Vaping Devices Research Articles

What Substances Are Adolescents Vaping? Estimating Nicotine-Specific and Cannabis-Specific Vaping from US National Youth Surveys

Background Youth use of electronic cigarettes (“e-cigarettes”) is an ongoing concern. Vaping is usually assumed to be of nicotine, but survey responses may also include vaping of non-nicotine substances (particularly cannabis), which can impose different risks. The current study quantifies the proportions of nicotine-specific and cannabis-specific vaping among adolescents. Methods Data from the Monitoring the Future (MTF) 2021 survey were analyzed with respect to the substance vaped: nicotine, cannabis, or flavoring only. Past-30-day (P30D) nicotine-specific vaping (exclusively, or also having vaped other substances) and cannabis-specific vaping were calculated. Results were also broken down by grade level, cigarette smoking history (current, former, or never), and frequency of e-cigarette use (<20 vs. 20+ days in P30D). Results Among 4706 P30D e-cigarette users, 84.2% vaped nicotine; the remaining 15.8% reported not vaping any nicotine in P30D. Cannabis vaping was reported by 48.4% of P30D vapers. Vaping both nicotine and cannabis in P30D was more common in current and former smokers than in never-smokers, and in frequent vapers (of any substance). Conversely, never-smokers were more commonly vaping cannabis but not nicotine, compared to current and former smokers. Supplementary NYTS 2022 analyses were consistent with these findings. Conclusions A notable proportion of self-reported P30D vapers reported not vaping nicotine; nearly half vaped cannabis. Capturing the variety of substances used in vaping devices is imperative for accurate public health surveillance of both nicotine and cannabis vaping among US adolescents, considering their different respective harms and regulatory frameworks.

Content Analysis of YouTube Videos Related to E-Cigarettes and COVID-19

Background E-cigarettes are frequently promoted on social media and portrayed in ways that are attractive to youth. While the COVID-19 pandemic significantly affected people’s lives, less is known about how the pandemic influenced e-cigarette-related marketing and information on social media. This study examined how e-cigarettes were portrayed on youtube, one of the most popular social media platforms during the COVID-19 pandemic. Methods We searched for combinations of search terms related to e-cigarettes (e.g., “electronic cigarette” and “vape”) and COVID-19 (e.g., “corona” and “COVID”) in July of 2021. To be included in analyses, videos must be: uploaded after February 1, 2020, in English, related to e-cigarettes and COVID-19, and less than 30 min in length. We conducted a content analysis of included videos, coding for uploader characteristics, what e-cigarette products were showcased, and specific themes that intersected between e-cigarettes and COVID-19. Results We examined N = 307 videos and found that N = 220 (73.6%) discussed the health effects of e-cigarette use on COVID-19, followed by videos on how COVID-19 affects e-cigarette sales (N = 40, 12.9%), face mask-related videos (N = 16, 5.1%; e.g., vape tricks including masks) and instructional videos (N = 10, 3.2%; e.g., sanitizing vape devices during COVID-19). Instructional videos had the highest number of likes (Median = 23; IQR = 32) and comments (Median = 10; IQR = 7). Conclusions Our findings support the need for continuous surveillance and research on novel vaping-related content in reaction to policies and events, such as the global pandemic. More research is needed to understand the impact of this content on young people’s perceptions and use of e-cigarettes.

Assessment of Online Marketing and Sales Practices Among Recreational Cannabis Retailers in Five U.S. Cities.

