E-cigarette Brands Research Articles

“Reviving Old Tricks in New Tobacco Marketing: Presence of e-Cigarette Brand Names on Merchandise Promoted by Influencers on Social Media.”

Background Tobacco brand sharing or brand stretching involves the placement of tobacco brand names, logos, or other distinctive elements of tobacco brands, on nontobacco products, e.g., merchandize, such as clothing, sunglasses, or sporting goods. The Tobacco Master Settlement Agreement (MSA) imposed major restrictions on tobacco company marketing practices in 1999, including banning the sale and distribution of merchandize with combustible cigarette or smokeless tobacco brand names or logos. However, the MSA does not include restrictions on e-cigarette marketing, as these products were not yet on the market at the time of the settlement. Exposure to or use of e-cigarette branded merchandize advertised on social media could contribute to normalization of e-cigarette use by youth. Methods We estimated the prevalence of merchandize (e.g., t-shirts, caps, and key chains) with e-cigarette brand names or logos in 2000 TikTok videos (2021–2022) that featured U.S. and international micro-influencers (content creators with about 10,000–100,000 followers) who promoted e-cigarettes on behalf of e-cigarette brands. Results Of 152 (8%) promotional videos had merchandize with e-cigarette brand names or logos. Of 125 (6%) featured micro-influencers wearing branded clothing items, i.e., t-shirts, caps, beanies, hoodies, and sweatshirts; and 27 (2%) featured influencers wearing or showing branded accessories, i.e., face masks, stickers, pins, mugs, car air fresheners, lanyards, and key chains. Conclusions Tobacco control authorities should consider adopting provisions banning the sale, distribution, and direct (e.g., by e-cigarette brands) or indirect (e.g., by influencers) advertising of merchandize bearing e-cigarette brand names or logos.

Social Media Marketing Strategies for Electronic Cigarettes: Content Analysis of Chinese Weibo Accounts.

E-cigarettes have gained popularity among teenagers due to extensive marketing strategies on social media platforms. This widespread promotion is a risk factor, as it fosters more positive attitudes toward e-cigarette use among teenagers and increases the perception that using e-cigarettes is normal. Therefore, the marketing of e-cigarettes on social media is a serious global health concern, and its strategies and impact should be clearly identified. This study examined how e-cigarette companies popularize their products via Weibo and identified the specific strategies influencing the effectiveness of their marketing. In phase 1, we conducted a search on Qcc.com and identified 32 e-cigarette brands with active Weibo accounts between October 1 and December 31, 2020, along with 863 Weibo posts. The data were investigated through content analysis. The codebook was developed into four categories: (1) product and features, (2) sales and promotions, (3) social contact and interaction, and (4) restrictions and warnings. To further understand the factors influencing e-cigarette brand marketing, we conducted a multiple linear regression analysis. Marketing tactics by e-cigarette companies on Chinese social media were documented, including emphasizing attractive product features, using trendy characters, implicit promotions, downplaying health concerns, and engaging with Weibo users in various ways. Out of 863 posts, 449 (52%) mentioned product characteristics. In 313 (36.3%) posts, visible figures were used to attract attention. Product promotion was absent in 762 (88.3%) posts, and purchase channels were not mentioned in 790 (98.3%) posts. Social interaction-related posts received attention (n=548, 63.5%), particularly those featuring hashtag content (n=538, 62.3%). Most posts did not include claims for restrictions on teenagers' purchases or use (n=687, 79.6%) or information on health warnings (n=839, 97.2%). Multiple linear regression analysis identified marketing strategies that effectively increase the exposure of e-cigarette posts on Weibo. Posts including engagement via posts encouraging reposts, comments, and likes (P<.001) and engagement topics related to e-cigarette brands were positively correlated with the number of reposts (P=.009). Posts highlighting nonmonetary incentives (P=.004), posts with age restriction statements (P<.001), engaging via stories and idea collection (P<.001), and engagement topics related to products (P<.001) and current affairs (P=.002) had a positive effect on the number of comments. Engagement topics related to brands (P<.001) or interactive sweepstakes (P<.001) had a positive effect on the number of likes. E-cigarette posts on Weibo that focus on product features and social interaction attract public attention, especially from teenagers. Stricter regulations and monitoring should be adopted to restrict the social media marketing of e-cigarettes.

E-cigarette retail outlets in Mexico: a country that bans the sale.

