Vaping Products Research Articles

Tobacco control policies discussed on social media: a scoping review

ObjectiveTo describe the scope of published literature about tobacco-related policy discussions from social media data and discuss implications for tobacco control policy and future research.Data sourcesPubMed, Medline, CINAHL and Web...

Biological Response after 14-Day Cannabidiol and Propylene Glycol Inhalation in Sprague-Dawley Rats.

Objective: Cannabidiol (CBD), a phytocannabinoid of increasing interest for its purported therapeutic effects, is primarily consumed via ingestion and inhalation. While the toxicology of orally administered CBD has been reported, little is known about the effects of CBD inhalation. Doses selected for the present analysis allowed for evaluation of dose-response at concentrations >100-fold higher than typical human consumption levels. Materials and Methods: CBD (98.89% pure) was formulated in propylene glycol (PG) and aerosolized by nebulization to evaluate biological response after nose-only inhalation. Sprague Dawley rats (n = 35 males, 30 females) were exposed to 1.0 and 1.3 mg/L nominal concentrations of CBD and PG, respectively, for 12-180 min. Resulting average daily presented dose ranges were 8.9-138.5 mg/kg CBD and 11.3-176.0 mg/kg PG. Aerosols of 1.4 µm median diameter were achieved. Biological response indicators included clinical signs, clinical chemistry, hematology, body/organ weights, and pulmonary/systemic histopathology. Results: Inflammatory and necrotic responses were observed in the nose at the highest doses of CBD. Limited findings in the larynx and lung were mainly observed at higher doses. There were no histological findings in extrapulmonary organs. Dosimetry modeling differentiated the no observable adverse effect level between the nasal region and lungs to be 2.8 and 10.6 mg/kg CBD, respectively. Conclusions: Dose-depending findings of histological changes in the respiratory tract are observed at high doses. At lower doses consistent with typical over-the-counter vape products there appears to be substantial safety margin in the present study (93- and 353-fold lower for nose and lung, respectively).

Assessing vitamin E acetate as a proxy for E-cigarette additives in a realistic pulmonary surfactant model

Additives in vaping products, such as flavors, preservatives, or thickening agents, are commonly used to enhance user experience. Among these, Vitamin E acetate (VEA) was initially thought to be harmless but has been implicated as the primary cause of e-cigarette or vaping product use-associated lung injury, a serious lung disease. In our study, VEA serves as a proxy for other e-cigarette additives. To explore its harmful effects, we developed an exposure system to subject a pulmonary surfactant (PSurf) model to VEA-rich vapor. Through detailed analysis and atomic-level simulations, we found that VEA tends to cluster into aggregates on the PSurf surface, inducing deformations and weakening its essential elastic properties, critical for respiratory cycle function. Apart from VEA, our experiments also indicate that propylene glycol and vegetable glycerin, widely used in e-liquid mixtures, or their thermal decomposition products, alter surfactant properties. This research provides molecular-level insights into the detrimental impacts of vaping product additives on lung health.

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

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

Association between adverse childhood experiences and current use of e-cigarettes or electronic vaping products across sex race ethnicity and age based on 2020–2022 BRFSS data

IntroductionThe use of e-cigarettes or other electronic vaping products (EOEVP) has been on the rise since their introduction. Concurrently, Adverse Childhood Experiences (ACEs) have been linked to various negative behavioral health outcomes. We explore the association between ACEs and current EOEVP use, with a focus on variations across sex, race/ethnicity, and age.MethodsUtilizing data from the Behavioral Risk Factor Surveillance System (BRFSS) for 2020–2022, we analyzed responses from 202,126 adults in the United States in a cross-sectional study. Multivariable logistic regression models were used to evaluate the adjusted odds ratios (aORs) of current EOEVP use for different levels of ACEs. Stratified and interaction analyses were used to examine potential effect modification.ResultsAmong adults 54 years of age and younger, even a lower number of ACEs [1 (aOR 1.52), 2 (aOR 2.01), and 3 (aOR 1.51)] was associated with higher odds of current EOEVP use. Stratified analyses revealed significant differences in the odds of current EOEVP use among Non-Hispanic White adults between 1 ACE (95% CI 1.75–2.28) and 4 ACEs (2.34–3.17). Hispanic adults with ≥ 1 ACEs (p-value 0.001) and 8 ACEs (p-value 0.005) showed strong associations compared to Non-Hispanic White adults. The influence of ACEs on current EOEVP use was observed to decrease with age, particularly in older adults with fewer ACEs. The aORs did not very by sex.ConclusionThe findings emphasize the importance of considering any number of ACEs in public health strategies targeting current EOEVP use, especially among younger adults and specific minority groups. These insights are crucial for tailoring interventions and policies to address the nuanced impacts of early life adversities on health risk behaviors.

