Adrian Bertrand

Objective: This study leverages three data sources to identify and characterize the top e-cigarette brands among young adults and in the e-cigarette retail market. Methods: Data were obtained from two cross-sectional surveys of current e-cigarette users participating in either the Truth Continuous Tracking Online (Truth CTO) or Texas College Tobacco Survey and from NielsenIQ Retail Scanner data, aggregated at the national and state (Texas) levels. Results: Eight brands (Esco Bars, Elf Bar, Vuse, JUUL, Puff Bar, SMOK, Geek Bar, and Lost Mary) dominated all sources. Rankings of the top e-cigarette brands in the Truth CTO, Texas College Tobacco Survey, and NielsenIQ Retail Scanner data differed. In 2023, Elf Bar, Esco Bars, and Vuse were the top brands among Texas college students, while the Truth CTO sample showed higher use of JUUL, Puff Bar, and Elf Bar. Brand rankings shifted in 2024, with Esco Bars and Elf Bar declining and Geek Bar emerging in the Texas College sample and Geek Bar and Lost Mary increasing in the Truth CTO sample. Conclusion: Results demonstrate how rapid surveillance and retail data can be used to complementarily characterize top e-cigarette brands in the US retail market. There is markedly more variation in the top e-cigarette brands at the state level. Continued monitoring of e-cigarette brands is needed to identify emergent trends and inform strategies to reduce e-cigarette use among young adults at the state, national, and retail market levels.

Background: Flavours play a key role in e-cigarette initiation and continued use among US youth. In 2021, e-cigarette manufacturers introduced ostensibly unflavoured products using a ‘clear’ descriptor. Using a mixed-methods approach, this study describes trends in retail sales and terminology used in online marketing or advertising of clear-flavoured e-cigarettes. Methods: We used NielsenIQ retail scanner data from October 2021 to August 2024 to estimate market share and changes in market share of clear-flavoured e-cigarettes. In addition, using the keywords “vape,” “e-cigarette,” “clear,” and “flavor,” six online searches were conducted in January and June 2024 to determine whether flavour or sensory terminology was used to describe clear-flavoured e-cigarettes. Trained coders recorded terminology in the product descriptions. Results: NielsenIQ data showed the market share of clear-flavoured e-cigarettes increased from US$34K in October 2021 to over US$1M by August 2024, representing 0.03% and 0.59% of the disposable e-cigarette market, respectively. Our analysis of product descriptions found that cooling-related terms like ‘menthol’ appeared in 25 of the 47 online listings (53.2%). An additional 10 (21.3%) descriptions included non-specific flavour and taste language, such as ‘classic taste’ and ‘smooth flavour’, suggesting the presence of flavourings without clearly indicating the specific taste profile. Conclusion: The presence of flavour terminology in clear-flavoured e-cigarette product descriptions suggests that purportedly unflavoured products, such as clear-flavoured e-cigarettes, are marketed with language that implies flavoured characteristics. E-cigarettes classified as ‘clear’ flavour may bypass state and local flavour restrictions, advertising flavour experiences that appeal to youth.

Objectives: The emergence of viral memes about oral nicotine products (ONPs) on TikTok is concerning, as popular content on a youth-centred platform may motivate youth use. We investigate when the viral emergence of (ONP) TikTok videos occurs in relation to accelerated growth of ONP sales. Methods: We used NielsenIQ aggregated US sales data to identify sales growth inflection points from 1 January 2021 to 28 October 2023 and TikTok’s research application programming interface (API) to collect ONP-related videos posted during the same time frame. Video view counts were aggregated at the same 28-day intervals as sales data to identify viral spikes in views. Joinpoint regression identified the timing of any key inflection points in the sales data. Results: ONP content first emerged in an initial viral spike in views between September 2022 and January 2023 (14.4% of views), followed by a second between July and October 2023 (80.9% of views). Joinpoint regression identified a single inflection point where the average percentage change across the 4- week period significantly increased from 2.94% to 6.22% in April 2023, following the first spike and preceding the second. Conclusions: Following >3 years of steady market growth, a viral spike in TikTok views precedes a significant acceleration in ONP sales followed by a larger spike in views. Although further research is needed to determine whether TikTok views offer a reliable predictor of period-to-period sales, our findings suggest that spikes in specific content signalling effective penetration of youth subcultures may be indicative of acute market changes.

