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Venkatesan P. UK tobacco and vapes bill one step closer. Lancet Oncol 2024; 25:541. [PMID: 38555932 DOI: 10.1016/s1470-2045(24)00185-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
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Borowiecki M, Kim Y, Emery S. A Patchy Prohibition: Product and Flavor Substitution After the Food and Drug Administration's Prioritized Enforcement Policy on Flavored E-cigarettes. Nicotine Tob Res 2024; 26:527-535. [PMID: 37948576 PMCID: PMC11033575 DOI: 10.1093/ntr/ntad212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 10/09/2023] [Accepted: 10/21/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION E-cigarettes have rapidly grown in use among U.S. adolescents; in response, the Food and Drug Administration (FDA) engaged in an "enforcement policy on banned e-cigarette flavors" ("enforcement action") for pod-based e-cigarettes in January 2020, which accounted for most U.S. e-cigarette sales. No literature has yet examined long-term changes in e-cigarette sales patterns changed in relation to the FDA enforcement action. AIMS AND METHODS We analyzed U.S. e-cigarette sales using Nielsen retail scanner data between March 2017 and December 2021, describing e-cigarette sales trends overall, by device type, and by flavor category. We also performed joinpoint regression analysis on the sales trends to detect significant changes in the rate of change of sales over time. RESULTS The FDA enforcement action was associated with a sharp initial decrease in prefilled pod dollar sales, followed by a steady increase from April 2020 through the end of 2021, growing beyond the previous maximum in August 2019. We also observed a dramatic change in the composition of flavors sold: A large decline in mint-flavored pod sales was offset by a similar increase in menthol-flavored sales. Simultaneously, disposable product sales increased nearly ten-fold from July 2019 to July 2020 before stabilizing, dominated by fruit-flavored products. CONCLUSIONS Our findings suggest rapid product substitution without a long-term decline in e-cigarette sales in association with the enforcement action, along with a growing dominance of youth-friendly flavors, contrasting against FDA policy goals. Our study revealed the weakness of the "patchy" enforcement action, raising concern about its unintended consequences as consumption simply shifted to other e-cigarette products. IMPLICATIONS This is the first detailed longitudinal study on e-cigarette sales trends in the United States following the FDA flavor enforcement action, with novel findings on flavor trends and their relation to policy events. We report sales overall, by product type, and by flavor category, and highlight several important trends following the action, such as the rise and persistence of disposable e-cigarettes increasingly and overwhelmingly dominated by youth-friendly flavors, and likely substitution of prefilled e-cigarette flavors without any long-term decline in sales. Our results highlight the weaknesses of "patchy" regulation and suggest the need for a more comprehensive approach to flavor regulation.
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Affiliation(s)
- Mateusz Borowiecki
- Department of Public Health, NORC At The University of Chicago, Chicago, IL, USA
| | - Yoonsang Kim
- Department of Public Health, NORC At The University of Chicago, Chicago, IL, USA
| | - Sherry Emery
- Department of Public Health, NORC At The University of Chicago, Chicago, IL, USA
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Ali FRM, Vallone D, Seaman EL, Cordova J, Diaz MC, Tynan MA, Trivers KF, King BA. Evaluation of Statewide Restrictions on Flavored e-Cigarette Sales in the US From 2014 to 2020. JAMA Netw Open 2022; 5:e2147813. [PMID: 35142832 PMCID: PMC8832173 DOI: 10.1001/jamanetworkopen.2021.47813] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
IMPORTANCE e-Cigarettes are the most commonly used tobacco product among US youths. Flavors are among the most cited reasons for use of e-cigarettes among youths, and therefore, some states have imposed restrictions on flavored e-cigarette sales. To our knowledge, no study has compared e-cigarette sales between states with statewide flavored e-cigarette restrictions and states without such restrictions while controlling for co-occurring events. OBJECTIVE To assess whether implementation of statewide restrictions on flavored e-cigarette sales in Massachusetts, New York, Rhode Island, and Washington was associated with a reduction in total e-cigarette unit sales from 2014 to 2020. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study with difference-in-differences analysis used e-cigarette retail sales data from Massachusetts, Rhode Island, and Washington, which implemented restrictions on flavored e-cigarette sales in October 2019; New York, which implemented these restrictions in May 2020; and 35 states without these restrictions (control states). Sales were summed into 4-week periods from August 24, 2014, to December 27, 2020, for a total of 2988 state-period observations. MAIN OUTCOMES AND MEASURES A difference-in-differences analysis was conducted to compare e-cigarette unit sales in the 4 states with flavor restrictions (before and after implementation) with those in the 35 control states. The model controlled for other population-based policies and emergent events (eg, the COVID-19 pandemic). Data on 4-week e-cigarette unit sales were sorted into 4 flavor categories (tobacco, menthol, mint, and other). Unit sales were standardized to reflect the most common package sizes for each product type. RESULTS Statewide restrictions on non-tobacco-flavored e-cigarette sales were associated with the following reductions in mean 4-week total e-cigarette sales in intervention states compared with control states from October 2019 to December 2020: 30.65% (95% CI, 24.08%-36.66%) in New York, 31.26% (95% CI, 11.94%-46.34%) in Rhode Island, and 25.01% (95% CI, 18.43%-31.05%) in Washington. In Massachusetts, the comprehensive sales prohibition of all e-cigarette products was associated with a 94.38% (95% CI, 93.37%-95.23%) reduction in 4-week sales compared with control states. Except in Massachusetts, where all sales of flavored e-cigarettes decreased, reductions were found only for non-tobacco-flavored e-cigarette sales in the other states with restrictions. Among control states, mean sales decreased by 28.4% from August 2019 to February 2020 but then increased by 49.9% from February through December 2020. CONCLUSIONS AND RELEVANCE In this cross-sectional study, statewide restrictions on the sale of flavored e-cigarettes in Massachusetts, New York, Rhode Island, and Washington were associated with a reduction in total e-cigarette sales. These findings suggest that not all e-cigarette users who purchased non-tobacco-flavored e-cigarettes switched to purchasing tobacco-flavored e-cigarettes after policy implementation.
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Affiliation(s)
| | | | | | | | | | - Michael A. Tynan
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Katrina F. Trivers
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brian A. King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Affiliation(s)
- Sam N Cwalina
- From the Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles (S.N.C., R.M., J.L.B.-T.), and the Clinical Pharmacology Program, Division of Cardiology, Department of Medicine, University of California, San Francisco (N.L.B.)
| | - Rob McConnell
- From the Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles (S.N.C., R.M., J.L.B.-T.), and the Clinical Pharmacology Program, Division of Cardiology, Department of Medicine, University of California, San Francisco (N.L.B.)
| | - Neal L Benowitz
- From the Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles (S.N.C., R.M., J.L.B.-T.), and the Clinical Pharmacology Program, Division of Cardiology, Department of Medicine, University of California, San Francisco (N.L.B.)
| | - Jessica L Barrington-Trimis
- From the Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles (S.N.C., R.M., J.L.B.-T.), and the Clinical Pharmacology Program, Division of Cardiology, Department of Medicine, University of California, San Francisco (N.L.B.)