Nicotine and cannabis routes of administration and dual use among U.S. young adults who identify as Hispanic, non-Hispanic Black, and non-Hispanic White

BackgroundUse of cannabis and nicotine is at record levels among young adults, and health consequences vary by route of administration. However, there is a paucity of research characterizing use of both substances, especially among individuals of racial/ethnic minoritized identities. MethodParticipants (N = 1,032; age 18–25 years) completed a cross-sectional survey administered through an online panel in 2021 in eight U.S. states where cannabis was legal for both recreational and medical use and eight states where cannabis was not legal for medical or recreational purposes. Sampling was stratified by race/ethnicity (Hispanic, non-Hispanic Black, non-Hispanic White) and gender (male, female). Survey weighting was based on state-level gender and race/ethnicity data in the 2021 U.S. Census Bureau. ResultsOver one third (37.9%) of respondents reported current use of both cannabis and tobacco, more than double the proportion using tobacco (12.1%) or cannabis (4.1%) only. Vaporization was the most common method for using nicotine (40.2%). Disposable nicotine vape products were used more than any other method (27.1%). Smoking was the most common route of administration for cannabis (35.7%). Simultaneous use of tobacco and cannabis was common (27.0%) overall and greater among those who identify as non-Hispanic Black than non-Hispanic White. There were few differences in product use by gender or state legality. DiscussionDual cannabis and tobacco use is prevalent among young adults. Given the dynamic regulatory landscape, continued monitoring of specific cannabis formulations and tobacco products is recommended. Trends in simultaneous use of cannabis and tobacco and associated adverse effects warrant continued assessment.

Categorizing E-cigarette-related tweets using BERT topic modeling

BackgroundSocial media platforms are critical channels for promoting e-cigarettes, particularly among youth, making analysis of their vast and diverse content essential for public health interventions. Prevalence rates of e-cigarette use are high and evidence suggests that social media are popular forums that promote e-cigarette use through direct and indirect marketing techniques. The volume and diverse nature of e-cigarette-related information on social media is challenging and may obfuscate public health prevention messaging. Traditional hand-coding methods are labor-intensive and limit scalability. In contrast, unsupervised machine learning approaches, such as topic modeling, allow for efficient analysis of large datasets, uncovering patterns and trends that manual methods cannot achieve at scale. The present study focused on ascertaining the extent to which themes and topics in tweets related to e-cigarettes can be successfully rendered into useful homogenous units using machine learning. A better understanding of current depictions and discussions around e-cigarette products and use on social media can inform public health counter messaging and policy interventions. MethodsWe used topic modeling (BERTopic) to iteratively derive vape-related tweet clusters and calculate the importance of particular words to these groupings. We conducted a qualitative content analysis to study clustered tweets. We also sought to determine the geographic locations of e-cigarette conversations using automated geoparsing methods, which translate toponyms in textual data into geographic identifiers, to attempt to infer the location of tweets. ResultsWe were able to successfully identify >100,000 tweets in broad thematic categories in English and Spanish. Our correlation and inter-topic map analysis of the machine-derived topics, which examines the relationships between topics, indicated that most of the topics were unique (correlation value < 0.5) and did not overlap with each other. We identified six topics: Flavors and Disposable Vapes, Cannabis, Vape Shops and Refillable Vapes, Vape Culture, Anti-vaping and Quitting, and Spanish Tweets and Vaping Nicotine. Further analysis of these topics using qualitative methods identified themes within each topic. For example, Category 6 (Spanish Tweets and Vaping Nicotine) included four topics focused on the health risks of vaping, personal motivations for vaping, and the regulation of vaping products. Using geoparsing, which automatically detects location information, we found that the United States had the highest number of tweets related to vaping. Discussion/conclusionResults underscore the possibility of leveraging BERTopic modeling to reduce large quantities of data to comprehensively describe and categorize myriad e-cigarette related messages to which social media users are exposed. This data reduction approach can be applied to various social media platforms to describe and categorize e-cigarette posts and thereby triangulate and validate findings. Thematic content analysis of the topics identified through this technique requires supervision and human inputs. Our approach provides a comprehensive understanding of the evolving e-cigarette discourse, informing public health counter-messaging and policy interventions. Moreover, findings support the need for regulation, such as reducing appealing flavors and suggest that social media can be used effectively to support public health messaging (i.e., quitting messages).

