E-cigarette Marketing Research Articles

Examining the e-cigarette scenario based on distribution, availability, marketing, and banning: A GIS-Based qualitative study in Bangladesh.

Globally, over 81 million people use e-cigarettes, and the majority of them are young adults. Using e-cigarettes causes different types of adverse health effects both in adults and elderly people. Over time, using e-cigarettes has detrimental consequences on lung function, brain development and numerous other illnesses. This study employed a mixed-methods conducted between June and September 2023, comprising two phases: Geographical Information System (GIS) mapping of available e-cigarette point-of-sale (POS) locations and conducting 15 in-depth interviews (IDIs) with e-cigarette retailers, along with 5 key informant interviews (KIIs) involving tobacco control activists and policy experts. ArcGIS was employed for spatial analysis, creating distribution and type maps, and buffer and multi-buffer ring analyses were conducted to assess proximity to hospitals and academic institutions. Data analysis involved descriptive statistics for GIS mapping and qualitative analysis for interview transcripts, utilizing a priori codebook and thematic analysis. A total of 276 POS were mapped in the entire Dhaka city. About 55 POS were found within 100m distance from academic institutions in Dhaka city, which offers the easy accessibility of young generations to e-cigarettes. The younger generation is becoming the major target for e-cigarettes because of their alluring flavors, appealing looks, and variation in flavors. Sellers have been using different marketing tactics such as postering, offering discounts and using internet marketing on social media. Moreover, they try to convince the customers by saying that e-cigarettes are 'not harmful' or 'less harmful'. However, retailers were mostly taking e-cigarettes from local wholesalers or distributors. Customers buy these products both from in-store and online services. Due to the absence of laws and regulations on e-cigarettes in Bangladesh, the availability, marketing, and selling of e-cigarettes are increasing alarmingly. E-cigarette retail shops are mostly surrounded by academic institutions, and it is expanding. Besides, frequent exposure, easy accessibility, and tactful promotion encourage the younger generations to consume e-cigarettes. The government should take necessary control measures on manufacturing, storage, advertising, promotion, sponsorship, marketing, distribution, sale, import, and export in order to safeguard the health and safety of young and future generations.

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.

“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.

Prevalence of E-Cigarettes in Children and Adolescents: A Failure of Public Health Prevention

The rising prevalence of e-cigarette use among children and adolescents poses a significant challenge to public health prevention efforts. As these electronic nicotine delivery systems gain popularity among youth, concerns about the health impacts and long-term consequences have escalated. In this article, we delve into the concerning trends of e-cigarette use among the younger population, exploring the factors driving this phenomenon and evaluating the failures in current public health prevention strategies. By examining the regulatory gaps in e-cigarette marketing to the youth and proposing interventions to combat this growing issue, we aim to shed light on the urgent need for stronger policies and enforcement mechanisms to protect the health and well-being of our youth.

Exposure to e-cigarette and heated tobacco product advertisements via digital, traditional media, and points-of-sale: An examination of associations with use intentions and perceived risk among adults in Armenia and Georgia.

E-cigarette and heated tobacco product (HTP) marketing often leverages digital media and points-of-sale (POS) and advertises risk reduction, including in Armenia and Georgia where male cigarette use rates are high. Using 2022 survey data from Armenian and Georgian adults (n=1468, mean age=42.92 years, 51.4% female; and past-month use of e-cigarettes 3.2%, HTPs 2.7%, and cigarettes 31.6%), multivariable linear regression examined 4 outcomes - e-cigarette and HTP use intentions and perceived risk (1=not at all, to 7=extremely) - in relation to past-month e-cigarette or HTP advertisement exposure via digital media, traditional media, and POS, controlling for covariates (country, age, gender, education level, relationship status, children, past-month cigarette and e-cigarette/HTP use). E-cigarette and HTP use intentions were low (mean score=1.47, SD=1.39 each), while perceived risk was high (mean score=5.83, SD=1.6, and mean score=5.87, SD=1.56, respectively). Past-month exposure to e-cigarette and HTP advertisements, respectively, were 12.9% and 11.2% via digital media, 6.1% and 4.8% traditional media, and 22.5% and 21.1% POS. For e-cigarettes, ad exposure via digital media was associated with greater use intentions (β=0.24; 95% CI: 0.03-0.44), ad exposure via traditional media (β= -0.32; 95% CI: -0.55 - -0.09) and POS (β= -0.30; 95% CI: -0.60 - -0.004) was associated with lower risk perceptions. For HTPs, ad exposure via digital media (β=0.35; 95% CI: 0.14-0.56) and POS (β=0.21; 95% CI: 0.04-3.63) was associated with greater use intentions, and ad exposure at POS was associated with lower risk perceptions (β= -0.23; 95% CI: -0.42 - -0.03). Tobacco control efforts should monitor and regulate e-cigarette and HTP marketing, particularly via digital media which may effectively promote use, and via POS which may target and influence risk perceptions.

