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He Y, Yang Q, Alish Y, Ma S, Qiu Z, Chen J, Wagener T, Shang C. Relationship Between Product Features and the Prices of e-Cigarette Devices Sold in Web-Based Vape Shops: Comparison Study Using a Linear Regression Model. JMIR Form Res 2024; 8:e49276. [PMID: 38723251 PMCID: PMC11117130 DOI: 10.2196/49276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 02/07/2024] [Accepted: 03/01/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Open-system electronic cigarette (EC) product features, such as battery capacity, maximum output wattage, and so forth, are major components that drive product costs and may influence use patterns. Moreover, continued innovation and monitoring of product features and prices will provide critical information for designing appropriate taxation policies and product regulations. OBJECTIVE This study will examine how product features are associated with the prices of devices sold in web-based vape shops. METHODS We draw samples from 5 popular, US-based, web-based vape shops from April to August 2022 to examine starter kits, device-only products, and e-liquid container-only products. We implemented a linear regression model with a store-fixed effect to examine the association between device attributes and prices. RESULTS EC starter kits or devices vary significantly by type, with mod prices being much higher than pod and vape pen prices. The prices of mod starter kits were even lower than those of mod devices, suggesting that mod starter kits are discounted in web-based vape shops. The price of mod kits, mod device-only products, and pod kits increased as the battery capacity and output wattage increased. For vape pens, the price was positively associated with the volume size of the e-liquid container. On the other hand, the price of pod kits was positively associated with the number of containers. CONCLUSIONS A unit-based specific tax, therefore, will impose a higher tax burden on lower-priced devices such as vape pens or pod systems and a lower tax burden on mod devices. A volume- or capacity-based specific tax on devices will impose a higher tax burden on vape pens with a larger container size. Meanwhile, ad valorem taxes pegged to wholesale or retail prices would apply evenly across device types, meaning those with advanced features such as higher battery capacities and output wattage would face higher rates. Therefore, policy makers could manipulate tax rates by device type to discourage the use of certain device products.
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Affiliation(s)
- Yanyun He
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Qian Yang
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Yousef Alish
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States
| | - Shaoying Ma
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Zefeng Qiu
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH, United States
| | - Jian Chen
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH, United States
| | - Theodore Wagener
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Medical Oncology Division, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Ce Shang
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Medical Oncology Division, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
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2
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Buckell J, Fucito LM, Krishnan-Sarin S, O'Malley S, Sindelar JL. Harm reduction for smokers with little to no quit interest: can tobacco policies encourage switching to e-cigarettes? Tob Control 2023; 32:e173-e179. [PMID: 35046127 PMCID: PMC9347898 DOI: 10.1136/tobaccocontrol-2021-057024] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/15/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE A pressing tobacco policy concern is how to help smokers who have little interest in quitting cigarettes, a group that often suffers severe health consequences. By switching from cigarettes to e-cigarettes, they could obtain nicotine, potentially with less harm. We examined if policy-relevant attributes of cigarettes/e-cigarettes might encourage these smokers to switch to e-cigarettes. METHODS An online survey and discrete choice experiment on a nationally-representative sample of adult smokers in the US who reported low interest in quitting (n=2000). We modelled preference heterogeneity using a latent class, latent variable model. We simulated policies that could encourage switching to e-cigarettes. RESULTS Participants formed two latent classes: (1) those with very strong preferences for their own cigarettes; and (2) those whose choices were more responsive to policies. The latter group's choices were only somewhat responsive to menthol cigarette bans and taxes; the former group's choices were unresponsive. CONCLUSIONS The policies studied seem unlikely to encourage harm reduction for individuals with little interest in quitting smoking.
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Affiliation(s)
- John Buckell
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Lisa M Fucito
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Stephanie O'Malley
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jody L Sindelar
- Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
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3
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Venrick SJ, Kelley DE, O'Brien E, Margolis KA, Navarro MA, Alexander JP, O'Donnell AN. U.S. digital tobacco marketing and youth: A narrative review. Prev Med Rep 2023; 31:102094. [PMID: 36820374 PMCID: PMC9938337 DOI: 10.1016/j.pmedr.2022.102094] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/12/2022] [Accepted: 12/17/2022] [Indexed: 12/23/2022] Open
Abstract
We describe findings from peer-reviewed articles on digital tobacco marketing (DTM) using U.S. data related to youth, including research that examines use of age restrictions, DTM exposure and engagement, and associated tobacco use. We searched PubMed, EMBASE, Web of Science, and EBSCOhost in May 2019 and May 2020 for published English language peer-reviewed articles examining DTM that were published from January 2016 to May 2020. Inclusion coding occurred in three stages. The first search identified 519 articles; 167 were coded for inclusion. The second search identified 189 articles; 67 were coded for inclusion. Two coders then assessed whether the included articles mentioned youth (age 18 and younger) or age restrictions in the method and results sections of the full text. Ultimately, 47 articles were included in this review. A codebook was developed and tested through training. Each article was coded for age restrictions, youth exposure to DTM, youth engagement with DTM, and youth tobacco use associated with DTM exposure or engagement. The studies reviewed indicate that DTM on social media was infrequently age-restricted and the stringency of age restriction varied by tobacco product, site owner, and channel. Youth reported being exposed to DTM frequently via the Internet. While youth reported less frequently engaging with DTM compared to being exposed, engagement increased over time. DTM exposure and engagement were associated with tobacco product use. The studies reviewed document an association between DTM exposure and engagement and future tobacco use; thus, DTM may be contributing to the youth tobacco epidemic.
