Electronic Nicotine Delivery Systems Products Research Articles

Assessment of abuse liability and switching potential of menthol-flavored pod-based electronic nicotine delivery systems among US adults who smoke cigarettes

BackgroundMenthol-flavored electronic nicotine delivery systems (ENDS) are a focus of public health and regulatory policy considerations. The abuse liability of five menthol-flavored pod-based ENDS was compared to combustible cigarettes, and switching potential of ENDS was also evaluated. Methods215 US adults who smoke cigarettes (34.4% female; mean age[SD]=29.60[8.75]; 40.9% non-Hispanic White; mean cigarettes/day[SD]=12.04[8.52]) completed a randomized 6-arm within-person cross-over product-use study. Participants used five pod-based menthol-flavored ENDS (JUUL2 Polar Menthol 1.5%, JUUL2 Prototype Fresh Menthol 3.0%, JUUL Menthol 5.0%, Vuse Alto Menthol 5.0%, NJOY Ace Menthol 5.0%) and their usual brand (UB) cigarette for 20minutes ad libitum. After each product use, subjective reinforcing effects relevant to abuse liability and associated with switching away from cigarettes (e.g., satisfaction, product liking) were assessed. ResultsAll ENDS products were rated substantially and statistically significantly lower than UB cigarette on measures of subjective reinforcing effects (ps<0.001). Satisfying effects of JUUL2 1.5% were rated significantly higher than other ENDS products. JUUL2 Prototype 3.0% and Vuse Alto 5.0% did not significantly differ (ps>0.05), and both were rated significantly higher than JUUL 5.0% and NJOY Ace 5.0% (ps<0.05). Differences in subjective responses to study products did not significantly differ by preference for menthol cigarettes or by current ENDS use. ConclusionsAbuse liability of all menthol-flavored ENDS in this study was substantially lower than combustible cigarettes. Abuse liability of JUUL2 1.5% was within the range of currently marketed pod-based menthol-flavored ENDS products. JUUL2 1.5% likely has high potential for facilitating switching among US adults who smoke.

Switching Away From Smoking and Reduction in Cigarette Consumption among US Adult Purchasers of the JUUL System across 24 Months Including Diverse Subpopulations Disproportionately Affected by Cigarette Smoking.

Electronic nicotine delivery systems (ENDS) can reduce tobacco-related health risks for adults who smoke cigarettes (AWS) by facilitating complete switching away from cigarettes. However, little is known about ENDS use and switching among subpopulations that have been disproportionately affected by smoking. AWS (age≥21 years) were recruited following their first purchase of a JUUL Starter Kit in 2018. Participants self-reported switching (no past-30-day cigarette smoking) at 1-, 2-, 3-, 6-, 9-, 12-, 15-, 18-, 21-, and 24-month follow-ups. Percent switched and percent with substantial smoking reduction (≥50% decrease in cigarettes/day among those who continued smoking) were calculated. Analyses focused on racial/ethnic minorities, persons with low income and education levels, sexual minorities, and those with mental and physical health conditions. Overall rates of switching away from cigarettes increased across follow-ups to 51.2% (Month-12) to 58.6% (Month-24, 87% of whom used ENDS). Among those who continued to smoke at 24 months, 45.4% reduced cigarettes/day by ≥50%. Rates of switching and substantial smoking reduction were largely similar across subgroups, with some statistically significant, but small, differences in Month-24 switching rates(e.g. education, mental/physical health conditions; switch rate range: 42~57%). AWS demonstrated progressively increasing switching rates over two years after purchasing JUUL products. Similar trends in switching and smoking reduction were observed across populations disproportionately affected by smoking. By facilitating switching and smoking reduction, ENDS products such as JUUL may provide an opportunity to reduce smoking-related harm among some populations disproportionately affected by smoking, potentially reducing tobacco-related health disparities. ENDS have the potential to benefit population health if they can replace cigarettes. This benefit must extend to populations disproportionately affected by smoking. In this real-world study, 59% of JUUL purchasers reported complete switching two years later (no past-30-day smoking, with most continuing to use ENDS). Further, 45% of those who continued to smoke reduced cigarette consumption by at least half. These rates of switching and smoking reduction were largely comparable across populations disproportionately affected by smoking (defined, e.g., by ethnicity and income). ENDS can serve as an effective harm reduction strategy to complement current efforts to reduce tobacco-related disparities.