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Berg CJ, Barker DC, Sussman S, Getachew B, Pulvers K, Wagener TL, Hayes RB, Henriksen L. Vape Shop Owners/Managers' Opinions About FDA Regulation of E-Cigarettes. Nicotine Tob Res 2021; 23:535-542. [PMID: 32722808 DOI: 10.1093/ntr/ntaa138] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 07/25/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION In the United States, prominent sources of vaping products are specialty vape shops, which are subject to Food and Drug Administration (FDA) regulation. This study interviewed vape shop owners/managers to assess: (1) reasons for entering into or engaging in vape shop retail; (2) personnel training, particularly with regard to FDA and state regulations; and (3) how existing regulations are perceived and the anticipated impact of future regulation. AIMS AND METHODS The current study involved phone-based semi-structured interviews of 45 vape shop owners/managers in six metropolitan statistical areas (Atlanta, Boston, Minneapolis, Oklahoma City, San Diego, and Seattle) during Summer 2018 as FDA regulations regarding minimum age verification, bans on product sampling, and health warnings (among others) were first being implemented. RESULTS Vape shop owners/managers reported: (1) entering the industry with positive intentions for their customers, (2) training their personnel to adhere to regulations and provide good customer service, and (3) significant concerns about the impact of FDA regulations. With regard to the latter, participants reported mistrust of the intentions of the FDA regulations, financial implications of the regulations (particularly for small businesses), difficulty understanding and interpreting the regulations, insufficient evidence to support the regulations, negative impact on customer service, negative impact on product offerings and product innovation/advancement, and negative implications of flavor bans and/or restrictions on sale of flavors. CONCLUSIONS These findings indicate the complexities in implementing tobacco regulations, particularly from the perspective of the vape shop industry. Current findings should inform future regulatory actions and efforts to assess compliance with regulations. IMPLICATIONS Current and impending FDA regulation of vaping products present a critical period for examining regulatory impact on the vape shop industry. Current results indicated that many vape shop owners/managers reporting positive intentions for engaging in the vaping product industry and in training vape shop personnel to adhere to regulations. However, the majority reported concerns about FDA regulation and other state/local regulations that could have negative implications for their industry. Particular concerns include difficulty understanding the regulations due to complexity, vagueness, and changes in language and/or interpretation over time. These issues have implications for compliance that must be addressed.
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Affiliation(s)
- Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health; George Washington Cancer Center, George Washington University, Washington, DC
| | | | - Steve Sussman
- Departments of Preventive Medicine and Psychology, and School of Social Work, University of Southern California, Alhambra, CA
| | - Betelihem Getachew
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kim Pulvers
- Department of Psychology, California State University San Marcos, San Marcos, CA
| | - Theodore L Wagener
- Ohio State University Comprehensive Cancer Center and Division of Medical Oncology, The Ohio State University, Columbus, OH
| | - Rashelle B Hayes
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Lisa Henriksen
- Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA
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Fucito LM, Malinosky H, Baldassarri SR, Herbst RS. Clearing the Haze: What Do We Still Need to Learn about Electronic Nicotine Delivery Systems? Cancer Prev Res (Phila) 2021; 14:5-10. [PMID: 33148678 PMCID: PMC8324047 DOI: 10.1158/1940-6207.capr-20-0394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/28/2020] [Accepted: 10/27/2020] [Indexed: 11/16/2022]
Abstract
Electronic nicotine delivery systems (ENDS; i.e., electronic cigarettes, e-cigarettes, vaping devices, vape pens) were introduced to the U.S. market in 2007 as a potential harm reduction alternative for people who smoked combustible cigarettes. Since that time, ENDS popularity grew very quickly, particularly among individuals who smoke cigarettes. However, young people and never smokers also started using ENDS, cohorts for whom these products were not intended. There are now a broad range of devices and e-liquid constituents. ENDS devices vary considerably in their design and generation of potentially toxic chemicals, with higher power devices likely much more hazardous than lower power devices. This landscape may further change after September 9, 2020, when all ENDS manufacturers are required to submit a premarket tobacco product application to the FDA to obtain authorization for marketing. Research has not kept pace with this rapidly changing technology and important questions remain regarding the relative benefits versus risks of ENDS. In light of these challenges, we propose key ENDS research priorities to address these gaps.
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Affiliation(s)
- Lisa M Fucito
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
- Yale Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Hannah Malinosky
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Stephen R Baldassarri
- Department of Internal Medicine, Section of Pulmonary, Critical Care & Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Roy S Herbst
- Yale Cancer Center, Yale University School of Medicine, New Haven, Connecticut
- Department of Internal Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, Connecticut
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Yingst JM, Bordner CR, Hobkirk AL, Hoglen B, Allen SI, Krebs NM, Houser KR, Livelsberger C, Foulds J. Response to Flavored Cartridge/Pod-Based Product Ban among Adult JUUL Users: "You Get Nicotine However You Can Get It". Int J Environ Res Public Health 2020; 18:ijerph18010207. [PMID: 33396598 PMCID: PMC7795757 DOI: 10.3390/ijerph18010207] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/22/2020] [Accepted: 12/24/2020] [Indexed: 11/17/2022]
Abstract
In order to curb increasing youth electronic cigarette (e-cig) use, the United States Food and Drug Administration (FDA) banned the sale of flavored cartridge/pod-based products in February 2020. This mixed-methods study aimed to evaluate the impact of the FDA ban on adult JUUL users. The samples of current adult JUUL users were surveyed via Amazon Mechanical Turk at three time-points n = 76 (Sample 1); n = 128 (Sample 2); n = 86 (Sample 3) before and after the FDA flavored/pod ban. The participants were asked to report the JUUL flavored pod used most often and answer questions on purchasing generic pods or refilling (Quantitative). JUUL users were then interviewed in order to explore their perceptions and behaviors related to the FDA ban of flavored cartridge/pod-based products (Qualitative; n = 16). Quantitative data analysis evaluated the differences in variables by time-point. Qualitative data were coded into themes while using the constant comparative method. We found a significant decrease in the use of mint pods (43.4%, 22.7%, 16.3%) (p < 0.01), while there was a significant increase in the use of menthol pods (6.6%, 26.6%, 37.2%) (p < 0.01). Themes that emerged from the qualitative data included switching from mint to menthol pods, refilling pods, and switching to other products that are available in the desired flavors, such as generic pods or disposable e-cigs. Future research is needed in order to evaluate the impact of these behaviors on public health.
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Affiliation(s)
- Jessica M. Yingst
- Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA 17033, USA; (J.M.Y.); (S.I.A.); (N.M.K.); (C.L.); (J.F.)
| | - Candace R. Bordner
- Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA 17033, USA; (J.M.Y.); (S.I.A.); (N.M.K.); (C.L.); (J.F.)
- Department of Psychiatry and Behavioral Health, Penn State University College of Medicine, Hershey, PA 17033, USA; (A.L.H.); (B.H.); (K.R.H.)
- Correspondence:
| | - Andréa L. Hobkirk
- Department of Psychiatry and Behavioral Health, Penn State University College of Medicine, Hershey, PA 17033, USA; (A.L.H.); (B.H.); (K.R.H.)
| | - Brianna Hoglen
- Department of Psychiatry and Behavioral Health, Penn State University College of Medicine, Hershey, PA 17033, USA; (A.L.H.); (B.H.); (K.R.H.)
| | - Sophia I. Allen
- Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA 17033, USA; (J.M.Y.); (S.I.A.); (N.M.K.); (C.L.); (J.F.)
| | - Nicolle M. Krebs
- Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA 17033, USA; (J.M.Y.); (S.I.A.); (N.M.K.); (C.L.); (J.F.)
| | - Kenneth R. Houser
- Department of Psychiatry and Behavioral Health, Penn State University College of Medicine, Hershey, PA 17033, USA; (A.L.H.); (B.H.); (K.R.H.)
| | - Craig Livelsberger
- Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA 17033, USA; (J.M.Y.); (S.I.A.); (N.M.K.); (C.L.); (J.F.)
| | - Jonathan Foulds
- Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA 17033, USA; (J.M.Y.); (S.I.A.); (N.M.K.); (C.L.); (J.F.)