Restrictive e-cigarette policies have not allowed for the characterization of the sale of these tobacco products in the countries where they are implemented. This is because it is believed that there are no stores. However, the use of e-cigarettes persists in these countries. A content analysis of electronic cigarette points of sale through the internet in Mexico was conducted. Cross-sectional study. Structured searches were performed in the Google Maps search engine with the terms "electronic cigarette store" and "vape store" in combination with the name of each state of Mexico, in the period from October 2021 to February 2022. A total of 695 e-cigarette stores were located, of which 481 (69.2%) were physical stores, 207 hybrid stores (29.8%), 4 online stores (0.6%) and 3 (0.4%) vending machines. A total of 316 e-cigarette brands and 578 vape liquid brands were identified. The sales attraction strategy they used the most was free shipping of products (85.8%). Stores used WhatsApp (92.5%), Facebook (86.3%) and Instagram (74.4%) to promote their products. Only 35.1% of stores checked the age of their customers, of which, 95.9% asked if the customer was of legal age and 4.1% asked for the date of birth. In addition, 25.6% of the stores warned about nicotine addiction and 24.2% specifically about the ingredients of the liquids. E-cigarettes are widely available and marketed in a variety of retail outlets in Mexico. The high number of stores, brands of liquids, and e-cigarettes indicates non-compliance with existing regulations. E-cigarette consumption has increased globally, even in countries with restrictive regulations. However, there is limited data on the density and characteristics of vape stores in low- and middle-income countries with restrictive regulations. This study found no significant differences in e-cigarette sales between countries with permissive and restrictive regulations. Therefore, it is suggested that, in addition to establishing restrictive policies on the sale of e-cigarettes, their enforcement should also be monitored. Countries with restrictive measures should regulate Internet sales and promotion of e-cigarettes with greater emphasis.

Health Warnings on Instagram Advertisements for Synthetic Nicotine E-Cigarettes and Engagement

Synthetic nicotine is increasingly used in e-cigarette liquids along with flavors to appeal to youths. Regulatory loopholes have allowed tobacco manufacturers to use social media to target youths. To analyze the extent to which synthetic nicotine e-cigarette brands have implemented US Food and Drug Administration (FDA) health warning requirements and to evaluate the association between health warnings and user engagement on Instagram. In this cross-sectional study, posts from 25 brands were analyzed across a 14-month period (August 2021 to October 2022). A content analysis was paired with Warning Label Multi-Layer Image Identification, a computer vision algorithm designed to detect the presence of health warnings and whether the detected health warning complied with FDA guidelines by (1) appearing on the upper portion of the advertisement and (2) occupying at least 20% of the advertisement's area. Data analysis was performed from March to June 2024. Synthetic nicotine e-cigarette advertisement on Instagram. The outcome variables were user engagement (number of likes and comments). Negative binomial regression analyses were used to evaluate the association between the presence and characteristics of health warnings and user engagement. Of a total of 2071 posts, only 263 (13%) complied with both FDA health warning requirements. Among 924 posts with health warnings, 732 (79%) displayed warnings in the upper image portion, and 270 (29%) had a warning covering at least 20% of the pixel area. Posts with warnings received fewer comments than posts without warnings (mean [SD], 1.8 [2.5] vs 5.4 [11.7] comments; adjusted incident rate ratio [aIRR], 0.70; 95% CI, 0.57-0.86; P < .001). For posts containing warnings, a larger percentage of the warning label's pixel area was associated with fewer comments (aIRR, 0.96; 95% CI, 0.93-0.99; P = .003). Flavored posts with health warnings placed in the upper image portion received more likes than posts with warnings in the lower portion (mean [SD], 34.6 [35.2] vs 19.9 [19.2] likes; aIRR, 1.48; 95% CI, 1.07-2.06; P = .02). In this cross-sectional study of synthetic nicotine brand Instagram accounts, 87% of sampled posts did not adhere to FDA health warning requirements in tobacco promotions. Enforcement of FDA compliant health warnings on social media may reduce youth engagement with tobacco marketing.

Sex-specific alterations in pulmonary metabolic, xenobiotic and lipid signalling pathways after e-cigarette aerosol exposure during adolescence in mice

BackgroundE-cigarette use is now prevalent among adolescents and young adults, raising concerns over potential adverse long-term health effects. Although it is hypothesised that e-cigarettes promote inflammation, studies have yielded conflicting...

