Puff bars: a dangerous trend in adolescent disposable e-cigarette use

Disposable e-cigarettes and their nicotine delivery, usage pattern, and subjective effects in occasionally smoking adults

New disposable e-cigarettes are popular, especially among young people. This study aimed to assess their addictive potential by examining puffing behaviors, subjective effects, and conducting laboratory investigations in an experimental setting. Single-center, four-arm, crossover study. Laboratory setting in Munich (LMU-University Hospital), Germany. Eighteen occasionally cigarette-smoking adults aged 19-28. Two disposable e-cigarettes of the same brand (strawberry-kiwi/ tobacco flavored) were tested with a cigarette and a conventional pod e-cigarette as comparators. Usage was ad libitum for 5 min (or the duration of smoking one cigarette) while puffing topography was recorded. Distributed over 30 min blood samples for nicotine plasma concentrations were drawn and hemodynamic parameters and subjective effects assessed. Nicotine delivery of disposable e-cigarettes (Cmax strawberry-kiwi: 7.1 ng/ml, tobacco: 6.9 ng/ml) was similar to the cigarette (8.1 ng/ml) and higher than for the pod e-cigarette (3.1 ng/ml). The nicotine plasma increase in the first minute was the fastest for disposable e-cigarettes. Tmax for the disposable e-cigarettes (strawberry-kiwi: 5 min, tobacco: 6 min) was reached faster than for the cigarette (8 min). Compared to the pod e-cigarette (6 min), tmax was reached faster with the disposable e-cigarette tobacco. Total nicotine uptake was the lowest for the pod e-cigarette. Puffing behavior differed between e-cigarettes and the cigarette and slightly between both disposable e-cigarettes. Satisfaction and motivation to consume the product again were higher for disposables with a slight preference for strawberry-kiwi flavor. New disposable e-cigarettes hold great addictive potential for young people unestablished in smoking. Besides conducting further research, it is crucial to observe usage trends and strengthen regulations.Trial registration number: DRKS00030978. Date of registration: 21.02.2023.

Clearing the haze: novel methodology objectively assessing children's online exposure to tobacco and vape marketing

Marketing of tobacco and vape products is effective at recruiting new users; yet, little is known about children's online exposure to such material. This research aimed to develop a methodology for assessing children's exposure to, and engagement with, online tobacco and vape marketing. This pilot study used data from the innovative Kids Online Aotearoa Study in which 156 11-13-year-olds from schools in the Wellington region of Aotearoa New Zealand used Zoom teleconferencing software to record real-time, screen-shared internet use for four consecutive days. We developed a coding framework to analyse the nature and extent of exposure to tobacco or vape marketing and applied it to a strategic subset of children's (n = 16) data. Twenty-one instances of tobacco or vape marketing were identified from 12 participants; four participants had no identified exposures. The findings show that children are exposed to such marketing online, despite legislation that should protect them; these insights improve understanding of the online marketing environment and may help to support global health promotion efforts in tobacco and nicotine control given the borderless nature of the online world. The Kids Online Aotearoa tobacco and vape marketing methodology and coding framework enables the direct assessment of children's exposure to online tobacco and vape marketing and is a valuable research tool to monitor and provide evidence to inform social and political action to protect children from online harm.

Disposable e-cigarette use: Factors, frequency and cigarette smoking among United States high school students

BACKGROUND AND AIMS

Disposable e-cigarette use has increased among United States (US) high school students in recent years. However, there is limited research on the profile of these users, how often they use these products, and whether they displace cigarette smoking. This study aimed to measure how disposable e-cigarette use among US youth varies according to demographic characteristics and whether there is any association between e-cigarette use and reduced use of traditional cigarettes.

DESIGN

We used cross-sectional data from the 2022 National Youth Tobacco Survey and conducted a multinomial logistic regression to examine factors associated with the types of e-cigarette devices used in the prior 30 days, adjusting for sex, sexual identity, grade level and race/ethnicity. We also used a finite mixture model to account for unobserved differences among users and identify e-cigarette use patterns in different subgroups of users.

SETTING

United States.

PARTICIPANTS

High school students in grades 9-12 (n = 14 389).

MEASUREMENTS

Survey participants self-reported the type of e-cigarette device used, the frequency of e-cigarettes used and cigarettes smoked over the past 30 days.

FINDINGS

Disposable e-cigarettes were the most popular e-cigarette type. Sex, sexual orientation, grade level and race/ethnicity were associated with disposable e-cigarette use. The odds of disposable e-cigarette use were lower in male students than in female students (odds ratio [OR] = 0.78, 95% confidence interval [CI] = [0.64-0.96]), and higher in students who identified as gay or lesbian (OR = 1.70, 95% CI = [1.11-2.61]) or bisexual (OR = 1.52, 95% CI = [1.16-1.99]) than in heterosexual students. The odds of disposable use were higher among students in higher grades (10th, 11th and 12th) than in 9th graders (OR = 1.71, 2.24 and 2.52, respectively). Disposable e-cigarette users had a lower frequency of traditional cigarette use than other e-cigarette users, both in the low-frequency class (incidence rate ratio [IRR] = 0.33, 95% CI = [0.12-0.92]) and the high-frequency class (IRR = 0.27, 95% CI = [0.08-0.92]).