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Affiliation(s)
- Samantha J. Venrick
- US Food and Drug Administration, Center for Tobacco Products, Office of Science, Silver Spring, MD, United States
| | - Dannielle E. Kelley
- US Food and Drug Administration, Center for Tobacco Products, Office of Science, Silver Spring, MD, United States
| | - Erin O'Brien
- US Food and Drug Administration, Center for Tobacco Products, Office of Health Communication and Education, Silver Spring, MD, United States
| | - Katherine A. Margolis
- US Food and Drug Administration, Center for Tobacco Products, Office of Science, Silver Spring, MD, United States
| | - Mario A. Navarro
- US Food and Drug Administration, Center for Tobacco Products, Office of Health Communication and Education, Silver Spring, MD, United States
| | - Jennifer P. Alexander
- US Food and Drug Administration, Center for Tobacco Products, Office of Science, Silver Spring, MD, United States
| | - Allison N. O'Donnell
- US Food and Drug Administration, Center for Tobacco Products, Office of Health Communication and Education, Silver Spring, MD, United States
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4
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Jongenelis MI. E-cigarette product preferences of Australian adolescent and adult users: a 2022 study. BMC Public Health 2023; 23:220. [PMID: 36726091 PMCID: PMC9893577 DOI: 10.1186/s12889-023-15142-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/12/2023] [Accepted: 01/25/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Research that comprehensively documents preferences for different types of novel nicotine products in Australia is lacking, making it difficult for policymakers to determine where public health efforts should be focused. This study thus sought to explore Australian adolescent and adult e-cigarette users' preferences for different types of e-cigarettes and e-liquids. Purchasing behaviours and sources of e-liquid were also examined. METHODS An online survey was administered to 4,617 Australians aged 12 + years, 636 of whom had used an e-cigarette in the last 30 days and were the focus of this study. Among users, 45% also smoked tobacco cigarettes, 41% were non-smokers, and 14% had never smoked. RESULTS The majority (82%) of e-cigarette users surveyed reported using nicotine-containing e-liquid in their devices. Fewer (60%) reported using non-nicotine e-liquid. The preference for nicotine over non-nicotine e-liquid was observed among all age and smoking groups. Most users (89%) reported using flavoured e-liquids, with adolescents (96%) significantly more likely than young adults (90%) and adults aged 25 + years (85%) to report using such e-liquids. Fruit flavours were the most popular among all subgroups. In terms of device type, disposable e-cigarettes were the most common product used among almost all groups; the exception being adults aged 25 + years who preferred systems with refillable tanks. Friends and tobacco retailers were the most frequently nominated sources of nicotine e-liquid among adolescents and young adults. Among adults aged 25 + years, tobacco retailers and the Internet were the most frequently nominated sources of these products. CONCLUSION Disposable e-cigarettes with flavoured, nicotine-containing e-liquid are popular among users of the devices, including adolescents. Measures that restrict the accessibility and availability of flavoured e-liquids and disposable e-cigarettes, and greater enforcement of laws regarding the sale and importation of nicotine e-liquids, are urgently needed to protect youth and never smokers from these products.
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Affiliation(s)
- Michelle I Jongenelis
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, University of Melbourne, 3010, Parkville, VIC, Australia.
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5
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Jensen JLK, Rebentisch K, Tripp HL, Merten JW. Price, convenience, the buying experience, and other motivations for purchasing tobacco and e-cigarettes online. Tob Induc Dis 2022; 20:74. [PMID: 36118561 PMCID: PMC9437897 DOI: 10.18332/tid/152138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/06/2022] [Accepted: 07/15/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Consumers have shifted to online purchases for many products, including tobacco and e-cigarettes. These shifts have occurred alongside internet tobacco purchasing restrictions being proposed and enacted across the US. The aim of this study was to identify motivations for and against purchasing tobacco and e-cigarettes online, to better understand potential impacts or loopholes. METHODS We surveyed 463 US adults who reported ever purchasing tobacco or e-cigarettes in April 2021, using Amazon's Mechanical Turk. Participants who reported purchasing tobacco or e-cigarettes online were asked to describe their reasons for doing so. Those who reported never purchasing online were asked to describe their reasons. Responses were triple-coded and thematically analyzed. RESULTS Most respondents (n=330; 71.3%) had purchased tobacco or e-cigarettes online. We identified 14 reasons for purchasing tobacco or e-cigarettes online across four themes: price (cheaper online, discounts, bulk purchases, avoiding taxes), product characteristics (availability, quality), buying experience (convenience, time, COVID-19 concerns, avoiding shame, discretion, avoiding salespersons, reading reviews), and curiosity. We identified 13 reasons for not purchasing tobacco or e-cigarette products online across seven themes: buying experience (convenience, time, discretion, seeing the product), concerns (legality, safety, quality), consumption, price, supporting local, unaware, and uninterested. CONCLUSIONS Both online and offline purchasers stated price and convenience motivated their choice to purchase tobacco or e-cigarettes online. Though few participants mentioned purchasing illicit products, concerns about legality and quality of online purchases were raised, and there was some awareness that online purchases attracted lower taxation.