E-Cigarette Nicotine Delivery Among Young Adults by Nicotine Form, Concentration, and Flavor

Concerns have been raised about the abuse liability of modern e-cigarettes that use acidic additives to form nicotine salts, making the inhalation of nicotine smoother than freebase nicotine. To examine the effects of nicotine form and concentration and e-liquid flavor on subjective effects ratings, vaping behavior, and nicotine uptake among young adults who use e-cigarettes. In this single-blind, within-participant, crossover randomized clinical trial, a convenience sample of young adults aged 21 to 25 years who currently used e-cigarettes was recruited from December 2021 to August 2023, for in-person research laboratory visits in Columbus, Ohio. Participants completed up to 9 vaping sessions, starting with their usual e-cigarette brand in the first session followed by 1 of 8 laboratory-prepared e-liquids in a randomly assigned order in each subsequent session. Prepared e-liquids varied by nicotine form (salt-based vs freebase), nicotine concentration (5% vs 1% weight per weight), and flavor (menthol vs tobacco). Each session included a 5-minute, 10-puff standardized vaping period followed by 30 minutes of ad libitum vaping. At 4 time points (0, 5, 10, and 35 minutes) during each vaping session, plasma samples were collected for assessing nicotine uptake, and self-reports of urges, craving, and withdrawal were collected via questionnaires. Positive subjective effects were self-reported after 35 minutes of vaping using a visual analog scale; urges and cravings were reported using the Questionnaire of Smoking Urges (QSU). Puff topography data were collected throughout each vaping session. Seventy-two participants (mean [SD] age, 22.4 [1.4] years; 42 [58.3%] female) who sampled at least 1 laboratory-prepared e-liquid composed the analytic sample. Salt-based (vs freebase) nicotine e-liquids increased nicotine intake, with 5% salt-based e-liquids delivering the highest mean plasma levels of nicotine (11.2 ng/mL [95% CI, 9.3-13.2 ng/mL] at 5 minutes; 17.2 ng/mL [95% CI, 14.3-20.1 ng/mL] at 35 minutes) irrespective of flavors. Higher positive subjective effect ratings (eg, for liking) were received by salt-based (42.8; 95% CI, 39.4-46.1) vs freebase (32.0; 95% CI, 28.6-35.3) nicotine, 1% (43.4; 95% CI, 40.2-46.6) vs 5% (31.2; 95% CI, 27.7-34.6) nicotine, and menthol-flavored (43.2; 95% CI, 39.7-46.7) vs tobacco-flavored (31.5; 95% CI, 28.4-34.7) e-liquids. Salt-based and 1% but not menthol-flavored nicotine elicited more intense puffing (eg, 25% [95% CI, 12%-40%] more total puffs for nicotine salts vs freebase). All study e-liquids reduced urges and cravings, with 5% vs 1% nicotine being more effective (mean [SE] QSU-Desire score at 35 minutes, 15.4 [0.5] vs 16.7 [0.5]). In this crossover randomized clinical trial among young adult e-cigarette users, salt-based (vs freebase) nicotine e-liquids increased nicotine intake and yielded more positive subjective effects ratings and intense puffing behaviors, suggesting higher abuse potential. Restricting the level of acidic additives and menthol flavoring may reduce the addictiveness of e-cigarettes. ClinicalTrials.gov Identifier: NCT05458895.

Use of disposable e-cigarettes among youth who vape in Canada, England and the United States: Repeat cross-sectional surveys, 2017-2023.

To measure changes over time (between 2017 and 2023) in disposable e-cigarette use and popular brands among youth in Canada, England and the United States (US) who vaped. Nine waves of repeat cross-sectional data from the International Tobacco Control Policy Evaluation Project (ITC) Youth Tobacco and Vaping Survey. Online surveys conducted in Canada, England and the US between 2017 and 2023. Youth aged 16 to 19 years who had vaped in the past 30 days (n = 19710). Usual type (disposable, cartridge/pod, tank) and brand of e-cigarette used; covariates sex at birth, age, race/ethnicity, cigarette smoking status, vaping on ≥20 of the past 30 days. In 2017, the majority of youth who vaped in the past 30 days reported using refillable tank e-cigarettes, whereas disposable e-cigarettes were the least commonly used product type in Canada (10.0%), England (8.6%) and the US (14.4%). Cartridge/pods overtook tank devices in Canada and the US by 2020; however, by 2023, disposables were the leading type of e-cigarette used by youth who vaped in all three countries (Canada = 58.5%; England = 83.2%; US = 67.3%). The shift to disposables occurred among all socio-demographic groups, with few differences by vaping and smoking status. The percentage of youth who vaped that reported 'no usual' brand also decreased substantially from 2017 (29% to 42%) to 2023 (11% to 17%). The rise of disposable e-cigarettes appeared to be driven primarily by individual brands in the US (Puff Bar in 2020/2021, Elf Bar in 2022/2023) and England (Elf Bar in 2022/2023). The e-cigarette market has evolved rapidly with notable shifts in the types of e-cigarettes used by youth who vape in Canada, England and the United States. Although the timing differed across countries, major shifts in device types appear to be driven by individual brands and were often accompanied by increases in vaping prevalence among youth.

The impact of exposure to FDA e-cigarette authorization messages on product perceptions and interest - an experiment with adults who smoke and youth.