A Practical Framework for Novel Electronic Nicotine Delivery System Evaluation: Chemical and Toxicological Characterization of JUUL2 Aerosol and Comparison with Reference Cigarettes.

Electronic nicotine delivery systems (ENDSs) are designed as a non-combustible alternative to cigarettes, aiming to deliver nicotine without the harmful byproducts of tobacco combustion. As the category evolves and new ENDS products emerge, it is important to continually assess the levels of toxicologically relevant chemicals in the aerosols and characterize any related toxicology. Herein, we present a proposed framework for characterizing novel ENDS products (i.e., devices and formulations) and determining the reduced risk potential utilizing analytical chemistry and in vitro toxicological studies with a qualitative risk assessment. To demonstrate this proposed framework, long-term stability studies (12 months) analyzing relevant toxicant emissions from six formulations of a next-generation product, JUUL2, were conducted and compared to reference combustible cigarette (CC) smoke under both non-intense and intense puffing regimes. In addition, in vitro cytotoxicity, mutagenicity, and genotoxicity assays were conducted on aerosol and smoke condensates. In all samples, relevant toxicants under both non-intense and intense puffing regimes were substantially lower than those observed in reference CC smoke. Furthermore, neither cytotoxicity, mutagenicity, nor genotoxicity was observed in aerosol condensates generated under both intense and non-intense puffing regimes, in contrast to results observed for reference cigarettes. Following the proposed framework, the results demonstrate that the ENDS products studied in this work generate significantly lower levels of toxicants relative to reference cigarettes and were not cytotoxic, mutagenic, or genotoxic under these in vitro assay conditions.

Are e-cigarettes a safer alternative to reduce incidences of oral cancer?

The rapid increase in the use of electronic nicotine delivery systems (ENDS), such as e-cigarettes and vape pens, has raised concerns about their potential impact on oral health and the risk of oral cancer. Despite their popularity and claims of being a safer alternative to traditional smoking, there is a lack of conclusive evidence regarding the detrimental effects of vaping. ENDS were initially introduced as a safer option for smokers, attracting both traditional smokers and adolescents due to appealing flavours. These devices use a battery-powered heating element to aerosolise a liquid containing nicotine, flavourings, formaldehyde, glycerol, and heavy metals. However, the variability in product composition and design makes it challenging to establish reliable toxicity profiles. This commentary aims to provide an overview of the existing evidence to inform oral and maxillofacial surgery (OMFS) practitioners about the potential risks associated with vaping on oral health and cancer. Data was extracted from ten recent studies, which included systematic reviews, meta-analyses, literature reviews, cross-sectional analyses, and in-vitro studies. While e-cigarettes have fewer carcinogens than traditional cigarettes, concerns remain about their potential for DNA damage. Reported oral symptoms related to e-cigarette use include dry mouth, irritation, pain, oral ulcers, nicotine-related conditions, and accidents resulting from device malfunctions. ENDS exposure has been linked to oral health issues like dysbiosis, inflammation, periodontal disease, and alterations in the oral microbiome. In-vitro studies have shown that e-cigarettes can induce DNA damage, oxidative stress, and genotoxicity in oral cells. Although direct causality between e-cigarettes and oral cancer remains unclear, there are case reports of oral cancer in heavy e-cigarette users without other traditional risk factors. Additionally, some ENDS components, such as formaldehyde and acetaldehyde, are known human carcinogens, potentially posing a nasopharyngeal cancer risk. ENDS use may increase chemotherapy resistance and alter immune-related gene expression, potentially facilitating HPV-16 infection. Moreover, there is concern that ENDS use could lead to future tobacco smoking among adolescents. The variability in ENDS products further complicates assessing their oral health effects. Based on current evidence, ENDS should not be considered 'safe'. The authors recommend documenting ENDS consumption and emphasise the need for extensive research to better understand their effects on oral cavity tissues. Clinicians should remain vigilant and educate patients about the potential risks associated with vaping to make informed decisions about their oral health.