CONCLUSIONS

Disposable e-cigarette use appears to be higher among United States high school students who are female, older and/or identify as gay, lesbian or bisexual. Disposable e-cigarettes appear to be associated with reduced traditional cigarette use.

Detecting changes in tobacco product marketplace prominence using social media, advertising, sales, and web traffic data: The example of Puff Bar in the United States tobacco marketplace from 2019 to 2021

Puff Bar, a disposable electronic nicotine delivery system (ENDS), was the ENDS brand most commonly used by U.S. youth in 2021. We explored whether Puff Bar's rise in marketplace prominence was detectable through advertising, retail sales, social media, and web traffic data sources. We retrospectively documented potential signals of interest in and uptake of Puff Bar in the United States using metrics based on advertising (Numerator and Comperemedia), retail sales (NielsenIQ), social media (Twitter, via Sprinklr), and web traffic (Similarweb) data from January 2019 to June 2022. We selected metrics based on (1) data availability, (2) potential to graph metric longitudinally, and (3) variability in metric. We graphed metrics and assessed data patterns compared to data for Vuse, a comparator product, and in the context of regulatory events significant to Puff Bar. The number of Twitter posts that contained a Puff Bar term (social media), Puff Bar product sales measured in dollars (sales), and the number of visits to the Puff Bar website (web traffic) exhibited potential for surveilling Puff Bar due to ease of calculation, comprehensibility, and responsiveness to events. Advertising tracked through Numerator and Comperemedia did not appear to capture marketing from Puff Bar's manufacturer or drive change in marketplace prominence. This study demonstrates how quantitative changes in metrics developed using advertising, retail sales, social media, and web traffic data sources detected changes in Puff Bar's marketplace prominence. We conclude that low-effort, scalable, rapid signal detection capabilities can be an important part of a multi-component tobacco surveillance program.

Online Interest in Elf Bar in the United States: Google Health Trends Analysis

BACKGROUND

Despite the popularity of JUUL e-cigarettes, other brands (eg, Elf Bar) may be gaining digital attention.

OBJECTIVE

This study compared Google searches for Elf Bar and JUUL from 2022 to 2023 using Google Health Trends Application Programming Interface data.

METHODS

Using an infodemiology approach, we examined weekly trends in Google searches (per 10 million) for "Elf Bar" and "JUUL" at the US national and state levels from January 1, 2022, to December 31, 2023. Joinpoint regression was used to assess statistically significant trends in the search probabilities for "Elf Bar" and "JUUL" during the study period.

RESULTS

Elf Bar had less online interest than JUUL at the beginning of 2022. When the US Food and Drug Administration denied JUUL marketing authority on June 23, 2022, JUUL searches peaked at 2609.3 × 107 and fell to 83.9 × 107 on September 3, 2023. Elf Bar searches surpassed JUUL on July 10, 2022, and steadily increased, reaching 523.2 × 107 on December 4, 2022. Overall, Elf Bar's weekly search probability increased by 1.6% (95% CI 1.5%-1.7%; P=.05) from January 2022 to December 2023, with the greatest increase between May 29 and June 19, 2022 (87.7%, 95% CI 35.9%-123.9%; P=.001). Elf Bar searches increased after JUUL's suspension in Pennsylvania (1010%), Minnesota (872.5%), Connecticut (803.5%), New York (738.1%), and New Jersey (702.9%).

CONCLUSIONS

Increasing trends in Google searches for Elf Bar indicate that there was a growing online interest in this brand in the United States in 2022.

What are the characteristics of disposable electronic cigarettes users in Switzerland? A quantitative study among 14-25 year olds

ABSTRACT

Introduction

Disposable electronic cigarettes (DEC) appeared in Switzerland in 2020. The aim of this study is to determine the prevalence of DEC use among youth (14-25 year olds) living in French-speaking Switzerland and their characteristics.

Methods

Data were obtained from a web-based survey conducted in August 2022. Participants were divided into four DEC user groups according to and were compared on sociodemographic data, substance use, family substance use and advertising viewing. Additional questions such as purchase methods and motivations were asked to the user groups.

Results

Among the 1362 participants, 41.2% had never used a DEC (NEVER), 14.4% once (ONCE), 15.1% several times but not in the last 30 days (PAST) and 29.2% several times in the last 30 days (CURRENT). At the multivariate level, compared with the NEVER group, participants in the CURRENT group were more likely to have used cigarettes and cannabis in the last 30 days, to report family electronic cigarettes use and to have seen online advertising for DEC. Among DEC users, compared with the ONCE group, those in the CURRENT group were less likely to be cisgender males, to have acquired their last DEC through peers or family and to use DEC out of curiosity.