In the United States, e-cigarettes have entered a new regulatory era, needing authorizations from FDA to remain on or enter the marketplace. This study explored the impact of e-cigarette authorization messages on product perceptions and interest. We conducted an online experiment in June 2022 with nationally-representative samples of adults (21+) who smoke cigarettes (n=866) and youth ages 15-20 (n=859). They were randomized to one of five conditions: viewing an ad for a fictional e-cigarette brand with no reference to FDA (control), an ad with an "authorized for sale by FDA" claim in varying presentation styles (plain text, FDA "approved" stamp, FDA logo), or reading a fictional news excerpt about the product's authorization plus control ad. We compared group differences on product interest, susceptibility, harm perceptions and message perceptions. Among adults who smoke, there were no effects on product interest nor susceptibility, but ratings of the product's harmfulness compared to cigarettes were lower among those in the news versus control condition (β=-0.25, p=.04). Among youth, odds of susceptibility were higher among ever e-cigarette users who viewed the ad with the FDA logo authorization message relative to the control ad (OR=6.3, 95% CI:1.67-23.9, p<0.01). About 40% of all participants agreed the authorization claim makes them think the product is safe to use, but fewer (14-19%) agreed it makes them more interested in trying it. FDA e-cigarette authorization messages may impact some beliefs about product harm. More research is needed to track potential impacts on product use. This study provides new data about the potential impact of messages about FDA authorization of e-cigarette products (presented as ad claims or a news story) on authorized product perceptions, interest and susceptibility among adults who smoke cigarettes and youth. Our results suggest that FDA e-cigarette authorization messages may impact harm-related beliefs among adults who smoke and product susceptibility among youth who have ever used e-cigarettes before, though real-world effects are likely to be impacted by message type and format, and perceived message source and credibility. Authorization messages are likely to be misinterpreted as "FDA approval" by some; therefore, providing clarifications about authorization meaning and standards are relevant where possible.

An observational human laboratory assessment of nicotine delivery, vaping topography and subjective effects of usual brand electronic cigarette use among young adults.

To measure nicotine delivery, vaping topography and subjective effects of current generations of disposable, cartridge-based and other types of electronic cigarettes (e-cigarettes) among young adults. Observational, human laboratory assessment of e-cigarette use in Columbus, Ohio, USA (July 2020 to June 2021). Participants (n = 96, 60.4% female, age mean = 21.7 [standard deviation = 1.7] years, 82.4% white race) were identified via their participation in a cohort study or other convenience sampling and were 18 to 25 years old, vaped ≥4days/week for ≥4weeks and used other tobacco products for ≤5days of past 30 days. Participants completed a pre-vaping questionnaire, vaped their usual brand of e-cigarette ad libitum for 30 min and completed a post-vaping questionnaire. Outcome variables included pre- and post-vaping measures of plasma nicotine (t = 0 and t = 30, respectively) and craving and withdrawal symptoms, as well as vaping topography (e.g. flow rate and inter-puff interval), pre-vaping expectancies and post-vaping product appeal. Variables used to characterize the sample included demographics, e-cigarette and other tobacco use history, e-cigarette dependence and e-cigarette device characteristics (e.g. device type, flavor and nicotine form). Participants reported moderate nicotine dependence on average via the E-Cigarette Dependence Scale (mean = 6.9 [standard deviation = 4.0]). Following 30 min of ad libitum vaping, participants achieved substantial plasma nicotine boost (mean = 18.8 [standard deviation = 14.5] ng/mL), corresponding with statistically significant decreases in withdrawal symptoms measured via the Minnesota Nicotine Withdrawal Scale (pre-vaping mean = 9.0 [standard deviation = 5.1], post-vaping mean = 4.3 [standard deviation = 3.9]; P-value <0.0001). Pre-vaping, participants reported moderate vaping expectancies (e.g. mean = 2.5 [standard deviation = 1.0] on a scale from 0 to 4 for smell and taste expectancies); post-vaping, participants reported high satisfaction (mean = 4.6 [standard deviation = 1.2] on a scale from 1 to 7) and moderate reward (mean = 2.9 [standard deviation = 1.2]) and respiratory sensations (mean = 3.7 [standard deviation = 1.6]). Nearly half of participants (47.9%) used disposable e-cigarettes, and most used a mint/menthol or fruit flavored (99.0%) and nicotine salt (98.9%) e-liquid. Among young adults in the United States, the latest generations of e-cigarettes appear to deliver large quantities of nicotine (similar to cigarettes) and significantly relieve withdrawal symptoms, and they are appealing.

Nicotine information disclosed online by e-cigarette brands popular with young people.

