JUUL's 2019 Removal of Mint-Flavored Pods and Changes to the Retail Environment of Electronic Nicotine Delivery Systems in Florida and the United States

E-Cigarette Brand Use by Race/Ethnicity in a US Sample of Adolescent and Young Adult E-Cigarette Users, 2022-2023

INTRODUCTION

To determine whether e-cigarette brand use varies according to race/ethnicity among adolescent and young adult e-cigarette users.

AIMS AND METHODS

Data are from a cross-sectional online survey of respondents aged 15-24 years (January 2022-June 2023; 300 unique respondents/week). The analytic sample was restricted to current e-cigarette users (n = 6387). Respondents selected their usual brand and reported frequency of past 30-day e-cigarette use (in days). ANOVAs measured differences in frequency of use by usual brand, stratified by race/ethnicity. Linear regression identified changes in usual brand over time by race/ethnicity, controlling for age and use of other tobacco/nicotine products.

RESULTS

One-quarter (25.6%) of Black and 22.2% of Hispanic e-cigarette users reported JUUL as their usual brand, compared to those who are White (15.7%) or another race (16.5%). Puff Bar was the second-most reported brand among Black (15.1%) or Hispanic (16.6%) e-cigarette users, to a greater extent than White (7.8%) e-cigarette users. Frequency of use varied significantly according to respondents' usual brand when stratified by race/ethnicity (p < .001).

CONCLUSIONS

Across all racial and ethnic categories, frequency of use was greater for brands marketed with more flavor options and containing nicotine (EB Design, SMOK, Hyde, and Vuse). Despite declines in popularity, Black or Hispanic respondents report using JUUL and Puff Bar to a greater extent than other respondents, and vape less frequently than White non-Hispanic respondents regardless of brand. As e-cigarette brands continue to proliferate, monitoring e-cigarette brand selection by race/ethnicity can inform studies of nicotine exposure, polyuse, and health disparities.

IMPLICATIONS

Our study demonstrates the importance of research methods to detect rapidly changing patterns of e-cigarette use by race/ethnicity and age. The inclusion of measures capturing brand use can detect evidence of product features and targeted marketing that may have consequences for patterns of tobacco use and nicotine exposure among these groups.

Interest in quitting e-cigarette use by device type and smoking history in US adults

BACKGROUND

The use of e-cigarettes has been increasing, especially since the introduction of 'pod' devices to the marketplace since 2018. Most adults who vape report interest in quitting. The present study examined level of interest in e-cigarette cessation between users with varying cigarette smoking histories and device types.

METHODS

Data obtained from wave 5 (2018-2019) of the Population Assessment of Tobacco and Health study (n=34 309). Analyses were conducted on adult current established e-cigarette users, categorised on cigarette smoking history (current, former or never) and device type (disposable, cartridge/pod, tank or mod). Participants reported if they planned to ever quit e-cigarettes, attempted to quit in the past year and attempted to quit by cutting back in the past year.

RESULTS

Of the 2922 established e-cigarette users, 68.21% reported plans to quit vaping; 17.27% reported attempting to quit e-cigarettes in the past year; and 29.28% reported attempting to quit by cutting back in the past year. Cartridge users had higher odds of interest in quitting than tank and mod users. Disposable and cartridge users had higher odds of reporting a past year quit attempt than tank and mod users. Individuals with no smoking history had higher odds of reporting a past year quit attempt or cutting back relative to those reporting dual use (of both e-cigarettes and cigarettes) and former smoking.

CONCLUSIONS

Tobacco control should consider the type of e-cigarette device that is being used, alongside users' cigarette smoking history, when developing interventions and other resources for vaping cessation.

Understanding the Cardiovascular Fallout of E-cigarettes: A Comprehensive Review of the Literature

E-cigarettes (ECs) deliver chemicals, including nicotine. They can cause respiratory distress, addiction, cardiovascular effects, and death. More research is needed, especially regarding their impact on the cardiovascular system (CVS) and during pregnancy. Our article aims to fill this gap by summarizing studies elaborating upon the current impact of ECs and the components thereof on the CVS. Acute respiratory distress outbreaks, nicotine addiction, CVS effects, and deaths have been occasionally reported within this cohort, although these events are not uncommon with neighboring age groups. Randomized control trials implying ECs have some contribution toward quitting smoking have been studied. To regulate EC distribution, the Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) have created key checkpoints. Additionally, taxation, pricing, age restriction, and media campaigns could be modulated to significantly reduce illicit sales. Education to the users, distributors, and regulators about this product can also play an aiding role in promoting responsible EC use. Another strategy about licensing could be employed, which could incentivize genuine resellers. The effects on CVS and child-bearing by ECs are grim, which calls for strict regulation, awareness, and avoidance by the teetotaler public. They may help individuals stop smoking but not without harming themselves. Strict regulations are necessary to prevent non-judicious use of these devices.

A Patchy Prohibition: Product and Flavor Substitution After the Food and Drug Administration's Prioritized Enforcement Policy on Flavored E-cigarettes

INTRODUCTION

E-cigarettes have rapidly grown in use among U.S. adolescents; in response, the Food and Drug Administration (FDA) engaged in an "enforcement policy on banned e-cigarette flavors" ("enforcement action") for pod-based e-cigarettes in January 2020, which accounted for most U.S. e-cigarette sales. No literature has yet examined long-term changes in e-cigarette sales patterns changed in relation to the FDA enforcement action.