Biomarkers of Nicotine and Toxicant Exposure by E-liquid Nicotine Concentration Level among U.S. Adult Exclusive E-cigarette Users.

The current e-cigarette market has been rapidly evolving with an increase in the share of high nicotine concentration vaping products. This study examined urinary biomarkers of exposure (BOEs) by nicotine concentration level among exclusive e-cigarette users. Data were drawn from Wave 5 (December 2018-November 2019) of the Population Assessment of Tobacco and Health (PATH) Study. Between-subject differences in BOEs of nicotine, metal, tobacco-specific nitrosamine (TSNA), and volatile organic compounds (VOC) were examined across e-cigarettes containing nicotine or not (yes [n=300] vs. no [n=31] vs. non-tobacco use [n=3021]) and different nicotine concentration levels (0.1-1.7%, 1.8-4.9%, and 5.0%+). Among 3353 participants, exclusive e-cigarette users exhibited higher mean concentrations of nicotine metabolites than non-tobacco users. Nicotine e-cigarette users had higher concentrations of TNE2 (mean [95% CI]=21.8 [15.2-31.2] vs. 0.2 [0.1-0.6] nmol/mg creatinine, p<.0001) and cotinine (1418.2 [998.0-2015.4] vs. 12.2 [0.1-0.6], p<.0001) ng/mg creatinine, p<.0001) than non-nicotine e-cigarette users. Users of e-cigarette products with nicotine levels of 1.8-4.9% had higher TNE2 and cotinine levels than those using 0.1-1.7%, though differences were insignificant after adjusting for covariates. As compared to non-tobacco users, nicotine vapers had higher concentrations of lead (adjusted p=0.01). Nicotine containing e-cigarette users exhibited elevated levels of nicotine metabolites than non-nicotine containing vapers and non-tobacco users. Future research needs to investigate health effects of e-cigarette use across different nicotine levels Impact: Regulating the nicotine content in e-cigarettes could be crucial in managing nicotine exposure and potentially mitigating associated health risks.

E-cigarette market share by nicotine claims.

Nicotine forms (salt vs. freebase) and isomers (synthetic vs. tobacco-derived) are key characteristics of e-cigarettes that manufacturers manipulate, and "tobacco-free" claims may have served to attract new consumers and increase their intention to use. This study presents a snapshot of nicotine marketing claims for e-cigarettes using Nielsen ScanTrack data from brick-and-mortar stores. Market share was calculated as the ratio of unit sales of each nicotine claim category to the total unit sales of e-cigarettes during the four weeks ending 1-20-2024. We summarized the market share for the following six nicotine form/isomer category: 1) nicotine (77%), 2) nicotine salt (10%), 3) synthetic nicotine (2%), 4) zero tobacco or tobacco-free (2%), 5) zero nicotine or nicotine-free (0.03%), and 6) no claim or CBD/hemp/cannabis (9%). The market share of products that explicitly carried nicotine salt claims (10%) or synthetic nicotine or tobacco-free claims (2% each) was notable. This study informs regulatory authorities on the recent trend of nicotine claims marketed by the e-cigarette industry, which may be contributing to the use of these products or addiction to nicotine among young people and non-users.

Electronic Cigarette and Heated Tobacco Product Use and Their Association With Tobacco Control Factors Among Adults in Indonesia, Kazakhstan, and the Philippines.

