E-cigarette Brands Research Articles

Prevalence of Awareness and Use of JUUL E-cigarettes in a National Probability Sample of Adolescents in the United States.

Objective: In this study, we estimate the prevalence of awareness and use of the JUUL e-ciga- rette among adolescents in the United States (US). Methods: We conducted a cross-sectional, self-report online survey between September 21 and October 3, 2018 that assessed awareness and use of JUUL e-cigarettes, other e-cigarettes, and combustible cigarettes in a national prob- ability sample of 1017 US adolescents aged 13-17 years. Results: Approximately 45.5% of adolescents aged 15-17 years and 29.1% of adolescents aged 13-14 years had ever seen or heard of a brand of e-cigarette called 'JUUL'. Among adolescents aged 15-17 years, 7.6% had ever used a JUUL, 4.0% had used a JUUL in the past 30 days, and 0.3% had used a JUUL on 20-30 of the past 30 days. Among adolescents aged 13-14 years, 1.5% had ever used a JUUL, 0.8% had used a JUUL in the past 30 days, and 0.0% had used a JUUL on 20-30 of the past 30 days. Conclusion: In September-October 2018, we estimated that about 39 in 100 US adolescents aged 13-17 years were aware of the JUUL brand of e-cigarette, and about 3 in 100 were estimated to have used a JUUL e-cigarette in the past 30 days. Close to half of all past 30-day e-cigarette use involved use of a JUUL e-cigarette. Present prevalence estimates may be limited to online modes of survey data collection and to the time period in which the data were collected. Findings reinforce the public health importance of acting to reduce youth access to JUUL vaping products, and of rou- tinely monitoring youth awareness and use of specific e-cigarette brands.

Commentary on Gravely et al (2019): Beginning a new era of nicotine products-beyond the four national-level determinants of nicotine vaping products (NVPs) use.

Recently, tobacco companies have increased their ownership of alternative tobacco products, such as nicotine vaping products (NVPs) and heated tobacco products (HTPs). In addition to the examination of essential national-level characteristics, including regulation of both NVPs and conventional cigarettes, future studies should also consider HTPs, which are already popular in some countries. Gravely and colleagues have updated their study estimating the prevalence of nicotine vaping product (NVP) use among current and recent ex-smokers in 14 countries 1, 2. In the updated paper 1, the status of NVP use in each country was assessed on four national-level characteristics: (1) regulatory policies for NVPs, (2) whether countries are classed as high- or middle-income, (3) attitudes towards harm reduction by NVPs and (4) the regional location of each country. With a few exceptions, considerable differences between countries in ever-use, and current/daily use of NVPs were observed such that NVP use patterns vary according to the combination of the four national-level characteristics. Lower prevalence of NVP use was observed in countries with strong regulations (e.g. where NVPs are prohibited from sale and regulations are strongly enforced), such as Australia, Brazil and Uruguay, regardless of whether these were high- or middle-income countries. Conversely, the highest prevalence of NVP use was observed in England, where regulation is weak and NVPs are promoted for harm reduction. Compared with middle-income countries, high-income countries had a higher prevalence of NVP use and the interaction between national-level environments and NVP use is also further complicated by the interaction of the above-mentioned four factors. However, we must also take some additional points into account in any future study. First, we need to consider the associations between NVP use and national-level tobacco control policy status, i.e. whether countries have implemented the measures recommended by the World Health Organization (WHO) MPOWER policy package, such as tobacco taxation and smoke-free policies. This matters, because the price of tobacco cigarettes, as influenced by taxation, may affect NVP use, or a strict smoke-free policy in schools may encourage students to use NVPs, which can be easily concealed 3. However, the 2017 MPOWER report suggests that taxation levels in each country, defined as the share of total taxes or the affordability of cigarettes, do not have a straightforward association with the prevalence of NVP use among the 14 countries analysed by Gravely et al. 4. More investigation into the relative prices of cigarettes and NVPs and the way this influences NVPs use is needed 5, as people may be more likely to choose NVPs if they are much cheaper than cigarettes. Secondly, in order to monitor usage of all nicotine-containing products in addition to NVPs, we should also consider heated tobacco products (HTPs) such as IQOS and PloomTECH, developed by the tobacco companies Philip Morris International and Japan Tobacco, respectively. IQOS is currently sold in more than 40 countries or regions world-wide, particularly in high-income countries 6. After becoming popular and widely used in Japan 7, IQOS has also gained widespread acceptance in the Republic of Korea 8. Given the marketing strategies of the big tobacco companies, the world-wide market share of nicotine-containing products accounted for by HTPs is likely to grow, increasing the potential for public health concern. Thirdly, the big tobacco companies have also bought electronic cigarette (e-cigarette) companies. For example, the tobacco company Altria (the parent company of Philip Morris International) recently took a 35% stake in the e-cigarette company JUUL, the makers of the most popular e-cigarette brand in the United States 9. As a result, all major nicotine-containing products, including conventional cigarettes, other tobacco products such as snus, NVPs (e-cigarettes) and HTPs, have now become part of the big tobacco companies’ range of products. This is concerning, because the use of NVPs and/or HTPs is strongly influenced by the marketing strategies of tobacco companies 10, 11. The time-period since the first appearance of NVPs and HTPs on the market has been relatively short, and thus our knowledge of the dissemination of these new products and our appropriate responses in relation to their regulation are limited and a consensus has not yet been reached. We should continue to gather information and evidence on these products to objectively judge the best approach for our society, and carefully determine our attitudes towards each nicotine-containing product. In order to carry out basic epidemiological data monitoring of health behaviour, HTPs, which are increasingly widely used, should be included in future analysis, either separately or jointly with NVPs. Ultimately, we need to recognize that our society has already entered a ‘new era of new nicotine-containing products diffusion’ following the ‘era of the conventional cigarette epidemic’. None.

