determine the effect of sweet/fruit-flavored disposable ECs on early nicotine initiation. Moreover, it is difficult to determine if sweet/fruit-flavored disposable EC have a role in the avoiding the initiation of tobacco cigarettes or delaying the initiation by the effect of competition. The findings from this systematic review are preliminary and require validation through high-quality, global studies among youth and young adult never-smokers/never-vapers who initiated using tobacco products with sweet/fruit-flavored disposable ECs and continue vaping and/or smoking any tobacco products (and any flavors). Trial registration The study protocol of this systematic review was registered in International Prospective Register of Systematic Reviews (PROSPERO) with registration number CRD42024585153.

Keywords

• Disposable e-cigarette
• Cig-a-like e-cigarette
• Early nicotine initiation
• Sweet/ fruit-flavored e-liquid
• Youths