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Zhang Y, Kennedy RD, Czaplicki L, Moran MB. E-Cigarette "Tobacco Flavor," How Do I Name Thee? Let Me Count the Ways…. Nicotine Tob Res 2024; 26:1108-1112. [PMID: 38310643 DOI: 10.1093/ntr/ntae022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 12/11/2023] [Accepted: 01/30/2024] [Indexed: 02/06/2024]
Abstract
INTRODUCTION In recent years, hundreds of jurisdictions around the world have enacted policies that prohibit sales of flavored e-cigarettes. In most cases, these jurisdictions permit the sale of tobacco flavored e-cigarettes. We sought to understand how tobacco flavor in e-cigarette advertisements were presented. AIMS AND METHODS Our sample included 2966 U.S. English-language e-cigarette ads compiled by a market research firm, Numerator, that ran from January 2018 to December 2020. We describe the prevalence of different tobacco flavor names in our sample and classified each name into one of the following thematic categories: Traditional Tobacco, Pipe/Cigar Tobacco, Sensory Expectancies, Color, Physical Attribute, Place, and non-characterizing Concept flavor. RESULTS In our sample, 28% (n = 832/2966) of ads promoted at least one tobacco flavored e-cigarette product (e-cigarette device or liquid). Across the 832 ads, we counted 1019 tobacco flavored products and identified 51 unique tobacco flavor names. The most common tobacco flavor names were Traditional Tobacco names like "Tobacco" (n = 393), "Classic tobacco" (n = 107) and 'Original' (n = 59). Some names were associated with Color (eg, 'Golden tobacco'; n = 153), Sensory Expectancy (eg, 'Rich tobacco'; n = 148), Place where tobacco cultivation takes place (eg, 'Carolina tobacco'; n = 83), Physical Attributes of tobacco (eg, 'Cut tobacco'; n = 17) and non-characterizing Concept flavor (eg, 'Freedom juice'; n = 14). Few tobacco flavors suggested a type of Pipe/Cigar Tobacco (eg, "Cavendish"; n = 4). CONCLUSIONS We identified 51 different tobacco flavor names, highlighting the practice describing the flavor beyond "tobacco." Future research can investigate whether these flavor names and descriptors influence consumers' perceptions, including perceived risks, of e-cigarette products. IMPLICATIONS Flavors are used to market e-cigarettes. Globally, many jurisdictions restrict flavored e-cigarette sales, but few restrict tobacco flavor. This study identified 51 unique ways tobacco flavored e-cigarettes have been named in a sample of U.S. English-language ads, suggesting diversified ways to market "tobacco." We identified several sub-categories of tobacco flavor names that rely on Color, Sensory Expectancies, and non-characterizing Concept flavor attributes. As e-cigarette flavor restrictions that exempt tobacco flavor are still prevalent, this study highlights the need for continued monitoring of naming conventions of tobacco flavored products and examination of how nuanced flavor names influence perceptions and expectations.
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Affiliation(s)
- Ying Zhang
- Department of Health, Behavior & Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ryan David Kennedy
- Department of Health, Behavior & Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Institute for Global Tobacco Control, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Lauren Czaplicki
- Department of Health, Behavior & Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Institute for Global Tobacco Control, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Meghan Bridgid Moran
- Department of Health, Behavior & Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Sommer N, Franzen K, Andreas S, Pankow W, Kunstmann W, Hanewinkel R. [Harmful health effects of flavors in e-cigarettes]. Laryngorhinootologie 2024. [PMID: 38996433 DOI: 10.1055/a-2341-0544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024]
Abstract
BACKGROUND Almost all e-cigarettes contain flavorings that make the product more attractive. In the evaluation of e-cigarettes on health, flavors have so far played a subordinate role. METHOD Selective literature search in PubMed, supplemented by legal regulations on the use of flavors in e-cigarettes. RESULTS Flavors make it easier to start using e-cigarettes and have a consumption-promoting effect. Deeper inhalation increases nicotine uptake and the absorption of toxic substances from the e-cigarette liquid. For some flavors, pathological effects have been demonstrated in addition to other toxic components of the e-cigarette. To date, no toxicological analyses are available for the vast majority of flavors contained in e-cigarettes. CONCLUSIONS The proven consumption-promoting effect and the health risks that can be extrapolated from preclinical data are significant for the political discussion of a ban on flavors for e-cigarettes, analogous to the ban on flavors in tobacco products already in force.
