4.5 Review

Ice flavours and non-menthol synthetic cooling agents in e-cigarette products: a review

Journal

TOBACCO CONTROL
Volume -, Issue -, Pages -

Publisher

BMJ PUBLISHING GROUP
DOI: 10.1136/tobaccocontrol-2021-057073

Keywords

E-cigarettes; synthetic cooling agents; menthol; e-cigarette flavors

Funding

  1. National Institutes of Health (NIH)
  2. National Cancer Institute (NCI) [U54CA180905]
  3. FDA Center for Tobacco Products (CTP) [U54CA180905, U54DA036151]
  4. National Institute on Drug Abuse (NIDA) [U54DA036151, K24DA048160]
  5. National Institute of Environmental Health Sciences (NIEHS) of the National Institutes of Health (NIH) [R01ES029435]

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The use of e-cigarettes with cooling flavors has become more diverse, which complicates tobacco control efforts. The emergence of ice-hybrid flavors and products containing non-menthol cooling agents presents challenges in terms of chemistry, toxicity, marketing, user perception, prevalence, and policy implications. Further research and regulatory attention are warranted to address the knowledge gaps in the epidemiology, toxicology, health effects, and potential for smoking cessation with these products.
E-cigarettes with cooling flavours have diversified in ways that complicate tobacco control with the emergence of: (1) Ice-hybrid flavours (eg, 'Raspberry Ice') that combine cooling and fruity/sweet properties; and (2) Products containing non-menthol synthetic cooling agents (eg, Wilkinson Sword (WS), WS-3, WS-23 (termed 'koolada')). This paper reviews the background, chemistry, toxicology, marketing, user perceptions, use prevalence and policy implications of e-cigarette products with ice-hybrid flavours or non-menthol coolants. Scientific literature search supplemented with industry-generated and user-generated information found: (a) The tobacco industry has developed products containing synthetic coolants since 1974, (b) WS-3 and WS-23 are detected in mass-manufactured e-cigarettes (eg, PuffBar); (c) While safe for limited oral ingestion, inhalational toxicology and health effects from daily synthetic coolant exposure are unknown and merit scientific inquiry and attention from regulatory agencies; (d) Ice-hybrid flavours are marketed with themes incorporating fruitiness and/or coolness (eg, snow-covered raspberries); (e) WS-23/WS-3 concentrates also are sold as do-it-yourself additives, (f) Pharmacology research and user-generated and industry-generated information provide a premise to hypothesise that e-cigarette products with ice flavours or non-menthol cooling agents generate pleasant cooling sensations that mask nicotine's harshness while lacking certain aversive features of menthol-only products, (g) Adolescent and young adult use of e-cigarettes with ice-hybrid or other cooling flavours may be common and cross-sectionally associated with more frequent vaping and nicotine dependence in convenience samples. Evidence gaps in the epidemiology, toxicology, health effects and smoking cessation-promoting potential of using these products exist. E-cigarettes with ice flavours or synthetic coolants merit scientific and regulatory attention.

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