AIMS AND METHODS

We analyzed U.S. e-cigarette sales using Nielsen retail scanner data between March 2017 and December 2021, describing e-cigarette sales trends overall, by device type, and by flavor category. We also performed joinpoint regression analysis on the sales trends to detect significant changes in the rate of change of sales over time.

RESULTS

The FDA enforcement action was associated with a sharp initial decrease in prefilled pod dollar sales, followed by a steady increase from April 2020 through the end of 2021, growing beyond the previous maximum in August 2019. We also observed a dramatic change in the composition of flavors sold: A large decline in mint-flavored pod sales was offset by a similar increase in menthol-flavored sales. Simultaneously, disposable product sales increased nearly ten-fold from July 2019 to July 2020 before stabilizing, dominated by fruit-flavored products.

CONCLUSIONS

Our findings suggest rapid product substitution without a long-term decline in e-cigarette sales in association with the enforcement action, along with a growing dominance of youth-friendly flavors, contrasting against FDA policy goals. Our study revealed the weakness of the "patchy" enforcement action, raising concern about its unintended consequences as consumption simply shifted to other e-cigarette products.

IMPLICATIONS

This is the first detailed longitudinal study on e-cigarette sales trends in the United States following the FDA flavor enforcement action, with novel findings on flavor trends and their relation to policy events. We report sales overall, by product type, and by flavor category, and highlight several important trends following the action, such as the rise and persistence of disposable e-cigarettes increasingly and overwhelmingly dominated by youth-friendly flavors, and likely substitution of prefilled e-cigarette flavors without any long-term decline in sales. Our results highlight the weaknesses of "patchy" regulation and suggest the need for a more comprehensive approach to flavor regulation.

Changes in Sales of Vaping Products and Cigarettes Associated With the New York State Flavored Vaping Product Sales Restriction

INTRODUCTION

New York (NY) implemented a statewide restriction on the retail sale of flavored vaping products to reduce availability of vaping products having youth-appealing flavors in 2020. We assessed the intended effects of the NY law on sales of flavored vaping products and explored whether policy implementation had unintended effects on consumer behavior by evaluating policy-associated changes in sales of combusted cigarettes, which could serve as more harmful substitute products for NY consumers of flavored vaping products.

AIMS AND METHODS

We analyzed custom product-level weekly retail tobacco sales scanner data for NY and a comparison state (California [CA]) for convenience stores and other outlets from June 2018 through June 2021. We categorized flavor descriptors for vaping products as flavored or as tobacco or unflavored and categorized cigarettes as menthol or non-menthol. We used a difference-in-difference model to assess the effect of the sales restriction on unit sales of flavored and unflavored vaping products and menthol and non-menthol cigarettes in NY compared with CA.

RESULTS

Following NY policy implementation, flavored and total vaping product sales decreased in NY relative to CA. Unflavored vaping product sales increased in NY, while menthol cigarette sales did not change significantly relative to CA sales.

CONCLUSIONS

The NY flavored vaping product policy was associated with fewer sales of flavored and total vaping products. The increase in sales of unflavored vaping products did not suggest complete substitution, and sales data suggest that consumers did not turn to cigarettes after flavored vaping products became unavailable.

IMPLICATIONS

This study provides evidence that NY's flavored vaping product policy is associated with reduced flavored vaping product access and sales. Our analyses of potential unintended consequences indicate that some consumers switched from flavored to unflavored vaping products, but that cigarette sales did not change concurrent with the policy which means that decreased availability of flavored vaping products did not result in vapers switching to cigarettes. NY's policy had its intended effect with limited unintended consequences.

Electronic nicotine delivery systems (ENDS) dependence among Texas Young Adults, 2014-2019: Increasing trajectory after the 2017 surge in vape pod popularity

INTRODUCTION

Use of electronic nicotine delivery systems (ENDS) increased significantly after 2017. The increase is attributed to a surge in popularity of vape pods containing nicotine salts, which are high nicotine concentration ENDS that may heighten risk for dependence. However, little is known about changes in ENDS dependence before and after the 2017 surge. We examined the trajectory of ENDS dependence among young adults from 2014 to 2019.

METHODS

Participants were 1700 18-25-year-olds (57.6 % female) from 24 Texas colleges who reported past 30-day ENDS use in at least one of eight study waves. ENDS dependence was assessed at all waves with one item, use of ENDS within 30 min of waking. A discontinuous growth curve model was fit to test the hypothesis that the ENDS dependence trajectory would increase only after 2017, from 2018 to 2019. The model included socio-demographic and cigarette dependence covariates RESULTS: The proportion of young adults reporting ENDS dependence ranged from 2.3 % in 2014 to 8.2 % in 2019. Results from the discontinuous growth curve model indicated that the ENDS dependence trajectory was flat from fall 2014 to spring 2017. However, the post-2017 trajectory, from spring 2018 to spring 2019, was positive and significant indicating that the proportion of young adults reporting ENDS dependence increased after 2017.

CONCLUSIONS

The increase in ENDS dependence after 2017 likely resulted from the surge in popularity of vape pods containing nicotine salts. These vape pods are a disruptive technology that may result in more young adults developing nicotine dependence symptoms than do earlier generation devices.