US FDA seeks data on seizures that follow e-cigarette use

The US Food and Drug Administration is warning consumers about reports of seizures in people, particularly children and young adults, who use e-cigarettes. From 2010 to early 2019, the FDA identified 35 reported cases of seizures after e-cigarette use, the agency announced on April 3. It is too early to tell if e-cigarette use is associated with an increased risk of seizures. “Many of the reports received to date lack enough information to identify a specific brand or sub-brand of e-cigarette. The reports also don’t provide enough detail to establish a clear pattern or cause for these incidents,” FDA commissioner Scott Gottlieb and principal deputy commissioner Amy Abernethy say in a statement. Nonetheless, the FDA wants consumers to be aware of potential safety concerns related to e-cigarette use. The agency is encouraging e-cigarette users to report past and future incidents of seizures and other adverse effects to the agency. The

“Think it. Mix it. Vape it.”: A Content Analysis on E-Cigarette Radio Advertisements

Background: E-cigarette (EC) use is increasing rapidly across the United States, especially among youth. EC advertisements are one likely contributor to this increase, as they currently have few marketing restrictions. Radio advertising reaches most of the U.S. population and may be particularly influential in this regard. Objectives: The purpose of the current study was to examine content themes and spending data from EC radio advertisements. Methods: Competitrack, a marketing tracking firm, gathered 19 advertisements from four different EC brands across the United States from 2015 to 2016, which were coded by two individuals and analyzed for main content themes. Additionally, spending data were analyzed by identified EC brand. Results: Logic was the most common EC brand advertised on the radio and included themes potentially appealing to youth, such as humor and sound effects. Of the 28 analyzed content themes, references to “taste” were the most popular, followed by highlighting benefits of using ECs, presence of music, and comparison to other EC brands. Only Logic advertisements (n = 7) included health disclaimers and age restriction messages, yet frequently included themes that were attractive to youth. Conclusions/Importance: As these radio advertisements are exposing youth and other vulnerable populations to ECs, regulations, similar to those made for conventional cigarette advertising, are necessary for prevention efforts.

An Experimental Study of Nicotine Warning Statements in E-cigarette Tweets.

