E-cigarette Products Research Articles

Disparities in Transitions From E-cigarette Use to Other Tobacco Use Patterns Among Sexual Minority Versus Heterosexual Women and Men in the United States.

Despite elevated rates of e-cigarette use among sexual minority versus heterosexual young adults, limited research has examined sexual identity in relation to transitions from e-cigarette use to other tobacco use patterns. We analyzed data from 608 US young adults in a 2-year study (2018-2020) who reported using e-cigarettes in the past 6 months (time period between assessments) but no other tobacco product at baseline (Fall 2018). Multinomial logistic regressions among women and men, separately, examined associations between sexual identity and past 6-month tobacco use in Fall 2020 (nonuse [referent group] vs e-cigarette only, other tobacco product only, e-cigarette and other tobacco product dual use), controlling for age and race/ethnicity. Among women (n = 340; mean [M]age = 23.42; n = 147 [43.4%] sexual minority; 29.4% racial/ethnic minority), 34.4% reported nonuse at follow-up, 26.8% e-cigarette only, 10.3% other tobacco product only, and 28.5% e-cigarette and other tobacco product dual use. Sexual minority (vs heterosexual) women displayed greater odds of e-cigarette-only use, as well as dual use relative to nonuse at follow-up. Among men (n = 244; Mage = 24.30; n = 51 [20.9%] sexual minority; 36.1% racial/ethnic minority), 25.4% reported no use, 20.9% e-cigarette only, 17.2% other tobacco product only, and 36.5% dual use at follow-up. Sexual minority (vs heterosexual) men displayed lower odds of e-cigarette only, other tobacco product only, and dual use relative to nonuse at follow-up. Research is needed to assess and intervene on tobacco/nicotine product perceptions (eg, harm, social acceptability) and reasons for use (eg, mood regulation) associated with high-risk tobacco use patterns and trajectories, particularly among sexual minority young adult women who may have distinct profiles and risks associated with use.

The Impact of New Jersey's 2020 E-Cigarette Flavor Ban on E-Cigarette, Cigarette, and Cigar Sales in NJ.

On April 20, 2020, New Jersey (NJ) implemented a comprehensive ban on the sale of flavored e-cigarettes. This study compares sales of e-cigarettes, cigarettes, and cigars before and after the law. Data were biweekly retailer scanner sales in NJ convenience stores for e-cigarettes, cigarettes, and cigars between August 2019 and December 2020. We used Joinpoint regression to assess sales trends for cigarettes (non-menthol, menthol), cigars (unflavored, flavored), and e-cigarettes (unflavored, fruit/sweet/concept flavor, menthol flavor) in the 36 weeks before and 36 weeks after a statewide ban on flavored e-cigarettes. Flavored e-cigarette sales, not including menthol, significantly decreased over the study period while menthol e-cigarette sales significantly increased until the e-cigarette flavor ban took effect, after which these sales rapidly declined through May 2020, then slowed. Unflavored e-cigarette sales declined through September 2019, then grew modestly until the flavored e-cigarette ban, after which sales significantly increased. Flavored cigar sales increased between March and May 2020, then declined; non-flavored cigar sales increased between mid-February and early July 2020, then declined. Cigarette sales were decreasing before the flavored e-cigarette ban but after, significantly increased until June 2020. Overall, there was no significant trend in the average biweekly percent change for cigarette sales. Flavored e-cigarette sales were declining prior to the ban but the pace of the decline accelerated following federal and state restrictions on flavored e-cigarette sales, then slowed by the second half of 2020, with a brief period of increased cigarette and cigar sales immediately following the ban. New Jersey's 2020 statewide e-cigarette flavor ban offered the opportunity to observe how sales of e-cigarette, cigarette, and cigar products shifted after the change. The effect of the state law, at least in the short-term, was decreased sales of flavored e-cigarettes and increased sales of unflavored e-cigarettes. Research on long term policy effects is needed.