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Affiliation(s)
| | - Kayla Rebentisch
- Department of Health and Kinesiology, University of Utah, Salt Lake City, United States
| | | | - Julie W. Merten
- Brooks College of Health, University of North Florida, Jacksonville, United States
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6
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Buckell J, Vasavada V, Wordsworth S, Regier DA, Quaife M. Utility maximization versus regret minimization in health choice behavior: Evidence from four datasets. HEALTH ECONOMICS 2022; 31:363-381. [PMID: 34787942 DOI: 10.1002/hec.4455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/22/2021] [Accepted: 10/26/2021] [Indexed: 06/13/2023]
Abstract
Choice models in health are almost exclusively based on the neoclassical economic paradigm of utility maximization. Recently developed choice models have captured and shown empirical support for regret minimization as an alternative decision rule. In health economics, recent applications of RRM models indicate that individuals making health-based choices may exhibit regret minimization-type behavior. In this paper, we build on this research using a more flexible model that allows for heterogeneous decision rules, separately from preference heterogeneity, and comparing it to models that assume single decision rules. We use four datasets from diverse settings in which individuals make health choices: tobacco markets, genomic testing, and HIV prevention. We found that, if a one-size-fits-all rule is applied, then utility maximization was preferable to regret minimization for these datasets. However, we also find that individuals apply varying decision rules in similar proportions in these health settings, suggesting that models for heterogeneous decision rules were needed to capture these behaviors in these settings.
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Affiliation(s)
- John Buckell
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Vrinda Vasavada
- Department of Computer Science, Stanford University, Stanford, California, USA
| | - Sarah Wordsworth
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Dean A Regier
- Cancer Control Research, BC Cancer, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, UK
| | - Matthew Quaife
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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7
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Yang JS, Cuomo RE, Purushothaman V, Nali M, Shah N, Bardier C, Obradovich N, Mackey T. Campus Smoking Policies and Smoking-Related Twitter Posts Originating From California Public Universities: Retrospective Study. JMIR Form Res 2021; 5:e33331. [PMID: 34951597 PMCID: PMC8742203 DOI: 10.2196/33331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 11/26/2022] Open
Abstract
Background The number of colleges and universities with smoke- or tobacco-free campus policies has been increasing. The effects of campus smoking policies on overall sentiment, particularly among young adult populations, are more difficult to assess owing to the changing tobacco and e-cigarette product landscape and differential attitudes toward policy implementation and enforcement. Objective The goal of the study was to retrospectively assess the campus climate toward tobacco use by comparing tweets from California universities with and those without smoke- or tobacco-free campus policies. Methods Geolocated Twitter posts from 2015 were collected using the Twitter public application programming interface in combination with cloud computing services on Amazon Web Services. Posts were filtered for tobacco products and behavior-related keywords. A total of 42,877,339 posts were collected from 2015, with 2837 originating from a University of California or California State University system campus, and 758 of these manually verified as being about smoking. Chi-square tests were conducted to determine if there were significant differences in tweet user sentiments between campuses that were smoke- or tobacco-free (all University of California campuses and California State University, Fullerton) compared to those that were not. A separate content analysis of tweets included in chi-square tests was conducted to identify major themes by campus smoking policy status. Results The percentage of positive sentiment tweets toward tobacco use was higher on campuses without a smoke- or tobacco-free campus policy than on campuses with a smoke- or tobacco-free campus policy (76.7% vs 66.4%, P=.03). Higher positive sentiment on campuses without a smoke- or tobacco-free campus policy may have been driven by general comments about one’s own smoking behavior and comments about smoking as a general behavior. Positive sentiment tweets originating from campuses without a smoke- or tobacco-free policy had greater variation in tweet type, which may have also contributed to differences in sentiment among universities. Conclusions Our study introduces preliminary data suggesting that campus smoke- and tobacco-free policies are associated with a reduction in positive sentiment toward smoking. However, continued expressions and intentions to smoke and reports of one’s own smoking among Twitter users suggest a need for more research to better understand the dynamics between implementation of smoke- and tobacco-free policies and resulting tobacco behavioral sentiment.
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Affiliation(s)
- Joshua S Yang
- Department of Public Health, California State University Fullerton, Fullerton, CA, United States
| | - Raphael E Cuomo
- Global Health Policy and Data Institute, San Diego, CA, United States.,Department of Anesthesiology, University of California San Diego, San Diego, CA, United States
| | - Vidya Purushothaman
- Global Health Policy and Data Institute, San Diego, CA, United States.,Department of Anesthesiology, University of California San Diego, San Diego, CA, United States
| | - Matthew Nali
- Global Health Policy and Data Institute, San Diego, CA, United States.,Department of Anesthesiology, University of California San Diego, San Diego, CA, United States.,S-3 Research, San Diego, CA, United States
| | - Neal Shah
- Global Health Policy and Data Institute, San Diego, CA, United States
| | - Cortni Bardier
- Global Health Policy and Data Institute, San Diego, CA, United States.,S-3 Research, San Diego, CA, United States.,Global Health Program, Department of Anthropology, University of California, San Diego, La Jolla, CA, United States
| | - Nick Obradovich
- Center for Humans and Machines, Max Planck Institute for Human Development, Berlin, Germany
| | - Tim Mackey
- Global Health Policy and Data Institute, San Diego, CA, United States.,S-3 Research, San Diego, CA, United States.,Global Health Program, Department of Anthropology, University of California, San Diego, La Jolla, CA, United States
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Haupt MR, Xu Q, Yang J, Cai M, Mackey TK. Characterizing Vaping Industry Political Influence and Mobilization on Facebook: Social Network Analysis. J Med Internet Res 2021; 23:e28069. [PMID: 34714245 PMCID: PMC8590191 DOI: 10.2196/28069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/01/2021] [Accepted: 08/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background In response to recent policy efforts to regulate tobacco and vaping products, the vaping industry has been aggressive in mobilizing opposition by using a network of manufacturers, trade associations, and tobacco user communities, and by appealing to the general public. One strategy the alternative tobacco industry uses to mobilize political action is coordinating on social media platforms, such as the social networking site Facebook. However, few studies have specifically assessed how platforms such as Facebook are used to influence public sentiment and attitudes towards tobacco control policy. Objective This study used social network analysis to examine how the alternative tobacco industry uses Facebook to mobilize online users to influence tobacco control policy outcomes with a focus on the state of California. Methods Data were collected from local and national alternative tobacco Facebook groups that had affiliations with activities in the state of California. Network ties were constructed based on users’ reactions to posts (eg, “like” and “love”) and comments to characterize political mobilization networks. Results Findings show that alternative tobacco industry employees were more likely to engage within these networks and that these employees were also more likely to be influential members (ie, be more active) in the network. Comparisons between subnetworks show that communication within the local alternative tobacco advocacy group network was less dense and more centralized in contrast to a national advocacy group that had overall higher levels of engagement among members. A timeline analysis found that a higher number of influential posts that disseminated widely across networks occurred during e-cigarette–related legislative events, suggesting strategic online engagement and increased mobilization of online activity for the purposes of influencing policy outcomes. Conclusions Results from this study provide important insights into how tobacco industry–related advocacy groups leverage the Facebook platform to mobilize their online constituents in an effort to influence public perceptions and coordinate to defeat tobacco control efforts at the local, state, and federal level. Study results reveal one part of a vast network of socially enabled alternative tobacco industry actors and constituents that use Facebook as a mobilization point to support goals of the alternative tobacco industry.
