Regulation Of E-cigarettes Research Articles

Understanding commercial actors’ engagement in policy debates on proposed e-cigarette regulation in Scotland

IntroductionThere is growing concern about transnational tobacco corporations’ (TTCs) and other commercial actors’ involvement in e-cigarette policy development. Previous analyses suggest that TTCs used e-cigarette debates to demonstrate alignment with...

Awareness and prevalence of e-cigarette use among Chinese adults: policy implications

ObjectiveTo assess the awareness and prevalence of electronic cigarettes (e-cigarettes) and associated factors among Chinese adults (15 years and older).MethodThis study examined data from Global Adults Tobacco Survey China Project,...

Use Patterns, Flavors, Brands, and Ingredients of Nonnicotine e-Cigarettes Among Adolescents, Young Adults, and Adults in the United States

Nonnicotine e-cigarettes contain chemicals, flavorants, and solvents that have known health harms and/or have not been proven safe for inhalation. To evaluate nonnicotine e-cigarette use patterns, including common flavors, brands, and ingredients. This cross-sectional study included a convenience sample of US residents aged 13 to 40 years who completed an online survey in November and December 2021. Quota sampling was used for an equal proportion of participants aged 13 to 17 years, 18 to 20 years, and 21 to 40 years, balanced for sex, race, and ethnicity per the latest US Census. Nonnicotine e-cigarette use (ever, past 30- and past 7-day, number of times used, time taken to finish); co-use with nicotine e-cigarettes; age at first try; and flavors, brands, and ingredients used. Overall, 6131 participants (mean [SD] age, 21.9 [6.8] years; range, 13-40 years; 3454 [56.3%] identifying as female) completed the survey (55.1% completion rate). Among all participants, 1590 (25.9%) had ever used a nonnicotine e-cigarette, 1021 (16.7%) used one in the past 30 days, and 760 (12.4%) used one in the past 7 days. By age group, 227 of 1630 participants aged 13 to 17 years (13.9%), 497 of 2033 participants aged 18 to 20 years (24.4%), 399 of 1041 participants aged 21 to 24 years (38.3%), and 467 of 1427 participants aged 25 to 40 years (32.7%) had ever used nonnicotine e-cigarettes. Among 1590 participants who had ever used a nonnicotine e-cigarette, 549 (34.5%) had used one more than 10 times; 1017 (63.9%) finished 1 nonnicotine e-cigarette in less than 1 week. Co-use of nonnicotine with nicotine e-cigarettes was reported by 1155 participants (18.8%), 1363 (22.2%) exclusively used nicotine e-cigarettes, and 431 (7.0%) exclusively used nonnicotine e-cigarettes. Most-used flavors were sweet, dessert, or candy (578 [36.3%]); fruit (532 [33.4%]); and mint or menthol (321 [20.2%]); similar flavor patterns were observed for the top 2 flavors among those who used nonnicotine e-cigarettes in the past 30 days, followed by combinations of coffee, alcohol, flower, plant, and mint or menthol flavors by age group. Participants most reported using tetrahydrocannabinol (587 [36.9%]), cannabidiol (537 [33.7%]), melatonin (438 [27.5%]), caffeine (428 [26.9%]), and essential oils (364 [22.9%]) in their nonnicotine e-cigarettes. In this study of adolescents, young adults, and adults, a sizeable proportion reported having used nonnicotine e-cigarettes and co-using them with nicotine e-cigarettes. Surveillance studies should further assess nonnicotine e-cigarette use patterns and regulations, and prevention should be developed to address youth appeal, unsubstantiated health claims, and possible health harms.

The youth e-cigarette epidemic: updates and review of devices, epidemiology and regulation

Adolescent e-cigarette use constitutes a major public health challenge that has reversed the steady progress made in the past three decades to reduce youth tobacco use in the United States (U.S.). Although the prevalence of e-cigarette use has declined in the past two years, 24% of 12th grade students and 8.9% of 8th grade students in 2021 used e-cigarettes or engaged in vaping of any kind in the prior 30 days. The current e-cigarette landscape is dominated by discrete and stylish pod-based e-cigarettes with varying capacity for customized nicotine delivery, vapor concealment, and child-appealing e-liquid flavors. E-cigarettes continue to evolve rapidly with innovative technology as manufacturers seek loopholes in regulatory efforts and to maximize existing marketing opportunities. Regulatory efforts so far have focused largely on marketing restrictions with enforcement decisions prioritizing smoking cessation potential of e-cigarettes for adult smokers over risk of nicotine addiction in adolescents. Disposable e-cigarette products advertising synthetic nicotine and menthol-containing products remain on the market and continue to gain popularity among adolescents. This article describes e-cigarette devices, provides an overview on epidemiology of U.S. adolescent e-cigarette use, and reviews the existing federal, state, and local e-cigarette regulations with future recommendations for stakeholders.