Instructional Health-Risk Communication: A Content Analysis of Vaping-Associated Lung Injury Outbreak Coverage in U.S. College Newspapers

ABSTRACT This study examined instructional health-risk communication involving the outbreak of e-cigarette or vaping product use-associated lung injury (EVALI). Using the IDEA model, we investigated how U.S. college newspapers communicated health risk messages during the vaping outbreak. Our analysis of 331 news articles showed that college newspapers placed greater emphasis on explanation of the EVALI outbreak than internalization and action messages. The findings also revealed that news sources played a significant role in communicating instructional health risk messages. Specifically, news stories that included expert sources were more likely to communicate CDC-recommended action messages. The findings have significant implications for designing instructional health-risk communication and anti-smoking interventions tailored to specific populations.

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.

A prescription model for vapes: the way we 'do' medicines policy in Australia.

On 2 May 2023, the Australian Federal Government announced a suite of reforms aimed at ensuring the effectiveness of the prescription model of regulation of vaping (or e-cigarette) products in Australia. These reforms are intended to protect Australians, particularly young people, from the harms of vaping and nicotine dependence. The ensuing public debate on the issue has often created the impression that the options under consideration are to either retain 'recently introduced' prescription regulation or to 'revert to' a retail supply approach. However, the sale of nicotine vapes by retailers such as tobacconists and convenience stores has never been lawful in Australia. The reforms do not seek to change the way nicotine vaping products are regulated, but rather to ensure that the existing prescription model can be effectively enforced and can function as originally intended. This paper describes the historical context and rationale for strengthening prescription regulation of vapes in this country.

Importance of Various E-Cigarette Device and E-Liquid Characteristics by Smoking Status among Young Adults Who Vape

Background E-cigarette product characteristics are known to influence appeal among young adults. Understanding which characteristics appeal to individuals with (vs. without) a history of combusted tobacco use is essential for developing effective tobacco control policies. Methods Anonymous, self-report data were collected from young adults (18-30 years) who had used e-cigarettes in the past 30 days (n = 295) online via Prolific from September-October 2019. Using a visual analogue scale (range: 0-100), participants rated the importance of ten e-cigarette device and nine e-liquid characteristics. Adjusted linear regression models were used to evaluate the association of combusted tobacco use status (never, former, current) with mean rating scores for each of the nineteen characteristics. Results The most important e-cigarette device characteristics were price (Mean = 81.1; [SD = 17.9]), size (Mean = 75.5 [SD = 20.9]), and hit strength (Mean = 73.8 [SD = 20.4]) while the most important e-liquid characteristics were flavor (M = 85.1 [SD = 16.3]), price (M = 80.9 [SD = 18.4]), and nicotine level (M = 77.8 [18.9]). Differences by combusted tobacco use status were observed for device brand, temperature/voltage, customizability, color, and popularity, with the highest ratings generally observed among those concurrently using combustible tobacco products. For e-liquids, differences by use status were observed for flavor, price, and bottle type. Notably, those concurrently using combusted products rated flavor as less important than those with no history of combustible tobacco use (B=-5.01[95%CI=-9.97, −0.05]). Conclusions The self-rated importance of e-cigarette device and e-liquid attributes varies by combustible tobacco use status among young adults which may be used to inform regulatory decisions regarding e-cigarette product characteristics.

A Review of the Toxicity of Ingredients in e-Cigarettes, Including Those Ingredients Having the FDA's "Generally Recognized as Safe (GRAS)" Regulatory Status for Use in Food.