Abuse liability of two electronic nicotine delivery systems compared with combustible cigarettes and nicotine gum from an open-label randomized crossover study

An assessment of the likelihood of use and abuse potential for new tobacco products is an important part of tobacco product regulation in the United States and abroad. This paper reports the results of a randomized, open-label, crossover clinical study that assessed factors related to product adoption and abuse liability (AL), comparing two closed electronic nicotine delivery system (ENDS) products to combustible cigarettes and nicotine gum, high- and low-AL comparator products, respectively. During an 11-day confinement period that included multiple product familiarization sessions, healthy adult smokers participated in AL test sessions to evaluate the abuse liability of each product. During these test sessions, changes in subjective measures; speed and amount of nicotine uptake; and maximum changes in physiological effects before, during, and after use of each assigned product were assessed over 4 h. Positive subjective effects measures scores such as product-liking and overall intent to use again were highest for cigarettes, followed by the Vuse ENDS, with nicotine gum consistently having the lowest scores. The PK results (Cmax and Tmax) of the Vuse ENDS products are between UB cigarettes and nicotine gum, which correlates with the subjective effects. All nicotine uptake measures for the Vuse ENDS products were lower than that of usual brand (UB) cigarettes, including peak nicotine uptake and overall nicotine uptake, and were either similar to or lower than nicotine gum. The time course of nicotine uptake after use of the ENDS was more similar to that of combustible cigarettes than nicotine gum. The results indicate that the AL of each ENDS product is lower than that of UB cigarettes and similar to that of nicotine gum.

Depressive symptoms prospectively increase risk for new onset cigarette and ENDS dependence symptoms

Little research has examined the new onset of cigarette and Electronic Nicotine Delivery System (ENDS) dependence symptoms among young adults. This study aims to 1) examine new onset cigarette and ENDS dependence symptoms over a 4.5-year period and 2) examine how depressive symptoms impact new onset dependence symptoms among young adults. Participants were drawn from 24 colleges in Texas who were participating in a multi-wave cohort study (2014–2019). The present study included 4536 participants aged 18–25 who did not report cigarette or ENDS dependence symptoms at wave 1 (64.1% female; 65.2% non-white; m age = 20.62 [SD = 1.80] at wave 1). Cox’s regression models were employed to determine the hazard of new onset cigarette and ENDS dependence symptoms overall and the impact of depressive symptoms. Models controlled for sociodemographic factors and other tobacco product use. 14.4% of participants reported new onset cigarette dependence symptoms and 14.6% reported new onset ENDS dependence symptoms over the 4.5 years of the study. Depressive symptoms significantly predicted increased risk for new onset cigarette (HR = 1.30, CI = [1.21, 1.39]) and ENDS (HR = 1.20, CI = [1.12, 1.29]) dependence symptoms. Young adults exhibited dependence symptoms for cigarettes and ENDS products at similar rates across the 4.5 years of the study. Elevated depressive symptoms increased risk of new onset cigarette and ENDS dependence symptoms, advancing evidence for the self-medication hypothesis. Tobacco and nicotine prevention and cessation programs and messaging are needed particularly among young adults who experience depressive symptoms.