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Abstract
Electronic cigarettes (e-cigarettes) are noncombustible tobacco products that have been promoted as safer alternatives to conventional cigarettes and beneficial tools for smoking cessation. However, e-cigarettes have been shown to produce aerosols with high concentrations of propylene glycol, glycerol, volatile organic compounds, and free radicals, which can lead to lung damage. Furthermore, e-cigarettes can deliver nicotine at concentrations higher than traditional combustibles, making them highly addictive. As delivery devices became smaller, less expensive, and refillable, the use of e-cigarettes dramatically increased, especially among adolescents and young adults in the United States. This rise in popularity of noncombustible products led to an outbreak of e-cigarette or vaping product use-associated lung injury (EVALI) in the fall of 2019. In this article, we review the history of e-cigarettes and its prevalence among American youth, the EVALI outbreak and clinical presentation of EVALI patients, and recent legislative efforts to regulate e-cigarette use.
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Affiliation(s)
- Meagan Shinbashi
- Virginia Commonwealth University, Department of Pediatrics and the Children's Hospital of Richmond at VCU, Richmond, VA, United States
| | - Bruce K Rubin
- Virginia Commonwealth University, Department of Pediatrics and the Children's Hospital of Richmond at VCU, Richmond, VA, United States.
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Laestadius LI, Wahl MM, Vassey J, Cho YI. Compliance With FDA Nicotine Warning Statement Provisions in E-liquid Promotion Posts on Instagram. Nicotine Tob Res 2020; 22:1823-1830. [PMID: 32433737 PMCID: PMC7542640 DOI: 10.1093/ntr/ntaa092] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/14/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Effective August 2018, the U.S. Food and Drug Administration (FDA) required that nicotine addiction warnings be placed on ads for nicotine containing e-liquids. As per FDA comments, this provision pertains to visual ads communicated via social media, raising questions about compliance within the large e-liquid promotion community on Instagram. AIMS AND METHODS This study examines use of warnings on promotional Instagram posts before and after provisions took effect on August 10, 2018. Netlytic was used to gather a sample of 500 promotional #eliquid and #ejuice posts from: May 2017, October 2017, March 2018, August 2018, and September 2018. The 1500 prewarning and 1000 postwarning posts were coded using content analysis. Changes in products and marketing strategies were also considered. Post volume was tracked monthly between May 2017 and February 2020. RESULTS In the prewarning period, nicotine warning statements were absent on all posts. Following August 10, 2018, FDA compliant warnings were present on 13.6% of posts. Among US-based posts, 36.4% used the warnings, with warnings more common on posts made by e-liquid brands (52.3%) and posts promoting e-liquids with nicotine (40.0%). Promotional strategies and products did not significantly change. The share of posts made by US Instagram users decreased by 11%, although total post volume continued to grow. CONCLUSIONS Many e-liquid promotion posts on Instagram remained noncompliant with nicotine warnings after FDA provisions took effect. The large volume of international users also limited the impact of FDA-mandated warnings on the social media environment. IMPLICATIONS Further guidance and enforcement are needed to ensure that US e-liquid marketers on visual social media platforms adhere to current provisions, particularly for individual social media users who are sponsored by industry. The inherently global span of social media also indicates the importance of a shared approach to marketing regulations. Further work is needed to assess enforcement strategies viable for the social media environment.
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Affiliation(s)
- Linnea I Laestadius
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI
| | - Megan M Wahl
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI
| | - Julia Vassey
- The Center for Integrative Research on Childhood Leukemia and the Environment, University of California-Berkeley, Berkeley, CA
| | - Young Ik Cho
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI
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Abstract
OBJECTIVES The finalized 'Deeming Rule' extended the Food and Drug Administration (FDA) authority to regulate e-cigarettes, cigars, and other newly deemed tobacco products. We seek to assess the neighborhood characteristics associated with retail violations of sales to minors (RVSM) by tobacco product. STUDY DESIGN We collected national inspection data on tobacco retailers during August 8, 2016, and May 31, 2018, from the FDA compliance check database. METHODS A web scraping tool was applied to text mine the FDA decision letters and extract information on the tobacco product involved in RVSM. Separate logistic regression models with random effects were performed to examine the association between zip code-level neighborhood characteristics and RVSM by tobacco product. RESULTS Of 268,317 minor-involved compliance inspections, 35,403 (13.2%) were identified as RVSM. Among 23,352 warning letters included in the final analysis, e-cigarettes, cigars, cigarettes, and smokeless tobacco accounted for 20.0% (n = 4673), 40.4% (9439), 35.6% (8303), and 4.0% (937) of RVSM, respectively. Flavored tobacco products were abundant among underage sales. For e-cigarettes, RVSM were more likely to occur in zip codes with a larger proportion of youth population aged 10-17 years (adjusted odds ratio [AOR] = 1.17 [1.02-1.34]). A larger proportion of African Americans was associated with a higher risk of RVSM for cigars (AOR = 1.09 [1.07-1.11]) but a lower risk of RVSM for e-cigarettes (AOR = 0.90 [0.87-0.93]). CONCLUSIONS Retail violations of underage sales for cigars and e-cigarettes are prevalent and neighborhood characteristics associated with violations differ by tobacco product. Continued inspections with tailored strategies to reduce RVSM of all tobacco products are needed.
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Affiliation(s)
- Hongying Dai
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States.
| | - Jianqiang Hao
- Bellevue University, College of Business, Omaha, NE, United States
| | - Delwyn Catley
- The Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Hospital, Kansas City, MO, United States
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Abstract
In the 10 years that the U.S. Food and Drug Administration (FDA) has been regulating tobacco products, the agency has been plagued with setbacks, some of its own making, and some the result of outside forces. What has been consistently true is that the public health community has not had as much of a voice as it should have until public health groups began filing lawsuits against the FDA. This article examines four areas of FDA regulation over the last decade in an attempt to qualitatively describe the work of the Center for Tobacco Products and identify opportunities for public health groups to have greater advocacy success in the future.
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Lester JM. The Next 10 Years of Federal Tobacco Regulation: A Road Map to Protect Public Health and Advance Health Equity. J Leg Med 2020; 40:355-368. [PMID: 33797328 DOI: 10.1080/01947648.2020.1868941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
After a decade of fits and starts in regulating commercial tobacco products, the U.S. Food and Drug Administration (FDA) has built the infrastructure needed for robust tobacco product regulation. This article lays out a vision for the FDA in its second decade of tobacco product regulation. To realize the promise of the Family Smoking Prevention and Tobacco Control Act, the FDA must move quickly to adopt high-impact tobacco product regulation, define and operationalize the public health standard in a way that advances health equity, and bring all of its authority and resources to bear to reduce health disparities. In addition, the agency must engage more productively with states to reduce and eliminate tobacco use.