Some firms and marketers of electronic cigarettes (e-cigarettes; a type of electronic nicotine delivery system (ENDS)) and refill liquids (e-liquids) have made claims about the safety of ingredients used in their products based on the term "GRAS or Generally Recognized As Safe" (GRAS). However, GRAS is a provision within the definition of a food additive under section 201(s) (21 U.S.C. 321(s)) of the U.S. Federal Food Drug and Cosmetic Act (FD&C Act). Food additives and GRAS substances are by the FD&C Act definition intended for use in food, thus safety is based on oral consumption; the term GRAS cannot serve as an indicator of the toxicity of e-cigarette ingredients when aerosolized and inhaled (ie, vaped). There is no legal or scientific support for labeling e-cigarette product ingredients as "GRAS." This review discusses our concerns with the GRAS provision being applied to e-cigarette products and provides examples of chemical compounds that have been used as food ingredients but have been shown to lead to adverse health effects when inhaled. The review provides scientific insight into the toxicological evaluation of e-liquid ingredients and their aerosols to help determine the potential respiratory risks associated with their use in e-cigarettes.

Evaluating trends in recruitment challenges in vape shop research, e-cigarette product characteristics and use among shop customers from 2019 to 2023: A mixed-methods study.

Brick-and-mortar vape shops specialize in the sale of e-cigarettes and remain a primary source for purchasing emerging e-cigarette products. New regulatory policies have been implemented at local-, state- and federal-level; the retail environment at vape shops and product preferences among vape shop customers shifted accordingly. From 2019 to 2023, we collected anonymous interview data from vape shop customers (n=572) from 83 vape shops in Southern California. We aggregated the data by month and treated each month as the unit of analysis to document changes in recruitment efforts among the vape shops in relation to major policy implementations over 4 years. We also examined the systematic fluctuations and trends in customers' e-cigarette product preferences and nicotine content in these products. The monthly average shop-level consent rate was 52.9% (SD=8.7), with an overall decreasing trend over time. It was necessary for our data collection team to approach a greater number of vape shops to obtain consent with implementation of various state and federal tobacco regulations and following COVID-19. We observed an increase in the purchase of disposable products and nicotine concentrations in the products, while the average use frequency remained the same. Our findings demonstrated that user preferences, product characteristics and challenges in research involving vape shops are closely associated to changes in regulations. We documented a dramatic increase in nicotine concentration in products. Future policies restricting the amount of nicotine in tobacco products at the federal level are necessary to protect consumers from further nicotine addiction. This study provides documentation over time of the drastic increases in nicotine concentration among e-cigarette users as a result of the fluctuations in the product market. Regulating nicotine content in tobacco products could safeguard against further unsafe modifications in e-cigarettes and other types of tobacco products.

#Discreetshipping: Selling E-cigarettes on TikTok.

Youth and young adult use of e-cigarette products continues to remain high despite regulatory approaches to reduce youth access. This study sought to examine TikTok content regarding the sale and distribution of e-cigarettes. TikTok videos (n = 475) and metadata posted between June 2022 and August 2023 were scraped using a TikTok application programming interface and popular hashtags used to sell vaping products (ie, #discreetshipping [40.8 million], #puffbundle [14.8 million], #hiddennic [1.0 million]). After watching the 25 most viewed videos (39600-868800 views), a codebook was developed. All metadata were annotated using 11 unique codes: Small business, brand, cannabis, bundled, hidden, fake, international sales, no ID, order via Instagram, order via another method, and cost. Overall, 367 videos (with an average of 2017 likes) were deemed relevant. Videos advertised popular vaping brands (50.4%) that included cannabis products (45%). Products were described as bundled (28.6%), hidden (8.7%), and able to be shipped internationally (6%) without age verification (45.2%). Some videos (8.2%) evaded algorithms' detection of illegal activity by describing the post as "Fake." Customers were directed to other social media platforms (most often Instagram, 57.5%) and/or other websites/links (58.3%) to purchase products; 22.1% advertised discounts, free shipping, or low costs (ranging from $25-$35). Social media platforms, such as TikTok and Instagram, are being used to circumvent e-cigarette regulatory policies. Regulatory agencies should expand enforcement strategies to include social media platforms where users are illegally selling and distributing e-cigarettes internationally to young audiences. TikTok users across the globe are violating local, state, and federal laws by selling e-cigarettes concealed inside other products or bundled in packages that avoid detection. TikTok videos posted by self-proclaimed small business owners advertise discreet shipping practices that evade age verification in order to sell nicotine and cannabis bundles worldwide. Accounts used phrases describing the post to be "fake" to avoid detection by algorithms or TikTok administrators. E-cigarette regulatory agencies can partner with social media platforms to close regulatory gaps.

