Intended for healthcare professionals

Rapid response to:


Tobacco industry involvement in children’s sugary drinks market

BMJ 2019; 364 doi: (Published 14 March 2019) Cite this as: BMJ 2019;364:l736

Rapid Response:

Sweetness arms race coming back full circle to tobacco products

Nguyen and colleagues cogently describe how the tobacco industry marketing juggernaut firmly established artificially flavoured sugar-sweetened drinks as a part of children’s diets, contributing to today’s obesity and diabetes epidemic.

While tobacco companies sold their sugary beverage assets years ago, this groundwork likely underlies today’s strong preference of adolescents and young adults for intensely flavoured and sweetened tobacco products marketed by the same companies, including Reynolds and Altria (owning Philip Morris) 1. For example, popular cherry-flavored e-cigarettes contain the same flavor chemical, benzaldehyde, as cherry flavored sweet beverages 2 3. In the United States, where flavored cigarettes were banned in 2009, new little cigar products were introduced that are not only intensely flavoured in varieties such as “sweet”, “honey berry”, “pink vanilla”, “apple” or “grape” but, according to our studies, are strongly sweetened with artificial sweeteners, including saccharin, sucralose, acesulfame-K and neotame 4. Newly introduced smokeless tobacco products such as snus, currently reviewed by FDA as modified risk tobacco products, are sweetened with sucralose and are sweeter than older smokeless product, with sweetness exceeding their weight in sugar 5.

Thus, the recent increase in nicotine content in tobacco products, termed a nicotine arms race, is accompanied by a sweetness and flavour intensity arms race 4-6. Children seek out more highly sweetened foods and this preference is stronger in some populations such as African Americans and Hispanics, populations that also consume more sweetened and flavoured tobacco products 7-9. Thus, the tobacco industry’s past investment in sweetened beverages appears to be coming full circle, creating new young users of tobacco products.

1. Hoffman AC, Salgado RV, Dresler C, et al. Flavour preferences in youth versus adults: a review. Tobacco control 2016;25(Suppl 2):ii32-ii39. doi: 10.1136/tobaccocontrol-2016-053192 [published Online First: 2016/09/17]
2. Loch C, Reusch H, Ruge I, et al. Benzaldehyde in cherry flavour as a precursor of benzene formation in beverages. Food chemistry 2016;206:74-7. doi: 10.1016/j.foodchem.2016.03.034 [published Online First: 2016/04/05]
3. Pankow JF, Kim K, McWhirter KJ, et al. Benzene formation in electronic cigarettes. PloS one 2017;12(3):e0173055. doi: 10.1371/journal.pone.0173055 [published Online First: 2017/03/09]
4. Erythropel HC, Kong G, deWinter TM, et al. Presence of High-Intensity Sweeteners in Popular Cigarillos of Varying Flavor Profiles. Jama 2018;320(13):1380-83. doi: 10.1001/jama.2018.11187 [published Online First: 2018/10/05]
5. Miao S, Beach ES, Sommer TJ, et al. High-Intensity Sweeteners in Alternative Tobacco Products. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco 2016;18(11):2169-73. doi: 10.1093/ntr/ntw141 [published Online First: 2016/05/25]
6. Jackler RK, Ramamurthi D. Nicotine arms race: JUUL and the high-nicotine product market. Tobacco control 2019 doi: 10.1136/tobaccocontrol-2018-054796 [published Online First: 2019/02/09]
7. Mennella JA, Bobowski NK. The sweetness and bitterness of childhood: Insights from basic research on taste preferences. Physiology & behavior 2015;152(Pt B):502-7. doi: 10.1016/j.physbeh.2015.05.015 [published Online First: 2015/05/24]
8. Schiffman SS, Graham BG, Sattely-Miller EA, et al. Elevated and sustained desire for sweet taste in african-americans: a potential factor in the development of obesity. Nutrition (Burbank, Los Angeles County, Calif) 2000;16(10):886-93. [published Online First: 2000/10/31]
9. Sterling KL, Fryer CS, Pagano I, et al. Little Cigars and Cigarillos Use Among Young Adult Cigarette Smokers in the United States: Understanding Risk of Concomitant Use Subtypes. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco 2016;18(12):2234-42. doi: 10.1093/ntr/ntw170 [published Online First: 2016/09/11]

Competing interests: Dr. Jordt’s research is supported by the National Institute on Drug Abuse and the National Insitute of Environmental Health Sciences of the National Institutes of Health (NIH) and the Center for Tobacco Products of the US Food and Drug Administration (FDA) under award numbers U54DA036151 and R01ES029435. The content of this letter is solely the responsibility of the authors and does not necessarily represent the views of the NIH or the FDA. Dr. Jordt received research reagents from GlaxoSmithkline Pharmaceuticals and provided consulting services to Hydra Biosciences and Sanofi Pharmaceuticals, for studies unrelated to this response.

18 March 2019
Sven-Eric Jordt
Associate Professor of Anesthesiology, Pharmacology and Cancer Biology
Sairam Jabba, D.V.M., Ph.D.
Duke University School of Medicine
Durham, North Carolina, USA