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Blackwell AKM, Kosīte D, Marteau TM, Munafò MR. Policies for Tobacco and E-Cigarette Use: A Survey of All Higher Education Institutions and NHS Trusts in England. Nicotine Tob Res 2020; 22:1235-1238. [PMID: 31586403 PMCID: PMC7291800 DOI: 10.1093/ntr/ntz192] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 10/01/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION There is an absence of evidence regarding the impact of treating tobacco smoking and vaping equivalently in workplace policies. We aimed to describe and compare smoking and vaping policies in acute nonspecialist NHS Trusts (n = 131) and Higher Education Institutions (HEIs) (n = 131) in England. METHODS We conducted a census of smoking and vaping policies through organizational websites searches and direct requests for information. We recorded whether and where smoking and vaping were permitted. RESULTS Smoking was prohibited indoors in all organizations. No NHS Trust permitted smoking freely outdoors, in contrast with 60% of HEIs. In 27% of NHS Trusts and 33% of HEIs smoking was permitted in designated areas, while in 73% of NHS Trusts and 8% of HEIs smoking was prohibited anywhere on site. Vaping was prohibited indoors in all NHS Trusts and all but one HEI, but permitted freely outdoors in 18% of NHS Trusts and 75% of HEIs. Vaping was permitted in designated outdoor spaces in 23% of NHS Trusts: 21% had areas shared with smokers; 2% had separate vaping areas. Vaping was permitted in designated outdoor areas in 18% of HEIs, all of which were shared with smokers. Vaping was prohibited anywhere on site in 54% of NHS Trusts and 6% of HEIs. CONCLUSIONS Policies vary considerably in whether vaping and smoking are treated equivalently. Smoking policies in most HEIs should be reviewed to include more effective tobacco control approaches. Evidence is needed on the impact of imposing shared or separate spaces on vapers and smokers. IMPLICATIONS This report provides a comprehensive review of smoking and vaping policies in two types of organization across England. It highlights key discrepancies between current public health recommendations for vaping and existing workplace policies, which often lead to smokers and vapers sharing spaces. The report identifies the need for evidence on the impact of imposing shared spaces on smokers and vapers to inform workplace policies that maximize public health benefit.
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Affiliation(s)
| | - Daina Kosīte
- Behaviour and Health Research Unit, University of Cambridge, Institute of Public Health, Cambridge, UK
| | - Theresa M Marteau
- Behaviour and Health Research Unit, University of Cambridge, Institute of Public Health, Cambridge, UK
| | - Marcus R Munafò
- School of Psychological Science, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre (NIHR Bristol BRC), Bristol, UK
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Printz C. Fighting the teen vaping epidemic: With rates of adolescent vaping on the rise, experts caution that new federal rules targeting e-cigarettes may not be strong enough. Cancer 2020; 126:1147-1148. [PMID: 32108947 DOI: 10.1002/cncr.32779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Du Y, Liu B, Xu G, Rong S, Sun Y, Wu Y, Snetselaar LG, Wallace RB, Bao W. Association of Electronic Cigarette Regulations With Electronic Cigarette Use Among Adults in the United States. JAMA Netw Open 2020; 3:e1920255. [PMID: 32003818 PMCID: PMC7042861 DOI: 10.1001/jamanetworkopen.2019.20255] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
IMPORTANCE Millions of Americans use electronic cigarettes (e-cigarettes). A growing number of state and local governments have started to draft and implement laws regarding the sale, marketing, and use of e-cigarettes. The association of US state regulations regarding e-cigarettes with e-cigarette use remains unknown. OBJECTIVE To examine the association of US state regulations regarding e-cigarettes with current e-cigarette use among adults in the United States. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included adults aged 18 years or older from the 2016 and 2017 Behavioral Risk Factor Surveillance System, which is a nationwide, telephone-administered survey that collects state-representative data on health-related risk behaviors, chronic health conditions, and use of preventive services. Data analysis was performed from February 1, 2019, to April 31, 2019. EXPOSURES United States state laws regulating e-cigarette use, including prohibiting e-cigarette use in indoor areas of private workplaces, restaurants, and bars; requiring retailers to purchase a license to sell e-cigarettes; prohibiting self-service displays of e-cigarettes; prohibiting sales of tobacco products, including e-cigarettes, to persons younger than 21 years; and e-cigarette taxes. MAIN OUTCOMES AND MEASURES Current use of e-cigarettes. RESULTS Among 894 997 participants aged 18 years or older (503 688 women [51.3%], 679 443 non-Hispanic white [62.6%], 71 730 non-Hispanic black [16.3%], 69 823 Hispanic [11.4%], and 74 001 non-Hispanic other races [9.8%]), 28 907 (weighted prevalence, 4.4%) were currently using e-cigarettes. The age-standardized weighted prevalence of current e-cigarette use varied across US states and territories, from 1.0% in Puerto Rico to 6.2% in Guam. After adjustment for demographic, socioeconomic, and lifestyle factors, including conventional cigarette use, the odds ratios of current e-cigarette use were 0.90 (95% CI, 0.83-0.98) for state laws prohibiting e-cigarette use in indoor areas of private workplaces, restaurants, and bars; 0.90 (95% CI, 0.85-0.95) for state laws requiring retailers to purchase a license to sell e-cigarettes; 1.04 (95% CI, 0.99-1.09) for state laws prohibiting self-service displays of e-cigarettes; 0.86 (95% CI, 0.74-0.99) for state laws prohibiting sales of tobacco products, including e-cigarettes, to persons younger than 21 years; and 0.89 (95% CI, 0.83-0.96) for state laws applying taxes to e-cigarettes. CONCLUSIONS AND RELEVANCE These findings suggest that several state regulations regarding e-cigarettes may be associated with reduced e-cigarette use among US adults.
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Affiliation(s)
- Yang Du
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City
| | - Buyun Liu
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City
| | - Guifeng Xu
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City
| | - Shuang Rong
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City
| | - Yangbo Sun
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City
| | - Yuxiao Wu
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City
| | - Linda G. Snetselaar
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City
| | - Robert B. Wallace
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City
| | - Wei Bao
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City
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Gottlieb S. Pot Legalization Makes Vaping Deadly. Mo Med 2020; 117:9-10. [PMID: 32158031 PMCID: PMC7023940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Scott Gottlieb
- Scott Gottlieb, MD, a resident fellow at the American Enterprise Institute, served as Commissioner of the Food and Drug Administration, 2017-19. He consults with and invests in drug makers
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Abstract
The rapid increase in e-cigarette use among adolescents and young adults has led to drastic changes in patterns of nicotine consumption worldwide. The use of e-cigarettes, many of which contain high levels of nicotine, is especially harmful in this age group and is associated with increased use of cigarettes and other substances among youth. While the risks of short- and long-term e-cigarette use and secondhand aerosol exposure remain only partially understood, e-cigarettes should not be recommended for smoking cessation for youth in any circumstances given the lack of evidence for effectiveness and potential harmful physical and mental health effects. The perceptions of low e-cigarette risk of adolescents and young adults combined with few market regulations and the appeal of youth-friendly flavors, have created ideal conditions for the e-cigarette industry to thrive and place millions of youth at risk of developing an addiction to nicotine. Policies and regulations aiming to prevent youth-directed marketing and sales of e-cigarette and all nicotine delivery products are needed to protect young people. Public health-led education campaigns and educational curricula are also needed to help inform youth and families about the risks of e-cigarette use. While more research is required to determine the best ways to help youth quit e-cigarette use, adolescent health providers can play a key role in screening and counseling youth about e-cigarette use and should be adequately trained and supported to care for youth with e-cigarette addiction.