Clinical manifestations of EVALI in adolescents and the impact of e-cigarettes on the respiratory disease

In recent years there has been a significant increase in the popularity of electronic cigarettes among adolescents and young adults worldwide. E-cigarettes have reached the market without the extensive preclinical toxicology testing or long-term safety studies required for conventional therapeutics and medical devices. Their effectiveness as a smoking cessation intervention, their impact at the population level and whether they are less harmful than combustible tobacco products are highly controversial. Studies show measurable adverse biological effects on organ and cell health in humans, animals and in vitro. E-cigarette use also increases the risk of respiratory diseases such as chronic obstructive pulmonary disease (COPD) and asthma. There is a serious risk of complications associated with e-cigarette use, such as EVALI (E-cigarette or Vaping Product Use-Associated Lung Injury) - serious lung damage associated with, especially for adolescents. This paper reviews the effects of e-cigarettes on respiratory health.

The prospective relationship between a-priori intentions for and patterns of e-cigarette use among adults who smoke cigarettes

BackgroundElectronic (e-)cigarettes may help adult cigarette smokers achieve cigarette cessation, depending on patterns of e-cigarette use. Among cigarette smokers who do not use e-cigarettes, it is unclear if and how a-priori intentions for use are related to uptake patterns. Longitudinal studies have focused on established e-cigarette users or adolescent and young adult populations exclusively. MethodsWithin a nationwide randomized clinical trial (N = 638), adult cigarette smokers not currently using e-cigarettes were randomized (2:1) to receive (or not) one-month sampling of e-cigarettes. An exploratory factor analysis (EFA) was performed on an established 15-item measure assessing a-priori intentions for e-cigarette use to identify latent variables. Among those receiving e-cigarette products, regression models examined relationships between intentions and: 1) uptake (yes/no), 2) frequency (number of days per week), and 3) amount (puffing episodes per day) of e-cigarette use at one-month follow-up. ResultsTwo factors emerged from the EFA: 1) cigarette-related intentions (e.g., cigarette cessation, no smell) and 2) novel appeal of e-cigarettes (e.g., flavors). Three items remained and were treated as separate intentions: “feels like cigarette smoking”, “curiosity”, and “affordability“. In the final multivariable models, “feel like cigarette smoking” predicted more frequent e-cigarette use (β = 0.187, SE = 0.086, p = 0.03); however, none of the five factors/intentions were significantly associated with uptake or amount of use. ConclusionsFor adult cigarette smokers not currently using e-cigarettes, a-priori intentions for using e-cigarettes might not be predictive of if or how these products will be used in the future, suggesting that motives may not drive use behavior.

Chemometric assessment of electronic cigarettes based on the ICP-MS determination of multiple heavy metal concentrations