E-cigarette use is most prevalent among adolescents and young adults - and there are often misperceptions about product risk. The purpose of this study was to determine what nicotine information is provided on e-cigarette brand websites. Based on national and local surveys, we identified 44 e-cigarette brands commonly used in the US by adolescents and young adults. For each of these brands, their associated websites were analyzed for disclosed nicotine information. Specifically, for each brand's website, we coded whether there was information on nicotine concentration (recorded if a numerical value was provided such as '5% nicotine'), nicotine form (free-base, nicotine salts, or not stated), and nicotine type (tobacco-derived, synthetically derived, or not stated). Coding allowed for both lay (e.g. 'nic salts') as well as scientific (e.g. 'isomers') terms. Of the 44 brands examined, all provided basic information on nicotine concentration (e.g. '5% nicotine'). However, 23% of brands did not disclose information on nicotine form (i.e. nicotine salt vs free-base), and 66% of brands did not disclose information on nicotine type (i.e. synthetic vs tobacco-derived). Overall, these results suggest that the e-cigarette industry is not fully informing its consumers about the nicotine in their products. Given that nicotine form and type have implications for e-cigarette addiction potential, these findings highlight a public health concern. There is a need for more comprehensive national regulations for mandating product constituents and emissions disclosures.

Use of 'Elf Bar' among youth and young adults who currently vape in England: cross-sectional associations with demographics, dependence indicators and reasons for use.

Elf Bar is currently the leading e-cigarette (vape) brand in Great Britain. This study examined youth and young adults' use of Elf Bar, socio-demographic characteristics and dependence indicators and reasons for use over other brands. Cross-sectional survey. Online 2022 International Tobacco Control Project Youth Tobacco and Vaping Survey (N = 1355 16-29-year-olds in England who had vaped in the past 30 days). Currently using Elf Bar most often (versus other brands) and associations with: socio-demographics, owning a vaping device, dependence indicators and reasons for brand choice. Logistic regressions were used. Among 16-29-year-olds who vaped in the past 30 days, 48.4% (n = 732) reported Elf Bar as the brand they used most often. Among 16-17-year-olds, 40.7% used Elf Bar over other brands; this was lower than among 18-19-year-olds (60.1%) and 20-29-year-olds (47.4%) (P ≤ 0.002). Using Elf Bar over other brands was higher among those who were female (55.2 versus 41.5% male), identified as White (53.1 versus 30.9% other/mixed), a student (54.5 versus 44.3% not), did not own a vape (66.7 versus 44.4% who did) and typically vaped 5-8hours after waking (62.7 versus 36.8% within 5min) (P ≤ 0.044). Most who vaped but had never smoked used Elf Bar (64.3%), although use did not significantly differ from those who currently (45.4%), formerly (42.3%) or experimentally (48.7%) smoked (all P ≥ 0.060). Popular reasons for choosing Elf Bar over other brands were better flavour/taste (47.5%), less expensive (28.7%), easier to get (26.1%), smoother to inhale (24.0%) and popularity (23.1%). 'Better for quitting smoking' (10.1%) was least frequently selected reason for choosing Elf Bar over other brands. Elf Bar brand e-cigarettes were used by approximately half of 16-29-year-olds who vaped in England in 2022 and was mainly chosen over other brands for subjective responses (e.g. flavour/taste), rather than for quitting smoking.

How to Identify e-Cigarette Brands Available in the United States During 2020-2022: Development and Usability Study.

Prior studies have demonstrated that the e-cigarette market contains a large number of brands. Identifying these existing e-cigarette brands is a key element of market surveillance, which will further assist in policy making and compliance checks. To facilitate the surveillance of the diverse product landscape in the e-cigarette market, we constructed a semantic database of e-cigarette brands that have appeared in the US market as of 2020-2022. In order to build the brand database, we searched and compiled e-cigarette brands from a comprehensive list of retail channels and sources, including (1) e-liquid and disposable brands sold in web-based stores, (2) e-cigarette brands sold in brick-and-mortar stores and collected by the Nielsen Retail Scanner Data, (3) e-cigarette brands compiled by Wikipedia, (4) self-reported e-cigarette brands from the 2020 International Tobacco Control Four-Country Smoking and Vaping (ITC 4CV) US survey, and (5) e-cigarette brands on Twitter. We also estimated the top 5 e-cigarette brands by sales volume in brick-and-mortar stores, by the frequency and variety of offerings in web-based shops, and by the frequency of self-reported brands from the 2020 ITC 4CV US survey. As of 2020-2022, a total of 912 e-cigarette brands have been sold by various retail channels. During 2020-2022, the top 5 brands are JUUL, vuse, njoy, blu, and logic in brick-and-mortar stores; blu, king, monster, twist, and air factory for e-liquids in web-based stores; hyde, pod mesh, suorin, vaporlax, and xtra for disposables sold in web-based stores; and smok, aspire, vaporesso, innokin, and eleaf based on self-reported survey data. As the US Food and Drug Administration enforces the premarket tobacco market authorization, many e-cigarette brands may become illegal in the US market. In this context, how e-cigarette brands evolve and consolidate in different retail channels will be critical for understanding the regulatory impacts on product availability. Our semantic database of e-cigarette brands can serve as a useful tool to monitor product and marketplace development, conduct compliance checks, assess manufacturers' marketing behaviors, and identify regulatory impacts.