It is unclear whether warnings on electronic cigarette (e-cigarette) advertisements required by the US Food and Drug Administration (FDA) will apply to social media. Given the key role of social media in marketing e-cigarettes, we seek to inform FDA decision making by exploring how warnings on various tweet content influence perceived healthiness, nicotine harm, likelihood to try e-cigarettes, and warning recall. In this 2 × 4 between-subjects experiment participants viewed a tweet from a fictitious e-cigarette brand. Four tweet content versions (e-cigarette product, e-cigarette use, e-cigarette in social context, unrelated content) were crossed with two warning versions (absent, present). Adult e-cigarette users (N = 994) were recruited via social media ads to complete a survey and randomized to view one of eight tweets. Multivariable regressions explored effects of tweet content and warning on perceived healthiness, perceived harm, and likelihood to try e-cigarettes, and tweet content on warning recall. Covariates were tobacco and social media use and demographics. Tweets with warnings elicited more negative health perceptions of the e-cigarette brand than tweets without warnings (p < .05). Tweets featuring e-cigarette products (p < .05) or use (p < .001) elicited higher warning recall than tweets featuring unrelated content. This is the first study to examine warning effects on perceptions of e-cigarette social media marketing. Warnings led to more negative e-cigarette health perceptions, but no effect on perceived nicotine harm or likelihood to try e-cigarettes. There were differences in warning recall by tweet content. Research should explore how varying warning content (text, size, placement) on tweets from e-cigarette brands influences health risk perceptions. FDA's 2016 ruling requires warnings on advertisements for nicotine-containing e-cigarettes, but does not specify whether this applies to social media. This study is the first to examine how e-cigarette warnings in tweets influence perceived healthiness and harm of e-cigarettes, which is important because e-cigarette brands are voluntarily including warnings on Twitter and Instagram. Warnings influenced perceived healthiness of the e-cigarette brand, but not perceived nicotine harm or likelihood to try e-cigarettes. We also saw higher recall of warning statements for tweets featuring e-cigarettes. Findings suggest that expanding warning requirements to e-cigarette social media marketing warrants further exploration and FDA consideration.

Vaping versus JUULing: how the extraordinary growth and marketing of JUUL transformed the US retail e-cigarette market

BackgroundWhile national surveys showed declines in e-cigarette use in the USA between 2015 and 2016, recent reports indicate that JUUL, a sleekly designed e-cigarette that looks like a USB drive,...

White Paper on Electronic Nicotine Delivery System.

Electronic nicotine delivery systems (ENDS) or e-cigarettes or vape pens/vaping devices are battery-powered devices used to smoke or ‘vape’, a flavoured solution containing varying concentrations of nicotine, an addictive chemical found in cigarettes and other forms of tobacco products. Amongst these various types of ENDS devices, e-cigarettes are the most common type. They produce an aerosolized mixture of the flavoured liquids and nicotine, which is inhaled by the user. Nicotine is considered as one of the most addictive substances. The rapidity at which it is introduced into the body, age of first exposure and the dosage administered all add to determine the potential risk of a person being addicted to it throughout life. Nicotine addiction is established more strongly when the exposure occurs in adolescence. The various flavours and attractive designs also add to the allure of these products to the young population. ENDS or e-cigarettes are manufactured in such a way to resemble conventional tobacco products such as cigarettes, pipes and cigars and common gadgets such as flash drives, flashlights or pens (Figs. ​(Figs.11 and ​and22)1. Structurally, most e-cigarettes contain four different components: a cartridge or reservoir, which holds a liquid solution containing varying amounts of nicotine with flavourings, and other chemicals (e-liquid or e-juice), namely a power source (usually a battery), a heating element (atomizer) and a mouthpiece that the person uses to inhale. They date back to 17th August 1965 when the first documented patent for this type of device was issued in Pennsylvania. Since then, it took several decades of additional propagation before mass production was initiated in 2003 in China and some other countries. Currently, there are more than 460 different e-cigarette brands with varied configuration of nicotine delivery available in the market, for example, cigar-likes (first generation), tank systems (second generation) and personal vaporizers (third generation) with over 7700 flavours2. This makes collation of data on health effects more difficult for generation of scientific evidence. Open in a separate window Fig. 1 Various types of electronic nicotine delivery systems devices. Source: Ref. 1

Use of JUUL E-cigarettes Among Youth in the United States.