Patterns and perceptions of vaping among adults living in social housing: a representative survey in Great Britain, 2023

BackgroundVaping products are effective for helping people to stop smoking and may therefore offer a potential means to reduce high rates of smoking in socioeconomically disadvantaged groups. This study aimed to examine current patterns and perceptions of vaping among people living in social housing in Great Britain compared with those living in other housing types.MethodsData were from the Smoking Toolkit Study; a nationally-representative survey conducted in 2023 (n = 23,245). Logistic regression tested cross-sectional associations between living in social (vs. other) housing and current vaping among adults; vaping frequency, device type, nicotine concentration, and source of purchase among current vapers; use of vaping products as a smoking cessation aid among past-year smokers who tried to quit; and harm perceptions of vaping products relative to cigarettes among current smokers.ResultsCurrent vaping prevalence was twice as high among adults living in social housing (19.4%) compared with those in other housing types (10.4%; OR = 2.07, 95%CI = 1.84–2.33). This was partly explained by differences in sociodemographic characteristics and smoking status; after adjustment, the odds of being a current vaper were 33% higher (ORadj=1.33, 95%CI = 1.14–1.54). Among vapers, there were no notable differences by housing tenure in vaping frequency, main device type used, usual nicotine concentration, usual source of purchase, or use as a smoking cessation aid. However, current smokers living in social housing were more likely to think vaping is more harmful than cigarettes (31.6% vs. 21.8%; ORadj=1.61, 95%CI = 1.30–1.99).ConclusionsIn Great Britain, adults who live in social housing are more likely to vape than those who live in other housing types, even after accounting for their younger age and higher smoking rates. However, misperceptions about the relative harms of vaping products and tobacco are common among smokers living in social housing. Interventions addressing these misperceptions could help encourage more people living in social housing to switch from smoking to vaping and reduce smoking-related health inequalities.Pre-registrationThe study protocol and analysis plan were pre-registered on Open Science Framework (https://osf.io/n3mvs/).

Does perceived vaping addiction predict subsequent vaping cessation behaviour among adults who use nicotine vaping products regularly?

BackgroundThis study aimed to investigate whether perceived vaping addiction is a predictor of quitting nicotine vaping product (NVP) use among adults who have ever smoked and currently vape exclusively or predominantly in four countries: Australia, Canada, the US, and England. MethodData analysed (n = 574) came from participants (aged 18 + ) who completed the International Tobacco Control (ITC) Four Country Smoking and Vaping survey in 2018 and again in 2020. Baseline inclusion criteria were: (1) currently not smoking or non-daily smoking; and (2) using NVPs daily/weekly for a period of at least 4 months. Association of self-reported baseline levels of perceived vaping addiction with making any attempts to quit vaping and successful attempts reported at follow-up were examined using logistic regression models, controlling for potential sociodemographic and smoking/vaping-related confounders. ResultsParticipants who perceived themselves as being addicted to vaping were less likely to attempt to quit vaping than those who perceived themselves as not addicted. Among those who tried, those who perceived themselves being addicted were also less likely to succeed than those who perceived themselves as not addicted. No significant country differences in associations were observed for both outcomes. ConclusionsPerceived vaping addiction was shown to have predictive utility for vaping cessation behaviours, possibly acting as an indicator of task difficulty, and thus may serve as a useful screening tool for identifying NVP users who may benefit from tailored cessation support programs if they want to stop using these products.