E-Cigarette Brand Trends in the United States: An Investigation of Data From a Youth and Young Adult Sample and the E-Cigarette Retail Market (2022).

Electronic cigarettes (e-cigarettes) remain the most used tobacco product among young people in the United States (US). Given the need for current data on popular e-cigarette products, the current study leverages data from a rapid surveillance survey of young people and examines whether the top e-cigarette brands identified from this source align with US market data. Data were obtained from current e-cigarette users (N = 4145) participating in the Truth Continuous Tracker Online (CTO; a cross-sectional tracking survey of 15-24 year-olds sourced from the national Dynata panel) and NielsenIQ retail scanner data, collected in 2022 and aggregated by quarter (Q1, Q2, and Q3). The top 15 e-cigarette brands were determined from respondents' endorsement in the Truth CTO and ranked total sales in NielsenIQ in nominal dollars. Overall, 58% of e-cigarette brands overlapped across the Truth CTO and NielsenIQ data (60% for Q1, 47% for Q2 and 67% for Q3). Pod-based (JUUL; VUSE) and disposable (Hyde; Breeze Smoke) brands appeared as top brands in both datasets. Top brands were fairly consistent within and across quarters; though, more variability was found in the Truth CTO, relative to NielsenIQ. Many top brands were disposable. Results suggest that data from rapid surveillance and retail data can be used complementarily to characterize the popular e-cigarette brands currently on the US market. Many of these popular e-cigarette brands have yet to receive marketing granted orders under the US Food and Drug Administration, suggesting the need to continue monitoring e-cigarette brands among young people.

Reliable biological indicator identification and evaluation of tobacco-derived nicotine using an ultra-sensitive gas chromatography-tandem mass spectrometric method.

Several countries have exempted synthetic nicotine from existing regulatory frameworks, resulting in the widespread substitution of synthetic nicotine (SN) in almost all e-cigarette products available. However, it remains uncertain whether the purported synthetic nicotine is indeed genuine SN. There is a need to develop biological indicators and an analytical method that more clearly distinguishes between the two sources. Impurities in neat tobacco-derived nicotine (TDN) were characterized and identified through non-targeted and targeted analysis. Gas chromatography-tandem mass spectrometry (GC-MS/MS) conditions were optimized for detecting biological indicators in e-cigarette products. Nine tobacco-related alkaloids were identified and selected as biological indicators for TDN. A liquid-liquid extraction and GC-MS/MS quantitative method were developed to detect nine biological indicators in e-cigarette products with the limit of quantification ranging from 0.2 to 4.2µg L-1 using 0.5mL of e-liquid. This method was applied to 50 e-cigarette brands purchased in the Korean market. The developed method was able to easily and accurately identify the origin of nicotine even using a small amount of e-liquid sample. It is expected that effective e-cigarette regulation will be possible if the nicotine biological indicator and high-sensitivity analysis method developed in this study are used.

Electronic vape fluid activates the pulmonary endothelium and disrupts vascular integrity in vitro through an ARF6-dependent pathway

The use of e-cigarettes or vapes is increasingly popular amongst a range of different demographics however the research in this area is surprisingly sparse. Clinical reports of e-cigarette- or vaping use-associated lung injury (EVALI) and vascular disruption, in both nicotine-containing and nicotine-free e-cigarette smokers, prompts the need for further research with a focus on the pulmonary endothelium. Using a common brand of e-cigarette (eVape) and an in vitro model of the human lung microvasculature, we investigated the effect of nicotine-free eVape fluid on pulmonary endothelial barrier integrity, oxidative stress and inflammation profile. Findings demonstrate reactive oxygen species-dependent breakdown of the pulmonary endothelium and release of inflammatory cytokines. These phenotypic changes, following exposure to nicotine-free eVape fluid, were accompanied by dysregulation of a number of adheren junctions-related genes of which ARF6 was most abundantly overexpressed. Further investigation of ARF6 identified it as a key regulator in eVape-induced barrier disruption and ROS accumulation. This study demonstrates, for the first time, the barrier disruptive effect of nicotine-free e-cigarette fluid on the pulmonary microvasculature and the ARF6 and ROS-dependent molecular mechanisms underlying this damage. Whilst these studies focus on a human in vitro model of the pulmonary microvasculature, the results support clinical case studies on EVALI and demonstrate a need for further investigation of the impact of nicotine-free e-cigarettes on the lung.