To determine whether e-cigarette brand use varies according to race/ethnicity among adolescent and young adult e-cigarette users. Data are from a cross-sectional online survey of respondents aged 15–24 years (January 2022–June 2023; 300 unique respondents/week). The analytic sample was restricted to current e-cigarette users (n = 6387). Respondents selected their usual brand and reported frequency of past 30-day e-cigarette use (in days). ANOVAs measured differences in frequency of use by usual brand, stratified by race/ethnicity. Linear regression identified changes in usual brand over time by race/ethnicity, controlling for age and use of other tobacco/nicotine products. One-quarter (25.6%) of Black and 22.2% of Hispanic e-cigarette users reported JUUL as their usual brand, compared to those who are White (15.7%) or another race (16.5%). Puff Bar was the second-most reported brand among Black (15.1%) or Hispanic (16.6%) e-cigarette users, to a greater extent than White (7.8%) e-cigarette users. Frequency of use varied significantly according to respondents’ usual brand when stratified by race/ethnicity (p < .001). Across all racial and ethnic categories, frequency of use was greater for brands marketed with more flavor options and containing nicotine (EB Design, SMOK, Hyde, and Vuse). Despite declines in popularity, Black or Hispanic respondents report using JUUL and Puff Bar to a greater extent than other respondents, and vape less frequently than White non-Hispanic respondents regardless of brand. As e-cigarette brands continue to proliferate, monitoring e-cigarette brand selection by race/ethnicity can inform studies of nicotine exposure, polyuse, and health disparities. Our study demonstrates the importance of research methods to detect rapidly changing patterns of e-cigarette use by race/ethnicity and age. The inclusion of measures capturing brand use can detect evidence of product features and targeted marketing that may have consequences for patterns of tobacco use and nicotine exposure among these groups.

Introduction: This study examines limitations of the current regulatory framework for tobacco advertising on Instagram. We first investigate compliance with Food and Drug Administration (FDA) warning label requirements for posts by tobacco-owned accounts. Next, we examine the prevalence of content that has been restricted in broadcast or print for its youth appeal, followed by content meeting more expansive criteria for youth appeal set forth in the FDA’s guidance document. Aims and Methods: Posts by tobacco-brand-owned accounts between January 1, 2021, and February 14, 2022, were sampled from Mintel’s Comperemedia Omni database. Instagram posts from 15 accounts were examined for violations of FDA warning label requirements and content that has been restricted on other mediums, including cartoons, sports branding, unauthorized claims, and young models (N = 1243). Finally, a subsample of n = 453 unambiguously branded posts was coded for themes that met the FDA’s criteria of resonating with younger audiences, particularly that “adolescents rely on external information as they seek to shape their own identities.” Results: Only 12.8% of posts had fully compliant warning labels. Content that has been in some way regulated on other mediums, such as cartoons (1.6%), unauthorized health claims (<1%), sports branding (<1%), and young models (4.4%) were infrequent. However, a conservative analysis focusing only on branded posts found that posts frequently highlighted tech elements (45%), device customizability (24.5%), vaper identity (17.7%), stylized product photography (33.6%), social media engagement (32.2%), and memes (5.7%). Conclusions: Enforcement of existing regulations on Instagram is minimal. Explicit content restrictions applying evidence-based guidance on youth-appealing advertising are needed. Implications: This research has important implications for enforcing and expanding advertising regulations on social media. First, Instagram’s self-imposed regulations are ineffective, permitting tobacco companies to post ads from brand-owned accounts despite claiming to restrict tobacco promotion on the platform. Second, policymakers should seek to apply FDA guidance on youth-appealing advertising informed by decades of research to create explicit enforceable content restrictions that extend beyond cartoons, sports figures, and young models to include content likely to situate tobacco use within the developing self-concept of vulnerable youth such as presenting e-cigarettes as hi-tech devices, highlighting vaper identity, or infiltrating online social media culture. Finally, greater resources for enforcement are needed given the only applicable regulation, warning labels, remains largely ignored.

Objective This project assesses how online vape shops (OVSs) verify buyer identification (ID) and the shipping methods used to send products within the USA. Methodology In January 2023, we conducted three online searches (eg, ‘best online vape shops’) from our office in Washington, District of Columbia, to identify popular OVSs. Two trained coders identified discrete features available within the site sections: ‘About Us’, ‘Shipping Policy’ and ‘Frequently Asked Questions’, or displayed within the site’s homepage. Coders recorded OVS listed locations, shipping discounts, shipping companies used and ID verification methods. Lastly, coders indicated if the site requested ID/age verification after adding an item to the shopping cart and initiating checkout procedures. Results We identified 64 unique OVSs; 92.2% (n=59) offered shipping and 82.8% (n=53) shipped to US buyers; 76.6% (n=49) allowed visitors to type a birthday or choose the ‘21 or older’ option to access the site. Of the 59 sites shipping to buyers, 76.3% (n=45) offered free shipping, 21.9% (n=14) required login to purchase products, while most sites (n=45, 76.3%) allowed visitors to reach the checkout page without ID verification. The US Postal Service is the most commonly used shipping carrier (n=23), in violation of the Preventing All Cigarette Trafficking Act. Conclusions Most OVSs rely on age self-certification, which underage youth can easily exploit to access these products. Findings warrant that the Food and Drug Administration, state and local policymakers explore additional actions regulating online tobacco sales to address the compliance issues our data elucidate. These include enhanced surveillance, compliance checks and stricter penalties.