Detection and quantification of synthetic cannabinoids in seven illicitly sourced disposable vapes submitted by an individual presenting to a UK drug and alcohol service.

In the United Kingdom and internationally, synthetic cannabinoids (SCs) are a common adulterant in illicitly sourced vaping products. Recently, their use is increasingly being linked to severe health effects, particularly among children. Here, we aimed to conduct the first detection and quantification of SCs in illicit disposable vaping products. A cross-section of seven illicitly sourced disposable vape samples that were initially sold as cannabis products was submitted for analysis by a single individual presenting to a drug and alcohol service in the United Kingdom. Qualitative and quantitative analyses of these samples were conducted using nuclear magnetic resonance and gas chromatography/electron ionization-mass spectrometry. Qualitative analysis identified the SC 5F-MDMB-PICA in all seven samples, in the absence of any other pharmacologically active compounds. Quantitative analysis revealed that the median concentration of 5F-MDMB-PICA was 0.85 mg/ml (range = 0.59-1.63). The external appearance of these vape samples closely resembled regulated vaping products, and the presence of SCs was not identifiable by any labelling or packaging. The SC 5F-MDMB-PICA was detected at a median concentration of 0.85 mg/ml in seven disposable vapes which were illegally sourced in the United Kingdom, were mis-sold as cannabis products and closely resembled legal, regulated products.

Vaping-associated illness: a reassessment

BackgroundIn 2019, there was widespread presentation of respiratory distress as well as other organ system involvement in patients with a history of vaping. There continue to be reports of vaping-associated illness (VAI). This has come to be known as e-cigarette and vaping product associated lung injury (EVALI). The mechanism of injury remains unclear.ObjectivesThis study reexamines the clinical characteristics of patients affected by vaping and suggests that lung injury may not be the primary organ dysfunction but be part of a larger systemic illness.MethodsThis is a retrospective chart review of all patients presenting to one hospital identified as having vaping-associated illnessResultsFourteen patients were identified ranging in age from 15 to 33 years. Patients had a broad range of clinical severity. Respiratory symptoms occurred in 64%, gastrointestinal symptoms in 57%, fever in 78%, neurological symptoms in 15% and other constitutional symptoms in 50%. 35% presented with no respiratory symptoms.ConclusionWhile the lungs are certainly involved in vaping-associated illness, recognizing the extent of involvement of other organ systems may provide insight into the pathophysiology of the disease. Providers should be aware that vaping-associated illness presents with a multitude of symptoms outside of lung injury, such as abdominal pain, headache or even fever.

Contingent Effects of E-Cigarette Warning Label Messages on Cognitive Elaboration and Fear Among U.S. Youth Ages 14-17 by Vaping Experience and Peer Vaping Behavior.

The U.S. Food and Drug Administration (FDA) currently requires a warning about the addictive nature of nicotine to be placed on electronic cigarette advertisements and packaging. To consider the value of additional warning messages on public health outcomes, this study examines the additive effect of new warnings that are based on recent claims from U.S. federal authorities. We conducted a secondary analysis of recent data from 1,202 U.S. youth ages 14-17 to test the impact of exposure to additional warnings placed on advertisements for vaping products on cognitive elaboration, fear, and willingness to vape and smoke. This investigation also looked closely at effects on youth who may have increased risk of future vaping due to prior vaping experiences or having friends who vape. Exposure to the alternative warnings did not amplify cognitive elaboration compared to the current FDA warning alone, but it did increase fear. Youth elaboration on both the benefits and risks of vaping was associated with willingness to both vape and smoke, but fear was not associated with either outcome. The effects of warning label exposure and cognitive elaboration varied by prior vaping experience and having at least one friend who vapes. We conclude by discussing the implications of this contingent pattern of effect and association.

