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Keck School of Medicine of USC Flavor and Menthol Tobacco Products and E-cigarettes Since e-cigarettes have come to the Southern California market,the University of Southern California's expert faculty and research staff at the Keck School of Medicine have focused on exploring the potential impacts of e- cigarettes and flavored tobacco products on the general population as well as vulnerable populations, such as adolescents and young adults. E-cigarettes are drawing in new youth smokers who would have otherwise been unlikely to smoke combustible cigarettes. • Two studies examining trends in tobacco use over time have shown that youth with no history of cigarette use and who are otherwise unlikely to have smoked combustible cigarettes are initiating e- cigarettes (1, 2). • Cartoon images and non-traditional flavors and unique flavor names are appealing to youth and increase youth interest in e-cigarettes; most youth report initiation and continued use with flavored e-cigarettes (3-7).* • A study from Southern California youth reported that the most common reason for use of e-cigarettes are the availability of e-cigarettes in a wide variety of flavors (i.e. fruit, dessert, mint, etc.) (7, 8). • E-cigarette companies actively market and re-post flavor-related information on social media at a much higher rate than non-flavor related posts (9). • The availability of flavored e-cigarettes has been tied not only to initiation but also to continued use among youth, and a majority of youth reported that they would no longer use e-cigarettes if flavors were not available (6, 11).t • JUUL and other low profile products that resemble computer flash drivers thwart efforts to enforce smoking policy by providing easy concealment from authorities (3). • A content analysis of customer reviews of 103 vape shops revealed that the most important attribute of a shop was related to their flavor selection (10). • 17.3%of California high school students reported being a current user of an electronic vapor product, versus 13.2% national (12).t There are clear health-related consequences of e-cigarette use among youth. • Youth who use e-cigarettes are 3 times as likely as those who have never used e-cigarettes to begin smoking combustible cigarettes (13-19)*. • Youth who use e-cigarettes and subsequently begin smoking cigarettes follow a similar trajectory into more frequent cigarette smoking as their peers who began smoking cigarettes without using e- cigarettes first(1, 2). • A study among Southern California Hispanic young adults reported that using e-cigarettes increased the likelihood of transitioning from a non-user to user of cigarettes or marijuana and was not associated with smoking cessation (38). • Level of nicotine in e-cigarettes has been associated with higher frequency of subsequent cigarette smoking (36). • Exposure to nicotine in e-cigarettes is addictive (14-19)*. • E-cigarettes can have adverse respiratory effects (20)*. • E-liquids contain many harmful chemicals (i.e. acetals, formaldehyde, cinnamaldehyde, diacetyl, benzaldehyde, etc.)that are used to create the wide variety of flavors (21, 22).t 'Research conducted outside of USC *Both USC and Outside Research Updated 5/22/2019