E-cigarette Transitions Among US Youth and Adults: Results from the Population Assessment of Tobacco and Health Study (2013-2018).

Currently, the debate surrounding the regulation of e-cigarettes focuses mainly on the size of e-cigarettes' potentially beneficial effects (i.e., adult cessation) versus their unwarranted effects (i.e., initiation among tobacco-naïve adolescents). Therefore, we investigated the relative scale of e-cigarette use transitions in the United States. We reported cross-sectional weighted prevalence estimates of past-month e-cigarette use by ever cigarette use from Waves 1-4 of the Population Assessment of Tobacco and Health study (2013-2018) among youth (12-17years) and adults (≥ 18years). We also examined past-month e-cigarette mono and dual transitions related to cigarette smoking and reported the longitudinal weighted prevalence across waves. Among youth new e-cigarette users, the proportion of never-cigarette smokers increased from 24.1 in Wave 1 (n = 418) to 51.4% in Wave 4 (n = 310) (p < 0.0001 for trend). Of youth past-monthe-cigarette mono-users in Wave 1 (n = 151), 15.2% transitioned to cigarette mono-use and 8.2% dual-use at Wave 2 or 3 or 4, compared to 60.2% no tobacco use and 16.4% e-cigarette mono-use. Among young adult past-monthdual-users (18-24years; n = 684), 22.6% transitioned to no tobacco use, 60.1% continued cigarette use, 11.4% dual use, and 5.9% e-cigarette mono-use. Among adult dual-users ≥ 25years old (n = 1560), 13.6% transitioned to no tobacco use, 71.3% cigarette mono-use, 9.0% dual-use, and 6.1% e-cigarette mono-use. Transition to cigarette mono-use and continued dual-use were common among adult past-month e-cigarette users, while e-cigarette initiation was common among youth never-cigarette smokers. These findings contrast with data from other countries showing limited evidence of e-cigarette initiation among youth never cigarette smokers. Both e-cigarette and cigarette use should be addressed in youth and adults, given the potential for dual use in both populations.

Impact of an e-cigarette tax on cigarette and e-cigarette use in a middle-income country: a study from Indonesia using a pre–post design

ObjectivesIndonesia implemented its first e-cigarette regulation in 2018, a 57% tax on the retail price of e-cigarette liquid (e-liquid), exceeding the 40% average tax on cigarettes. Economic research suggests that...

Analysis of illicit drugs in purchased and seized electronic cigarette liquids from the United Kingdom 2014-2021.

Increasing popularity and known shortfalls in the regulation of electronic cigarettes (ECs) emphasises the urgent need for closer content monitoring and for comprehensible information on their possible health effects. This study investigated components of EC liquids in samples submitted from 2014 to 2021 and discussed the trends driven by legislation changes. Samples originating from prisoners, teenagers and 'test purchases' of commercially available ECs were analysed by gas chromatography-mass spectrometry (GC-MS). For those containing delta-9-tetrahydrocannabinol (THC) and/or cannabidiol (CBD), the content of these components was quantified by liquid chromatography with quadrupole time-of-flight mass spectrometry (LC-QTOF-MS) to show variation of these compounds in EC liquids; 112 EC liquids were included in this study. Nicotine was detected in 87 (78%) of the EC liquids analysed. Twenty-two, including samples from before and after introduction of the UK Psychoactive Substances Act (2016), contained one or more synthetic cannabinoid receptor agonist (SCRA). THC was detected in only 11 samples, whereas a single sample was found to contain CBD only. Six samples contained a mixture of THC and CBD. In all cases where information was available, the THC/CBD content was less than that stated on the product label. The data collected showed great variation in EC liquid content. Therefore, it is important that users are educated regarding risks associated with EC use. Additionally, substances now controlled under both the UK Misuse of Drugs Act and Psychoactive Substances Act were present. These substances each carry a potential risk to health, which is possibly exacerbated if multiple compounds are inhaled concomitantly.