Nicotine dependence among undergraduates who use nicotine salt-based e-cigarettes

Objective This study examined the relationship between use patterns of a popular e-cigarette brand using nicotine salts, JUUL, and symptoms of nicotine dependence in a college cohort. Participants Data for this study came from a prospective cohort of undergraduate students at a large Midwestern university from 2018 to 2019. Methods Among participants who had ever tried a JUUL (N = 411), univariate and multivariable logistic regression were used to test the associations between use frequency (past 30-day use) and quantity (time to finish a pod) and nicotine dependence at follow up. Results In the multivariable models, both frequency of use and quantity of use were associated with subsequent nicotine dependence, based on most indicators of dependence. Conclusions As salt-based nicotine is now present in the most popular e-cigarette brands used by young people, such findings inform our contemporary understanding of e-cigarettes’ addictive potential and can help inform campus-based interventions.

Symptoms of nicotine dependence by e-cigarette and cigarette use behavior and brand: A population-based, nationally representative cross-sectional study

BackgroundMany modern e-cigarette brands contain equivalent or higher nicotine levels than traditional cigarettes. ObjectiveTo examine differences in four nicotine dependence indicators (i.e., use within 30minutes of waking, cravings, needing to use, and frequent use) among adolescents (aged 12–17 years) with past 30-day (P30D) exclusive use of e-cigarettes, cigarettes, or dual use of both. MethodsData were from Wave 5 (2018–2019) of the Population Assessment of Tobacco and Health (PATH) study (n=1060; N=2053,659). Multivariable logistic regression was performed to determine differences in indicators by P30D e-cigarette and cigarette use behavior (exclusive vs. dual use) and brand (e-cigarette use: JUUL vs. non-JUUL vs. Unknown). ResultsThe odds of frequent use among adolescents with JUUL (AOR: 2.11; 95% CI=1.02–4.37) and non-JUUL (AOR: 2.12; 95% CI=0.95–4.77) use were similar and paralleled that for dual use (AOR: 3.50; 95% CI=1.46–8.43) but were stronger (JUUL only) than exclusive cigarette use. The odds of using within 30minutes of waking for adolescents with JUUL (AOR: 2.23; 95% CI=0.80–6.25) and non-JUUL (AOR:1.42; 95% CI=0.47–4.32) use were similar and paralleled that for both dual (AOR=3.00; 95% CI=1.01–8.88) and exclusive cigarette use. For adolescents who used unknown brands, the odds of all indicators paralleled exclusive cigarette use but were lower than JUUL, non-JUUL, and dual use. ConclusionCompared to exclusive cigarette use, symptoms of nicotine dependence are similar for adolescents with exclusive e-cigarette use, irrespective of brand. Symptoms of nicotine dependence for JUUL and non-JUUL use parallel dual use. Tobacco regulation should consider these findings when assessing the abuse liability of e-cigarettes.

Metal Concentrations in E-Cigarette Aerosol Samples: A Comparison by Device Type and Flavor.

The rapid evolution of electronic cigarette (e-cigarette) products warrants surveillance of the differences in exposure across device types-modifiable devices (MODs), cartridge ("pod")-containing devices (PODs), disposable PODs (d-PODs)-and flavors of the products available on the market. This study aimed to measure and compare metal aerosol concentrations by device type and common flavors. We collected aerosol from 104 MODs, 67 PODs (four brands: JUUL, Bo, Suorin, PHIX), and 23 d-PODs (three brands: ZPOD, Bidi, Stig) via droplet deposition in a series of conical pipette tips. Metals and metalloids [aluminum (Al), arsenic (As), cobalt (Co), chromium (Cr), copper (Cu), iron (Fe), manganese (Mn), nickel (Ni), lead (Pb), antimony (Sb), tin (Sn), and zinc (Zn)] were measured using inductively coupled plasma mass spectrometry (ICP-MS), results were log-transformed for statistical analysis, and concentrations are reported in aerosol units (). Of the 12 elements analyzed, concentrations were statistically significantly higher in MOD devices, except for Co and Ni, which were higher in PODs and d-PODs. Of the POD brands analyzed, PHIX had the highest median concentrations among four metals (Al, Ni, Pb, and Sn) compared to the rest of the POD brands. According to POD flavor, seven metals were three to seven orders of magnitude higher in tobacco-flavored aerosol compared to those in mint and mango flavors. Among the d-POD brands, concentrations of four metals (Al, Cu, Ni, and Pb) were higher in the ZPOD brand than in Bidi Stick and Stig devices. According to d-POD flavor, only Cr concentrations were found to be statistically significantly higher in mint than tobacco-flavored d-PODs. We observed wide variability in aerosol metal concentrations within and between the different e-cigarette device types, brands, and flavors. Overall, MOD devices generated aerosols with higher metal concentrations than PODs and d-PODs, and tobacco-flavored aerosols contained the highest metal concentrations. Continued research is needed to evaluate additional factors (i.e., nicotine type) that contribute to metal exposure from new and emerging e-cigarette devices in order to inform policy. https://doi.org/10.1289/EHP11921.