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Wagoner KG, Berman M, Rose SW, Song E, Cornacchione Ross J, Klein EG, Kelley DE, King JL, Wolfson M, Sutfin EL. Health claims made in vape shops: an observational study and content analysis. Tob Control 2019; 28:e119-e125. [PMID: 31123104 PMCID: PMC8142343 DOI: 10.1136/tobaccocontrol-2018-054537] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 01/22/2019] [Accepted: 01/24/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Prior to the final deeming rule, federal law in the USA prohibited electronic cigarettes (e-cigarettes) from being marketed as smoking cessation products; for other therapeutic purposes and in ways that conveyed Food and Drug Administration (FDA) approval/endorsement. After August 2016, additional federal prohibitions were added including false/misleading and unauthorised modified risk tobacco product (MRTP) claims. No systematic investigation of e-cigarette health claims has been conducted in the retail environment. We sought to document and characterise claims made in vape shops. METHODS Between November 2015 and February 2016, before final deeming rule implementation, two trained data collectors conducted unannounced observational assessments of 46 vape shops in North Carolina. Data collectors used wearable imaging technology to document health claims about e-cigarettes. Photos were coded for five claim types: (1) cessation device; (2) drug effect/device; (3) FDA-approved/endorsed; (4) false/misleading and (5) MRTP. Photos were double coded; differences between coders were adjudicated and reviewed by an expert panel. RESULTS At least one health claim was displayed in 41.3% (n=19) of retailers, ranging from 0 to 27 claims per retailer. All claim types were found. Cessation device claims were the most prevalent (62.2%, n=84), followed by MRTP (27.4%, n=37), drug effect/device (8.1%, n=11), false/misleading (1.5%, n=2), and FDA approved/endorsed (0.7%, n=1). Retail chains made the majority of claims compared with independent shops (88.9% vs 11.1%). CONCLUSIONS Many vape shops displayed e-cigarette health claims, which are all now FDA prohibited. These claims could mislead consumers and influence behaviour. Findings highlight the need for retailer education, continued surveillance, enforcement specific to advertising and research on consumer perceptions of claims.
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Affiliation(s)
- Kimberly G Wagoner
- Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Micah Berman
- Health Services Management and Policy, The Ohio State University College of Public Health and Moritz College of Law, Columbus, Ohio, USA
| | - Shyanika W Rose
- Truth Initiative, Schroeder Institute for Tobacco Research and Policy Studies, Washington, DC, USA
| | - Eunyoung Song
- Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Elizabeth G Klein
- Health Behavior and Health Promotion, The Ohio State University College of Public Health, Columbus, Ohio, USA
| | - Dannielle E Kelley
- School of Media and Journalism, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jessica L King
- Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Mark Wolfson
- Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Erin L Sutfin
- Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Leventhal AM, Goldenson NI, Cho J, Kirkpatrick MG, McConnell RS, Stone MD, Pang RD, Audrain-McGovern J, Barrington-Trimis JL. Flavored E-cigarette Use and Progression of Vaping in Adolescents. Pediatrics 2019; 144:e20190789. [PMID: 31659004 PMCID: PMC6856781 DOI: 10.1542/peds.2019-0789] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2019] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES Electronic cigarettes (e-cigarettes) are available in nontraditional flavors (eg, fruit and candy) that are banned in combustible cigarettes in the United States. Whether adolescent use of e-cigarettes in nontraditional flavors prospectively predicts continuation of vaping and progression to more frequent vaping is unknown. METHODS High school students in Los Angeles, California, completed 5 semiannual surveys (2014-2017 [10th grade to 12th grade]). Among past-6-month e-cigarette users at survey waves 1 to 4 (N = 478), e-cigarette flavor (or flavors) used was coded into 2 mutually exclusive categories at each wave (use of ≥1 nontraditional flavors [fruit, candy, sweet or dessert, buttery, blends or combinations, and other] versus exclusive use of tobacco, menthol or mint, or flavorless). Flavor used during waves 1 to 4 was modeled as a time-varying, time-lagged regressor of vaping status and frequency outcomes 6 months later at waves 2 to 5. RESULTS Across waves 1 to 4, there were 739 (93.8%) observations of nontraditional-flavor use and 49 (6.2%) observations of exclusive use of tobacco, mint or menthol, or flavorless e-cigarettes. Use of e-cigarettes in nontraditional flavors (versus only tobacco, mint or menthol, or flavorless) was positively associated with vaping continuation (64.3% vs 42.9%; adjusted odds ratio = 3.76 [95% confidence interval 1.20 to 10.31]) and past-30-day number of puffs per nicotine vaping episode (mean: 3.1 [SD 5.5] vs 1.5 [SD 3.8]; adjusted rate ratio = 2.41 [95% confidence interval 1.08 to 5.92]) 6 months later. Flavor used was not associated with the subsequent number of past-30-day vaping days or episodes per day. CONCLUSIONS Adolescents who vaped e-cigarettes in nontraditional flavors, compared with those who exclusively vaped tobacco-flavored, mint- or menthol-flavored, or flavorless e-cigarettes, were more likely to continue vaping and take more puffs per vaping occasion 6 months later.
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Affiliation(s)
- Adam M Leventhal
- Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California;
- Departments of Psychology and
| | - Nicholas I Goldenson
- Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Junhan Cho
- Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Matthew G Kirkpatrick
- Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Rob S McConnell
- Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Matthew D Stone
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California; and
| | - Raina D Pang
- Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Janet Audrain-McGovern
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Affiliation(s)
| | - Clive Bates
- Counterfactual Consulting Limited, London, UK
| | - Ben Youdan
- ASH (NZ), c/o Heart Foundation, Auckland, New Zealand
| | - Ruth Bonita
- University of Auckland, Devonport, Auckland 0624, New Zealand
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Weishaar HB, Ikegwuonu T, Smith KE, Buckton CH, Hilton S. E-Cigarettes: A Disruptive Technology? An Analysis of Health Actors' Positions on E-Cigarette Regulation in Scotland. Int J Environ Res Public Health 2019; 16:ijerph16173103. [PMID: 31455009 PMCID: PMC6747168 DOI: 10.3390/ijerph16173103] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 08/18/2019] [Accepted: 08/19/2019] [Indexed: 12/03/2022]
Abstract
Concerns have been raised that the divisions emerging within public health in response to electronic cigarettes are weakening tobacco control. This paper employed thematic and network analysis to assess 90 policy consultation submissions and 18 interviews with political actors to examine the extent of, and basis for, divisions between health-focused actors with regard to the harms and benefits of e-cigarettes and appropriate approaches to regulation in Scotland. The results demonstrated considerable engagement in e-cigarette policy development by health-focused actors and a widely held perception of strong disagreement. They show that actors agreed on substantive policy issues, such as age-of-sale restrictions and, in part, the regulation of advertising. Points of contestation were related to the harms and benefits of e-cigarettes and the regulation of vaping in public places. The topicality, limitations of the evidence base and underlying values may help explain the heightened sense of division. While suggesting that some opportunities for joint advocacy might have been missed, this analysis shows that debates on e-cigarette regulation cast a light upon differences in thinking about appropriate approaches to health policy development within the public health community. Constructive debates on these divisive issues among health-focused actors will be a crucial step toward advancing public health.
