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Figure 1 Materials and methods A search of scientific literature was conducted using the PubMed database ( The following Medical Subject Headings (MeSH) terms were used: e-cigarettes AND flavor AND nicotine AND e-liquid AND cytotoxicity AND cellular damage and health AND adolescent AND young people. We included publications from 2020 to 2025 because fourth-generation electronic cigarettes appeared on the market in 2020 ( in vitro studies, in silico models, and studies using cannabis cigarettes or tobacco flavors, hookahs, nicotine pouches, and waterpipes

This evidence currently derived primarily from animal and in vitro studies