JUUL has emerged as the leading brand in a rapidly evolving electronic cigarette (e-cigarette) market. JUUL is distinctive for its novel nicotine delivery method that results in high nicotine concentrations, as well as its sleek, discreet design. This study examined national estimates of JUUL among youth in the United States, including whether JUUL users report different patterns of use compared to users of other e-cigarettes. Data were analyzed from the US arm of the International Tobacco Control Policy Evaluation Project (ITC) Youth Tobacco and E-cigarette Survey, an online survey conducted in July-August 2017 with youth aged 16-19 years recruited from consumer panels (n = 4086). Overall, 14.2% of respondents had used an e-cigarette in the past 30 days. JUUL was the second-most popular brand reported by past-30-day e-cigarette users (9.7%). Compared to e-cigarette users of other brands, JUUL users were significantly older (adjusted odds ratio [aOR] = 2.50, 95% confidence interval [CI] = 1.56 to 4.01) and reported a greater number of computers in the household (a socioeconomic status proxy; aOR = 1.55, 95% CI = 1.22 to 1.96), with no differences by sex, race/ethnicity, or student status. Controlling for sociodemographic variables, JUUL users were more likely than other e-cigarette users to have ever tried to quit e-cigarettes (aOR = 2.65, 95% CI = 1.12 to 6.30), with no differences observed by smoking status, frequency of e-cigarette use, urges to use e-cigarettes, or perceived addiction to e-cigarettes. JUUL was among the most popular e-cigarette brands among youth, and there were few differences in sociodemographic profile or patterns of use between users of JUUL and other e-cigarette brands. This study examined national estimates of JUUL e-cigarette use among youth in the United States, during the early phase of JUUL's popularity. JUUL was among the most popular e-cigarette brands among youth, and there were few differences in sociodemographic profile or patterns of use between JUUL and other e-cigarette brands. The findings help to characterize the rapid rise of this new product category within the rapidly evolving e-cigarette market at a time when the US Food and Drug Administration and public health community are seeking to understand JUUL and its appeal among young people.

AAFP OFFERS RESOURCES AS ‘JUULING’ INCREASES AMONG YOUTH

One particular brand of e-cigarette, known as JUUL, has been drawing a lot of heat. Extremely popular among adolescents and young adults, the product is the focus of an FDA crackdown and multiple lawsuits. To ensure that AAFP members stay up-to-date on the concerns swirling around this relative

Engagement With Online Tobacco Marketing Among Adolescents in the United States: 2013-2014 to 2014-2015.

To assess changes in engagement with online tobacco and electronic cigarette (e-cigarette) marketing (online tobacco marketing) among adolescents in the United States between 2013 and 2015. We assessed the prevalence of six forms of engagement with online tobacco marketing, both overall and by brand, among adolescents sampled in Wave 1 (2013-2014; n = 13651) and Wave 2 (2014-2015; n = 12172) of the nationally representative Population Assessment for Tobacco and Health Study. Engagement was analyzed by tobacco use status: non-susceptible never tobacco users; susceptible never tobacco users; ever tobacco users, but not within the past year; and past-year tobacco users. Among all adolescents, the estimated prevalence of engagement with at least one form of online tobacco marketing increased from 8.7% in 2013-2014 to 20.9% in 2014-2015. The estimated prevalence of engagement also increased over time across all tobacco use statuses (eg, from 10.5% to 26.6% among susceptible adolescents). Brand-specific engagement increased over time for cigarette, cigar, and e-cigarette brands. Engagement with online tobacco marketing, both for tobacco and e-cigarettes, increased almost twofold over time. This increase emphasizes the dynamic nature of online tobacco marketing and its ability to reach youth. The Food and Drug Administration, in cooperation with social networking sites, should consider new approaches to regulate this novel form of marketing. This is the first study to estimate the national prevalence of engagement with online tobacco marketing among adolescents over time. The estimated prevalence of this engagement approximately doubled between 2013-2014 and 2014-2015 among all adolescents and, notably, among adolescents at relatively low risk to initiate tobacco use. This increase in engagement could represent public health harm if it results in increased initiation and use of tobacco products. Stronger federal regulation of online tobacco marketing and tighter control of access to tobacco-related content by social media sites could reduce adolescents' exposure to and engagement with online tobacco marketing.