Perceptions of nicotine vaping products among Australians living with HIV

ABSTRACT People living with HIV (PLHIV) are two to three times more likely to smoke tobacco compared to the general community. Evidence from the general population suggests that nicotine vaping products (NVPs) can be acceptable and effective smoking cessation aids, but there is limited evidence on the extent to which this is the case among PLHIV. This manuscript reports findings from the Tobacco Harm Reduction with Vaporised Nicotine (THRiVe) trial, a mixed-methods study investigating the feasibility of NVPs as smoking cessation aids among 29 PLHIV who smoked tobacco. Surveys and semi-structured interviews explored participants’ experiences and perceptions of NVPs, their features and functions, and support for various NVP regulatory policy options. Participants described seven reasons why NVPs were acceptable cessation aids: they satisfied nicotine cravings; differences between NVPs and cigarettes facilitated habit breaking; fewer adverse effects compared to traditional cessation aids; NVPs allowed for a “weaning process” rather than requiring abrupt abstinence; tobacco became increasingly unpleasant to smoke; NVPs provided an increased sense of control; and participants experienced a deeper understanding of personal smoking behaviours. This study provides valuable insight into the preferred features of NVPs among PLHIV and reasons why NVPs may be effective for promoting smoking cessation among PLHIV.

Synthetic cannabinoid identification in cases associated with blue lotus and valerian root vaping products.

Synthetic cannabinoids emerged in the early 21st century and have continued to evolve and flourish to present day. Like other novel psychoactive substances (NPS), synthetic cannabinoids have been sold under the guise of legitimate products. Some examples include "potpourri," "incense," and herbal material. Between May 2020 and December 2023, the United States Army Criminal Investigation Laboratory, Drug Chemistry Division (USACIL) received 29 seized drug cases mentioning "blue lotus" or "valerian root." In 90% of these cases, at least one exhibit contained one or more synthetic cannabinoids. During the same timeframe, the Armed Forces Medical Examiner System, Division of Forensic Toxicology received 65 toxicology cases that contained synthetic cannabinoids and/or their corresponding metabolites where case history mentioned "blue lotus." The most frequently observed synthetic cannabinoids between laboratories were 5F-MDMB-PICA, ADB-BUTINACA, and MDMB-4en-PINACA. Innocuous branding and marketing may deceive law enforcement, investigators, and healthcare providers into believing that the adverse effects of erratic behavior, sedation, slurred speech, and hallucinations are a result of toxicity from botanical extracts (e.g. apomorphine and nuciferine in blue lotus). Due to the dangerous nature of these NPS, synthetic cannabinoid screening is recommended for all cases where there is suspected use of vaping products suggested to contain "blue lotus" or "valerian root" as vendors continue to conceal the presence of these compounds.

Vaping habits and respiratory symptoms using a smartphone app platform

BackgroundWidespread use of e-cigarette (EC) or vaping products causes respiratory disorders including the nationwide outbreak of e-cigarette or vaping product use-associated lung injury (EVALI) in 2019. Chronic adverse health effects are now being reported as well. To address this important public health issue, an innovative approach of epidemic control and epidemiologic study is required. We aimed to assess the association between short-term and long-term use of EC products and respiratory health in adults using smartphone app data.MethodsA population-based, repeated measures, longitudinal smartphone app study that performed 8-day survey participation over 60 days for each participant from August 2020 to March 2021, including 306 participants aged 21 years and older in the US. The participants were asked to complete the respiratory health questionnaire daily, weekly, and monthly on their smartphone app. We analyzed the association between vaping habits and respiratory health using generalized linear mixed models (GLMMs).ResultsEC use in the previous 7 days was associated with frequent cough (OR: 5.15, 95% CI: 2.18, 12.21), chronic cough (OR: 3.92, 95% CI: 1.62, 9.45), frequent phlegm (OR: 3.99, 95% CI: 1.44, 11.10), chronic phlegm (OR: 3.55, 95% CI: 1.41, 8.96), episodes of cough and phlegm (OR: 4.68, 95% CI: 1.94, 11.28), mMRC grade 3–4 dyspnea (OR: 3.32, 95% CI: 1.35 to 8.13), chest cold (OR: 3.07, 95% CI: 1.29, 7.33), eye irritation (OR: 2.94, 95% CI: 1.34, 6.47) and nose irritation (OR : 2.02, 95% CI: 0.95, 4.30). Relatively long-term effects of the past 90 days EC use was associated with an increased risk of wheeze (OR: 3.04, 95% CI: 1.31, 7.03), wheeze attack (OR: 2.78, 95% CI: 1.07, 7.24), mMRC grade 3–4 dyspnea (OR: 2.54, 9% CI: 1.05 to 6.18), eye irritation (OR: 3.16, 95% CI: 1.49, 6.68), and eye irritation during the past month (OR: 3.50, 95% CI: 1.52, 8.04).ConclusionsIn this smartphone app-based repeated measures study, short-term and relatively long-term use of EC increased the risk of respiratory symptoms.

