One of the great public health controversies of our time surrounds the debate over what role Electronic Nicotine Delivery Systems (ENDS), of which e-cigarettes are the most common type, might play in tobacco harm reduction. A key element of this discussion concerns the role of flavorings.

Regular users of ENDS declare that flavor is important in their ability to cease smoking. In the absence of flavors to soften the sometimes-harsh taste of nicotine vapor, they are likely to resume smoking cigarettes.

Some public-health officials have expressed concern that certain flavors might attract young people to experiment with nicotine at an early age. Evidence for this thesis has not yet been demonstrated. Concerns about the safety of ENDS and whether ENDS might attract young people to nicotine use threaten to dominate what should be a far broader discussion about how tobacco-harm-reduction strategies could be used to improve public health.