Eric Wang

A team of researchers from Yale and Duke universities has found that high-intensity sweeteners are commonly applied to cigarillos, a smaller form of cigars.

High-intensity sweeteners activate the taste system when they are added in wrappers and mouth-tips of cigarillos, which come in contact with saliva. The study determined the levels of sweeteners — which are routinely added in high amounts to smokeless tobacco products — in cigarillos. The research was led by Julie Zimmerman, a professor of chemical and environmental engineering at the Yale School of Public Health, and published on Oct. 2 in the journal JAMA: The Journal of the American Medical Association.

“In this study, the idea was, can we find [high-intensity sweeteners] in cigarillos?” said Hanno Erythropel, a postdoctoral associate at the School of Engineering and first author of the study. “This is because cigarillos aren’t regulated the same way as cigarettes. With cigarettes, you can’t put anything that has a flavor — in fact, it’s called a characterizing flavor, so it can’t smell like strawberry or vanilla. But that doesn’t apply to cigarillos or cigars or any other tobacco products.”

First, the researchers identified the highest-selling cigarillo flavors in the United States, categorizing them as classic, sweet or with a characterizing flavor, such as grape.

Of the 31 cigarillos tested, 29 contained high-intensity sweeteners on the segment that comes in contact with saliva at levels comparable to smokeless tobacco products and a sugar-free candy or gum.

“If I buy a cigarillo that’s classic or original, I wouldn’t expect there to be a sweetener on the wrapper,” said Erythropel, who serves as a trainee at the Yale Tobacco Center of Regulatory Science. “I think this is what surprised us most, that it wasn’t only the ones that are called sweet, but literally across the board.”

According to Yann Mineur, a research scientist in psychiatry in the School of Medicine and trainee at the center who was not involved in the study, addiction may not directly stem from the sweetener itself. Nevertheless, anything that facilitates consumption of an addictive substance will contribute to addiction.

The sweet taste of cigarillos, in this case, can mask the taste of tobacco, making them less aversive, particularly for smokers not familiar with smoking, Mineur said.

John Buckell, a research scientist at the Yale School of Public Health and trainee at the center who was also not involved in the study, agreed, saying that the presence of high-intensity sweeteners in tobacco products contributes to a higher risk of addiction for certain populations of users.

“In particular, and of concern, is the popularity of these flavors to youth and young adult users,” Buckell said. “Not only are the flavors themselves preferred to tobacco, but their presence, and marketing, makes them appealing to non-users, too,” he said.

Yet in some cases, the availability of sweet flavors may play a role in promoting public health, Buckell said. For example, smokers that have no intention of quitting tobacco products may be attracted to less harmful tobacco products such as e-cigarettes if they enjoy these sweet flavors.

Buckell stressed that evidence is essential for understanding the market dynamics and setting policies to protect public health. He added that the U.S. Food and Drug Administration is now collecting scientific data to make policy determinations on whether to ban high-intensity sweeteners in tobacco products.

“One of the arguments we’re making is, if you’re going to start banning [characterizing] flavors from tobacco products, you should probably also think about banning ‘sweeteners,’ although they might not qualify as a distinctive flavor — given that they might similarly promote initiation and continued use,” Erythropel said.

In 2014, among middle and high school students who used cigars in the past 30 days, 63.5 percent reported using a flavored cigar during that time, according to the Centers for Disease Control and Prevention.

Eui Young Kim  | euiyoung.kim@yale.edu