Motives for using electronic nicotine delivery systems (ENDS) as a cessation tool are associated with tobacco abstinence at 1-year follow-up: A prospective investigation among young adults in the United States Air Force

IntroductionSmokers use electronic nicotine delivery systems (ENDS), including e-cigarettes, as a harm reduction strategy even though the Food and Drug Administration (FDA) has not approved them for tobacco cessation. The limited literature about ENDS use for cigarette cessation is concerning for the U.S. military, which is largely comprised of young adults at increased risk for tobacco use. Thus, the current study aims to evaluate use of ENDS products as a cessation tool in relation to point-prevalence tobacco abstinence at one-year follow-up in a cohort of 8,901 U.S. Air Force personnel attending entry-level job training from March 2016 to April 2019. MethodsA propensity-score adjusted multinomial logistic regression model was used to assess the association between the baseline motives for ENDS use (i.e., for cigarette cessation versus alternative reasons) and tobacco use at the one-year follow-up (cigarette use, non-cigarette tobacco product use, and tobacco abstinence) among those reporting history of cigarette use at baseline. ResultsSmokers reporting ENDS use for cigarette cessation were more likely to be abstinent at one-year follow-up (Odds Ratio[OR] = 1.62, 95% CI: 1.06–2.49, P =.03) as well as quit using non-cigarette tobacco products (OR = 2.11, 95% CI: 1.65–2.70, P <.001) than those reporting ENDS use for alternative reasons. ConclusionsCurrent tobacco users are recommended to use FDA-approved products for smoking cessation, such as nicotine replacement therapy. However, given the high prevalence of cigarette use among military populations, ENDS may provide a useful alternative harm reduction strategy for this high-risk population.

Determination of chemical constituent yields in e-cigarette aerosol using partial and whole pod collections, a comparative analysis.

Literature reports the chemical constituent yields of electronic nicotine delivery systems (ENDS) aerosol collected using a range of aerosol collection strategies. The number of puffs to deplete an ENDS product varies widely, but collections often consist of data from the first 50-100 puffs. However, it is not clear whether these discrete puff blocks are representative of constituent yields over the life of a pod. We aimed to assess the effect of differing aerosol collection strategies on reported yields for select chemical constituents in the aerosol of closed pod-based ENDS products. Constituents analyzed were chosen to reflect important classes of compounds from the Final Premarket Tobacco Product Application Guidance. Yields were normalized to total device mass loss (DML). Collection strategies that consisted of partial pod collection were valid for determining yields of constituents whose DML normalized yields were consistent for the duration of pod life. These included primary aerosol constituents, such as propylene glycol, glycerol, and nicotine, and whole pod yields could be determined from initial puff blocks. However, changes were observed in the yields of some metals, some carbonyl compounds, and glycidol over pod life in a chemical constituent and product dependent manner. These results suggest that collection strategies consisting of initial puff block collections require validation per chemical constituent/product and are not appropriate for chemical constituents with variable yields over pod life. Whole pod collection increased sensitivity and accuracy in determining metal, carbonyl, and glycidol yields compared to puff block-based collection methodologies for all products tested.

Tobacco Product Marketing Orders and Online Marketing and Sale of Unauthorized ENDS Products

This study characterizes online marketing of unauthorized electronic nicotine delivery systems (ENDS).

Comparison of the toxicological potential of two JUUL ENDS products to reference cigarette 3R4F and filtered air in a 90-day nose-only inhalation toxicity study.

Electronic nicotine delivery systems (ENDS) are generally recognized as less harmful alternatives for those who would otherwise continue to smoke cigarettes. The potential toxicity of aerosols generated from JUUL Device and Virginia Tobacco (VT3) or Menthol (ME3) JUULpods at 3.0% nicotine concentration was assessed in rats exposed at target aerosol concentrations of 1400μg/L for up to 6h/day on a 5 day/week basis for at least 90 days (general accordance with OECD 413). 3R4F reference cigarette smoke (250μg/L) and Filtered Air were used as comparators. JUUL ENDS product aerosol exposures at >5x the 3R4F cigarette smoke level resulted in greater plasma nicotine and cotinine levels (up to 2x). Notable cigarette smoke related effects included pronounced body weight reductions in male rats, pulmonary inflammation evidenced by elevated lactate dehydrogenase, pro-inflammatory cytokines and neutrophils in bronchoalveolar lavage fluid, increased heart and lung weights, and minimal to marked respiratory tract histopathology. In contrast, ENDS aerosol exposed animals had minimal body weight changes, no measurable inflammatory changes and minimal to mild laryngeal squamous metaplasia. Despite the higher exposure levels, VT3 and ME3 did not result in significant toxicity or appreciable respiratory histopathology relative to 3R4F cigarette smoke following 90 days administration.