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Affiliation(s)
- Natascha Sommer
- Medizinische Klinik II, Excellence Cluster Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center (UGMLC), Mitglied des Deutschen Zentrums für Lungenforschung (DZL), Justus-Liebig-Universität Gießen
| | - Klaas Franzen
- Universitätsklinikum Schleswig-Holstein, Medizinische Klinik III, Pneumologie, Campus Lübeck, Airway Research Center North (ARCN), Deutsches Zentrum für Lungenforschung (DZL), Lübeck/Großhansdorf
| | - Stefan Andreas
- Lungenfachklinik Immenhausen, Immenhausen, Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Deutsches Zentrum für Lungenforschung
| | - Wulf Pankow
- Philipps-Universität Marburg - Fachbereich Medizin
| | - Wilfried Kunstmann
- IFT-Nord gGmbH, Institut für Therapie- und Gesundheitsforschung, Kiel, Deutschland
| | - Reiner Hanewinkel
- IFT-Nord gGmbH, Institut für Therapie- und Gesundheitsforschung, Kiel, Deutschland
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Sommer N, Franzen K, Andreas S, Pankow W, Kunstmann W, Hanewinkel R. [Harmful health effects of flavors in e-cigarettes]. Dtsch Med Wochenschr 2024; 149:646-653. [PMID: 38458230 DOI: 10.1055/a-2260-5003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
BACKGROUND Almost all e-cigarettes contain flavorings that make the product more attractive. In the evaluation of e-cigarettes on health, flavors have so far played a subordinate role. METHOD Selective literature search in PubMed, supplemented by legal regulations on the use of flavors in e-cigarettes. RESULTS Flavors make it easier to start using e-cigarettes and have a consumption-promoting effect. Deeper inhalation increases nicotine uptake and the absorption of toxic substances from the e-cigarette liquid. For some flavors, pathological effects have been demonstrated in addition to other toxic components of the e-cigarette. To date, no toxicological analyses are available for the vast majority of flavors contained in e-cigarettes. CONCLUSIONS The proven consumption-promoting effect and the health risks that can be extrapolated from preclinical data are significant for the political discussion of a ban on flavors for e-cigarettes, analogous to the ban on flavors in tobacco products already in force.
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Affiliation(s)
- Natascha Sommer
- Medizinische Klinik II, Excellence Cluster Cardio-Pulmonary Institute (CPI), Universities of Gießen and Marburg Lung Center (UGMLC), Mitglied des Deutschen Zentrums für Lungenforschung (DZL), Justus-Liebig-Universität Gießen
| | - Klaas Franzen
- Universitätsklinikum Schleswig-Holstein, Medizinische Klinik III, Pneumologie, Campus Lübeck, Airway Research Center North (ARCN), Deutsches Zentrum für Lungenforschung (DZL), Lübeck/Großhansdorf
| | - Stefan Andreas
- Lungenfachklinik Immenhausen, Immenhausen, Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Deutsches Zentrum für Lungenforschung
| | - Wulf Pankow
- Philipps-Universität Marburg - Fachbereich Medizin
| | | | - Reiner Hanewinkel
- IFT-Nord gGmbH, Institut für Therapie- und Gesundheitsforschung, Kiel
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Ma S, Kaareen A, Park H, He Y, Jiang S, Qiu Z, Xie Z, Li D, Chen J, O'Connor RJ, Fong GT, Shang C. How to Identify e-Cigarette Brands Available in the United States During 2020-2022: Development and Usability Study. JMIR Form Res 2024; 8:e47570. [PMID: 38416562 PMCID: PMC10938231 DOI: 10.2196/47570] [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: 03/24/2023] [Revised: 10/31/2023] [Accepted: 01/30/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Prior studies have demonstrated that the e-cigarette market contains a large number of brands. Identifying these existing e-cigarette brands is a key element of market surveillance, which will further assist in policy making and compliance checks. OBJECTIVE To facilitate the surveillance of the diverse product landscape in the e-cigarette market, we constructed a semantic database of e-cigarette brands that have appeared in the US market as of 2020-2022. METHODS In order to build the brand database, we searched and compiled e-cigarette brands from a comprehensive list of retail channels and sources, including (1) e-liquid and disposable brands sold in web-based stores, (2) e-cigarette brands sold in brick-and-mortar stores and collected by the Nielsen Retail Scanner Data, (3) e-cigarette brands compiled by Wikipedia, (4) self-reported e-cigarette brands from the 2020 International Tobacco Control Four-Country Smoking and Vaping (ITC 4CV) US survey, and (5) e-cigarette brands on Twitter. We also estimated the top 5 e-cigarette brands by sales volume in brick-and-mortar stores, by the frequency and variety of offerings in web-based shops, and by the frequency of self-reported brands from the 2020 ITC 4CV US