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Affiliation(s)
- Heide Beatrix Weishaar
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Top floor, 200, Renfield Street, Glasgow G2 3AX, UK.
| | - Theresa Ikegwuonu
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Top floor, 200, Renfield Street, Glasgow G2 3AX, UK
| | - Katherine E Smith
- School of Social Work & Social Policy, University of Strathclyde; Lord Hope Building, 141 St James Road, Glasgow G4 0LT, UK
| | - Christina H Buckton
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Top floor, 200, Renfield Street, Glasgow G2 3AX, UK
| | - Shona Hilton
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Top floor, 200, Renfield Street, Glasgow G2 3AX, UK
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Rebollar A, Perea MD, Doncel JC, Panero J, Gómez-Chacón MC. [Tobacco products and related: EU-CEG European Portal]. Rev Esp Salud Publica 2019; 93:e201908077. [PMID: 31407675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 07/29/2019] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE The Tobacco Products Directive (2014/40/EU) obliges manufacturers and importers of tobacco products and related to notify Member States the commercialization of these products through the EU Common Entry Portal (EU-CEG). The objective of this study is to describe the main data available in EU-CEG in Spain and analyze its implications for smoking control policies. METHODS Cross-sectional analysis of the data obtained in EU-CEG for Spain. The access is done through .xml or .pdf files, downloaded from the portal or consulted through its interface. It describes the distribution of products, manufacturers, presence of priority ingredients, Slim cigarettes and concentration of nicotine in liquids. RESULTS In the EU-CEG portal for Spain there are currently 42,736 records. 83.7% corresponds to the devices susceptible to nicotine release (67% of refill liquids, mainly with concentrations of 3, 6, 12 and 18 mg). In tobacco products, cigarettes (5%), cigars (5.9%) and water pipe tobacco (2.8%) stand out. Herbal products for smoking account for 0.1%. 5 of the priority ingredients for surveillance are present in more than 75% of cigarettes and rolling tobacco. There are 44 records of Slim cigarettes and 9 novel tobacco products. CONCLUSIONS The EU-CEG portal has become a powerful tool in tobacco control. We highlight challenges that require a joint and comprehensive approach in aspects such as labeling and ingredients, Slim cigarettes and new forms of consumption.
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Affiliation(s)
- Aarón Rebollar
- Subdirección General de Promoción de la Salud y Vigilancia en Salud Pública. Dirección General de Salud Pública, Calidad e Innovación. Ministerio de Sanidad, Consumo y Bienestar Social. Madrid. España
- Asistencia técnica TRAGSATEC en el Ministerio de Sanidad, Consumo y Bienestar Social. Madrid. España
| | - María Dolores Perea
- Subdirección General de Promoción de la Salud y Vigilancia en Salud Pública. Dirección General de Salud Pública, Calidad e Innovación. Ministerio de Sanidad, Consumo y Bienestar Social. Madrid. España
- Asistencia técnica TRAGSATEC en el Ministerio de Sanidad, Consumo y Bienestar Social. Madrid. España
| | - Julio César Doncel
- Subdirección General de Promoción de la Salud y Vigilancia en Salud Pública. Dirección General de Salud Pública, Calidad e Innovación. Ministerio de Sanidad, Consumo y Bienestar Social. Madrid. España
- Asistencia técnica TRAGSATEC en el Ministerio de Sanidad, Consumo y Bienestar Social. Madrid. España
| | - Javier Panero
- Subdirección General de Promoción de la Salud y Vigilancia en Salud Pública. Dirección General de Salud Pública, Calidad e Innovación. Ministerio de Sanidad, Consumo y Bienestar Social. Madrid. España
| | - Mª Cristina Gómez-Chacón
- Subdirección General de Promoción de la Salud y Vigilancia en Salud Pública. Dirección General de Salud Pública, Calidad e Innovación. Ministerio de Sanidad, Consumo y Bienestar Social. Madrid. España
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Affiliation(s)
- Andy S L Tan
- Dana-Farber Cancer Institute, Population Sciences Division, Center for Community-Based Research, Boston, MA 02215, USA; Harvard University, TH Chan School of Public Health, Boston, MA, USA.
| | - Samir Soneji
- Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
| | - Meghan Bridgid Moran
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
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Jongenelis MI, Kameron C, Rudaizky D, Pettigrew S. Support for e-cigarette regulations among Australian young adults. BMC Public Health 2019; 19:67. [PMID: 30646873 PMCID: PMC6334386 DOI: 10.1186/s12889-019-6410-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 01/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surveying support for various regulatory options relating to e-cigarettes can assist policymakers to identify those that have broad support and are therefore likely to be easier to implement. However, data on support for potential e-cigarette regulations in Australia are limited. To inform regulatory efforts, the present study assessed attitudes to the regulation of e-cigarettes among Australian young adults, the most prevalent users of e-cigarettes and therefore the most likely population segment to be affected by e-cigarette regulations. METHODS A total of 1116 Australians aged 18 to 25 years (59% female) completed an online survey where they were presented with various statements relating to the regulation of e-cigarettes and asked to report on the extent to which they agreed or disagreed with each. Statements presented either a restrictive or non-restrictive approach to e-cigarette regulation. RESULTS Across all statements, 10-22% of respondents responded "don't know" while 23-35% neither agreed nor disagreed, indicating general ambivalence. There was a moderate level of support (33-37%) for regulating e-cigarette sales/use and treating e-cigarettes like tobacco products. Only 20% of respondents were in favour of allowing the use of e-cigarettes in smoke-free areas. Smokers, e-cigarette users, and those who did not believe in the harms associated with e-cigarettes were typically less likely than other respondents to support restrictive approaches. CONCLUSIONS The young Australian adults surveyed were somewhat supportive of restrictions around the sale and use of e-cigarettes, but generally opposed outright bans and any need for a prescription from a medical practitioner. Increasing awareness of the harms associated with the use of e-cigarettes represents a potential strategy to gaining regulatory support.