Protonitazene detection in two cases of opioid toxicity following the use of tetrahydrocannabinol vape products in Australia

Introduction Protonitazene is an opioid belonging to the 2-benzylbenzimidazole structural class. We describe two cases of opioid toxicity involving the reported inhalation of a delta-9-tetrahydrocannabinol vape product in which protonitazene was detected. Case reports Case 1 was a young male found unconscious after the reported use of a delta-9-tetrahydrocannabinol vape. He suffered two subsequent apnoeic episodes requiring bag-valve-mask ventilation before eventual recovery. Only protonitazene was detected in blood at a concentration of 0.74 µg/L. Case 2 was a young male who died shortly after being found unresponsive. The postmortem femoral blood concentrations of protonitazene and delta-9-tetrahydrocannabinol were 0.33 µg/L and 2 µg/L, respectively. Analysis of a pod vaping device found in the decedent’s hand and a separate e-liquid bottle labelled as delta-9-tetrahydrocannabinol showed a mixture of protonitazene and delta-9-tetrahydrocannabinol. Discussion The opioid effects of protonitazene are mediated through β-arrestin2 and mu opioid receptor signalling pathways. Benzimidazole opioids are lipophilic and, when mixed with a suitable solvent, can be used in a vape device. It is anticipated that naloxone would have provided effective reversal of toxicity in our cases. Conclusions Novel routes of opioid administration, like vaping, may appear relatively innocuous in comparison to intravenous administration, but opioids may still be absorbed at high concentrations, resulting in severe opioid toxicity or death.

A content analysis of nicotine descriptors on the front of vape packaging in the United Kingdom.

The Tobacco and Related Products Regulations (TRPR) 2016 require consumers in the United Kingdom (UK) to be informed about the presence of nicotine in vaping products. However, there is misunderstanding among some young people and adults around the strength of products. We examined how nicotine content is displayed on the front of vape packaging in the UK. Between August and December 2022, we systematically analysed a representative, stratified selection of vapes and refill packs (n=156) on the UK market to assess TRPR compliance. This paper presents an analysis of free-text responses collected to indicate the presence of nicotine information on the front-of-pack including metric, percentage, graphic, and text indicators. Data were analysed using descriptive statistics produced for the sample as a whole and for five product categories. Most packs (n=126, 81%) displayed at least one front-of-pack nicotine descriptor, including the majority of disposables (n=43, 90%), e-liquid (n=42, 88%) and refill pods (n=36, 100%). Many packs (n=107, 69%) contained a nicotine-related metric (e.g. mg/ml), a quarter (n=37, 24%) included a percentage indicator and most (n=126, 81%) displayed at least one of these. Almost two-fifths (n=57, 37%) mentioned nicotine beyond the warning. Less observed indicators included graphic and textual depictions of strength, dosage information, and equivalent number of cigarettes. The front of vape packaging communicates important product information to consumers. There is inconsistency in how nicotine content is currently displayed. Future research should examine how best to display nicotine content to promote consumer understanding and informed decision-making. This pack analysis of a representative sample of UK vape packaging highlights the varied way in which nicotine content and strength is currently communicated to consumers on the front of vape packaging. The inconsistent presentation of nicotine content on the front of packs may contribute to misperceptions around product strength. A consistent and easily understood way of communicating nicotine content on the front of vape packaging may help consumers make more informed choices about vape products.