Reasons for using e-cigarettes and support for e-cigarette regulations: Findings from the 2020 ITC Malaysia Survey.

INTRODUCTIONMalaysia has the largest e-cigarette (EC) market in Southeast Asia, and it has been estimated that 17% of adult daily cigarette smokers also used ECs on a daily basis in 2020. However, few studies have examined the reasons people use ECs in Malaysia. This cross-sectional study of adult cigarette smokers from Malaysia assessed reasons for EC use and their support for key proposed EC regulations.METHODSData are from the 2020 International Tobacco Control (ITC) Malaysia Wave 1 Survey of adult (aged ≥18 years) smokers who reported that they used ECs at least monthly (N=459 out of 1047 smokers). Weighted analyses were conducted on EC users’ reasons for using ECs and their support for various EC regulations.RESULTSSmokers who used ECs at least monthly were more likely to be male, aged 25–39 years, of Malay ethnicity, married, more highly educated, and living in Peninsular Malaysia. Smokers who used ECs daily reported using ECs to reduce the number of cigarettes smoked (91.3%), pleasant taste (90.1%), to quit smoking (87.9%), and enjoyment (87.5%). Smokers who used ECs less than daily reported using ECs for their pleasant taste (weekly 89.4%, monthly 87.5%), curiosity (weekly 79.5%, monthly 88.8%), being offered EC by someone (weekly 76.3%, monthly 81.6%), and to reduce the number of cigarettes smoked (weekly 76.2%, monthly 77.6%). Smokers who also used ECs were most likely to support EC regulations requiring a minimum purchasing age (88.3%) and limiting nicotine concentration (79.6%), and least likely to support regulations banning EC fruit and candy flavors (27.1%).CONCLUSIONSThe most prevalent reasons for using ECs in Malaysia are comparable to those of other ITC countries, including Canada, US, England, and Australia. An understanding of use patterns of ECs, especially their interaction with cigarettes, are important in developing evidence-based regulations in Malaysia.

The Role of Nicotine and Flavor in the Abuse Potential and Appeal of Electronic Cigarettes for Adult Current and Former Cigarette and Electronic Cigarette Users: A Systematic Review.

Many adult cigarette smokers use electronic cigarettes (e-cigarettes) to cut down on or quit smoking cigarettes. E-cigarettes with higher abuse potential and appeal might facilitate complete switching. E-liquid nicotine concentration and flavor are two of the characteristics that may affect the abuse potential and appeal of e-cigarettes. The objective of this systematic review was to compile results from survey, animal, human laboratory, and clinical studies to understand the possible effects of nicotine concentration and flavor on abuse potential and appeal of e-cigarettes in adult current and former cigarette and e-cigarette users. A comprehensive literature search was conducted in Ovid Medline and PsycINFO followed by citation tracking in Web of Science Core Collection. Peer-reviewed studies published in English between 2007 and August 2020 were selected that analyzed differences between e-liquid nicotine concentration and/or flavors, had outcome measures related to abuse potential and/or appeal, and included adult humans (18+) or animals. A total of 1624 studies were identified and screened. A qualitative synthesis of results was performed. Results from 104 studies included in this review suggest that higher nicotine concentration and access to a variety of flavors are likely to be associated with higher abuse potential and appeal of e-cigarettes for adult current and former cigarette and e-cigarette users. Higher nicotine concentrations and the availability of a variety of flavors in e-cigarettes might facilitate complete substitution for cigarettes. Future e-cigarette regulations should take into account their impact on smokers, for whom e-cigarettes may be a cessation tool or reduced-harm alternative. E-cigarettes may provide a reduced-harm alternative to cigarettes for smokers unwilling/unable to quit or serve as a path for quitting all nicotine products. Higher nicotine concentrations and flavor variety are associated with higher abuse potential and appeal of e-cigarettes. Higher abuse potential and appeal products may help facilitate complete switching from cigarettes to e-cigarettes. Regulation of nicotine concentration and flavors aimed at decreasing naïve uptake may inadvertently decrease uptake and complete switching among smokers, reducing the harm reduction potential of e-cigarettes. Evidence-based effects of regulating nicotine concentration and flavors must be considered for the population as a whole, including smokers.