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Affiliation(s)
- Michael Robert Haupt
- Department of Cognitive Science, University of California, San Diego, La Jolla, CA, United States.,Global Health Policy and Data Institute, San Diego, CA, United States
| | - Qing Xu
- Global Health Policy and Data Institute, San Diego, CA, United States.,Department of Healthcare Research and Policy, University of California, San Diego Extension, La Jolla, CA, United States.,S-3 Research, San Diego, CA, United States
| | - Joshua Yang
- Department of Public Health, California State University, Fullerton, CA, United States
| | - Mingxiang Cai
- Global Health Policy and Data Institute, San Diego, CA, United States.,Department of Healthcare Research and Policy, University of California, San Diego Extension, La Jolla, CA, United States.,S-3 Research, San Diego, CA, United States
| | - Tim K Mackey
- Global Health Policy and Data Institute, San Diego, CA, United States.,S-3 Research, San Diego, CA, United States.,Global Health Program, Department of Anthropology, University of California, San Diego, La Jolla, CA, United States
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9
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Xu Q, Yang J, Haupt MR, Cai M, Nali MC, Mackey TK. Digital Surveillance to Identify California Alternative and Emerging Tobacco Industry Policy Influence and Mobilization on Facebook. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111150. [PMID: 34769666 PMCID: PMC8583030 DOI: 10.3390/ijerph182111150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 11/16/2022]
Abstract
Growing popularity of electronic nicotine-delivery systems (ENDS) has coincided with a need to strengthen tobacco-control policy. In response, the ENDS industry has taken actions to mobilize against public health measures, including coordination on social media platforms. To explore this phenomenon, data mining was used to collect public posts on two Facebook public group pages: the California Consumer Advocates for Smoke Free Alternatives Association (CCASAA) and the community page of the Northern California Chapter of SFATA (NC-SFATA). Posts were manually annotated to characterize themes associated with industry political interference and user interaction. We collected 288 posts from the NC-SFATA and 411 posts from CCASAA. A total of 522 (74.7%) posts were categorized as a form of political interference, with 339 posts (64.9%) from CCASAA and 183 posts (35.1%) from NC-SFATA. We identified three different categories of policy interference-related posts: (1) providing updates on ENDS-related policy at the federal, state, and local levels; (2) sharing opinions about ENDS-related policies; (3) posts related to scientific information related to vaping; and (4) calls to action to mobilize against tobacco/ENDS policies. Our findings indicate that pro-tobacco social media communities on Facebook, driven by strategic activities of trade associations and their members, may act as focal points for anti-policy information dissemination, grass-roots mobilization, and industry coordination that needs further research.
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Affiliation(s)
- Qing Xu
- Global Health Policy and Data Institute, San Diego, CA 92121, USA; (Q.X.); (M.R.H.); (M.C.); (M.C.N.)
- S-3 Research, LLC, San Diego, CA 92121, USA
| | - Joshua Yang
- Department of Public Health, California State University, Fullerton, CA 92834, USA;
| | - Michael R. Haupt
- Global Health Policy and Data Institute, San Diego, CA 92121, USA; (Q.X.); (M.R.H.); (M.C.); (M.C.N.)
- Department of Cognitive Science, University of California, San Diego, CA 92093, USA
| | - Mingxiang Cai
- Global Health Policy and Data Institute, San Diego, CA 92121, USA; (Q.X.); (M.R.H.); (M.C.); (M.C.N.)
- S-3 Research, LLC, San Diego, CA 92121, USA
- Global Health Program, Department of Anthropology, University of California, San Diego, CA 92093, USA
| | - Matthew C. Nali
- Global Health Policy and Data Institute, San Diego, CA 92121, USA; (Q.X.); (M.R.H.); (M.C.); (M.C.N.)
- S-3 Research, LLC, San Diego, CA 92121, USA
- Global Health Program, Department of Anthropology, University of California, San Diego, CA 92093, USA
| | - Tim K. Mackey
- Global Health Policy and Data Institute, San Diego, CA 92121, USA; (Q.X.); (M.R.H.); (M.C.); (M.C.N.)