Analytical approaches for the evaluation of data deficient simulated leachable compounds in ENDS products: a case study.

Leachable investigations are routinely undertaken across a range of sectors (e.g., pharmaceuticals, medical devices, etc.) to determine whether chemicals from a container closure system transfer into a product under normal conditions of use. For Electronic Nicotine Delivery Systems (ENDS) the container closure system includes all materials in contact with the e-liquid that is aerosolized and subsequently inhaled by the user. Currently, there is no guidance for conducting leachable studies for ENDS products, however, there are relevant guidance documents for orally inhaled drug products that can be applied to an ENDS container closure system. We present a case study of the analytical investigation of two leachable compounds identified in simulated leachable studies using aged JUULpods filled with unflavored e-liquid (PG/VG/nicotine/benzoic acid). Both compounds had limited toxicological information and were considered data deficient. A qualitative analysis of the aerosol collected from aged commercial JUULpods (Virginia Tobacco and Menthol), using a similar analytical method (LC-MS/MS) used in the simulated leachable studies, showed no trace or detectable levels of either leachable compound. Therefore, this qualitative analysis did not provide semi-quantitative values for the data-deficient leachable compounds necessary to support toxicological risk assessment. Further, no commercial authentic standards or reasonable synthetic route were available due to the molecular size and structural complexity of the compounds. Instead, method limits were established using an alternative approach to standard ICH guidelines. The experimentally determined method limit of quantitation, using spiked samples of simulated leachable e-liquid, provided conservative semi-quantitative values for each data deficient leachable compound in the aerosol that enabled a transfer efficiency from e-liquid to aerosol to be estimated. The transfer efficiency of each leachable compound was experimentally determined to be less than 2% based on the limit of quantitation, which then could be used to define a relevant exposure limit for the toxicological risk assessment. This work details a novel analytical approach for determining the transfer efficiency of data deficient leachable compounds from ENDS container closure systems into the ENDS aerosol to support toxicological health risk assessments.

The Impact of High or Low Doses of Nicotine in a Mouse Model of Vapor Self-Administration.

A wide variety of nicotine concentrations and formulations are available to users of electronic nicotine delivery systems (ENDS). This is increasingly true when considering the many flavors available with ENDS products. To date, there have been few preclinical investigations into the impact of nicotine doses, with and without flavors, on vaping-related behaviors. This present study evaluated how nicotine concentrations relevant to tank-based and pod-based ENDS, with and without flavors, impact reinforcement-related behavior in a mouse model. Adult male and female C57/BL6J mice were used in vapor-inhalation self-administration assays. Mice were assigned e-liquids containing 6 mg/mL or 60 mg/mL nicotine. Additional mice were assigned these nicotine doses with green apple or menthol flavorants. Mice were trained on fixed-ratio 1 for 10, 2-hour sessions, then five sessions at FR3, three progressive ratio sessions, and two FR3 sessions. We observed male mice exhibited higher reinforcement-related behavior to menthol-flavored 6 mg/mL nicotine when compared to female mice. Males were only observed to have a menthol-induced enhancement of self-administration at 6 mg/mL nicotine and not 60 mg/mL nicotine. However, female mice exhibited significant menthol-induced increases in reinforcement-related behaviors with 60 mg/mL nicotine. These data provide evidence that males and females exhibit different dose sensitivities to nicotine. These sex-dependent differences in nicotine sensitivity also indicate that flavor-induced enhancement in nicotine intake is dependent on the different doses for each sex. There has been much discussion recently regarding the impact of flavors on vaping-related behavior. Our current study may support prior investigations that suggest flavors enhance the palatability of nicotine-containing products. However, this current study provides evidence that males and females exhibit different sensitivities to nicotine.