Public support for further regulating smoking, snus and e-cigarettes in Norway, and its associations with risk perceptions and tobacco use.

Public support is an indication of the legitimacy of governmental tobacco interventions. Little is known about what it is that shapes the support for various tobacco policy measures. We examine whether there are differences in public support for new measures against smoking, snus, and e-cigarettes in Norway, and whether public support is associated with user status and perceptions of the products' harm potential. In December 2017, 4,002 people aged between 16 and 89 answered a web-based questionnaire. The sample was randomly drawn from Norstat's web panel, and pre-stratified by gender, age, region, and education in order to obtain an approximate country-representative sample. Respondents were asked to indicate their support for eight possible future measures to further restrict accessibility of tobacco (asked separately with regard to smoking tobacco, snus and e-cigarettes respectively), on a five-point scale from 1='no support' to 5='full support'. We utilized means and t-tests to address differences in support between measures. We then constructed sum scores to assess the total support for regulating each tobacco product and subjected these indexes to linear regression analyses, controlling for background variables. For six of the eight proposed measures, public opinion is less supportive of e-cigarette regulations than of similar regulations for snus and, especially, smoking tobacco. In all three regression models, significant associations with risk perception, user status and gender were maintained after multiple controls. The associations with risk perceptions were stronger for support of snus and e-cigarette regulation than for smoking tobacco. Overall, these findings illustrate the key role of risk perceptions in forming public opinions regarding tobacco-preventive regulations and underline the importance of information to ensure that population risk perceptions are accurate.

#NicotineAddictionCheck: Puff Bar Culture, Addiction Apathy, and Promotion of E-Cigarettes on TikTok.

This study aimed to classify and delineate types of user-generated content about the disposable e-cigarette Puff Bar shared on the popular video-based social media platform TikTok. We qualitatively analyzed 148 popular TikTok videos collected in July 2020. During an iterative process of data reduction and thematic analysis, we categorized videos by overarching genres and identified emergent themes. Young adults were engaged at all stages of the research process. Together, videos were viewed over 137 million times on TikTok. Seven genres of Puff Bar content emerged: skits and stories, shared vaper experiences, videos to show off, product reviews, product unboxing, promotion of Puff Bar, and crafts. Videos depicted Puff Bar users’ apathy about addiction and a lack of concern of the health effects of e-cigarette use. Additionally, Puff Bar promotion content from underground retailers was extensive and some targeted underage persons. Qualitative analysis of social media content can richly describe emerging online culture and illuminate the motivations of adolescent and young adult e-cigarette use. Social media can facilitate new product adoption; comprehensive e-cigarette regulation and enforcement can counteract these effects by closing loopholes through which new products emerge.

Correlates of e-cigarette use before and after comprehensive regulatory changes and e-liquid flavour ban among general population.

In 2016, the Finnish Tobacco Act was revised to harmonise e-cigarette regulations with the EU Tobacco Products Directive. Unlike before, the sale of nicotine-containing e-liquids was allowed while additional national regulations included, for example, a ban for other than unflavoured and tobacco-flavoured e-liquids. This study examines the correlates of e-cigarette use before and after the comprehensive regulatory change, and characteristics and correlates of flavoured e-cigarette use after the flavour ban in the general Finnish population. Repeated cross-sectional population-based drug surveys for 15-69-year-olds in 2014 (n=3485; 50% response rate) and in 2018 (n=3229; 46%). Correlates of e-cigarette use were studied with logistic regression models. Current e-cigarette use remained infrequent (approximately 2%) and the correlates of e-cigarette use varied only slightly between the study years. In 2018, of past-year e-cigarette users (n=316), 43% used unflavoured e-liquids, 24% used tobacco and 43% used other flavours, fruits being the most common. In univariate models, demographic variables, smoking and e-cigarette use-related factors were associated with flavoured e-cigarette use. In multivariable models, those who used e-cigarettes to experiment used unflavoured e-cigarettes more likely than other than tobacco flavours (odds ratio 3.00, 95% confidence interval 1.15-7.82). In Finland, the regulated entry of nicotine-containing e-liquids to retail sales has not led to increased e-cigarette use in the general population. After the flavour ban, other than tobacco-flavoured e-cigarette use still occurs. The use of flavoured e-cigarettes is associated with reasons for e-cigarette use. Flavoured e-cigarette use and its correlates warrant further monitoring.