Data on e-cigarette (EC) and heated tobacco product (HTP) use and the reasons for their use are useful for policy making. We report comparable nationally representative estimates of EC and HTP use and their associated factors. Global Adult Tobacco Survey data from Indonesia (2021), Kazakhstan (2019), and the Philippines (2021) were analyzed. The weighted prevalence rates and 95% CI of EC and HTP awareness, current use, and ever use, and their distribution by cigarette smoking status were calculated. Binary logistic regression analyses assessed socioeconomic, and tobacco control factors associated with EC and HTP use. The prevalence (%) of EC awareness, ever use and current use were 48.7-69.4, 3.6-8.8, and 1.9-3.0, respectively. The prevalence(%) of HTP awareness, ever use and current use were 2.7-21.7, 0.2-2.1, and 0.1-1.2, respectively. The main reasons for EC and HTP use were attractive flavors(45.8%-73.9%), less harmful than smoking(23.0%-70.1%), and enjoyment(40.8%-76.7%). Avoiding going back to smoking(0.9%-54.4%) and quitting smoking(19.4%-49.8%) were less frequently cited reasons (except in the Philippines). EC/HTP use was associated with younger age, higher education and wealth, current/past smoking, exposure to information about the dangers of tobacco use, and advertisements about tobacco products and smoke-free rules at home. The prevalence of EC and HTP use was higher among younger men with higher education and wealth, and current/past smoking. EC and HTP use should be closely monitored. Regulations to restrict the widespread marketing and sales of EC and HTP are needed to prevent the escalation of their use. The population-level data provide the benchmark for future monitoring use of e-cigarettes and HTPs and identify population subgroups for future surveillance in low- and middle-income countries. The association of EC/HTP use with tobacco control-related factors provides leads for policies that should be formulated and implemented to regulate the product contents, marketing, and sales of EC and HTP.

A Systematic Literature Review on the Composition, Health Impacts, and Regulatory Dynamics of Vaping.

This comprehensive review deals with the multifaceted aspects of electronic cigarettes (e-cigarettes), examining their composition, health implications, regulatory challenges, and market dynamics. E-cigarettes, also known as vaping devices, function by warming a solution of liquid containing flavors, nicotine, and various other compounds to produce an aerosol for users to inhale. This review underscores the evolution and widespread adoption of e-cigarettes since their introduction in 2003, highlighting their appeal as alternatives to traditional tobacco smoking. The essential parts of e-cigarettes are the battery, heating element, e-liquid (or e-juice), and mouthpiece. Propylene glycoland vegetable glycerinare common ingredients in e-liquids, along with nicotine and other flavors. Concerns over the health impacts of e-cigarettes have grown, particularly in light of incidents like the e-cigarette or vaping-associated lung injuryoutbreak in 2019 linked to vaping-associated lung injuries. Evidence suggests that while e-cigarettes may pose fewer risks than conventional cigarettes, they are not without health consequences, including potential respiratory and cardiovascular effects. Regulatory efforts worldwide have struggled to keep pace with the rapid evolution of e-cigarettes, exacerbated by their diverse flavors and marketing strategies that appeal to youth. The review discusses global regulatory responses, including bans and restrictions, to curb youth uptake and address public health concerns. Furthermore, the rise of a black market for e-cigarettes poses additional challenges to effective regulation and tobacco control efforts. In conclusion, while e-cigarettes offer potential harm reduction benefits for adult smokers seeking alternatives to traditional tobacco products, their widespread availability and evolving landscape necessitate vigilant regulatory oversight to protect public health, especially among youth. Future research should continue to explore the long-term health impacts and efficacy of e-cigarettes as smoking elimination aids, informing evidence-based policies and interventions.

Method Development and Validation of an Aerosol Sampling Technique for the Analysis of Nicotine in Electronic Cigarette Aerosols.

Because of the increasing popularity of e-cigarettes, monitoring the e-cigarette market has become important for national health authorities to guarantee safety and quality. In the EU, the Tobacco Products Directive requires emission studies for e-cigarette products. The absence of industry guidelines for studying these emissions and the lack of proper validation in the literature led us to develop and validate a method using the total error approach for the determination of nicotine in e-cigarette aerosols. A commercial vaping device was used to generate aerosols, which were then collected on Cambridge filter pads and measured for nicotine concentration by UHPLC-DAD after extraction. The method was successfully validated by generating accuracy profiles, which show that the β-expectation tolerance intervals remained below the acceptance limits of ±20%. Within-run repeatability and intermediate precision were considered acceptable since the highest RSD value obtained was below 5%. The method was applied to 15 commercial e-liquids. A complete validation of a method for the analysis of e-cigarette emissions is presented, including several parameters that impact the accuracy and reproducibility. Similar systematic approaches for method development and validation could be used for other e-cigarette emission analysis methods to ensure the reliability of the measurements.