Background: With more states legalizing recreational cannabis, examining cannabis retail and marketing is crucial, as it may influence consumers' perceptions and behaviors. Particularly understudied is online cannabis retail. Methods: In Spring 2022, coders collected and analyzed data regarding retailer characteristics, age verification, and marketing strategies (e.g., product availability, health-related content, promotions, website imagery) among 195 cannabis retail websites in five U.S. cities (Denver, Colorado; Seattle, Washington; Portland, Oregon; Las Vegas, Nevada; Los Angeles, California). Descriptive analyses characterized the websites overall and across cities. Results: Overall, 80.5% verified age for website entry, and 92.8% offered online purchases (92.3% of retailers in Seattle, where prohibited). Of these, 82.9% required age verification for purchases, and 30.9% offered delivery. Almost all (>92%) offered flower/bud, concentrates, edibles, vaping devices, topicals, and tinctures. Health warnings were displayed on 38.3% of websites. Although all five states required health warnings regarding use during pregnancy, only 10.3% had these warnings. In addition, 59.0% posted some unsubstantiated health claims, most often indicating physical and mental health benefits (44.6%). Although Colorado, Washington, and Oregon prohibit health claims, 51.2-53.8% of these retailers posted them. Discounts, samples, or promotions were present on 90.8% of websites; 63.6% had subscription/membership programs. Subpopulations represented in website content included the following: 27.2% teens/young adults, 26.2% veterans, 7.2% sexual/gender minorities, and 5.6% racial/ethnic minorities. Imagery also targeted young people (e.g., 29.7% party/cool/popularity, 18.5% celebrity/influencer endorsement). Conclusions: Regulatory efforts are needed to better monitor promotional strategies and regulatory compliance (e.g., health claims, youth-oriented content, underage access) among online cannabis retailers.

Current Practice to Address Adolescent Vaping in Primary Care

Adolescent vaping usage has grown exponentially over the last decade. Studies have demonstrated increased vaping use in adolescents because of the ease of concealment and the use of vaping and e-cigarette devices. Provider knowledge of this problem; screening recommendations; and treatment with pharmacotherapy, nicotine cessation programs, and behavioral considerations are important for physician and advanced practice registered nurse providers. The purpose of this article is to educate health care providers about the current practices surrounding screening and treatment for adolescents who vape.

Diverse e-cigarette regulations in the Asia Pacific: A health economic perspective.

Diverse e-cigarette regulations in the Asia Pacific: A health economic perspective.

Evaluation of the Effect of Electronic Cigarette Devices/Vape on the Color of Dental Ceramics: An In Vitro Investigation.

The use of vaping or electronic cigarette devices (ECDs) has recently increased as an alternative to conventional tobacco smoking products. By recording the CIELAB coordinates (L*a*b*) and computing the total color difference (ΔE) values using a spectrophotometer, the effect of ECDs on contemporary aesthetic dental ceramics was investigated in this in-vitro study. A total of seventy-five (N = 75) specimens from five different (n = 15) dental ceramic materials (Pressable ceramics (PEmax); Pressed and layered ceramics (LEmax); Layered zirconia (LZr); Monolithic zirconia (MZr) and Porcelain fused to metal (PFM)) were prepared and exposed to aerosols produced by the ECDs. The color assessment was performed using a spectrophotometer at six time intervals (0 = baseline; 250-puff exposures; 500-puff exposures; 750-puff exposures; 1000-puff exposures; 1250-puff exposures; and 1500-puff exposures). By recording L*a*b* and computing total color difference (ΔE) values, the data were processed. A one-way ANOVA and Tukey procedure for pairwise comparisons were used to assess color differences between tested ceramics (p < 0.05). All test materials demonstrated significant color differences (ΔE) after exposure to vaping (p < 0.05). The LZr group displayed noticeably high ΔE values at all the distinct puff exposure intervals, with the highest ΔE value of (13.67) after 1500 puffs. The lowest (ΔE) values were observed in the PFM group after 250 and 500 puffs (0.85 and 0.97, respectively). With the exception of the group PEmax (p = 0.999), all groups produced readings of "ΔE" that indicated significant differences (p < 0.05) at various degrees of puff exposures. ECDs can noticeably alter the color of the dental ceramics affecting the esthetics of the patients. All the materials tested demonstrated significant color changes (ΔE > 3.33) above the clinically acceptable threshold, except for the PFM and PEmax group (ΔE < 3.33) which showed color stability after exposure to the ECDs.