To elucidate the concentrations of heavy metal elements in commercially available electronic cigarettes and improve quality assessment. Inductively coupled plasma-mass spectrometry (ICP-MS) coupled to chemometrics was used to determine the concentrations of Cr, Ni, As, Cd, Sn, Sb, Hg, and Pb in the e-liquids and aerosols derived from 32 electronic cigarettes sold commercially under six brand names. The e-liquids contained: 4.858 to 274.658 (Cr), 17.292 to 3068.375 (Ni), 3.217 to 29.867 (As), 0.225 to 24.717 (Cd), 0.783 to 17.042 (Sn), 0.658 to 36.033 (Sb), 0.658 to 187.592 (Hg), and 2.458 to 17.417 (Pb) ng g−1. The aerosol samples contained: 276.075 to 3333.175 (Cr), 72.908 to 1150.183 (Ni), 4.567 to 86.958 (As), 0.400 to 12.842 (Cd), 1.092 to 32.142 (Sn), 0.976 to 10.633 (Sb), 3.483 to 234.708 (Hg), 27.833 to 849.100 (Pb) ng 100 puffs−1. The recovery of heavy metals ranged from 99.1% to 112.4% in the e-liquids and from 87.3% to 116.6% in the aerosols, with RSD values below 10%. Hierarchical cluster analysis grouped the e-liquids into eight clusters, and the aerosols into five, indicating differences between products within brands and between different brands. Orthogonal partial least squares discriminant analysis coupled with variable importance in projection (VIP > 1) identified As and Sb as the primary heavy metals causing differences between the e-liquids, while differences between the aerosols were caused by Hg, As, Pb, Cd, and Cr. The use of chemometric methods yields a greater depth of information that will support improvements to the quality control of e-cigarette products and the assessment of their potential risk to human health.

Characterization of mass distribution in a biomimetic aerosol exposure system

Objective Lack of biomimicry in geometry and flow conditions of emissions systems for analytical testing and biological exposure has led to fundamental limitations, including a poor understanding of dose delivered to specific airway locations. This work characterizes mass distribution of a JUUL® brand e-cigarette in a Biomimetic Aerosol Exposure System (BAES). Materials and Methods A combination of mass balance, direct measurements, and inferences based on direct measurements were used to characterize regional and local dose as a function of system flow path configuration and emissions topography profile. Results Doses produced by the emissions topography profile with only puffing were significantly different from profiles with clean air inhalation following puffs. Mass characterization results support that dose can be manipulated using flow path geometry. Local and regional deposition was mapped throughout the system. Discussion and Conclusions We estimate the fraction of yield to the mouth deposited at several locations throughout the system for a variety of puffing and respiration topographies and show that emissions topography profile and system flow path geometry affect dose. This work provides proof-of-concept for assessing mass distribution as a function of aerosol generator (e-cigarette product), user airway geometry, and inhalation and puffing topography.

Developing a National Longitudinal Tobacco Cohort of Youth and Young Adults: The Tobacco Epidemic Evaluation Network (TEEN+) Study.

Timely and relevant data are critical to monitoring the rapidly changing youth vaping epidemic and for understanding the prevalence, patterns of use, knowledge, and perceptions of tobacco products. While e-cigarettes have been the most used tobacco product among youth for nearly a decade, new nicotine delivery products continue to be introduced to the US market. Flavored tobacco products, including flavored e-cigarettes, menthol cigarettes, and flavored cigars, drive disparities in use by young people. To examine tobacco use among youth and young adults, the Monitoring E-Cigarette Use among Youth project established a longitudinal cohort of youth and young adults (13-24)-the Tobacco Epidemic Evaluation Network (TEEN+) study. TEEN+ focuses on e-cigarette and other tobacco products use and also includes questions about other substance use (eg, marijuana, alcohol), physical health, mental health, and social determinants of health (eg, discrimination, poverty, sexual and gender identity). Geocoding of responses allows for the evaluation of local tobacco control policies. The cohort includes an oversample of California residents to generate reliable and representative state-level estimates. This manuscript provides an overview of methods and baseline demographics from Wave 1. The initial Wave 1 TEEN+ cohort included 10 255 in the national sample and 2761 in the California sample. TEEN+ study data complement nationally-representative cross-sectional studies and allow for rapid evaluation of local and state policies. This manuscript describes the study's probability-based sample recruitment. Furthermore, we identify this initiative as a resource for evaluating the impact of flavored tobacco restriction policies and informing policy implementation efforts. This manuscript provides an overview of the methodology and baseline characteristics for a new longitudinal cohort of youth and young adults, the Tobacco Epidemic Evaluation Network (TEEN+) study. The TEEN+ study data can be used to evaluate the impact of flavored tobacco product restriction policies and informing policy implementation efforts.