Identifying e-cigarette content on TikTok: Using a BERTopic Modeling approach.

The use of hashtags is a common way to promote e-cigarette content on social media. Analysis of hashtags may provide insight into e-cigarette promotion on social media. However, the examination of text data is complicated by the voluminous amount of social media data. This study used machine learning approaches (i.e., Bidirectional Encoder Representations from Transformers [BERT] topic modeling) to identify e-cigarette content on TikTok. We used 13 unique hashtags related to e-cigarettes (e.g., #vape) for data collection. The final analytic sample included 12,573 TikTok posts. To identify the best fitting number of topic clusters, we used both quantitative (i.e., coherence test) and qualitative approaches (i.e., researchers checked the relevance of text from each topic). We, then, grouped and characterized clustered text to each theme. We evaluated that N=18 was the ideal number of topic clusters. The 9 overarching themes were identified: Social media and TikTok-related features (N=4; "duet", "viral"), Vape shops and brands (N=3; "store"), Vape tricks (N=3; "ripsaw"), Modified use of e-cigarettes (N=1; "coil", "wire"), Vaping and girls (N=1; "girl"), Vape flavors (N=1; "flavors"), Vape and cigarettes (N=1; "smoke"), Vape identities and communities (N=1; "community"), and Non-English language (N=3; Romanian and Spanish). This study used a machine learning method, BERTopic modeling, to successfully identify relevant themes on TikTok. This method can inform future social media research examining other tobacco products, and tobacco regulatory policies such as monitoring of e-cigarette marketing on social media. This study can inform future social media research examining other tobacco products, and tobacco regulatory policies such as monitoring of e-cigarette marketing on social media.

Recognition of online e-cigarette marketing and e-cigarette-related attitudes and behaviors among young adults.

Past research examining the relationship between exposure to online e-cigarette marketing and e-cigarette-related attitudes and behaviors has relied on unaided recall measures that may suffer from self-report bias. To date, few studies have presented participants with e-cigarette marketing stimuli and assessed recognition. This study examined the associations between recognition of online e-cigarette marketing stimuli and e-cigarette-related attitudes and behaviors among young adults in California. A non-probability representative sample of young adults (ages 18-24; N=1500) living in California completed an online survey assessing their recognition of online e-cigarette marketing stimuli, including image-based (i.e., Instagram, email) and audiovisual (i.e., YouTube, TikTok) promotions, and positive e-cigarette-related attitudes (e.g., appeal of e-cigarettes) and behaviors (e.g., e-cigarette use). Adjusted and weighted logistic regression analyses were used. 79.0% (n=1185) of young adults, including 78.1% (n=310/397) of participants under 21 years old, recognized online e-cigarette marketing. Participants who reported recognition of stimuli, compared with those who did not, had greater odds of reporting appeal of e-cigarettes (AOR=2.26, 95% CI=1.65-3.09) and e-cigarette purchase intentions (AOR=1.66, 95% CI=1.13-2.43) among all participants, and susceptibility to use e-cigarettes among never users (AOR=2.29, 95% CI=1.59-3.29). Young adults in California recognized audiovisual and image-based online e-cigarette marketing. Such recognition may lead to positive e-cigarette-related attitudes and behavioral intentions, especially among never users. Future research should examine the causal relationship between the associations found in this study. Findings may inform the development and evaluation of psychometrically valid measures of online e-cigarette marketing exposures. Recognition of online e-cigarette marketing stimuli was associated with greater odds of reporting appeal and benefits of e-cigarettes, purchase intentions, and lifetime e-cigarette use among all participants, and susceptibility to use e-cigarettes among never users. These findings may motivate the development and evaluation of psychometrically valid measures of online e-cigarette marketing exposures.

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.

E-cigarette use among early adolescent tobacco cigarette smokers: testing the disruption and entrenchment hypotheses in two longitudinal cohorts

ObjectiveUsing longitudinal data from two large-scale cohorts in the UK and USA, we examine whether e-cigarette use steers adolescent early smokers away from tobacco cigarettes (disruption hypothesis) or deepens early...

