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Methods: A comprehensive literature search was conducted in PubMed, Embase, Web of Science, the Cochrane Library, China National Knowledge Infrastructure, and Wanfang Database for studies published up to 12 November 2025

Many flavored e-liquids as well as flavoring chemicals used in e-liquids have been shown to be cytotoxic 6,7,8,9 , and the negative effects of nicotine-containing e-liquids in the lungs of animal models have been well documented by us and others 10,11,12,13,14

Wood pulp paper remains common but may contain bleaching agents, which makes it less desirable than natural alternatives

The tobacco industry has reason to look more closely at flavourings, because the FDA could mandate nicotine to be reduced in cigarettes to a non-addictive level over a ten-year period, notes Glynn

This is not something reported with tobacco alone, so the cannabis must be the causal factor