Conclusions

Although most youth do not consume DEC regularly, these results raise concerns about growing exposure of young people to highly addictive products. They underline the importance of monitoring products availability, marketing and prevalence. They also confirm the necessity to inform the public, denormalise use and strengthen regulations.

Unburned Tobacco Smoke Affects Neuroinflammation-Related Pathways in the Rat Mesolimbic System

Tobacco use disorder represents a significant public health challenge due to its association with various diseases. Despite awareness efforts, smoking rates remain high, partly due to ineffective cessation methods and the spread of new electronic devices. This study investigated the impact of prolonged nicotine exposure via a heat-not-burn (HnB) device on selected genes and signaling proteins involved in inflammatory processes in the rat ventral tegmental area (VTA) and nucleus accumbens (NAc), two brain regions associated with addiction to different drugs, including nicotine. The results showed a reduction in mRNA levels for PPARα and PPARγ, two nuclear receptors and anti-inflammatory transcription factors, along with the dysregulation of gene expression of the epigenetic modulator KDM6s, in both investigated brain areas. Moreover, decreased PTEN mRNA levels and higher AKT phosphorylation were detected in the VTA of HnB-exposed rats with respect to their control counterparts. Finally, significant alterations in ERK 1/2 phosphorylation were observed in both mesolimbic areas, with VTA decrease and NAc increase, respectively. Overall, the results suggest that HnB aerosol exposure disrupts intracellular pathways potentially involved in the development and maintenance of the neuroinflammatory state. Moreover, these data highlight that, similar to conventional cigarettes, HnB devices use affects specific signaling pathways shaping neuroinflammatory process in the VTA and NAc, thus triggering mechanisms that are currently considered as potentially relevant for the development of addictive behavior.

Analysis of e-cigarette warning letters issued by the Food and Drug Administration in 2020 and 2021

PURPOSE

This study analyses the Food and Drug Administration (FDA) warning letters sent to e-cigarette companies from 1 January 2020 to 9 September 2021. Study results can inform regulation of e-cigarettes.

METHODOLOGY

Warning letters retrieved from FDA's website were coded for company type (retailer, manufacturer or distributor), location (domestic or international), infractions listed (PMTA (premarket tobacco product application), selling to minors, advertising to youth or packaging violation/mislabelling), product type (e-liquid, device or both), flavour (fruit, candy, tobacco, menthol/mint, concept flavour) and consequence (civil money penalties, product seizure and injunction, product detention and refusal of entry to the USA, no-tobacco-sales order, criminal prosecution).

RESULTS

Of 303 coded letters (126 from 2020 and 177 from 2021), 97.4% were sent to small online retailers. Overall, 94.1% of the companies cited were located within the USA, 75.2% of the infractions were identified by reviewing a company's website and 70.5% were PMTA violations. In 2020, 55.6% of infractions were PMTA violations; in 2021, nearly all infractions were PMTA violations. The letters cited 880 products; 92.2% of which were e-liquid products, with 32.4% fruit and 31.1% concept flavours.

DISCUSSION

Warning letters targeted small online retailers rather than large e-cigarette brands or products most used by youth: pod mods and disposables. The focus of these enforcement actions comprises a small share of the market and the impact on use was likely minimal. With PMTA decisions pending for the largest brands of e-cigarettes, the FDA should use its enforcement powers to target manufacturers, distributors and sellers of the tobacco products that have the greatest impact on youth and products that provide no public health benefit.

E-Cigarettes Reexamined: Product Toxicity

The introduction of e-cigarettes, or electronic nicotine delivery systems (ENDS), has been accompanied by controversy regarding their safety and effectiveness as a cessation aid and by an explosion in their use by youth. Their use does not involve the combustion of tobacco and the creation of harmful combustion products; they have been seen as a "harm reduction" tool that may be of assistance in promoting smoking cessation. Recognition that ENDS can deliver an array of chemicals and materials with known adverse consequences has spurred more careful examination of these products. Nicotine, nitrosamines, carbonyl compounds, heavy metals, free radicals, reactive oxygen species, particulate matter, and "emerging chemicals of concern" are among the constituents of the heated chemical aerosol that is inhaled when ENDS are used. They raise concerns for cardiovascular and respiratory health that merit the attention of clinicians and regulatory agencies. Frequently cited concerns include evidence of disordered respiratory function, altered hemodynamics, endothelial dysfunction, vascular reactivity, and enhanced thrombogenesis. The absence of evidence of the consequences of their long-term use is of additional concern. Their effectiveness as cessation aids and beneficial impact on health outcomes continue to be examined. It is important to ensure that their production and availability are thoughtfully regulated to optimise their safety and permit their use as harm reduction devices and potentially as smoking-cessation aids. It is equally vital to effectively prevent them from becoming ubiquitous consumer products with the potential to rapidly induce nicotine addiction among large numbers of youth. Clinicians should understand the nature of these products and the implications of their use.