Evolution of Electronic Cigarette Brands From 2013-2014 to 2016-2017: Analysis of Brand Websites.

BackgroundThe electronic cigarette (e-cigarette) industry has grown in size and organizational complexity in recent years, most notably with the entry of major tobacco companies in 2012 and the proliferation of vape shops. Many brands maintain retail websites that present e-cigarette marketing claims and sell directly to consumers. Understanding of the evolving composition of different types of e-cigarette brand websites is currently underdeveloped.ObjectiveThis paper presents how e-cigarette brand websites surveyed in 2013-2014 evolved by 2016-2017, and how the websites run by different types of e-cigarette producers currently differ.MethodsIn 2016-2017, we revisited 466 e-cigarette brand websites surveyed in 2013-2014, 288 of which were extant, and identified 145 new English-language websites. We compared product designs, marketing claims, and age-based warnings presented by types of e-cigarette producers: major tobacco companies, independent vape shops, and independent internet-only companies.ResultsAmong the 433 websites examined in 2016-2017, 12 were owned by major tobacco companies, 162 operated a physical vape shop, and 259 were internet-only operations. Closed-system product designs were sold by 83% (10/12) of tobacco-owned brands. In comparison, 29.0% (47/162, P<.001) of vape shop and 55.2% (143/259, P=.06) of internet-only brands sold closed-system designs. Compared with vape shop and internet-only brands, tobacco-owned brands offered a smaller set of product models (P values <.001) and a narrower range of flavors (P values <.01), with greater emphasis on the traditional combustible cigarette flavors of tobacco and menthol (P values <.001). Tobacco-owned brands also offered a narrower range of nicotine options than the vape shops (P=.002) and were less likely to offer nicotine-free e-liquid compared with internet-only and vape shop brands (P values <.001). Finally, 83% (10/12) of tobacco-owned brand websites featured age verification pop-up windows. In comparison, only 50.2% (130/259) of internet-only brands (P=.01) and 60.5% (98/162) of vape shop brands (P=.06) featured age verification windows. Websites surveyed in both 2013-2014 and 2016-2017 became more likely to sell open-system mods (P<.001) and sold an increased number of product models (P<.001), flavors (P<.001), and nicotine options (P<.001). Prevalence of several types of claims decreased significantly, including indirect claims regarding smoking cessation (P<.001), claims regarding e-cigarettes as healthier (P<.001), less expensive (P<.001), and usable in more places (P<.001) compared with combustible cigarettes.ConclusionsThe number of e-cigarette brands has not appeared to increase since 2014, even as website messaging evolved, with brands owned by tobacco companies and vape shops pulling in opposite directions. Brands owned by tobacco companies offered a limited range of e-cigarette products, whereas brands owned by vape shops emphasized a panoply of flavor and nicotine options. Furthermore, the Food and Drug Administration’s regulatory action may influence the types of e-cigarette products offered and the market shares of various companies.

Whose Post Is It? Predicting E-cigarette Brand from Social Media Posts

E-cigarette advertisers know that 76% of youth use social media, yet little is known about the nature of e-cigarette advertising on social media most favored by youth. We utilized text-mining to characterize e-cigarette advertising and marketing messages from image-focused social media brand sites, and to construct and test an algorithm for predicting brand from brand-generated social media posts. Data comprised 5022 unique posts accompanied by an image from Facebook, Instagram or Pinterest e-cigarette brand pages for Blu, Logic, Metro, and NJOY from February 2012 to April 2015. Text-tokenization was used to quantify text for use as predictors in analyses. Blu had the largest social media presence (65%), followed by Logic (16%), NJOY (12%) and Metro (7%). Blu's average post length was significantly shorter than all other brands. Words most commonly used in posts differed by brand. Regression analyses successfully differentiated Blu and NJOY brands from other brands. Analyses revealed e-cigarette brands used different types of messages to appeal to social media users. Whereas words used by Blu and NJOY sold a "lifestyle," words used by Logic and Metro relied on device and product identification.