Risks of flavored nicotine and nicotine-free substances on adolescents

Nicotinic substances, tobacco, and vape pods have been widely used in electronic cigarettes that have been increasing in global popularity among adolescents. Global rise in electronic cigarettes and vaping devices are mainly being promoted through social media platforms such as Instagram advertisements and TikTok commercials1,2. Particularly, the inhalation (vaping) of electronic cigarettes contains toxic particles such as nicotine combined with various flavors that are delivered to the lungs and brain. Chronic vaping of toxic particles can cause addiction, dyspnea, cough, chest pain, and increased risks of hypoxemia3,4. Recent commercials promote non-nicotine (0 mg) vape pods consisting of harmful particles that target adolescents to smoke electronic cigarettes and to keep up with current societal norms1,4. Ultrafine particles found in vaping products can harm vital organs such as the lungs, and gastrointestinal tract, and cause neurological dependence on flavored nicotinic substances3,4. A recent study by Smith and colleagues includes computed tomography images of the lungs when exposed to 90 days of smoking electronic cigarette particles to cause acute lung injury. The computed tomography images show ground-glass opacities associated with consolidation in the lungs that can clinically manifest as hypersensitivity pneumonitis, alveolar hemorrhage, and/or respiratory bronchiolitis interstitial lung disease3. Flavored inhalation of nicotine or nicotine-free substances increases the risks of lung injury and can cause oxidative stress in the body. A similar study by Caporale and colleagues emphasizes the toxicity of non-nicotine electronic cigarettes to impact the endothelial function of a healthy nonsmoker. Specifically, the study highlights when nonsmokers went through magnetic resonance imaging before and after inhaling nicotine-free cigarette aerosol, there was vascular resistance in the arterioles which resulted in lowering venous hemoglobin saturation that may be a result of hypoxemia. Regardless of smoking, nicotine or nicotine-free substances some microparticles can penetrate the blood-brain barrier, which can cause adverse reactions such as neuroinflammation and neurotoxicity4. Therefore, limiting electronic cigarettes in the market should be implemented to promote the healthy development of adolescents. Should the government implement school classes to educate adolescents about the dangers of electronic cigarettes? The benefits of public awareness about the toxicity of vaping outweigh the potential government spending that may be required. Educating the youth about the dangers of vaping can limit its usage and can promote normal adolescent development. However, there is a rise in non-nicotine vape pods, which were originally introduced to assist chronic smokers in quitting conventional cigarettes. Now nicotine-free vape pods are being used as a stepping stone for young individuals to start vaping and potentially use products with nicotine. Some suggestions to counter the rise of vaping can be to increase the prices of electronic cigarettes, raise taxes on each purchase, increase the minimum age to buy vaping devices, and monitor social media advertisements. Another way to curb and limit the usage of nicotine vaping devices in the community is to dispense electronic cigarettes with medical prescriptions. Moreover, a common problem that educational institutions may face is the rise in social media trends that use vaping as a way for students to bond with one another. To counter this trend, institutions should ensure healthier social groups by introducing clubs such as sports, gaming, drama, art, and cooking, or promoting any gathering of students’ interest that avoids inhalation or ingestion of toxic microparticles. Therefore, electronic cigarettes should be difficult to purchase for adolescents and further research is necessary on non-nicotine vaping devices and the potential pathologic problems that could cause chronic diseases or halt normal development. Ethical approval None. Sources of funding None. Author contributions T.Z.: conceptualization, literature review, writing—original draft, writing—reviewing and editing of the manuscript. A.A.S.: literature review, writing—original draft. D.R.: literature review, revising, and editing of the manuscript. M.M.: literature review and revising the manuscript. Conflicts of interest disclosure The authors declare that they have no financial conflict of interest with regard to the content of this report. Guarantor Tayyab Zahoor. Consent None.

An in vitro evaluation of e-vapor products: The contributions of chemical adulteration, concentration, and device power.

Homemade e-liquids and power-adjustable vaping devices may carry higher risks than commercial formulations and fixed-power devices. This study used human macrophage-like and bronchial epithelial (NHBE) cell cultures to investigate toxicity of homemade e-liquids containing propylene glycol and vegetable glycerin (PG/VG), nicotine, vitamin E acetate (VEA), medium-chain fatty acids (MCFAs), phytol, and cannabidiol (CBD). SmallAir™ organotypic epithelial cultures were exposed to aerosols generated at different power settings (10-50 W). Carbonyl levels were measured, and endpoints reflecting epithelial function (ciliary beating frequency [CBF]), integrity (transepithelial electrical resistance [TEER]), and structure (histology) were investigated. Treatment with nicotine or VEA alone or with PG/VG did not impact cell viability. CBD, phytol, and lauric acid caused cytotoxicity in both culture systems and increased lipid-laden macrophages. Exposure of SmallAir™ organotypic cultures to CBD-containing aerosols resulted in tissue injury and loss of CBF and TEER, while PG/VG alone or with nicotine or VEA did not. Aerosols generated with higher power settings had higher carbonyl concentrations. In conclusion, the presence and concentration of certain chemicals and device power may induce cytotoxicity in vitro. These results raise concerns that power-adjustable devices may generate toxic compounds and suggest that toxicity assessments should be conducted for both e-liquid formulations and their aerosols.