- S-3 Research, LLC, San Diego, CA 92121, USA
- Global Health Program, Department of Anthropology, University of California, San Diego, CA 92093, USA
- Correspondence: ; Tel.: +1-(951)-491-4161
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10
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Cuomo RE, Purushothaman VL, Li J, Bardier C, Nali M, Shah N, Obradovich N, Yang J, Mackey TK. Characterizing Self-Reported Tobacco, Vaping, and Marijuana-Related Tweets Geolocated for California College Campuses. Front Public Health 2021; 9:628812. [PMID: 33928062 PMCID: PMC8076505 DOI: 10.3389/fpubh.2021.628812] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/15/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: College-aged youth are active on social media yet smoking-related social media engagement in these populations has not been thoroughly investigated. We sought to conduct an exploratory infoveillance study focused on geolocated data to characterize smoking-related tweets originating from California 4-year colleges on Twitter. Methods: Tweets from 2015 to 2019 with geospatial coordinates in CA college campuses containing smoking-related keywords were collected from the Twitter API stream and manually annotated for discussions about smoking product type, sentiment, and behavior. Results: Out of all tweets detected with smoking-related behavior, 46.7% related to tobacco use, 50.0% to marijuana, and 7.3% to vaping. Of these tweets, 46.1% reported first-person use or second-hand observation of smoking behavior. Out of 962 tweets with user sentiment, the majority (67.6%) were positive, ranging from 55.0% for California State University, Long Beach to 95.8% for California State University, Los Angeles. Discussion: We detected reporting of first- and second-hand smoking behavior on CA college campuses representing possible violation of campus smoking bans. The majority of tweets expressed positive sentiment about smoking behaviors, though there was appreciable variability between college campuses. This suggests that anti-smoking outreach should be tailored to the unique student populations of these college communities. Conclusion: Among tweets about smoking from California colleges, high levels of positive sentiment suggest that the campus climate may be less receptive to anti-smoking messages or adherence to campus smoking bans. Further research should investigate the degree to which this varies by campuses over time and following implementation of bans including validating using other sources of data.
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Affiliation(s)
- Raphael E. Cuomo
- Department of Anesthesiology, San Diego School of Medicine, University of California, San Diego, San Diego, CA, United States
- Global Health Policy and Data Institute, San Diego, CA, United States
| | - Vidya L. Purushothaman
- Department of Anesthesiology, San Diego School of Medicine, University of California, San Diego, San Diego, CA, United States
- Global Health Policy and Data Institute, San Diego, CA, United States
| | - Jiawei Li
- S-3 Research, San Diego, CA, United States
| | - Cortni Bardier
- Global Health Policy and Data Institute, San Diego, CA, United States
| | - Matthew Nali
- Global Health Policy and Data Institute, San Diego, CA, United States
| | - Neal Shah
- Global Health Policy and Data Institute, San Diego, CA, United States
| | - Nick Obradovich
- Center for Humans and Machines, Max Planck Institute for Human Development, Berlin, Germany
| | - Joshua Yang
- Department of Public Health, California State University, Fullerton, Fullerton, CA, United States
| | - Tim K. Mackey
- Department of Anesthesiology, San Diego School of Medicine, University of California, San Diego, San Diego, CA, United States
- Global Health Policy and Data Institute, San Diego, CA, United States
- S-3 Research, San Diego, CA, United States
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Pepper JK, MacMonegle AJ, Nonnemaker JM. Adolescents' Use of Basic, Intermediate, and Advanced Device Types for Vaping. Nicotine Tob Res 2020; 21:55-62. [PMID: 29294122 DOI: 10.1093/ntr/ntx279] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 12/21/2017] [Indexed: 11/13/2022]
Abstract
Introduction Advanced vaping devices likely pose a greater risk to adolescent health than basic or intermediate devices because advanced devices deliver nicotine more effectively and heat e-liquid to higher temperatures, producing more harmful chemical emissions. However, little is known about adolescents' risk factors for using different device types. Methods We used social media to recruit an online sample of 1508 US adolescents aged 15-17 who reported past 30-day use of electronic vaping products (EVPs) in September 2016. We assessed tobacco use, beliefs, and knowledge about EVPs and EVP use behavior, including the device type participants use most frequently. We used multinomial logistic regression to examine differences between adolescents who usually use intermediate versus basic and advanced versus basic devices. Results Most respondents usually used modifiable advanced devices (56.8%) rather than basic "cigalike" (14.5%) or pen-style intermediate (28.7%) devices. Use of multiple device types was common, particularly among those who primarily used basic devices. Younger age and less frequent vaping were associated with mainly using basic devices. Adolescents who were older, male, personally bought their main device, and had ever mixed e-liquids were at elevated risk for usually using advanced devices. Conclusions Adolescents who primarily use basic devices may be newer users who are experimenting with multiple devices. Future research should examine which adolescents are most likely to transition to advanced devices in order to develop targeted interventions. Regulators should consider strategies to reduce access to all types of EVPs, such as better enforcement of the current ban on sales to minors. Implications This research addresses two gaps in research on adolescent electronic vaping product use: (1) characterizing use of advanced devices as distinct from intermediate devices rather than grouping them together and (2) examining factors associated with use of specific device types. This study suggests that there are distinct profiles of adolescents who use primarily basic, intermediate, or advanced devices. Adolescents who most often use basic devices may be new users experimenting with vaping, whereas adolescents who most often use advanced devices appear to be buying devices for themselves and engaging in risky behaviors such as mixing their own e-liquid.