Social Network Analysis of e-Cigarette-Related Social Media Influencers on Twitter/X: Observational Study.

An e-cigarette uses a battery to heat a liquid that generates an aerosol for consumers to inhale. e-Cigarette use (vaping) has been associated with respiratory disease, cardiovascular disease, and cognitive functions. Recently, vaping has become increasingly popular, especially among youth and young adults. The aim of this study was to understand the social networks of Twitter (now rebranded as X) influencers related to e-cigarettes through social network analysis. Through the Twitter streaming application programming interface, we identified 3,617,766 unique Twitter accounts posting e-cigarette-related tweets from May 3, 2021, to June 10, 2022. Among these, we identified 33 e-cigarette influencers. The followers of these influencers were grouped according to whether or not they post about e-cigarettes themselves; specifically, the former group was defined as having posted at least five e-cigarette-related tweets in the past year, whereas the latter group was defined as followers that had not posted any e-cigarette-related tweets in the past 3 years. We randomly sampled 100 user accounts among each group of e-cigarette influencer followers and created corresponding social networks for each e-cigarette influencer. We compared various network measures (eg, clustering coefficient) between the networks of the two follower groups. Major topics from e-cigarette-related tweets posted by the 33 e-cigarette influencers included advocating against vaping policy (48.0%), vaping as a method to quit smoking (28.0%), and vaping product promotion (24.0%). The follower networks of these 33 influencers showed more connections for those who also post about e-cigarettes than for followers who do not post about e-cigarettes, with significantly higher clustering coefficients for the former group (0.398 vs 0.098; P=.005). Further, networks of followers who post about e-cigarettes exhibited substantially more incoming and outgoing connections than those of followers who do not post about e-cigarettes, with significantly higher in-degree (0.273 vs 0.084; P=.02), closeness (0.452 vs 0.137; P=.04), betweenness (0.036 vs 0.008; P=.001), and out-of-degree (0.097 vs 0.014; P=.02) centrality values. The followers who post about e-cigarettes also had a significantly (P<.001) higher number of followers (n=322) than that of followers who do not post about e-cigarettes (n=201). The number of tweets in the networks of followers who post about e-cigarettes was significantly higher than that in the networks of followers who do not post about e-cigarettes (93 vs 43; P<.001). Two major topics discussed in the networks of followers who post about e-cigarettes included promoting e-cigarette products or vaping activity (55.7%) and vaping being a help for smoking cessation and harm reduction (44.3%). Followers of e-cigarette influencers who also post about e-cigarettes have more closely connected networks than those of followers who do not themselves post about e-cigarettes. These findings provide a potentially practical intervention approach for future antivaping campaigns.

Comparison of Indicators of Dependence for Vaping and Smoking: Trends Between 2017 and 2022 Among Youth in Canada, England, and the United States.

The current study sought to examine trends in indicators of dependence for youth vaping and smoking during a period of rapid evolution in the e-cigarette market. Data are from repeat cross-sectional online surveys conducted between 2017 and 2022 among youth aged 16-19 in Canada, England, and the United States (US). Participants were 23 145 respondents who vaped and/or smoked in the past 30 days. Four dependence indicators were assessed for smoking and vaping (perceived addiction, frequent strong urges, time to first use after waking, days used in past month) and two for vaping only (use events per day, e-cigarette dependence scale). Regression models examined differences by survey wave and country, adjusting for sex, age, race, and exclusive/dual use. All six indicators of dependence increased between 2017 and 2022 among youth who vaped in the past 30 days (p < .001 for all). For example, more youth reported strong urges to vape at least most days in 2022 than in 2017 (Canada: 26.5% to 53.4%; England: 25.5% to 45.4%; US: 31.6% to 50.3%). In 2017, indicators of vaping dependence were substantially lower than for smoking; however, by 2022, youth vaping was associated with a greater number of days used in the past month (Canada, US), shorter time to first use (all countries), and a higher likelihood of frequent strong urges (Canada, US) compared to youth smoking. From 2017 to 2022, indicators of vaping dependence increased substantially. By 2022, vaping dependence indices were comparable to those of smoking. Indicators of vaping dependence among youth have increased substantially since 2017 to levels that are comparable to cigarette dependence among youth who smoke. Future research should examine factors underlying the increase in dependence among youth who vape, including changes to the nicotine profile and design of e-cigarette products.