“I've lost my children to vaping”: A frame analysis of the Australian media's construction of the “Youth vaping crisis”

BackgroundYouth vaping has become an issue of extreme concern in the Australian public and political discourse, recently culminating in the announcement of further restrictions on the sale and use of nicotine vaping products (NVPs) by the Federal Government. We examine how youth vaping has been framed in the Australian news media in the six months leading up to the announcement of these new measures in May 2023. MethodsDrawing a sample from the Factiva database, we conducted a frame analysis on articles published during this six month period, identifying media framings that included the necessary components of a distinct Problem Definition, Causal Attribution, Moral Evaluation, and Treatment Recommendation. ResultsWe identified 123 relevant articles, and four dominant framings being applied. Most common was that of A Failure of Control, followed by A Poisonous Epidemic, A Health Behaviour Needing Regulation, and A Moral Failure. ConclusionThese findings are discussed in the context of moral panic theory and how framings are constructed by the media in collaboration with policy actors to support particular policy measures.

Young people's experiences of addiction to nicotine vaping products: A qualitative analysis from Aotearoa New Zealand.

Young people who use nicotine-containing electronic cigarettes, or 'vapes', risk becoming addicted to these products. While several studies document dependency symptoms, few report in-depth qualitative analyses of addiction. We explored experiences of self-reported vaping addiction using in-depth interviews with 22 young people aged 16-20 years who vaped and lived in Aotearoa New Zealand. Our semi-structured interview guide probed participants' early experiences and how they progressed from experimentation to addiction and explored how addiction affected their perceptions and daily routines. We used an inductive reflexive thematic analysis approach to interpret the data. Vaping's pervasiveness piqued participants' curiosity and encouraged trial. Most transitioned from experimentation to addiction within a couple of months; while a minority described a slower progression, nearly all felt irritable, angry or uncomfortable if they had to delay vaping. Intense cravings disrupted school and work routines and dictated how they spent their time. Many deeply regretted vaping and some suffered shame and embarrassment. These participants saw vaping as a threat to the well-being of younger youth, which they tried to shield from addiction. We go beyond earlier studies by probing the burden vaping comes to represent, offering new insights into young people's everyday experiences of vaping addiction. In addition to informing health promotion campaigns, our findings could inform policy directions. Understanding the speed with which addiction can occur, its impact on daily life, and the considerable regret many felt could help inform a more strategic and sorely needed approach to reducing youth vaping.

Packaging of disposable vaping products and e-liquids in England, Canada and the United States: A content analysis.

Vaping product packaging is varied and often features bright colours and novel designs, particularly among recently marketed disposable vapes. This study provides an overview of attributes found on the packaging of popular disposable vapes and e-liquid bottles in England, Canada and the United States (US) and assesses compliance with local packaging regulations. Content analysis. Brick-and-mortar and online shops in England (London), Canada (Ontario) and the US (New Hampshire and South Carolina). 108 vaping products (including packaging) from 76 brands in a range of flavours and nicotine levels. Specifically, 48 disposable vapes (15 from England, 16 from Canada, 17 from the US) and 60 e-liquid bottles (20 per country). Textual and graphic branding and marketing elements, independently coded by two researchers and checked by a third. Compliance with local packaging regulations varied across countries. Health warnings were present on the packaging of all but one nicotine-containing product, although 33% of disposables and 17% of e-liquids featuring the warning did not adhere to formatting requirements. Leaflets were seldom included with e-liquid bottles, even in England (45%) where mandatory, and omitted elsewhere. Labelling of nicotine type and batch numbers was inconsistent. Vaping product packaging featured claims relating to sensory perceptions (41%), most often flavours, and some (32%) featured youth-appealing content. Common graphic elements included stylised brand fonts (80%), brand logos (54%), product representations on the external packaging (47%) and abstract graphic elements (64%). Colours on packaging, disposable vapes and e-liquid bottles were associated with product flavour. In England, Canada and the United States, popular disposable vapes and e-liquid bottles appear to have varying compliance with local packaging regulations and inconsistent labelling of nicotine and product characteristics. The use of colourful designs, evocative descriptors and appealing graphics to promote flavours underscores the need for comprehensive packaging regulations and enforcement.