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Affiliation(s)
- Michelle I. Jongenelis
- School of Psychology, Curtin University, Kent Street, Bentley, Western Australia 6102 Australia
| | - Caitlin Kameron
- School of Psychology, Curtin University, Kent Street, Bentley, Western Australia 6102 Australia
- Cancer Council WA, 420 Bagot Road, Subiaco, Western Australia 6008 Australia
| | - Daniel Rudaizky
- School of Psychological Science, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009 Australia
| | - Simone Pettigrew
- School of Psychology, Curtin University, Kent Street, Bentley, Western Australia 6102 Australia
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Zavala-Arciniega L, Reynales-Shigematsu LM, Lozano P, Rodríguez-Andrade MÁ, Arillo-Santillán E, Thrasher JF. Patterns of awareness and use of electronic cigarettes in Mexico, a middle-income country that bans them: Results from a 2016 national survey. Prev Med 2018; 116:211-218. [PMID: 30261244 PMCID: PMC6276365 DOI: 10.1016/j.ypmed.2018.09.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 09/10/2018] [Accepted: 09/22/2018] [Indexed: 12/23/2022]
Abstract
Among high-income countries, awareness and use of e-cigarettes is lower in countries with more restrictive e-cigarette regulations. Little is known about e-cigarettes in middle-income countries, many of which like Mexico, ban e-cigarette sales and marketing. The current study determined the national-level prevalence and correlates of e-cigarette awareness and consumption in Mexico. Data were analyzed from a 2016 nationally representative survey. Prevalence of e-cigarette awareness, trial and current use was estimated separately for adolescents (n = 12,436), adult nonsmokers (n = 36,966), and adult smokers (n = 7347). For each group, crude and adjusted logistic models regressed e-cigarette outcomes on sociodemographic and smoking-related variables, adjusting for the sampling design and weights. Prevalence varied across subgroups for e-cigarette awareness (adolescents = 45.3%; adult nonsmokers = 33.9%; adult smokers = 54.3%), e-cigarette trial (adolescents = 6.5%; adult nonsmokers = 2.6%; adult smokers = 18.2%) and current use of electronic cigarettes (adolescents = 1.1%; adult nonsmokers = 0.3%; adult smokers = 4.5%). Among adolescents and adults, current smoking and higher smoking frequency were significantly associated with e-cigarette awareness, trial and use. Among adolescents and nonsmokers, awareness, trial and use of e-cigarette were significantly lower among females than males. Among adult smokers, however, females were more likely to use e-cigarettes than males (AOR = 1.80; 95% CI = 1.08-3.02). Higher education and greater wealth increased the likelihood of trial of e-cigarettes among adult nonsmokers and smokers. Despite the ban on the distribution and sales of e-cigarettes, a substantial number of Mexicans, have access to e-cigarettes. Decision makers and advocates should consider e-cigarette regulations as recommended by the WHO, at the same time Mexico must invest in the infrastructure needed to enforce these regulations.
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Affiliation(s)
- Luis Zavala-Arciniega
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Paula Lozano
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | | | - Edna Arillo-Santillán
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, Mexico
| | - James F Thrasher
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, Mexico; Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, USA
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Keith D, Peters K, Husten CG. Notes from the Field: Inspection of 59 "Vape Shops" - United States, October-November, 2016. MMWR Morb Mortal Wkly Rep 2018; 67:964-965. [PMID: 30161100 PMCID: PMC6124816 DOI: 10.15585/mmwr.mm6734a6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gartner C, Bromberg M, Musgrove T, Luong K. Vape Club: Exploring Non-Profit Regulatory Models for the Supply of Vaporised Nicotine Products. Int J Environ Res Public Health 2018; 15:E1744. [PMID: 30110903 PMCID: PMC6121462 DOI: 10.3390/ijerph15081744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/04/2018] [Accepted: 08/07/2018] [Indexed: 11/26/2022]
Abstract
Vaporised nicotine products (VNPs) that are not approved as therapeutic goods are banned in some countries, including Australia, Singapore, and Thailand. We reviewed two non-profit regulatory options, private clubs and the Australian Therapeutic Goods Administration Special Access Scheme (SAS) that have been applied to other controlled substances (such as cannabis) as a potential model for regulating VNPs as an alternative to prohibition. The legal status of private cannabis clubs varies between the United States, Canada, Belgium, Spain, and Uruguay. Legal frameworks exist for cannabis clubs in some countries, but most operate in a legal grey area. Kava social clubs existed in the Northern Territory, Australia, until the federal government banned importation of kava. Access to medical cannabis in Australia is allowed as an unapproved therapeutic good via the SAS. In Australia, the SAS Category C appears to be the most feasible option to widen access to VNPs, but it may have limited acceptability to vapers and smokers. The private club model would require new legislation but could be potentially more acceptable if clubs were permitted to operate outside a medical framework. Consumer and regulator support for these models is currently unknown. Without similar restrictions applied to smoked tobacco products, these models may have only a limited impact on smoking prevalence. Further research could explore whether these models could be options for regulating smoked tobacco products.
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Affiliation(s)
- Coral Gartner
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane 4006, Australia.
- Queensland Alliance for Environmental Health Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane 4072, Australia.
| | - Marilyn Bromberg
- Law School, University of Western Australia, Perth 6009, Australia.
| | - Tanya Musgrove
- Law School, University of Western Australia, Perth 6009, Australia.
| | - Kathy Luong
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane 4006, Australia.
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Singh H, Kennedy RD, Lagasse LP, Czaplicki LM, Cohen JE. E-cigarettes and Weight Loss-Product Design Innovation Insights From Industry Patents. Nicotine Tob Res 2018; 20:1010-1014. [PMID: 28525609 PMCID: PMC6037115 DOI: 10.1093/ntr/ntx112] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/17/2017] [Indexed: 11/13/2022]
Abstract
Objective There is emerging evidence that e-cigarettes are being used by some to mitigate weight gain after quitting smoking, and being used to help control weight. This study sought to identify and describe patents related to innovations for e-cigarette devices associated and weight loss. Methods Relevant patents were identified using Google Patents with the core search terms: "electronic cigarette" OR "e-cigarette" OR "vaporizer" OR "vapourizer" AND "nicotine" AND "weight loss" OR "weight control" OR "obesity" OR "hunger". Patents were reviewed to identify and classify the innovation related to weight loss or weight control. Results Our search identified 23 unique patents that were filed between 2004 and 2015. Patent applications were sponsored by individual inventors (n = 7), tobacco companies (n = 5), e-cigarette companies (n = 8), pharmaceutical companies (n = 2) and a cannabis company (n = 1). More than half the patents (n = 12) were filed in the United States; other countries included China, Germany, South Korea, and South Africa. Strategies included using e-cigarette devices to deliver constituents to users that support weight loss through altered metabolism, reduced nutrient absorption, suppressed appetite, or supported healthy behavior change. In most cases (n = 18), the innovations detailed in the patents were intended to be used with an e-cigarette device that delivered nicotine to the user. Conclusions Companies from around the world, and from a range of industries are developing and patenting technologies related to e-cigarettes and weight loss. E-cigarettes may be presented to cigarette users as a possible solution to support smoking cessation and address the fear of weight gain. Implications This article presents evidence that a range of industries are innovating to design e-cigarettes or constituents to be used with e-cigarettes to deliver a variety of drugs beyond nicotine including weight loss drugs, laxatives, and nutritional supplements. This study may inform surveillance studies to systematically include weight loss as a possible motivation to use e-cigarettes. Further, market surveillance of e-cigarette products needs to monitor ingredients in e-liquids including constituents that have been historically used for weight loss or weight control. Regulations around e-cigarette marketing, promotion, product design including e-liquid constituents need to consider weight loss claims.
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Affiliation(s)
- Harkirat Singh
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ryan David Kennedy
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Lisa P Lagasse
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Lauren M Czaplicki
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Fraser T, Glover M, Truman P. Government and public health responses to e-cigarettes in New Zealand: vapers' perspectives. Harm Reduct J 2018; 15:13. [PMID: 29618352 PMCID: PMC5885311 DOI: 10.1186/s12954-018-0219-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 03/05/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The New Zealand (NZ) government is to lift the ban on the sale of nicotine for use in electronic cigarettes (e-cigarettes). METHODS Using a naturalistic approach, we sought to understand how the current law was experienced by e-cigarette users (vapers). Twenty-nine vapers were interviewed by telephone, between May and September 2016, using a semi-structured interview schedule. Open-ended questions covered: initiating vaping, the experience of stopping smoking, technical problems encountered, reasons for vaping, acceptability of vaping, addiction to vaping and advice given to smokers about vaping. The audio recordings were transcribed and then independently coded using a general inductive thematic analysis. RESULTS This paper presents the main theme which was that vapers employed a range of reactionary strategies to the ban on the sale of nicotine e-liquid in NZ. These included lobbying government, spreading the word, establishing vaper support groups, helping people stop smoking by switching to vaping and advocating for e-cigarettes to be incorporated into smoking cessation practice. CONCLUSIONS Vapers' experience and observations form a popular or lay epidemiology--one that identified that e-cigarettes were helping people stop smoking and could thus deliver public health benefits. Public health researchers and workers, and government fears about vaping, and proposals to strengthen restrictions contributed to the growth of the vaper community who reacted by forming self-help groups and providing alternative cessation support to smokers. For a significant switch from smoking to vaping to occur, the health sector needs to have a change of attitude towards vaping that is positive, and the public needs evidence-based information on vaping. A first step could be for the health sector to collaborate with the vaping community to reorient current tobacco control and cessation practice to encourage smokers to switch to less harmful smoke-free alternatives to smoking.