Dihydroxyacetone levels in electronic cigarettes: Wick temperature and toxin formation.

Recently, we reported the presence of dihydroxyacetone (DHA), the active ingredient in sunless tanners, in the aerosol of an electronic cigarette. DHA has been shown to react with DNA in vitro. The FDA restricts the use of DHA to external application only. It states that it should not be inhaled, ingested, or come into contact with any areas containing mucous membranes, due to unknown risk. Herein, the quantification of DHA in the aerosols of three brands of e-cigarettes has been carried out. These included two devices with horizontal heating coil configurations as well as one with a sub-ohm resistance vertical heating coil. In order to understand and begin to address the origin of DHA and related aerosol products, the wicking properties of the three e-cigarettes were compared. DHA levels were analyzed by a combination of GS/MS and 1H NMR. DHA was found in all three e-cigarettes, with substantially less in the sub-ohm, vertical coil device as compared to the horizontal coil devices (e.g., 0.088 μg/puff vs. 2.29 μg/puff, respectively). Correspondingly, the temperature of the wet layer of the wick for the vertical coil was relatively stable, compared to the wicks for the horizontal coils, upon increasing battery power output. This result is in agreement with prior studies of e-cigarette wicking efficiency and aerosol toxin formation. The temperature measurements reported are a simple means for comparing devices with different design properties during operation.

Initial ratings of different types of e-cigarettes and relationships between product appeal and nicotine delivery

AimsLittle is known about features of e-cigarettes (EC) that facilitate or hinder the switch from smoking to vaping. We tested eight brands of EC to determine how nicotine delivery and other product characteristics influence user’s initial reactions.MethodsFifteen vapers tested each product after overnight abstinence from both smoking and vaping. At each session, participant’s vaped ad lib for 5 min. Blood samples were taken at baseline and at 2, 4, 6, 8, 10 and 30 min after starting vaping. Participants rated the products on a range of characteristics. The products tested included six ‘cig-a-like’ and two refillable products, one with variable voltage. We also tested participants’ own EC.ResultsAll products significantly reduced urges to smoke. Refillable products delivered more nicotine and received generally superior ratings in terms of craving relief, subjective nicotine delivery, throat hit and vapour production but in overall ratings, they were joined by a cig-a-like, Blu. Participants puffed more on low nicotine delivery products. Participants’ estimates of nicotine delivery from different EC were closely linked to ‘throat hit’. Nicotine delivery was less important in the initial product ratings than draw resistance, mouthpiece comfort and effects on reducing urge to smoke.ConclusionsAll EC products reduced urges to smoke. Refillable products received generally more favourable ratings than ‘cig-a-likes’ with similar nicotine content. Perception of nicotine delivery was guided by throat sensations. Lower nicotine delivery was associated with more frequent puffing. The first impressions of EC products are guided less by nicotine delivery than by sensory signals.

Flavoring Chemicals and Aldehydes in E-Cigarette Emissions

Regulations on e-cigarettes in the U.S. do not provide guidelines on the chemical content of e-cigarette liquids. We evaluated emissions of aldehydes and flavoring chemicals in e-cigarette vapor under typical usage conditions. We selected 24 e-cigarette flavors from the top selling disposable e-cigarette brands. E-cigarettes were connected to a pump drawing air for two second puffs with sixty-second intervals between puffs. The vapor was analyzed for the presence of aldehydes using high-performance liquid chromatography-ultraviolet detector and for the presence of flavoring chemicals with gas chromatography and an electron capture detector. All e-cigarette emissions tested contained at least one aldehyde and/or flavoring chemical on either the FEMA "High Priority Chemicals" or FDA Harmful and Potentially Harmful Constituents lists when sampled at typical usage conditions. Diacetyl, a known respiratory hazard, along with acetoin, were the most prevalent of the flavoring chemicals in e-cigarette vapor, being found in more than 60% of samples. The presence of propionaldehyde, acetaldehyde and formaldehyde were correlated, corroborating previous work suggesting thermal degradation as a pathway for aldehyde generation in e-cigarette vapors. Median formaldehyde concentrations of 626 μg/m3 in e-cigarette vapor exceed the ACGIH maximum concentrations allowable for workers of 370 μg/m3.