Understanding the influence of atomizing power on electronic cigarette aerosol size and inhalation dose estimation.

Although many studies have estimated the inhalation dose of aerosols emitted from electronic cigarettes (e-cigs), the association between the atomizing power and inhalation dose of e-cig aerosols has not been fully examined. The aim of this study was to determine the mass and inhalation doses of e-cig aerosols and their association with the atomizing power of vaping devices. Size-segregated aerosol masses were collected using an 11-stage cascade impactor and the deposition dose in the human respiratory tract was estimated using the size-segregated aerosol mass. The results showed that an increase in atomizing power was positively associated with the amount of aerosol mass generated (p-value < 0.001). The mass median aerodynamic diameter and mass mean diameter of aerosol were 0.91 μm and 0.84 μm, respectively. The average deposition fractions of aerosols in the head airway, tracheobronchial region, and alveolar region were 67.2, 6.2, and 26.6%, respectively. In conclusion, vaping with a higher atomizing power increases the e-cig aerosol inhalation dose in the airway.

An examination of quitting smoking as a reason for vaping by the type of nicotine vaping device used most often among adults who smoke and vape: Findings from the Canada, England and the United States 2020 ITC Smoking and Vaping Survey

Several nicotine vaping product (NVP) device types are available to consumers, and many people who smoke report vaping to help them quit. This study included data from the Wave 3 (2020) ITC Smoking and Vaping Survey in the US, Canada, and England and included 2324 adults who were smoking cigarettes and vaping at least weekly. Device types currently used most often (disposables, cartridges/pods, or tank systems) were assessed using weighted descriptive statistics. Multivariable regression analyses were used to compare differences between respondents who reported vaping to quit smoking (‘yes’ vs. ‘no/don’t know’) by device type, overall and by country. Overall, 71.3% of respondents reported vaping to help them quit smoking, with no country differences (p = 0.12). Those using tanks (78.7%, p < 0.001) and cartridges/pods (69.5%, p = 0.02) were more likely to report this reason for vaping than those using disposables (59.3%); respondents using tanks were also more likely than those using cartridges/pods (p = 0.001) to report this reason. By country, respondents in England using cartridges/pods or tanks (vs. disposables) were more likely to report vaping to quit smoking (with no difference between cartridges/pods and tanks). In Canada, respondents using tanks were more likely to report vaping to quit smoking than those using cartridges/pods or disposables (no difference between disposables and cartridges/pods). No significant differences by device type were found in the US. In conclusion, most adult respondents who smoked and vaped reported using either cartridges/pods or tanks, which were associated with greater odds of vaping for the purpose of quitting smoking versus disposables, with some country variations.

Does India's Ban on Electronic Cigarettes Improve Public Health Outcomes?

&#x0D; In 2019, India banned Electronic Nicotine Delivery Systems (ENDS) – a broad category that includes electronic cigarettes, vaping devices, and Heat Not Burn (HNB) devices – because of concerns about health impacts, youth vulnerability, and their potential to undermine tobacco control efforts. This is a missed public health opportunity to reduce tobacco consumption, if ENDS actually help reduce and wean users off nicotine dependency in less harmful ways. This paper applies a risk analysis framework to examine whether India’s ban on ENDS improves public health outcomes, or whether an alternative approach such as regulation would be more effective. It studies global responses and compares how public health goals are served in the United States of America and the United Kingdom, based on four key parameters of concern – health impacts, normalisation of ENDS usage among non-smokers, appeal among youth, and device safety. This comparison demonstrates that the United Kingdom’s regulation-focused approach delivers superior outcomes across all four parameters. Thus, the evidence-based recommendation for India would be to regulate at least HNB devices under the Cigarettes and Other Tobacco Products Act (as they utilise tobacco), as this can help reduce harm and promote innovation in devices that can wean users off nicotine dependence.&#x0D;