Changes in Biomarkers of Exposure and Potential Harm in Smokers Switched to Vuse Vibe or Vuse Ciro Electronic Nicotine Delivery Systems.

Electronic nicotine delivery systems (ENDS) have the potential to provide nicotine to tobacco consumers while reducing exposure to combustion-related toxicants. Here, we report changes in biomarkers of exposure (BoE) and biomarkers of potential harm (BoPH) in smokers who completely switched to Vuse Vibe and Vuse Ciro ENDS products, or to smoking abstinence in a randomized, controlled clinical study. Thirteen BoE (12 urinary and one blood) that indicate exposure to harmful and potentially harmful toxicants (HPHCs) were evaluated at baseline on day 5. Urinary BoPH linked to oxidative stress, platelet activation, and inflammation were also assessed at baseline, and on day 5 and day 7. Nicotine exposure was lower in Vuse Vibe and Vuse Ciro groups compared to baseline values. Urinary non-nicotine BoE decreased significantly (52.3-96.7%) in the Vuse ENDS groups, and the reductions were similar in magnitude to those observed in the abstinence group. Blood carboxyhemoglobin decreased 52.8-55.0% in all study groups. Decreases (10-50%) in BoPH were observed in all study groups. Thus, smokers who switch exclusively to Vuse Vibe or Vuse Ciro products or completely abstain from smoking are exposed to substantially lower levels of HPHCs, and experience improvements in BoPH of oxidative stress and inflammation pathways.

Increased oxidative stress responses in murine macrophages exposed at the air-liquid interface to third- and fourth-generation electronic nicotine delivery system (ENDS) aerosols

BackgroundNew fourth generation electronic nicotine delivery system (ENDS) devices contain high levels of nicotine salt (up to 60 mg/mL), whose cellular and molecular effects on immune cells are currently unknown. Here, we used a physiologically-relevant in vitro air-liquid interface (ALI) exposure model to assess the toxicity of distinct ENDS, a 3rd-generation electronic-cigarette (e-cig) and two 4th-generation ENDS devices (JUUL and Posh Plus). MethodsMurine macrophages (RAW 264.7) were exposed at the ALI to either air, Menthol or Crème Brûlée-flavored ENDS aerosols generated from those devices for 1-hour per day for 1 or 3 consecutive days. Cellular and molecular toxicity was evaluated 24 h post-exposure. Results1-day of Menthol-flavored JUUL aerosol exposure significantly decreased cell viability and significantly increased lactate dehydrogenase (LDH) levels compared to air controls. Further, JUUL Menthol elicited significantly increased reactive oxygen species (ROS) and nitric oxide (NO) production compared to air controls. Posh Crème Brûlée-flavored aerosols displayed significant cytotoxicity – decreased cell viability and increased LDH levels –after 1- and 3-day exposures, while the Crème Brûlée-flavored aerosol produced by the 3rd-generation e-cig device only displayed significant cytotoxicity after 3 days compared to air controls. Further, both Posh and third-generation e-cig Crème Brûlée flavored-aerosols elicited significantly increased ROS plus high levels of 8-isoprostane after 1 and 3 days compared to air controls, indicating increased oxidative stress. Posh and third-generation e-cig Crème Brûlée flavored-aerosols elicited reduction in NO levels after one day, but elicited increase in NO after 3 days. Genes in common dysregulated by both devices after 1 day included α7nAChR, Cyp1a1, Ahr, Mmp12, and iNos. ConclusionOur results suggest that ENDS Menthol and Crème Brûlée-flavored aerosol exposures from both 3rd- and 4th-generation ENDS devices are cytotoxic to macrophages and cause oxidative stress. This can translate into macrophage dysfunction. Although 4th-generation disposable ENDS devices have no adjustable operational settings and are considered low-powered ENDS devices, their aerosols can induce cellular toxicity compared to air-exposed control cells. This study provides scientific evidence for regulation of nicotine salt-based disposable ENDS products.