Abstract 210: Carcinogenic influence of e-cigarette aerosols on breast and lung cancer models

Abstract Background and Purpose: With the rising popularity of E-cigarettes among the youth, there is an urgent need to understand their long-term health implications, particularly the potential for carcinogenesis. Although tobacco smoking is established as a major cancer risk factor, the carcinogenic potential of E-cigarettes remains underexplored. Given that metastatic cancer accounts for most cancer-related deaths in the United States, elucidating the biological impacts of E-cigarette aerosols on cancer progression is critical for developing effective interventions. This study aims to address this critical gap by exploring the effects of E-cigarette aerosols on cellular models pertinent to breast and lung cancer. Methods: Mouse breast epithelial cells (HC11), triple-negative breast cancer cells (4T1), and human lung adenocarcinoma cells (Calu-3) were exposed to E-cigarette aerosol at the air-liquid interface for one hour, followed by a 24-hour recovery period. Results: Our study revealed that E-cigarette aerosols with mint flavor induce epithelial-to-mesenchymal transition (EMT) in both normal mammary epithelial and breast cancer cells. Furthermore, we also observed activation of the TGF pathway and an increased expression of stemness-related markers (OCT4, SOX2, NANOG, KLF4, and c-MYC) in 4T1 cells exposed to mint and menthol-flavored E-cigarette aerosols in both 2D and 3D cell culture environments. Microscopic examination at a 10X magnification level revealed that 4T1 and Calu-3 cells exposed to menthol-flavored E-cigarette aerosols exhibited signs of cellular disassociation and detachment whereas the control cells maintained discoidal aggregate morphology. Conclusion: The data presented here illuminate a potential link between E-cigarette use and carcinogenic processes, challenging the notion of E-cigarettes as a safe smoking alternative. This research is of paramount importance to cancer research as it unveils possible new avenues for tumor progression, emphasizing the necessity for a critical evaluation of E-cigarette products. Citation Format: Rizwana Begum, Shilpa Thota, Naveen Chintala, Biplov Sapkota, Abhishek Pandit, Joseph Francis. Carcinogenic influence of e-cigarette aerosols on breast and lung cancer models [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 210.

Perceptions of social media harms and potential management strategies: vaping case study

BackgroundThe social media landscape is now ubiquitous in people’s everyday lives. It is a space where culture, politics, economics and sociological and public health discourses occur. There is mounting evidence that e-cigarette products are being promoted and advertised on social media, a media platform particularly popular with young people. Our research aimed to understand industry professionals’ perceptions of social media harms and potential management strategies using vaping as a case study.MethodsA critical realist perspective guided reflexive thematic analysis of the qualitative in depth, semi structured interviews. Data collection occurred in January and February 2023 with 13 participants working in the areas of public health, digital media, law, governance, tobacco control and advocacy.ResultsTwo superordinate themes emerged from the data: (1) Fathoming a complex system (social media) that contained the subordinate themes of Traversing Boundaries (crossing borders, crossing sectors) and Ungovernable (global and local landscapes, vested interests, self-regulation and opacity). (2) Addressing complexity (social media)– that contained the subordinate themes of Strengthening Institutions (global to local, policy and legislation, individuals and organisations); Defanging Industry (responsibility and transparency, moderation and algorithms, complaints); and Engaging Citizens (raising awareness, framing messaging).ConclusionsThere was consensus among participants that e-cigarette related social media content can be harmful and government action is urgently needed. There was an identified need for the development of government led national-level regulatory frameworks, with government led appropriate legislation; identification of an organisation or organisations with suitable levels of regulatory power and resources to monitor, enforce and penalise noncompliant social media companies; accompanied by increased community awareness raising of harmful social media content and improved digital literacy.

