The public health threat to youth and minority populations from smoking is climbing because of tobacco companies’ development and predatory marketing of new products such as candy and fruit flavored e-cigarettes, according to recent California Medical Association (CMA) findings.

Despite decades of policies and education about tobacco’s deadly toll, new products that appeal to young people and are falsely thought to be healthier have led to an uptick in those starting smoking and in continued use among established smokers, CMA found in a new white paper titled “Flavored and Mentholated Tobacco Products: Enticing a New Generation of Users.”

“This is more of the predatory targeting of youth, LGBT people and communities of color that we have seen for years from tobacco companies,” said Darin Latimore, M.D., vice-chair of CMA’s Council on Legislation. “They are using sweet-flavored products to hook a new generation of smokers to keep their industry alive and well, despite the fact that they are peddling products that lead to death and disease.”

Evidence shows that populations disproportionately targeted by tobacco company marketing tactics are particularly vulnerable to sweet flavors and menthol, and are largely driving this increased uptake and sustained use of flavored tobacco products.

The paper, based on numerous published studies, states that tobacco use remains the chief risk factor for the leading causes of death in California.

“A foundation of this strategy is the use of candy and fruit flavors and cooling additives in tobacco products that are intended to attract and retain users by masking the naturally harsh taste of tobacco,” CMA wrote. “Contrary to popular beliefs, flavorings do not reduce the health impacts and risks associated with tobacco use, and are not safer than non-flavored tobacco products.”

Tobacco companies have introduced flavored products that share the same flavors, names, packaging and logos as popular candy brands like Jolly Rancher, Kool-Aid, and Life Savers. Characteristic of Big Tobacco’s longtime predatory practices, bright packaging and product placement at the register, near candy, and often at children’s eye-level, increases tobacco flavored products’ visibility to kids. Flavored and menthol tobacco products are “starter” products that establish daily habits and increase addiction to tobacco products, make it harder to quit, and increase use of multiple tobacco products concurrently.

There are now over 460 brands of e-cigarettes and more than 7,700 unique e-cigarette flavors available for purchase online, including a wide range of child-friendly candy and fruit-flavors that are not permitted in cigarettes, such as Wrigley’s, Atomic Fireball, Tutti Frutti, and Cap N’ Crunch.

Teen e-cigarette use tripled between 2013 and 2014 and now exceeds youth use of traditional cigarettes. Approximately 2 million high school students and 450,000 middle school students currently use e-cigarettes, according to a Centers for Disease Control and Prevention (CDC) survey. In California, 63 percent of smokers start by the age of 18, and 97 percent start by age 26.

The paper was prepared by CMA and reviewed by its Council on Science and Public Health, a panel of physician experts, with input from subject matter researchers. It was approved by the CMA Board of Trustees on April 21, 2016.