Presence of flavoured electronic nicotine delivery system (ENDS) products in US ENDS advertisements, 2015–2020: a content analysis

ObjectivesElectronic nicotine delivery systems (ENDS) products come in a variety of flavours (eg, fruit, dessert, menthol). Tobacco advertising has historically used flavours as an advertising tactic, but little is known...

Biochemical validation of self-reported electronic nicotine delivery system and tobacco heaviness of use.

Research on tobacco use disorder relies on a combination of self-reported use (e.g., cigarettes per day) and biochemical validation to quantify heaviness of use. However, electronic nicotine delivery system (ENDS) users may be unaware of how much they have vaped per day. The aim of this study was to test the relationship between self-reported heaviness of ENDS/tobacco use and nicotine biomarkers. Young adults (n = 30) who currently use ENDS and other tobacco products completed a detailed tobacco use history, timeline follow-back, and an ENDS topography session. We evaluated the self-reports of own-brand ENDS use and tested correlations to determine which self-report measures of own-brand use, and which self-reported measures of puff topography, had the strongest correlations with urine and/or blood biomarkers of nicotine use. Participants reported using a variety of different ENDS devices and had a range of usage. The sum of the self-reported number of occasions or hours of ENDS use, along with the number of cigarettes and other tobacco products used, over the past 24 hr was significantly correlated with plasma cotinine levels. Puff topography measures correlated with increased nicotine concentrations, although participants underestimated the number of puffs they took during the topography session. This study provides preliminary evidence that summing together the hours of ENDS use, or the number of occasions of ENDS use, in addition to the number of other tobacco products used (i.e., cigarettes) based on self-report may be an accurate method of quantification. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Retailers’ perspectives on the prevention of underage tobacco and electronic nicotine delivery system sales

Background: Tobacco retailers have an important role to play in reducing access to tobacco among youth, but in the USA, their role has become more complicated because of recent developments in policies and industry, such as the Indiana Tobacco-21 law and the rising popularity of electronic nicotine delivery systems (ENDS) products. This study aimed to explore Indiana retailers’ knowledge, attitudes, and skills related to the prevention of underage sales of tobacco and ENDS products and identify retailers’ needs for further education and training. Methods: The study involved a secondary analysis of anonymous cross-sectional data from the 2020 Indiana Tobacco Compliance Survey conducted by the Indiana Division of Mental Health and Addiction (DMHA). Managers and owners of retail stores who sold tobacco or ENDS products (i.e., large corporate-owned stores and smaller venues such as tobacco shops, vapour shops, and convenience stores) were eligible for inclusion. Records of retailers’ tobacco certificates were utilised for random sampling. Subgroup comparisons were conducted using chi-square tests. Results: The survey sample ( n = 102) included participants from all 10 DMHA planning regions in Indiana and all types of tobacco retail stores. Many retailers did not know about or understand the negative impacts of ENDS products on young people or existing regulations to minimise these impacts and the Indiana State Tobacco-21 law. Retailers in larger stores had a greater objective knowledge and reported more frequent prevention programme utilisation than smaller stores (e.g., by means of ‘We Card’). Conclusions: Underage tobacco sale prevention procedures varied significantly, but resources such as ‘We Card’ and ‘This is Our Watch’ were more popular than alternatives. Retailers reported a need for more convenient education and training options on how to check photo identification and refuse sales to minors.

Purchase Intent and Appeal of ENDS Products among Current, Former and Never Ever Users of Tobacco Products in the U.S.