Abstract 6472: Self-reported knowledge of Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) potency in cannabis products among cancer patients and survivors: Results from a survey of cannabis consumers at an NCI-designated cancer center

Abstract Background: Cannabis use may introduce risks and/or benefits to cancer patient treatment and survivorship, depending on product type, composition and nature of its use. Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) are two primary cannabinoids that elicit therapeutic effects, but only THC has abuse potential, highlighting the importance of patient knowledge of cannabinoid potency in patient-provider interactions and provider risk-benefit assessments. This study aims to understand factors associated with knowledge of THC or CBD potency in cannabis products among a sample of cancer patients and survivors who consumed cannabis since diagnosis. Methods: Data were analyzed from a random sample of cancer patients and survivors using cannabis (n=343) and completed an anonymous, mixed-mode survey at Roswell Park. Survey questions asked about modes of use post-cancer diagnosis including smoking (joints/bongs/pipes/blunts), vaping (e-cigarettes/other vaping device), eating cannabis (foods/drinks), and taking orally (pills/tinctures/sublingually), and knowledge of cannabinoid potency was defined as knowing THC or CBD (mg or %) against no knowledge. Chi-square and separate multivariable logistic regression analyses for the most prevalent modes of cannabis use (smoking and eating) were examined to determine factors associated with knowledge of THC and CBD potency. Models controlled for acquisition source (informal; unlicensed seller vs formal; licensed seller), cannabis use instruction source (informal; personal vs formal; healthcare professional), current use status, and educational attainment. Results: Prevalence of cannabis use following cancer diagnosis was 26.5% (20.9% among patients in active treatment; 29.2% among survivors). Among consumers, eating cannabis foods/drinking cannabis beverages was the most prevalent mode of delivery (58.6%), followed by smoking cannabis in joints (52.8%), vaping (30.3%), and taking oral pills, tinctures, or sublingually (29.2%). Overall, 27.2% had knowledge of THC and CBD potency of the products that they consumed. Those who smoked cannabis had the lowest rates (7.8% &amp; 3.9%) followed by those eating cannabis foods/drinks (15.0% &amp; 7.0%). Controlling for other factors, knowledge of THC and CBD potency showed significant associations with cannabis acquisition source, cannabis use instruction source, and current use status. Conclusions: Overall, cancer patients and survivors who use cannabis have low levels of knowledge of THC and CBD potency. These data reinforce the need for provider awareness. Relying on patient self-report of THC and CBD potency is unlikely to provide key information that providers require to assess risks and benefits of cannabis use in relation to cancer symptom management. Citation Format: Michelle Goulette, Nicolas J. Schlienz, Amy Case, Eric Hansen, Rebecca L. Ashare, Maciej Goniewicz, Maansi Bansal-Travers, Andrew Hyland, Danielle M. Smith. Self-reported knowledge of Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) potency in cannabis products among cancer patients and survivors: Results from a survey of cannabis consumers at an NCI-designated cancer center [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6472.

Pattern and prevalence of vaping nicotine and non-nicotine drugs in the United Kingdom: a cross-sectional study

ObjectivesElectronic vaping devices are being used to consume nicotine and non-nicotine psychoactive drugs. We aimed to determine the pattern and prevalence of using vaping devices for nicotine and/or non-nicotine drug...

Sex Differences in Electronic Cigarette Device Use Among College Students.

Electronic cigarette use (vaping) has reached epidemic levels in the United States among teenagers and young adults. However, there is apaucity of studies that have examined the relationships between e-cigarette device types and user characteristics. Therefore, the main objective of this study was to characterize e-cigarette device use among a college population with a focus on sex differences in preferred vaping device. We employed a Qualtrics-based smartphone/online survey to gather responses on e-cigarette use; including device type, demographics and other related information during the period October 1, 2020 to January 30, 2022 in the Birmingham, AL metropolitan area. Participants were recruited via flyers with a QR code to the survey. The differences in e-cigarette device type used by the characteristics of the university e-cigarette users were assessed using either a Chi-square analysis or Fisher's Test. The magnitude of any association between the characteristics of the participants and vaping device used was analyzed via logistic regression. Out of 394 students who participated in the survey, 61 reported current exclusive e-cigarette use (15.5%) among our 18-24-year-old college student sample. Among vapers; more females reported use of Disposable e-cigarettes or Juul (pod-type) as their primary vaping device compared to males, who preferred Tanks and Mods + other rechargeable e-cigarettes (p < 0.05). Males also vaped more days per week compared to females. Vaping among young college students remains at concerning levels. The primary vaping device used significantly varies by the users' sex, making it an important factor to consider in future studies.