LC-MS/MS analysis of components in smoke from e-cigarettes that use guarana extract as the caffeine source.

Currently, e-cigarette products to inhale caffeine (Caf) are commercially available and widely used. Guarana extract (GE) is used as the caffeine source in some e-cigarette products. In this study, an LC-MS/MS analysis of components in the smoke from e-cigarettes with GE was performed. The concentration ranges of Caf and the minor components theophylline (TP), theobromine (TB), and paraxanthine (PX) in e-liquid and cigarette smoke extract (CSE) of five e-cigarette products were determined. The concentration ranges of e-liquid and CSE were 2.17-8.62mg/mL and 0.17-1.17µg/puff for Caf, 0.09-37.58µg/mL and 0.03-11.88ng/puff for TB, 50.28-185.26ng/mL and 0.00-0.05ng/puff for TP, and 0.44-4.09µg/mL and 0.03-0.20ng/puff for PX, respectively. By comparing the peak area ratios of e-liquid and CSE, we clarified that the heat degradation of Caf to its related components in GE products was accelerated. Epicatechin, which is another typical component in GE, was determined for CSE, but not for e-liquid.

A randomized controlled trial of potential tobacco policies prohibiting menthol flavor in cigarettes and e-cigarettes: a study protocol

BackgroundMenthol cigarette use remains a large public health problem and disproportionately affects Black adults in the United States. The Food and Drug Administration has proposed prohibiting menthol flavor in cigarettes to protect public health. However, e-cigarettes are available in menthol flavor and are a popular alternative product adults might switch to if menthol is prohibited in cigarettes. Research is needed to understand how availability of menthol (vs. tobacco) flavored e-cigarettes could impact cigarette use among adults who smoke menthol cigarettes.MethodsWe will recruit 150 adults who currently smoke menthol cigarettes and will randomize them to 1 of 3 conditions modeling different regulatory scenarios. We will recruit equal numbers of participants identifying as Black vs. non-Black and will stratify randomization by race. To promote standardization and adherence, cigarette and e-cigarette products will be provided for 8 weeks based on the assigned condition: (A) no menthol restriction (menthol cigarette and menthol flavored e-cigarette), (B) menthol prohibited in cigarettes only (non-menthol cigarette and menthol flavored e-cigarette), (C) menthol prohibited in both cigarettes and e-cigarettes (non-menthol cigarette and tobacco flavored e-cigarette). A follow-up visit will occur at week 12 to assess tobacco use status. The study aims are to (1) examine the impact of prohibiting menthol flavor in cigarettes and e-cigarettes on smoking behavior and (2) investigate whether outcomes differ by race to understand the impact of menthol policies on Black (vs. non-Black) individuals given high rates of menthol cigarette use in this population. The primary outcome will evaluate changes in the number of cigarettes smoked per day during the 8-week study period and will examine differences by regulatory scenario. Secondary outcomes will compare percent days smoke-free, changes in nicotine dependence, and motivation, confidence, and intentions to quit smoking by the regulatory scenarios. We will examine whether changes in the outcomes differ by Black vs. non-Black participants to compare the magnitude of the effect of the various menthol policy scenarios by race.DiscussionResults will contribute critical information regarding menthol in cigarettes and e-cigarettes to inform regulatory policies that maximize reductions in cigarette smoking and reduce tobacco-related health disparities.Trial registrationNCT05259566. Yale IRB protocol #2000032211, last approved 12/8/2023.