SUMMARY Background and objectives The last decade has seen extensive research into electronic nicotine delivery systems (ENDS) such as e-cigarettes. Although some studies assess ENDS’ potential benefits, there is a paucity of studies that provide population-level estimates of purchase intent or product appeal among various tobacco user groups, or that have examined the impact of different product characteristics on those variables. Methods Purchase intent and product appeal ratings were analyzed from six online studies for multiple sub-brands of Vuse vapor products (including different flavors, nicotine levels, and device styles). The sample in each study was weighted to represent the adult U.S. population of current established, former established, and never established cigarette smokers on five key demographics; providing population-level estimates. Results Results for purchase intent and appeal are remarkably consistent. Ratings of purchase intent and appeal are higher for current tobacco users (current established cigarette smokers, current established non-cigarette tobacco users, and current tobacco experimenters) than for former and never ever tobacco users. Conclusions and scientific significance These findings show that varying sub-brands of an e-cigarette has little or no impact on population level purchase intent and appeal ratings across tobacco user groups. Additionally, greater variability in ratings among current tobacco experimenters than other tobacco user groups is discussed as well as correlations between measures. This paper provides the first population estimates of both purchase intent and product appeal for various ENDS products among adult tobacco users and nonusers; information that is critical for evaluating the impact on public health. [Contrib. Tob. Nicotine Res. 32 (2023) 34–42]

“I’m both smoking and vaping”: a longitudinal qualitative study of US young adults who tried to quit smoking cigarettes by using electronic cigarettes

ObjectiveTo describe how young adults use electronic cigarettes (electronic nicotine delivery systems (ENDS)) for smoking cessation and reasons why they may or may not successfully quit smoking.MethodsLongitudinal qualitative data were...

Abstract LB052: Electronic nicotine delivery system (ENDS) use among LatinX youth in low-resource communities: Implications for policy and regulation

Abstract Introduction: Electronic nicotine delivery system (ENDS) use by youth who never previously used tobacco is a major health concern, as ENDS have been linked to DNA damage, inflammation, and cancer development. FDA’s regulation of ENDS products includes how the tobacco industry markets ENDS to young people, including youth from marginalized communities. LatinX youth are among the largest and fastest growing populations in the country, yet little is known about their susceptibility to using ENDS, including perceived risks of harm and addiction. The purpose of this study was to characterize ENDS use among LatinX youth in low-resource communities, and perceptions of its harm and addiction. Methods: N=622 middle and high school students identifying as LatinX and enrolled in a Title I school district in NJ completed an online survey during a class period. Lifetime ENDS use and its correlates were tested in bivariate and logistic regression models. Results: Based on Spanish-English language preference, 33% of LatinX youth had low acculturation to the US and 35% had high US acculturation: their overall prevalence of lifetime ENDS use was 20%. LatinX ENDS users were 3x more likely to acquire ENDS products from others (e.g., adults) than to purchase or obtain them themselves (16% vs. 5%). LatinX youth were considered further ‘susceptible’ to using ENDS based on their curiosity (30%), expected use within a year (11%), or uptake if offered by a friend (17%). In multivariable logistic regression models of the odds of ENDS use, LatinX students in Grade 11 were more likely to have ever used ENDS vs. those in Grade 7 (OR=1.23, 95% CI=0.77, 1.95). After adjusting for acculturation, LatinX youth who were more curious (OR=6.85, 95% CI=3.64, 12.87), intended to use ENDS in the next year (OR=4.96, 95% CI=2.24, 10.98), and would use the product if offered by a friend (OR=5.47, 95% CI=2.80, 10.68) had greater lifetime odds of being ENDS users. Also, LatinX youth who perceived no/low risks (OR= 2.02, 95% CI=1.22, 3.34) or health harms (OR=2.19, 95% CI=1.29, 3.73) were more likely to have ever used ENDS. When examined simultaneously, LatinX youth who both perceived no/low risk as well as no/low health harms were the most likely to have used ENDS products in their lifetimes (OR=3.10, 95% CI=1.72, 5.62). Conclusions: Across the acculturation continuum, LatinX youth from marginalized communities are especially susceptible and using ENDS. Prevention efforts directed towards these communities may benefit from health education messaging that emphasizes health harms and addiction potential to reduce ENDS experimentation. Citation Format: Marcelo Sleiman, Kenneth Tercyak, Mary R. Yockel. Electronic nicotine delivery system (ENDS) use among LatinX youth in low-resource communities: Implications for policy and regulation [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 2 (Clinical Trials and Late-Breaking Research); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(8_Suppl):Abstract nr LB052.