Assessing the Association Between E-Cigarette Use and Exposure to Social Media in College Students: A Cross-Sectional Study

ABSTRACTBackground: Social media platforms provide an indirect medium for encouraging e-cigarette use between individuals and also serve as a direct marketing tool from e-cigarette brands to potential users. E-cigarette users share information via social media that often contains product details or health-related claims. Objective: Determine whether e-cigarette use is associated with exposure to e-cigarettes on social media in college students. Methods: Data from a sample of 258 college students was obtained via a clicker-response questionnaire (90% response rate). Demographic, lifetime and current e-cigarette/cigarette use, and e-cigarette exposure via social media (peer posts or advertisements) were examined. Logistic regression was used to assess the relationship between lifetime and current e-cigarette use and viewing peer posts or advertisements on social media while adjusting for cigarette use and self-posting about e-cigarettes. Results: Overall, 46% of participants reported lifetime e-cigarette use, 16% current e-cigarette use, and 7% were current dual users of e-cigarettes and cigarettes. There were positive and significant associations between lifetime e-cigarette use and viewing peer posts (aOR = 3.11; 95% CI = 1.25–7.76) as well as advertisements (aOR = 3.01; 95% CI = 1.19–7.65) on e-cigarettes via social media after adjusting for cigarette use. Current e-cigarette use was only significantly associated with viewing peer posts via social media (aOR = 7.58; 95% CI = 1.66–34.6) after adjusting for cigarette use. Conclusions/Importance: Almost half of college students view peer posts and advertisements on e-cigarettes via social media. This exposure is associated with individual e-cigarette use. Continued efforts to examine online e-cigarette content are needed to help future interventions decrease e-cigarette use.

Point of Sale Scanner Data for Rapid Surveillance of the E-cigarette Market.

Describe e-cigarette sales trends and market share from U.S. convenience stores and mass market retailers. We used Nielsen Scantrack to calculate U.S. e-cigarette sales market share from convenience and mass market channels during the 4-week period ending 1/19/13 through the period ending 12/19/15. Internet searches were used to supplement Nielsen product information. From 2013 to 2015, rechargeable e-cigarette brands VUSE and MarkTen experienced the largest growth in Nielsen channels. E-liquid and tank type brands Vapin Plus and Haus experienced growth although their Nielsen market share is small compared to other brands. Sales of brands with high labeled nicotine content (according to packaging or website) increased. Fruit-flavored sales increased rapidly in Nielsen, yet still represent a minority of market share in these channels. Market-leading e-cigarette brands changed substantially in Nielsen channels from 2013 to 2015. Brand leaders in these channels are now owned by tobacco companies. Changes in labelled nicotine content and fruit-flavored products and product types suggest that as e-cigarette use increases, convenience store and mass market channels are offering new products to meet consumer preferences; however, Nielsen channels do not represent the entire e-cigarette marketplace.

Abstract 502: Electronic cigarette aerosols increase cellular reactive oxygen species and induce significant oxidative DNA damage