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Affiliation(s)
- Jessica K Pepper
- Center for Health Policy Science & Tobacco Research, RTI International, Research Triangle Park, NC
| | - Anna J MacMonegle
- Center for Health Policy Science & Tobacco Research, RTI International, Research Triangle Park, NC
| | - James M Nonnemaker
- Center for Health Policy Science & Tobacco Research, RTI International, Research Triangle Park, NC
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12
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Buckell J, Sindelar JL. The impact of flavors, health risks, secondhand smoke and prices on young adults' cigarette and e-cigarette choices: a discrete choice experiment. Addiction 2019; 114:1427-1435. [PMID: 30866132 PMCID: PMC6639008 DOI: 10.1111/add.14610] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/08/2018] [Accepted: 03/04/2019] [Indexed: 12/22/2022]
Abstract
AIMS To estimate young adults' preferences for cigarettes and e-cigarettes, and how preferences vary by policy-relevant factors. A related aim was to provide information on potential substitution/complementarity across cigarettes and e-cigarettes ahead of policy selection. DESIGN An online discrete choice experiment (DCE) in which respondents chose their preferred option among cigarettes, two types of e-cigarettes (disposable/reusable) and 'none'. Each cigarette-type was characterized by policy-relevant attributes: flavors, short-term health risks to self, secondhand smoke risks and price. A latent class model identified smoking types that respond differently to these. SETTING US tobacco market. PARTICIPANTS A total of 2003 young adults (aged 18-22 years) who ever tried either cigarettes or e-cigarettes, recruited via the survey platform Qualtrics, matched to the 2015 National Health Interview Survey by age, gender, education and census region. MEASUREMENTS Respondents' DCE choices. FINDINGS Young adults fell into two broad categories. One latent group, termed 'prefer smoking group', preferred cigarettes and another, 'prefer vaping group', preferred e-cigarettes. The 'prefer smoking group' preferred lower prices and lower health harms more than other attributes. The 'prefer vaping group' valued these, although price less intensely, and valued health and fruit/candy flavors more. CONCLUSION Banning all flavors in cigarettes and e-cigarettes might improve the health of young adults who ever tried either cigarettes or e-cigarettes. Young adult ever-triers might be deterred from smoking by increasing cigarette prices and encouraged to switch to e-cigarettes by reducing the health harms of e-cigarettes. Reducing health harms of e-cigarettes could also make the 'prefer vaping group' less likely to quit, resulting in increased health harm.
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Affiliation(s)
- John Buckell
- School of Public HealthYale University New Haven CT USA
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13
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Levy DT, Lindblom EN, Sweanor DT, Chaloupka F, O'Connor RJ, Shang C, Palley T, Fong GT, Cummings KM, Goniewicz ML, Borland R. An Economic Analysis of the Pre-Deeming US Market for Nicotine Vaping Products. TOB REGUL SCI 2019; 5:169-181. [PMID: 32864395 PMCID: PMC7454013 DOI: 10.18001/trs.5.2.8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Public health policies are often enacted without adequate consideration of the existing market structure or their impacts on that market structure. This paper provides context for the potential impact of regulations on nicotine vaping products (NVP) use by providing a structural analysis of competition in the US NVP market before FDA regulation. METHODS A literature review was conducted with the aim of providing a framework for analysis that: 1) defines the market; 2) evaluates market concentration; 3) identifies entry barriers; and 4) examines firm conduct. RESULTS The NVP market includes retail, internet sellers and vape shops. Although conventional retail became more concentrated after the major cigarette companies entered the NVP market, the vape shop and internet sectors remain substantially less concentrated, producing an overall low market concentration, with few entry barriers and competitive behavior. CONCLUSIONS The largely unregulated US NVP market has been highly competitive, with a high degree of innovation. However, new FDA deeming regulations as applied to NVPs could make it difficult for smaller companies to remain in the market and could discourage new companies and new product innovations from entering the market.
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Affiliation(s)
- David T Levy
- Cancer Prevention and Control, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Eric N Lindblom
- Tobacco Control and Food & Drug Law, O'Neill Institute for National & Global Health Law, Georgetown University Law Center, Washington, DC
| | - David T Sweanor
- Adjunct Professor, Faculty of Law, University of Ottawa, Canada
| | - Frank Chaloupka
- Health Policy Center, Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY
| | - Ce Shang
- Department of Pediatrics and Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | | | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Maciej L Goniewicz
- Department of Health Behavior, Division of Cancer Prevention and Population Studies, Roswell Park Cancer Institute, Buffalo, NY
| | - Ron Borland
- Nigel Gray Distinguished Fellow in Cancer Prevention, Cancer Council Victoria, Melbourne, Victoria, Australia
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14
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Buckell J, Marti J, Sindelar JL. Should flavours be banned in cigarettes and e-cigarettes? Evidence on adult smokers and recent quitters from a discrete choice experiment. Tob Control 2018; 28:tobaccocontrol-2017-054165. [PMID: 29807947 PMCID: PMC6261708 DOI: 10.1136/tobaccocontrol-2017-054165] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 04/18/2018] [Accepted: 04/19/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To provide the policy-relevant estimates of impacts of alternative flavour bans on preferences and demand for cigarettes and e-cigarettes in adult smokers and recent quitters. METHODS A best-best discrete choice experiment (DCE) is used to elicit smokers' and recent quitters' preferences for flavours, price, health impact and nicotine level in cigarettes and e-cigarettes. Choice of tobacco products and an opt-out option were examined. An efficient design yielded 36 choice sets. Exploded logit choice models were estimated. Flavour bans are modelled by restricting flavour coefficients in the estimated model. SETTING AND PARTICIPANTS A sample of 2031 adult smokers and recent quitters was recruited to complete an online survey and DCE. RESULTS Current smokers and recent quitters, on average, prefer cigarettes and menthol cigarettes over flavoured e-cigarettes. However, there is substantial preference heterogeneity by younger adults (ages 18-25), race/ethnicity and respondents with higher education. Our predictions suggest that a ban on menthol cigarettes would produce the greatest reduction in the choice of cigarettes (-5.2%), but with an accompanying increase in e-cigarettes use (3.8%). In contrast, banning flavours in e-cigarettes, while allowing menthol in cigarettes would result in the greatest increase in the selection of cigarettes (8.3%), and a decline in the use of e-cigarettes (-11.1%). A ban on all flavours, but tobacco in both products would increase 'opting-out' the most (5.2%) but would also increase choice of cigarettes (2.7%) and decrease choice of e-cigarettes (-7.9%). CONCLUSIONS A ban on flavoured e-cigarettes alone would likely increase the choice of cigarettes in smokers, arguably the more harmful way of obtaining nicotine, whereas a ban on menthol cigarettes alone would likely be more effective in reducing the choice of cigarettes. A ban on all flavours in both products would likely reduce the smoking/vaping rates, but the use of cigarettes would be higher than in the status quo. Policy-makers should use these results to guide the choice of flavour bans in light of their stance on the potential health impacts both products.