Knowledge and attitudes on smoking cessation of e-cigarettes: a mixed-methods study of pharmacy students in Surabaya, Indonesia

SummaryBackgroundPharmacy students as candidates for health workers who will take part in smoking cessation. Knowledge and attitudes of smoking cessation can help map the behavior of pharmacists in the future. This study aimed to explore knowledge and attitudes on smoking cessation of e-cigarettes with the mixed methods study of pharmacist students.MethodThis research was conducted in Januari-Juni 2021 in Surabaya. The research design was mix-method with sequential explanatory strategy. The variables were knowledge and attitudes on smoking cessation of e-cigarettes. The sample in this qualitative approach was derived from a sample of quantitative data. Respondents were interviewed in depth until the data reached the saturation level in order to obtain good and usable qualitative data.ResultsThis study involved 31 respondents. The highest level of knowledge about dangers of e-cigarettes, especially related to nicotine (100% of respondents answered correctly). The highest positive level of attitude about dangers of e-cigarettes, especially e-cigarettes harmful to passive smokers (27% of respondents had positive attitude). Cigarettes were harmful to lung and cardiovascular health, regarding the dangers of passive smoking, some agree and disagree. Non-smokers didn’t need to be recommended for e-cigarettes, e-cigarettes can be recommended for tobacco smokers, e-cigarettes cause addiction, and e-cigarettes can be a good recommendation for those who want to carry out smoking cessation. Regulation of e-cigarettes in Indonesia was considered to be lacking and needs to be improved.ConclusionsPharmacist students have a high level of knowledge and a positive attitude towards smoking cessation.

Moralization of E-cigarette Use and Regulation: A Mixed-Method Computational Analysis of Opinion Polarization

ABSTRACT E-cigarette use, or vaping, is undergoing a process of moralization in which issues about vaping evolve from being morally neutral to having discernible moral implications. Using Moral Foundations Theory, this study compared the moral narratives underlying polarized views about e-cigarette use and regulation. We integrated computational and human strategies by conducting the Chow test on the time series data and classification, topic modeling, and Chi-square tests on posts (N = 2,669) from 26 pro-vaping and 19 anti-vaping Facebook Pages. The observation period (August 1, 2019 to March 5, 2020) encompassed the outbreak of “e-cigarette or vaping product use associated lung injury” (EVALI), deaths and subsequent legislation. Results revealed that pro-vaping posts were more likely than anti-vaping posts to mention Fairness/cheating and Authority/subversion, involving a conspiracy belief in an “e-cigarettes vs. Big Tobacco” rivalry, while anti-vaping posts were more likely to mention Sanctity/degradation. There were no significant differences between pro-vaping and anti-vaping posts in the likelihood of mentioning Care/harm or Loyalty/betrayal. Nevertheless, according to the topic modeling results, the use of moral foundations varied between pro-vaping and anti-vaping narratives, with the meanings of Care/harm and Loyalty/betrayal dependent on the post author’s group affiliation. Health interventions can tailor persuasive messages to different moral values and debunk misinformation about public health policies to mitigate the vaping epidemic. Theoretical implications are also discussed.

Predicting the pulmonary effects of long-term e-cigarette use: are the clouds clearing?

Commercially available since 2007, e-cigarettes are a popular electronic delivery device of ever-growing complexity. Given their increasing use by ex-smokers, smokers and never-smokers, it is important to evaluate evidence of their potential pulmonary effects and predict effects of long-term use, since there has been insufficient time to study a chronic user cohort. It is crucial to evaluate indicators of harm seen in cigarette use, and those potentially unique to e-cigarette exposure. Evaluation must also account for the vast variation in e-cigarette devices (now including at least five generations of devices) and exposure methods used in vivo and in vitroThus far, short-term use cohort studies, combined with in vivo and in vitro models, have been used to probe for the effects of e-cigarette exposure. The effects and mechanisms identified, including dysregulated inflammation and decreased pathogen resistance, show concerning overlaps with the established effects of cigarette smoke exposure. Additionally, research has identified a signature of dysregulated lipid processing, which is unique to e-cigarette exposure.This review will evaluate the evidence of pulmonary effects of, and driving mechanisms behind, e-cigarette exposure, which have been highlighted in emerging literature, and highlight the gaps in current knowledge. Such a summary allows understanding of the ongoing debate into e-cigarette regulation, as well as prediction and potential mitigation of future problems surrounding e-cigarette use.