Abstract Background: E-cigarettes (ECs), also known as electronic nicotine delivery systems (ENDS) are battery-operated devices that deliver nicotine through inhaled aerosols. The health risks associated with EC use are unclear, but ECs have been promoted as a safer alternative to tobacco smoking and a smoking cessation aid. Currently, more than 13% of American high school students and 10% adults report using ECs. EC aerosols contain unique constituents (e.g. silicate beads, tin and flavorants), as well as other toxicants also present in tobacco smoke, including carcinogens and reactive oxygen species (ROS). The potential of EC aerosols to induce DNA damage has not been fully characterized. Aims: (1) To examine the effects of EC aerosol exposure in the levels of cellular reactive oxygen species (ROS); and (2) To evaluate the potential of EC aerosols to cause oxidative DNA damage. Methods: EC aerosols and mainstream smoke extracts were generated from distinct brands of ECs containing diverse nicotine concentrations and a reference combustible cigarette, in controlled conditions using a modified smoking apparatus. Human normal epithelial and oral cancer cell lines were exposed up to 2 weeks to diverse doses of EC aerosol extracts equivalent to 1 to 100 EC puffs. Levels of ROS were evaluated using the 2’,7’ -dichlorofluorescin diacetate (DCFDA) cellular ROS detection assay kit (Abcam). Overall DNA damage was quantified using two distinct assays q-PADDA and Comet assay. 8-Oxoguanine, one of the most common DNA lesions resulting from ROS, was quantified using a commercially available ELISA kit. Data were analyzed by Student’s t-test. Results: Exposure to EC aerosols caused a significant increase in ROS levels. Exposure to EC extracts induce significant DNA damage measurable by q-PADDA and Comet assay. Overall, EC aerosol extracts induced significantly less DNA damage than mainstream smoke extracts. Yet, a significant increase in 8-oxoguanine lesions was observed after acute and long-term exposure to EC extracts compared to the control. Conclusion: Both short- and long-term exposure to EC aerosols can increase cellular ROS levels and cause significant DNA damage. Moreover, EC aerosols cause oxidative DNA lesions which are highly mutagenic, and can lead to tumor initiation and progression. Our study emphasizes the urgent need to further investigate the potential short- and long-term health effects of EC aerosols. Grant support: This work was supported by the Oklahoma Tobacco Research Center (LQ). Dr. Queimado holds a Presbyterian Health Foundation Endowed Chair in Otorhinolaryngology. Citation Format: Vengatesh Ganapathy, Jimmy Manyanga, Dehra McGuire, Daniel Brobst, Theodore Wagener, David Rubenstein, Ilangovan Ramachandran, Lurdes Queimado. Electronic cigarette aerosols increase cellular reactive oxygen species and induce significant oxidative DNA damage [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 502. doi:10.1158/1538-7445.AM2017-502

The Advertising Strategies of Early E-cigarette Brand Leaders in the United States.

We examined differential advertising strategies used by 4 major United States e-cigarette companies with differential affiliations with the traditional tobacco industry (ie, Njoy - independent, Blu - acquired, Vuse and MarkTen - launched by cigarette companies) over time. We conducted a mixed-methods study regarding e-cigarette adspend, adspend per media channel (eg, TV, print), and advertising messaging strategies among these 4 top e-cigarette brands from January 2013 through December 2015. E-cigarette adspend increased from $59 million in 2013 to $91 million in 2014, followed by a sharp decline to $37 million in 2015. These companies showed distinct spending trajectories overall and across media channels, with Njoy and Vuse spending a higher proportion of their dollars on TV and Blu and MarkTen spending more on print. Marketing messages were also different by company. Key themes included switching from cigarettes (particularly by Njoy and Blu), circumventing smoke-free policies (particularly by Blu), and technological advancement (particularly by Vuse and MarkTen). These e-cigarette brands have shifted their adspend, use of media channels, and advertising messaging strategies over time. Some differing strategies may reflect the different affiliations of each brand to the traditional cigarette industry.

Celebrity-endorsed e-cigarette brand Instagram advertisements: Effects on young adults' attitudes towards e-cigarettes and smoking intentions.

Celebrities endorsing e-cigarette brands on social media may exert a strong influence on e-cigarette uptake. Using a between-subject experiment, this study examines the effects of endorser type (celebrities, non-celebrities and products only) in e-cigarette brand Instagram advertisements on e-cigarette attitudes and smoking intentions. Results showed that celebrity endorsers significantly increased positive attitudes towards e-cigarettes and smoking intentions, compared to non-celebrities or products only. Celebrity endorsers also rated significantly higher on trustworthiness, expertise, goodwill and attractiveness, compared to non-celebrities. Additionally, identification, social comparison, health consciousness and social networking site use moderated between endorser type and key dependent measures. Implications for e-cigarette marketing regulation are discussed.