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Affiliation(s)
- John Buckell
- School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Joachim Marti
- Institute of Social and Preventive Medicine (IUMSP), CHUV, Université de Lausanne, Lausanne, Switzerland
| | - Jody L Sindelar
- School of Public Health, Yale University, New Haven, Connecticut, USA
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15
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Williams RS, Derrick JC. Internet little cigar and cigarillo vendors: Surveillance of sales and marketing practices via website content analysis. Prev Med 2018; 109:51-57. [PMID: 29378269 PMCID: PMC5843555 DOI: 10.1016/j.ypmed.2018.01.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 01/18/2018] [Accepted: 01/21/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Cigar sales have nearly doubled as cigarette sales have dropped, and large cigars have been replaced by little cigars and cigarillos (LCCs). Many LCCs are flavored, are perceived as less harmful than cigarettes, and have become increasingly available from e-commerce sources. We conducted surveillance of the online retail environment in 2013 and 2014 for LCCs in order to describe characteristics of Internet tobacco vendors selling LCCs and their sales and marketing practices, youth access practices, and their practices in relation to cigarette and other tobacco product sales. METHODS In 2013, we identified and manually screened 32,446 websites, yielding 500 unique Internet LCC vendors. In 2014, we identified 511 vendors selling LCCs from a list of 31,239 manually screened websites. We then selected 249 in 2013 and 263 in 2014 for content analysis focusing on six domains including demographics, youth access, payment and delivery, products for sale, promotions and claims, and prices. RESULTS Just over half of vendors in both years were located solely in the U.S. with 70.1% of those selling flavored LCCs in 2013 and 76.1% in 2014. Nearly half only used proven ineffective age verification strategies and another 10% made no attempts to verify age at all. Most vendors accepted credit cards and advertised using the United States Postal Service. Half of vendors featured a variety of health warnings and most featured promotions. CONCLUSIONS Federal bans on flavored cigarettes and restrictions on age verification, payment, and shipping for Internet tobacco sales should be extended to include LCCs.
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Affiliation(s)
- Rebecca S Williams
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Jason C Derrick
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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16
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Internet-based Advertising Claims and Consumer Reasons for Using Electronic Cigarettes by Device Type in the US. TOB REGUL SCI 2017; 3:516-524. [PMID: 29104902 DOI: 10.18001/trs.3.4.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objectives Important differences exist between closed-system and open-system e-cigarettes, but it is unknown whether online companies are marketing these devices differently and whether consumer reasons for using e-cigarettes vary by device type. This paper compares Internet-based advertising claims of closed- versus open-system products, and evaluates US consumers' reasons for using closed- versus open-system e-cigarettes. Methods Internet sites selling exclusively closed (N = 130) or open (N = 129) e-cigarettes in December 2013-January 2014 were coded for advertising claims. Current users (≥18 years old) of exclusively closed or open e-cigarettes (N = 860) in a nationally representative online survey in February-March 2014 provided their main reason for using e-cigarettes. Results Internet sites that exclusively sold closed-system e-cigarettes were more likely to make cigarette-related claims such as e-cigarettes being healthier and cheaper than cigarettes (ps < .0001) compared to sites selling open systems. Many sites implied their products could help smokers quit. Exclusive users of both systems endorsed cessation as their top reason. Closed-system users were more likely to report their reason as "use where smoking is banned." Conclusions Although promotion of e-cigarettes as cessation aids is prohibited, consumers of both systems endorsed smoking cessation as their top reason for using e-cigarettes.