Associations between e-cigarette marketing exposure and vaping nicotine and cannabis among U.S. adults, 2021

IntroductionLittle is known about the influence of e-cigarette marketing on cannabis vaping behaviors. This study examined the associations between e-cigarette marketing exposure and nicotine and cannabis vaping among adults. MethodsThis cross-sectional study included a U.S. nationally representative sample of adults from the Wave 6 survey of the Population Assessment of Tobacco and Health Study. We used multinomial logistic regressions to examine the associations between past 30-day e-cigarette marketing exposure and past 30-day vaping behavior (sole- and dual-vaping of nicotine and cannabis) overall and stratified by age. ResultsOverall, 52.0 % of respondents reported e-cigarette marketing exposure, and 89.8 %, 5.6 %, 3.2 %, and 1.4 % reported no vaping, sole-nicotine vaping, sole-cannabis vaping, and dual-vaping, respectively. E-cigarette marketing exposure was associated with increased odds of reporting sole-cannabis vaping versus no vaping (adjusted risk ratio [aRR], 1.31; 95 % confidence interval [CI], 1.09–1.57) and dual-vaping versus no vaping (aRR, 1.26; 95 % CI, 1.01–1.57). This association was found among those aged 18–24 and 25–34 years. It was also associated with increased odds of reporting sole-cannabis vaping versus sole-nicotine vaping (aRR, 1.28; 95 % CI, 1.04–1.58). This association was found among those aged 18–24 years. DiscussionE-cigarette marketing exposure was associated with sole-cannabis vaping and dual-vaping, not sole-nicotine vaping among U.S. adults. Such associations were mainly driven by young adults aged 18–24 and 25–34 years. Greater restrictions on tobacco marketing may have reduced the influence of e-cigarette marketing on nicotine vaping, while gaps in marketing restrictions for cannabis may contribute to e-cigarette marketing influence on cannabis vaping.

Impact of product-based e-cigarette marketing on the attitudes and behavioural intentions of young Australians: an experimental study

BackgroundThe tobacco industry has a history of using language to downplay the harms associated with cigarettes and mislead consumers and policymakers. Emerging evidence suggests similar tactics are being used in...

“If I could try it, I’d try it”: Qualitative study of the illegal vaping culture in Singapore

Aims and backgroundSingapore has one the world’s strictest e-cigarette (vaping) regulations, with bans on e-cigarette import, sale, purchase, use and possession. Nevertheless, Singapore is seeing a growing vaping trend. Beyond estimates of vaping prevalence, little is known about vaping in countries where it is banned or the features and drivers of such illegal vaping cultures. This qualitative study thus explored the characteristics of Singapore’s illegal vaping culture. MethodsWe held ten focus group discussions with 63 Singaporeans aged 21–40 years, exploring participants’ experiences and views related to vaping in Singapore. Transcripts of the discussions were coded using deductive and inductive coding methods. ResultsDespite its illegal status, vaping was perceived as appealing due to the novelty flavours, ease of use, and convenient access. Harm perceptions were mixed, with concerns over the adverse health impacts along with beliefs that vaping was innocuous when used in moderation. A conspicuous vaping culture among young people, along with perceptions of lax enforcement, drove beliefs that vaping is an entrenched social norm in Singapore. This belief was in turn associated with a sentiment that Singapore should introduce a regulated e-cigarette market to better control its use among the general population. ConclusionsThe reinforcement of vaping as a social norm appears to be driving an illegal vaping culture in Singapore. Measures that denormalise vaping could help to strengthen the effectiveness of the vaping ban.

Neighborhood Inequities in Tobacco Product Descriptors, Washington, DC, 2018-2019.

The tobacco industry uses product descriptors to communicate reduced harm and increase appeal. This cross-sectional study assessed store-level racial, ethnic, and socioeconomic inequities in the distribution of retail tobacco product descriptors in a convenience sample of retailers in Washington, DC. Young adults (n = 146) who did not currently use tobacco reported real-time store visits over 14 days. Trained data collectors took high-resolution photographs of all tobacco (including e-cigarette) marketing in each store (n = 96) participants visited. We coded text descriptors on tobacco product advertisements and displays into descriptor categories (eg, fruit, sweet, concept). We fit multilevel models to examine relationships between store neighborhood census tract-level racial, ethnic, and socioeconomic characteristics and tobacco product descriptors in stores. As a supplementary analysis, we used geospatial methods to model predicted patterns of descriptors at the census tract level. Stores located in census tracts with the highest versus lowest percentage of Black residents had a greater count of fruit, sweet or dessert, alcohol, and concept descriptors (p < .05), similar to findings from the geospatial approach. Adjusted models also indicated some inequities in stores in census tracts with higher percentages of Hispanic or Latino residents for fruit, alcohol, and concept descriptors; however, tract-level models showed opposite results for concept flavors. In this convenience sample, fruit, alcohol, sweet/dessert, and concept FTP descriptors were prevalent in stores in neighborhoods with more Black residents demonstrated through two analytic approaches. Surveillance using representative samples of tobacco retailers could improve the ability to track the extent of this inequity. We document inequities in the amount of fruit, sweet or dessert, alcohol, and concept flavor descriptors in stores across neighborhoods in Washington, DC. Federal, state, and local regulatory action is needed to reduce inequities in flavored tobacco product availability and marketing, including for concept flavors.