Does Brand Choice Matter: Associations Between Usual E-Cigarette Brands and E-Cigarette Use Patterns Among U.S. Youth, 2021.

To inform youth about e-cigarette use prevention, it is important to understand whether using e-cigarette products from certain brands is associated with youth's differential e-cigarette use patterns and willingness to quit e-cigarettes. Data for this study come from the 2021 U.S. National Youth Tobacco Survey (NYTS). The sample was current (past-30-day) e-cigarette users (unweighted n = 1,436). We examined the associations between users' usual e-cigarette brands (Puff, Vuse, Smoke, JUUL, and others) and e-cigarette use patterns (use frequency, use with nicotine, use with flavors) and willingness to quit, controlling for covariates. In 2021, 25.6%, 9.7%, 8.1%, and 6.5% of users reported Puff, Vuse, Smok, and JUUL as their usual brands, respectively. Having Smok as a usual brand increased the odds of frequent e-cigarette use compared with other brands. Using Puff, Vuse, and Smok increased the odds of using e-cigarettes with nicotine. Using Puff and Smok increased the odds of using e-cigarettes with any flavors and fruit flavors, and using Smok and JUUL increased the odds of using mint flavors. Finally, using Vuse reduced the odds of having a willingness to quit e-cigarettes. Puff products, which are likely to be used infrequently and with fruit flavors, were the most endorsed usual brand by youth users. Vuse and Smok brand users demonstrated problematic use patterns, including high-frequency use of nicotine and reduced willingness to quit. The high prevalence of using flavors, especially banned flavors (e.g., mint for JUUL products), suggests the need for tightened restrictions on youth's access to flavored e-cigarettes.

Scalable Surveillance of E-Cigarette Products on Instagram and TikTok Using Computer Vision.

Instagram and TikTok, video-based social media platforms popular among adolescents, contain tobacco-related content despite the platforms' policies prohibiting substance-related posts. Prior research identified themes in e-cigarette-related social media posts using qualitative or text-based machine learning methods. We developed an image-based computer vision model to identify e-cigarette products in social media images and videos. We created a data set of 6999 Instagram images labeled for 8 object classes: mod or pod devices, e-juice containers, packaging boxes, nicotine warning labels, e-juice flavors, e-cigarette brand names, and smoke clouds. We trained a DyHead object detection model using a Swin-Large backbone, evaluated the model's performance on 20 Instagram and TikTok videos, and applied the model to 14 072 e-cigarette-related promotional TikTok videos (2019-2022; 10 276 485 frames). The model achieved the following mean average precision scores on the image test set: e-juice container: 0.89; pod device: 0.67; mod device: 0.54; packaging box: 0.84; nicotine warning label: 0.86; e-cigarette brand name: 0.71; e-juice flavor name: 0.89; and smoke cloud: 0.46. The prevalence of pod devices in promotional TikTok videos increased by 15% from 2019 to 2022. The prevalence of e-juices increased by 33% from 2021 to 2022. The prevalence of e-juice flavor names and e-cigarette brand names increased by about 100% from 2019 to 2022. Deep learning-based object detection technology enables automated analysis of visual posts on social media. Our computer vision model can detect the presence of e-cigarettes products in images and videos, providing valuable surveillance data for tobacco regulatory science (TRS). Prior research identified themes in e-cigarette-related social media posts using qualitative or text-based machine learning methods. We developed an image-based computer vision model to identify e-cigarette products in social media images and videos. We trained a DyHead object detection model using a Swin-Large backbone, evaluated the model's performance on 20 Instagram and TikTok videos featuring at least two e-cigarette objects, and applied the model to 14 072 e-cigarette-related promotional TikTok videos (2019-2022; 10 276 485 frames). The deep learning model can be used for automated, scalable surveillance of image- and video-based e-cigarette-related promotional content on social media, providing valuable data for TRS. Social media platforms could use computer vision to identify tobacco-related imagery and remove it promptly, which could reduce adolescents' exposure to tobacco content online.