Predictors of pod-type e-cigarette device use among Canadian youth and young adults.

Changes to federal legislation allowed nicotine-based e-cigarettes legal entry into the Canadian market in 2018. This included pod-type e-cigarettes (pods), such as JUUL, that were later found to be associated with steeply increasing prevalence and greater frequency of e-cigarette use among US and Canadian youth. Multiple studies of risk factors of JUUL use and use initiation have been conducted among various population groups in the US, but little evidence exists pointing to similar risk factors of pod use among Canadian youth and young adults. Understanding these risk factors can inform use prevention and intervention strategies in Canadian and other jurisdictions. A total of 668 Canadian youth and young adults recruited by the 2018-19 Youth and Young Adult Panel Study were provided a baseline survey 3 months before and a follow-up survey 9 months after the relaxation of federal nicotine e-cigarette regulations. We used multivariable logistic regression to understand and rank importance of baseline predictors of future pod use among respondents. Past-month cannabis use (OR [odds ratio] = 2.66, 95% CI: 1.66-4.21, p < 0.001), established cigarette use (OR = 3.42, 1.53-7.65, p < 0.01), past cigarette experimentation (OR = 2.40, 1.34-4.31, p < 0.01), having many friends who vaped (OR = 2.15, 1.37-3.34, p < 0.001), age below 18 compared to age over 22 (OR = 5.26, 2.63-10.00, p < 0.001) and male sex (OR = 1.69, 1.16-2.50, p < 0.01) were significant and the most influential predictors of future pod use. Similar factors drove pod use among Canadian and US youth and young adults. Appropriate preventive strategies can benefit from considering polysubstance use among high school-aged youth.

Developing a novel e-cigarette regulatory and policy control scale: results from the European Union

Background E-cigarette regulations vary considerably between countries though a standard approach for comparing regulatory frameworks does not exist. Additionally, there is no evidence on whether regulatory variations are associated with differences in e-cigarette use and smoking cessation. This study aims to develop a regulatory scale to measure and compare e-cigarette regulations between European Union countries and investigate whether scores are associated with e-cigarette use and smoking cessation. Methods Data from a range of sources, such as ECigIntelligence, were used to develop a scale and score countries in the respective areas of e-cigarette scale. We used correlation analysis to investigate association between scale scores and e-cigarettes market, e-cigarette prevalence and use of e-cigarettes for smoking cessation. Results An e-cigarette scale consisting of 10 domains was developed. Our analysis suggests that higher e-cigarette scale scores were associated with significantly greater use of e-cigarettes within countries, and greater increases in the prevalence of former smoking smokers between 2014 and 2017. Conclusions Whilst further work is needed to develop the scale in line with rapidly changing regulatory landscape and product development, the current findings suggest that countries that have implemented e-cigarette regulations might be more successful in obtaining public health gains such as increase in the proportion of former smokers compared to countries where e-cigarette market and sales is not regulated.

First E-Cigarette Flavor and Device Type Used: Associations With Vaping Persistence, Frequency, and Dependence in Young Adults