survey. RESULTS As of 2020-2022, a total of 912 e-cigarette brands have been sold by various retail channels. During 2020-2022, the top 5 brands are JUUL, vuse, njoy, blu, and logic in brick-and-mortar stores; blu, king, monster, twist, and air factory for e-liquids in web-based stores; hyde, pod mesh, suorin, vaporlax, and xtra for disposables sold in web-based stores; and smok, aspire, vaporesso, innokin, and eleaf based on self-reported survey data. CONCLUSIONS As the US Food and Drug Administration enforces the premarket tobacco market authorization, many e-cigarette brands may become illegal in the US market. In this context, how e-cigarette brands evolve and consolidate in different retail channels will be critical for understanding the regulatory impacts on product availability. Our semantic database of e-cigarette brands can serve as a useful tool to monitor product and marketplace development, conduct compliance checks, assess manufacturers' marketing behaviors, and identify regulatory impacts.
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Affiliation(s)
- Shaoying Ma
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Aadeeba Kaareen
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Hojin Park
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Yanyun He
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Shuning Jiang
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH, United States
| | - Zefeng Qiu
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH, United States
| | - Zidian Xie
- Department of Clinical and Translational Research, University of Rochester Medical Center, Rochester, NY, United States
| | - Dongmei Li
- Department of Clinical and Translational Research, University of Rochester Medical Center, Rochester, NY, United States
| | - Jian Chen
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH, United States
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Ce Shang
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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Raduka A, Gao N, Chatburn RL, Rezaee F. Electronic cigarette exposure disrupts airway epithelial barrier function and exacerbates viral infection. Am J Physiol Lung Cell Mol Physiol 2023; 325:L580-L593. [PMID: 37698113 PMCID: PMC11068398 DOI: 10.1152/ajplung.00135.2023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/07/2023] [Accepted: 09/06/2023] [Indexed: 09/13/2023] Open
Abstract
The use of electronic cigarettes (e-cigs), especially among teenagers, has reached alarming and epidemic levels, posing a significant threat to public health. However, the short- and long-term effects of vaping on the airway epithelial barrier are unclear. Airway epithelial cells are the forefront protectors from viruses and pathogens. They contain apical junctional complexes (AJCs), which include tight junctions (TJs) and adherens junctions (AJs) formed between adjacent cells. Previously, we reported respiratory syncytial virus (RSV) infection, the leading cause of acute lower respiratory infection-related hospitalization in children and high-risk adults, induces a "leaky airway" by disrupting the epithelial AJC structure and function. We hypothesized chemical components of e-cigs disrupt airway epithelial barrier and exacerbate RSV-induced airway barrier dysfunction. Using confluent human bronchial epithelial (16HBE) cells and well-differentiated normal human bronchial epithelial (NHBE) cells, we found that exposure to extract and aerosol e-cig nicotine caused a significant decrease in transepithelial electrical resistance (TEER) and the structure of the AJC even at noncytotoxic concentrations. Western blot analysis of 16HBE cells exposed to e-cig nicotine extract did not reveal significant changes in AJC proteins. Exposure to aerosolized e-cig cinnamon or menthol flavors also induced barrier disruption and aggravated nicotine-induced airway barrier dysfunction. Moreover, preexposure to nicotine aerosol increased RSV infection and the severity of RSV-induced airway barrier disruption. Our findings demonstrate that e-cig exposure disrupts the airway epithelial barrier and exacerbates RSV-induced damage. Knowledge gained from this study will provide awareness of adverse e-cig respiratory effects and positively impact the mitigation of e-cig epidemic.NEW & NOTEWORTHY Electronic cigarette (e-cig) use, especially in teens, is alarming and at epidemic proportions, threatening public health. Our study shows that e-cig nicotine exposure disrupts airway epithelial tight junctions and increases RSV-induced barrier dysfunction. Furthermore, exposure to aerosolized flavors exaggerates e-cig nicotine-induced airway barrier dysfunction. Our study confirms that individual and combined components of e-cigs deleteriously impact the airway barrier and that e-cig exposure increases susceptibility to viral infection.