Toxicological Assessment of Particulate and Metal Hazards Associated with Vaping Frequency and Device Age.

Electronic nicotine delivery systems (ENDS) aerosols are complex mixtures of chemicals, metals, and particles that may present inhalation hazards and adverse respiratory health risks. Despite being considered a safer alternative to tobacco cigarettes, metal exposure levels and respiratory effects associated with device aging and vaping frequency have not been fully characterized. In this study, we utilize an automated multi-channel ENDS aerosol generation system (EAGS) to generate aerosols from JUUL pod-type ENDS using tobacco-flavored e-liquid. Aerosol puff fractions (1-50) and (101-150) are monitored and sampled using various collection media. Extracted aerosols are prepared for metal and toxicological analysis using human primary small airway epithelial cells (SAEC). ENDS aerosol-mediated cellular responses, including reactive oxygen species (ROS), oxidative stress, cell viability, and DNA damage, are evaluated after 24 h and 7-day exposures. Our results show higher particle concentrations in later puff fractions (0.135 mg/m3) than in initial puff fractions (0.00212 mg/m3). Later puff fraction aerosols contain higher toxic metal concentrations, including chromium, copper, and lead, which elicit increased levels of ROS followed by significant declines in total glutathione and cell viability. Notably, a 30% increase in DNA damage was observed after 7 days because of later puff fraction exposures. This work is consistent with ENDS aerosols becoming more hazardous across the use of pre-filled pod devices, which may threaten respiratory health.

Smoking, e-cigarettes and the effect on respiratory symptoms among a population sample of youth: Retrospective cohort study.

E-cigarettes have been steadily increasing in popularity, both as cessation methods for smoking and for recreational and social reasons. This increase in vaping may pose cardiovascular and respiratory risks. We aimed to assess respiratory symptoms in youth users of e-cigarettes and cigarettes. A retrospective survey design was utilized to assess Canadian youth aged 16-25 years. Participants were recruited from the Ontario Tobacco Research Unit Youth and Young Adult Research Registration Panel November 2020 to March 2021. A total of 3082 subjects completed the baseline survey. Of these, 2660 individuals who did not have asthma were included in the analysis. The exposure of interest was pack-equivalent years, a novel measure of vaping exposure equivalent conceptually to cigarette pack years incorporating number of puffs per day, number of days vaped per month, and number of years vaped. Respiratory symptoms were measured using the five-item Canadian Lung Health Test. Poisson regression analyses were performed while adjusting for demographic confounders, stratified by smoking status. A non-stratified model tested the interaction of status and vaping dose and the effect of vaping device used was assessed among ever vapers. Analyses controlled for demographic characteristics, use of cannabis and alcohol, and survey date. Each additional puff year increased the rate ratio (RR) of respiratory symptoms by a factor of 11.36 (95% CI: 4.61-28.00; p<0.001) for never smokers, but among current daily smokers higher pack-equivalent years were not associated with more respiratory symptoms (RR=0.83; 95% CI: 0.23-3.11). Among current vapers, those using pod-style devices were more likely to have more respiratory symptoms (RR=1.25; 95% CI: 1.08-1.45) after adjusting for dose. Vaping is associated with an increased risk of reporting respiratory symptoms among never smoking youth and non-daily ever cigarette smokers. Use of e-cigarettes among non-smokers should be discouraged.