Type of e-cigarette flavoring and device during first use might differentiate later e-cigarette use and dependence. This retrospective cross-sectional study examined associations of recalled first nicotine vaping device and flavor used with current vaping frequency/dependence. A young adult cohort from Los Angeles, California, USA completed web-based surveys (N = 2553). Using cross-sectional data from 971 reporting ever vaping nicotine, multivariable hurdle regressions tested associations between recalled first flavor (fruit/sweet, menthol/mint, other) and device (Juul, disposable, mod, box, pod, pen, other) vaped with past-30-day vaping status (yes/no) and frequency (1-30 days), and with any vaping dependence symptoms (yes/no) and count (1-10 symptoms). The most common first-flavor was sweet (71%); the most common first-device was a vape pen (37%), then Juul (22%). First-flavor of mint/menthol (vs. other; adjusted odds ratio [AOR]: 2.22[95% CI = 1.16 to 4.25]), and first-device mod (AOR = 2.40[95% CI = 1.34 to 4.31]) and non-Juul pod (2.64[95% CI = 1.41 to 4.92]) (vs. pen) were associated with past-30-day vaping, and twice as many vaping days (adjusted rate ratios [ARRs] range: 1.96-2.12; ps < .05). First flavor of mint/menthol (vs. other; AOR: 1.95[95% CI = 1.003 to 3.79) and first device mod, box, non-Juul pod, and other (AORs range: 2.36-4.01; ps < .05) were associated with nicotine dependence. First device Juul, mod, box, and non-Juul pod were also associated with more dependence symptoms (ARRs range:1.38-1.59; ps < .05). Exposure to mint/menthol and certain devices (mod, box, Juul, and non-Juul pods) at first e-cigarette use may be associated with more frequent e-cigarette use and nicotine dependence symptoms in young adulthood. Mint/menthol and certain devices warrant consideration in regulation of e-cigarettes based on product characteristics. Characteristics (flavor and device type) of first e-cigarette product used were associated with higher usage and more dependence. Pending replication with prospective designs, the findings suggest certain flavors (mint/menthol) and devices (pods, mods) merit consideration in regulation because of their possible link with continued use and dependence among young people.

Collaborative Public Health Strategies to Combat e-Cigarette Regulation Loopholes

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Disposable E-Cigarette Use Prevalence, Correlates, and Associations With Previous Tobacco Product Use in Young Adults.

Novel, inexpensive disposable e-cigarettes widely sold in attractive flavors might be exempt from US federal regulations. To inform regulatory and public health priorities, this study examined young adult disposable e-cigarette use uptake among existing tobacco users versus non-users and possible use correlates that could be potential regulatory targets. Prospective cohort data were analyzed in 2021. Among baseline (2018-2019) never disposable e-cigarette users (n = 1903; mean [SD]: 19.3 [0.8] years-old), we tested prospective associations of baseline tobacco product use with follow-up (2020) disposable e-cigarette use initiation, followed by stratified analyses distinguishing baseline exclusive and dual e-cigarette/combustible tobacco use. Exploratory cross-sectional associations of tobacco-related correlate with vaping frequency among current disposable users (n = 266) were tested. Follow-up ever disposable e-cigarette use initiation was higher among baseline former (22.1%) and current (50.2%) versus never (6.3%) rechargeable (non-disposable) e-cigarette users. In stratified analyses, follow-up disposable e-cigarette use initiation was 0% in baseline never-vaping exclusive current smokers, higher in baseline never-vaping former smokers versus never users of any tobacco product (18.2% vs. 5.7%; adjusted odds ratio [95% CI] = 3.9 [2.1-7.5]), and higher among baseline current dual users versus never-smoking exclusive current vapers (61.3% vs. 42.2%; adjusted odds ratio [95% CI] = 3.0 [1.5-6.0]). Among follow-up current disposable e-cigarette users (overall prevalence = 10.9%), using ice-flavored (vs. fruit/sweet-flavored) e-cigarettes (adjusted rate ratio [95% CI] = 1.5 [1.0-2.1]) and vaping dependence symptoms (adjusted rate ratio [95% CI] = 2.2 [1.5-3.2]) were cross-sectionally associated with more past-month disposable e-cigarette use days. Young adult disposable e-cigarette use was of appreciable prevalence, including among tobacco product never users and former smokers. Regulation of disposable e-cigarettes, including ice-flavored products, might benefit young adult health. Sales of disposable e-cigarette products increased significantly in the United States from 2019 to 2020. These products contain high nicotine concentrations and various flavors that may appeal to young people. This study provides the first evidence that disposable e-cigarette use may be common among young adults, including among tobacco product never users and former smokers. Frequency of disposable e-cigarette use was positively associated with using ice-flavored e-cigarettes and vaping dependence. Regulatory policies and enforcement strategies addressing disposable e-cigarettes merit consideration in young adult health policy and prevention priorities.