(Reuters Health) - Nearly 50 alcohol-flavored tobacco product lines are marketed by more than 400 tobacco brands in the United States and these products may especially attract teens, luring them into tobacco addiction, according to a new study.

Adolescent drinking and smoking tend to go hand in hand, the authors write in the journal Tobacco Control, and the combination of alcohol flavors in tobacco products is sure to appeal to teen users.

So-called characterizing flavors in cigarettes, except for menthol, are banned by the U.S. Food and Drug Administration (FDA), and these restrictions should be extended to the many flavored tobaccos for cigars, cigarillos and hookahs, as well as e-cigarette liquids, they add.

“We were surprised by the large number of brands of alcohol-flavored tobacco products on the market and the wide variety of alcoholic flavors,” said lead author Dr. Robert Jackler of Stanford University in California.

“Not surprisingly, sweet and fruity varieties . . . which appeal to teenagers predominated,” he told Reuters Health by email.

Jackler and colleagues analyzed the top 20 U.S. brands of cigarillos and e-cigarettes using the Nielsen database, which includes unit sales in 25 major chains and 14,000 convenience stores. They also looked for the top hookah and shisha brands online. Then they searched among the top brands for products with flavors related to alcoholic beverages such as beer, appletini and margarita.

The research team found 455 e-cigarette brands and more than 100 flavored cigar, cigarillo and hookah brands. The most popular fruity flavors were pina colada, mojito and margarita, and the most popular spirit flavors were rum, bourbon and whiskey.

The cigars and cigarillos were marketed by large, multinational tobacco companies such as Philip Morris, Imperial Tobacco, Swisher International, Swedish Match and Scandinavian Tobacco Group, and the e-cigarette flavors were nearly all offered by minor brands, the study team notes.

“We found it disturbing that major international tobacco companies, which claim to be socially responsible and who profess they would never target underage youth, produce a wide spectrum of flavored mini-cigars and e-cigarettes, including quite a few with alcohol-themed names,” Jackler said.

In 2009, the FDA banned flavors other than menthol from traditional cigarettes, but rulings about e-cigarettes and other tobacco products are still under discussion. Since 2009, California cities such as San Francisco, Oakland, Sonoma, El Cerrito, Manhattan Beach and Berkeley have banned some flavored tobacco products.

In June, the San Francisco Board of Supervisors unanimously banned flavored tobacco. R.J. Reynolds Tobacco Company, which makes Newport menthol cigarettes, is reported to have spent $700,000 on a campaign to collect 34,000 signatures and bring a referendum before city voters. The choice will be on the ballot in June 2018.

“If R.J. Reynolds spent this much money on a local policy in one city, they’re sending a message that these bans could severely hurt their business and affect who smokes,” said Dr. Pamela Ling of the University of California at San Francisco School of Medicine, who wasn’t involved with the study.

“We’re going to see vociferous conversations about tobacco flavors in coming months (in San Francisco),” she told Reuters Health in a phone interview. “I think some people were misled when they were asked to sign the petition and didn’t realize what it was about.”

Jackler and colleagues are now studying how flavored products are advertised to appeal to teens. They’re comparing the differences on social media channels such as Twitter, which predominantly appeals to adult smokers, and Instagram, which appeals to younger smokers, he said.

“Our overall goal is to provide legislators and regulators with the evidence they need to enact effective regulations to protect American teens,” Jackler said.

Ling encourages parents to be informed and take a stand in their communities as well.

“Parents should take action and say they don’t want these products in their stores or neighborhoods,” she said. “There’s not a good scientific reason to leave these products on the market. We should protect our young people.”

SOURCE: bit.ly/2fcHpyA Tobacco Control, August 23, 2017.