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Affiliation(s)
- Trish Fraser
- Global Public Health, P O Box 82, Glenorchy, 9350, New Zealand
| | - Marewa Glover
- School of Health Sciences, College of Health, Massey University, Private Box 756, Wellington, 6140, New Zealand.
| | - Penelope Truman
- School of Health Sciences, College of Health, Massey University, Private Box 756, Wellington, 6140, New Zealand
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Nayak P, Barker DC, Huang J, Kemp CB, Wagener TL, Chaloupka F. 'No, the government doesn't need to, it's already self-regulated': a qualitative study among vape shop operators on perceptions of electronic vapor product regulation. Health Educ Res 2018; 33:114-124. [PMID: 29590316 PMCID: PMC6019017 DOI: 10.1093/her/cyy003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 02/05/2018] [Indexed: 06/08/2023]
Abstract
While the market share of electronic vapor products (EVPs), sold primarily through vape shops and other outlets, has increased rapidly, these products remained largely unregulated until 2016. This study, conducted prior to announcement of the deeming regulations, provides insights into vape shop operator attitudes toward potential government regulations of EVPs. In 2015, we conducted 37 in-person interviews of vape shop operators across nine US cities. Shops were identified through extensive web-searches. We used QSR International's NVivo 11 qualitative data analysis software to analyze the transcripts. Many vape shop operators viewed regulations requiring safe production of e-liquids, child-resistant bottles and listing e-juice ingredients as acceptable. They disagreed with the elimination of free samples and bans on flavored e-liquid sales, which generate significant revenue for their stores. Many held negative perceptions of pre-market review of new product lines and EVP-specific taxes. All agreed that EVPs should not be sold to minors, but most felt that owners should not be fined if minors visited vape shops. Findings from this study offer insights into the acceptability of proposed regulations, as well as barriers to effective regulation implementation.
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Affiliation(s)
- Pratibha Nayak
- Battelle Public Health Center for Tobacco Research, Atlanta, GA, USA
- School of Public Health, Georgia State University, Urban Life Building, Atlanta, GA, USA
| | - Dianne C Barker
- Barker Bi-Coastal Health Consultants, Inc., Calabasas, CA, USA
| | - Jidong Huang
- School of Public Health, Georgia State University, Urban Life Building, Atlanta, GA, USA
| | - Catherine B Kemp
- Georgia State University Tobacco Center of Regulatory Science, Georgia State University, Urban Life Building, Atlanta, GA, USA
| | - Theodore L Wagener
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma, USA
- Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma, USA
| | - Frank Chaloupka
- Health Policy Center, Institute for Health Research and Policy, University of Illinois, Chicago, IL, USA
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Affiliation(s)
- Ruth E Malone
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, California, USA
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Chapman S, Daube M, Maziak W. Should e-cigarette use be permitted in smoke-free public places? No. Tob Control 2017; 26:e3-e4. [PMID: 27821791 DOI: 10.1136/tobaccocontrol-2016-053359] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 08/30/2016] [Accepted: 09/06/2016] [Indexed: 11/04/2022]
Affiliation(s)
- Simon Chapman
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Mike Daube
- Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Wasim Maziak
- College of Public Health, Florida International University, Miami, Florida, 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: 320] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Lee JGL, D'Angelo H, Kuteh JD, Martin RJ. Identification of Vape Shops in Two North Carolina Counties: An Approach for States without Retailer Licensing. Int J Environ Res Public Health 2016; 13:ijerph13111050. [PMID: 27801793 PMCID: PMC5129260 DOI: 10.3390/ijerph13111050] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 10/17/2016] [Accepted: 10/24/2016] [Indexed: 12/30/2022]
Abstract
Stores that sell electronic nicotine delivery systems (ENDS) as their primary product are a new phenomenon and often termed “vape shops”. While vape shops are now regulated by state and federal agencies, not all states maintain lists of vape shops in operation. Standard ways of identifying tobacco retailers through off-premise alcohol permits and business listing services may not identify vape shops. We used four online business listing services (i.e., Google Maps, ReferenceUSA, YellowPages.com, Yelp) to identify vape shops in two counties in North Carolina (NC). In one county, we also assessed four vaping web sites. We drove primary and secondary roads to physically validate the identified stores and attempt to identify stores not listed online. To assess the accuracy of the online searches, we calculated sensitivity and positive predictive values (PPVs). This research was conducted in spring and summer 2016 and identified 28 vape shops online. We confirmed 16 vape shops (seven in Pitt County, NC, USA, and nine in Durham County, NC, USA). Online searches ranged in sensitivity, 62.5%–81.3%, and PPVs ranged from 73.3% to 92.3%. Because of the range of sensitivity found among the business listing services, state policymakers should consider uniform licensing requirements for vape and tobacco retailers to more easily track retailers and ensure compliance with regulations.
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Affiliation(s)
- Joseph G L Lee
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC 27858, USA.
| | | | - Jaleel D Kuteh
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC 27858, USA.
| | - Ryan J Martin
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC 27858, USA.
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Xu X, Wang X, Zhang X, Liu Y, He H, Mackay J. The debate on regulation of e-cigarettes in China. Lancet Respir Med 2016; 4:856-858. [PMID: 27743868 DOI: 10.1016/s2213-2600(16)30313-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 08/29/2016] [Accepted: 08/30/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Xiaoxin Xu
- School of Social Development and Public Policy, Beijing Normal University, Beijing 100875, China
| | - Xinsong Wang
- School of Social Development and Public Policy, Beijing Normal University, Beijing 100875, China.
| | - Xiulan Zhang
- School of Social Development and Public Policy, Beijing Normal University, Beijing 100875, China
| | - Yanli Liu
- School of Social Development and Public Policy, Beijing Normal University, Beijing 100875, China
| | - Huan He
- School of Public Administration, Southwestern University of Finance and Economics, Chengdu, Sichuan, China
| | - Judith Mackay
- Vital Strategies, Kowloon, Hong Kong Special Administrative Region, China
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Abstract
Legalization of cannabis is likely to lead to greater use. Balanced regulation of potentially less harmful modes of administration, such as vaporizers, is needed. Further research is warranted not only on the direct health effects of vaping cannabis, but also on its potential to decrease co-administration of tobacco with cannabis.
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Affiliation(s)
- Coral E Gartner
- School of Public Health, The University of Queensland, Public Health Building, Cnr Wyndham Street and Herston Road, Herston, Queensland, 4006, Australia.
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