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 a new white paper published by the California Medical Association (CMA).

Despite decades of policies and education about the deadly health toll of tobacco’s deadly, new products that appeal to young people and are falsely thought to be healthier have led to an uptick in the numbers of new smokers and in continued use among established smokers, CMA found in its 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.”

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 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.

Click here for an executive summary of the white paper or here for the full report.