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Affiliation(s)
- Andjela Raduka
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States
| | - Nannan Gao
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States
| | - Robert L Chatburn
- Enterprise Respiratory Care Research Cleveland Clinic, Cleveland Clinic Children's, Cleveland, Ohio, United States
| | - Fariba Rezaee
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States
- Center for Pediatric Pulmonary Medicine, Cleveland Clinic Children's, Cleveland, Ohio, United States
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Le N, McMann TJ, Cui M, Cuomo RE, Yang JS, Mackey TK. Tobacco Product Marketing Orders and Online Marketing and Sale of Unauthorized ENDS Products. JAMA Intern Med 2023; 183:1170-1172. [PMID: 37669043 PMCID: PMC10481318 DOI: 10.1001/jamainternmed.2023.3101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/20/2023] [Indexed: 09/06/2023]
Abstract
This study characterizes online marketing of unauthorized electronic nicotine delivery systems (ENDS).
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Affiliation(s)
- Nicolette Le
- Global Health Program, Department of Anthropology, University of California San Diego
| | - Tiana J. McMann
- Global Health Program, Department of Anthropology, University of California San Diego
| | - Mandy Cui
- Global Health Program, Department of Anthropology, University of California San Diego
| | - Raphael E. Cuomo
- Department of Anesthesiology, School of Medicine, University of California San Diego
| | - Joshua S. Yang
- Department of Public Health, California State University, Fullerton
| | - Tim Ken Mackey
- Global Health Program, Department of Anthropology, University of California San Diego
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Ma S, Jiang S, Wagener T, Mays D, Chen J, Shang C. The associations between e-liquid characteristics and its pricing: Evidence from online vape shops. PLoS One 2023; 18:e0286258. [PMID: 37235576 DOI: 10.1371/journal.pone.0286258] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Given the increase in electronic cigarette use during the past decade, the objectives of this study are to obtain comprehensive product-level information from online vape shops, which are one of the most common outlets for e-cigarette users to purchase vaping products, especially e-liquid products, and to examine the appeal of various e-liquid product attributes to consumers. We used web scraping and estimation of generalized estimating equation (GEE) models to obtain and analyze data from five popular online vape shops that sell nationwide across the US. The outcome measures are e-liquid pricing for the following e-liquid product attributes: nicotine concentration (in mg/ml), nicotine form (nicotine-free, freebase, or salt), vegetable glycerin/propylene glycol (VG/PG) ratio, and a variety of flavors. We find that the pricing for freebase nicotine and nicotine salt products are 1% (p<0.001) lower and 12% higher (p<0.001), respectively, than that for products that do not contain nicotine. For nicotine salt-based e-liquid products specifically, the pricing for a 50/50 VG/PG ratio is 10% (p<0.001) higher than the pricing for a more common 70/30 VG/PG ratio, and the pricing for fruity flavors is 2% (p<0.05) higher than that for tobacco/unflavored products. Regulating the nicotine form in all e-liquid products and fruity flavor in nicotine salt-based products will have a great impact on the market and consumers. The preference for VG/PG ratio varies by product nicotine form. More evidence on typical user patterns of a certain nicotine form (i.e., freebase or salt nicotine) is needed to assess the public health consequences of these regulations.
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Affiliation(s)
- Shaoying Ma
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States of America
| | - Shuning Jiang
- Department of Computer Science and Engineering, The Ohio State University, Columbus, Ohio, United States of America
| | - Theodore Wagener
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States of America
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
| | - Darren Mays
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States of America
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
| | - Jian Chen
- Department of Computer Science and Engineering, The Ohio State University, Columbus, Ohio, United States of America
| | - Ce Shang
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States of America
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
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