Factors associated with intentions to quit vaping and quit attempts among Adolescents: A structural equation modeling approach

ObjectivesPrevious youth tobacco research has identified multiple factors relating to intentions to quit vaping and quit attempts among current e-cigarette users in adolescents. The pathways in the complex associations with vaping cessation behaviors remain unclear. MethodsUsing data from the 2022 National Youth Tobacco Survey (NYTS) (grades 6–12), structural equation models (SEMs) are developed to examine the associations of social environment, vaping risk perceptions, e-cigarette marketing, vaping characteristics, and demographics with two outcome measures – intentions to quit vaping and past year quit attempts among current e-cigarette users. ResultsThe national sample of current e-cigarette users (n = 2,701) consisted of 52.7 % females, 47.0 % non-Hispanic Whites, 80.1 % high school students, and 56.2 % heterosexual individuals. Among them, 70.2 % reported intentions to quit vaping and 66.3 % reported past year quit attempts. The protective factor for quit intentions was vaping risk perceptions (p < 0.001). Risk factors included e-cigarette marketing (p = 0.04), dual use of e-cigarettes and other tobacco products (p = 0.003), vaping due to feeling anxious or stressed (p = 0.01), vaping for nicotine buzz (p = 0.002), nicotine dependence (p = 0.02), identifying as Gay or Lesbian (p < 0.001), bisexual (p = 0.03), or Hispanic (p = 0.04). Similar associations were observed with quit attempts except that e-cigarette marketing, vaping due to feeling anxious or stressed, vaping dependence, and identifying as Hispanic were not significant. Besides, high vaping frequency (p < 0.001), grade level (p < 0.001) and not sure about sexual orientation (p = 0.01) were also negatively associated with quit attempts. ConclusionsThis study provided insights into factors influencing vaping cessation outcomes among adolescent current e-cigarette users. Developing tailored vaping cessation programs based on these findings could enhance quit success.

Appealing characteristics of E-cigarette marketing in the retail environment among adolescents

BackgroundNearly 3 million U.S. adolescents use e-cigarettes. E-cigarette marketing is associated with adolescent e-cigarette use; however, studies have not asked adolescents their perceptions about whether and which e-cigarette marketing in retail stores influences purchase and use. MethodsEleven 90-minute focus groups with 12–19-year-olds (mean age 15.7, 46.6 % female) from 11 U.S. states (n = 58) recruited through Instagram and schools (May 2021-Aug 2022). Photographs of e-cigarette marketing in and around retail stores were used to aid discussion. Thematic analysis identified themes related to appealing marketing characteristics. ResultsAdolescents indicated that e-cigarette marketing in and around retail stores arouses their curiosity, reminds them to buy, and normalizes using e-cigarettes. Adolescents identified specific e-cigarette marketing characteristics that they believed influence their decision to purchase and use e-cigarettes including the Tobacco Power Wall, free samples and flavor smelling samples, price incentives such as discounts and starter-kits, e-cigarette displays near checkout encouraging grab-and-go, displays near food, snacks or candy, and e-cigarette advertising through posters on store windows and stickers at checkout. Adolescents reported combining online and social media strategies to bypass age verification in retail stores (e.g., buying gift cards online and using them in stores). Adolescents suggested adding warning images on negative health effects of e-cigarettes, increasing prominence of minimum-age-of-tobacco-sale signs, and developing marketing education as counter-marketing strategies. ConclusionsAdolescents indicate that specific e-cigarette marketing characteristics in retail stores influence their purchase and use decisions. Addressing such e-cigarette marketing exposures in retail stores through counter-marketing messages may bolster adolescent e-cigarette prevention efforts.