Assessing Adolescent Vaping Norms and Perceptions in a Statewide Multi-Community Project

Background: Adolescent e-cigarette use has increased dramatically in recent years and is quickly becoming a serious public health issue. While studies have identified the influence of social norms on the use of traditional cigarettes, few have examined these factors in the context of e-cigarettes and other vaping devices. Objective: The goal of this study was to examine social norms predictors of past 30-day e-cigarette use among high school students in 10 communities located in Minnesota. Results: In our sample (N = 3,285), students who believe most students in their school vape daily are more likely to have vaped in the past 30 days than those who believe most students vape weekly or less frequently. Further, students were likely to have used e-cigarettes in the past 30 days if they perceived that most students approved of vaping (i.e., they disagreed with the statement that, “vaping is not a good thing for anyone their age to do”). Findings from this study highlight social norms related to perceptions that increase the likelihood of past 30-day e-cigarette use. Conclusions: Results from this study lend themselves to norms-based prevention science strategies that are critical to reducing e-cigarette use among high school students.

Adolescents Who Vape Nicotine and Their Experiences Vaping: A Qualitative Study.

Understanding adolescent perceptions of vaping and roles it plays in their lives is needed to design effective interventions to help adolescents quit. We explored vaping experiences of 11 adolescents from initiation through quit attempts. A convenience sample of students who vaped in the last 90 days was recruited from one suburban high school in Massachusetts. Qualitative interviews were transcribed and coded. An inductive thematic analysis approach was employed. Areas of agreement and range of responses in code reports were summarized. Eleven open-ended semi-structured interviews were conducted (mean = 32.5 minutes each). Vaping initiation often occurred when socializing with friends who also supplied vaping devices. Vaping was "something to do" and new flavors engaged adolescents further. Solitary activities coupled with vaping included video gaming, getting ready for school, talking on the phone, or studying. Peak hours for vaping included morning, before and after school, before parents returned from work, and after parents went to bed. Several vaped to address anxiety/stress. For some, anxiety control was a main reason for vaping. Participants were concerned about health effects and nicotine dependence. Cost and health effects were drivers of quitting. Quit strategies relied on willpower and distraction. Peers have powerful influences on the initiation and maintenance of adolescent vaping. Vaping habits can become routinized into adolescent lives. Addiction is a concern although nicotine's anxiolytic effects were valued by many. Social connection was enhanced by communal vaping, sharing, and common vernacular, secrecy and rule-breaking. We describe the context in which adolescents vape nicotine, their reasons for vaping, and reasons to quit. This information can inform the development of interventions to better address adolescents' triggers to vape, and social and psychosocial barriers to quitting. Our findings suggest a desire to quit vaping but a limited awareness of quitting strategies.

Describing Memes Referencing Vaping: Thematic Analysis

Background: Memes, images or videos with text overlay that embody a concept or belief about the contemporary society, are endemic to Internet culture, are popular among youth and diffuse rapidly across social media platforms. E-cigarettes and vaping have grown in popularity in the era of Internet culture however there is little research describing the intersection of memes and vaping. This is an important gap in the literature as memes may be part of the broader online e-cigarette information landscape that can normalize vaping among young people. Memes could also point to emerging trends in product preferences. This study content analyzed memes to identify key themes, characters and vape products depicted therein. Methods: Data were drawn from a sub-reddit devoted to vaping-related memes. Memes were electronically copied from the forum to analyze (n = 527). Using an inductive approach, the research team identified 14 themes. Results: In-group communication (n = 202, 38.33%) was the most predominant theme followed by Critique of vaping regulations and public perceptions (n = 76, 14.42%), and Vape device modifications and hacks (n = 62, 11.76%). Memes included Cartoons (n = 124, 23.53%), Celebrities (n = 75, 14.23%), and Fictional characters (n = 53, 10.06%). Memes referenced Tanks or mods (n = 120, 22.77%), Component parts (n = 96, 18.22%) and E-liquids/Nicotine salts (n = 81, 15.37%). Conclusion: Memes referenced in-group communication and cartoons among other youth friendly images, raising concern about the potential to normalize vaping-related behaviors. Future research should monitor emerging vape devices and determine the impact of memes on attitudes and behaviors among adolescents and young adults. Implications: Given the popularity and reach of memes among youth, continuous monitoring of vaping-related memes may reveal aspects that may be addressed in vaping prevention campaigns.

Electronic cigarettes for smoking cessation.

Electronic cigarettes for smoking cessation.