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17
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Williams RS, Derrick J, Liebman AK, LaFleur K. Content analysis of e-cigarette products, promotions, prices and claims on Internet tobacco vendor websites, 2013-2014. Tob Control 2017; 27:e34-e40. [PMID: 29101294 DOI: 10.1136/tobaccocontrol-2017-053762] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 09/28/2017] [Accepted: 10/05/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To identify the population of Internet e-cigarette vendors (IEVs) and conduct content analysis of products sold and IEVs' promotional, claims and pricing practices. METHODS Multiple sources were used to identify IEV websites, primarily complex search algorithms scanning over 180 million websites. In 2013, 32 446 websites were manually screened, identifying 980 IEVs, with the 281 most popular selected for content analysis. This methodology yielded 31 239 websites for manual screening in 2014, identifying 3096 IEVs, with 283 selected for content analysis. RESULTS While the majority of IEVs (71.9%) were US based in 2013, this dropped to 64.3% in 2014 (p<0.01), with IEVs located in at least 38 countries, and 12% providing location indicators reflecting two or more countries, complicating jurisdictional determinations.Reflecting the retail market, IEVs are transitioning from offering disposable and 'cigalike' e-cigarettes to larger tank and "mod" systems. Flavored e-cigarettes were available from 85.9% of IEVs in 2014, with fruit and candy flavors being most popular. Most vendors (76.5%) made health claims in 2013, dropping to 43.1% in 2014. Some IEVs featured conflicting claims about whether or not e-cigarettes aid in smoking cessation. There was wide variation in pricing, with e-cigarettes available as inexpensive as one dollar, well within the affordable range for adults and teens. CONCLUSIONS The number of Internet e-cigarette vendors grew threefold from 2013 to 2014, far surpassing the number of Internet cigarette vendors (N=775) at the 2004 height of that industry. New and expanded regulations for online e-cigarette sales are needed, including restrictions on flavors and marketing claims.
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Affiliation(s)
- Rebecca S Williams
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Carrboro, North Carolina, USA.,Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Carrboro, North Carolina, USA
| | - Jason Derrick
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Carrboro, North Carolina, USA
| | - Aliza K Liebman
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kevin LaFleur
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Carrboro, North Carolina, USA
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18
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Williams RS, Derrick J, Liebman AK, LaFleur K, Ribisl KM. Content analysis of age verification, purchase and delivery methods of internet e-cigarette vendors, 2013 and 2014. Tob Control 2017; 27:287-293. [PMID: 28484040 DOI: 10.1136/tobaccocontrol-2016-053616] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/30/2017] [Accepted: 04/03/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Identify the population of internet e-cigarette vendors (IEVs) and conduct content analyses of their age verification, purchase and delivery methods in 2013 and 2014. METHODS We used multiple sources to identify IEV websites, primarily complex search algorithms scanning more than 180 million websites. In 2013, we manually screened 32 446 websites, identifying 980 IEVs, selecting the 281 most popular for content analysis. This methodology yielded 31 239 websites for screening in 2014, identifying 3096 IEVs, with 283 selected for content analysis. RESULTS The proportion of vendors that sold online-only, with no retail store, dropped significantly from 2013 (74.7%) to 2014 (64.3%) (p<0.01), with a corresponding significant decrease in US-based vendors (71.9% in 2013 and 65% in 2014). Most vendors did little to prevent youth access in either year, with 67.6% in 2013 and 63.2% in 2014 employing no age verification or relying exclusively on strategies that cannot effectively verify age. Effective age verification strategies such as online age verification services (7.1% in 2013 and 8.5% in 2014), driving licences (1.8% in 2013 and 7.4% in 2014, p<0.01) or age verification at delivery (6.4% in 2013 and 8.1% in 2104) were rarely advertised on IEV websites. Nearly all vendors advertised accepting credit cards, and about ¾ shipping via United States Postal Service, similar to the internet cigarette industry prior to federal bans. CONCLUSIONS The number of IEVs grew sharply from 2013 to 2014, with poor age verification practices. New and expanded regulations for online e-cigarette sales are needed, including strict age and identity verification requirements.
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Affiliation(s)
- Rebecca S Williams
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jason Derrick
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Aliza Kate Liebman
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kevin LaFleur
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kurt M Ribisl
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Glasser AM, Collins L, Pearson JL, Abudayyeh H, Niaura RS, Abrams DB, Villanti AC. Overview of Electronic Nicotine Delivery Systems: A Systematic Review. Am J Prev Med 2017; 52:e33-e66. [PMID: 27914771 PMCID: PMC5253272 DOI: 10.1016/j.amepre.2016.10.036] [Citation(s) in RCA: 333] [Impact Index Per Article: 47.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 10/07/2016] [Accepted: 10/26/2016] [Indexed: 12/20/2022]
Abstract
CONTEXT Rapid developments in e-cigarettes, or electronic nicotine delivery systems (ENDS), and the evolution of the overall tobacco product marketplace warrant frequent evaluation of the published literature. The purpose of this article is to report updated findings from a comprehensive review of the published scientific literature on ENDS. EVIDENCE ACQUISITION The authors conducted a systematic review of published empirical research literature on ENDS through May 31, 2016, using a detailed search strategy in the PubMed electronic database, expert review, and additional targeted searches. Included studies presented empirical findings and were coded to at least one of nine topics: (1) Product Features; (2) Health Effects; (3) Consumer Perceptions; (4) Patterns of Use; (5) Potential to Induce Dependence; (6) Smoking Cessation; (7) Marketing and Communication; (8) Sales; and (9) Policies; reviews and commentaries were excluded. Data from included studies were extracted by multiple coders (October 2015 to August 2016) into a standardized form and synthesized qualitatively by topic. EVIDENCE SYNTHESIS There were 687 articles included in this systematic review. The majority of studies assessed patterns of ENDS use and consumer perceptions of ENDS, followed by studies examining health effects of vaping and product features. CONCLUSIONS Studies indicate that ENDS are increasing in use, particularly among current smokers, pose substantially less harm to smokers than cigarettes, are being used to reduce/quit smoking, and are widely available. More longitudinal studies and controlled trials are needed to evaluate the impact of ENDS on population-level tobacco use and determine the health effects of longer-term vaping.
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Affiliation(s)
- Allison M Glasser
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia.
| | - Lauren Collins
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Jennifer L Pearson
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Haneen Abudayyeh
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Raymond S Niaura
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - David B Abrams
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - Andrea C Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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