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Emerging Trends in Electronic Cigarette Use and Vaping

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (15 May 2023) | Viewed by 29330

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Special Issue Editors

Dr. Andrea Hobkirk

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Guest Editor

Department of Psychiatry and Behavioral Health, Penn State University College of Medicine, Hershey, PA 17033, USA
Interests: use of harm-reduction tobacco products and their potential health outcomes; electronic cigarettes and vaping products as well as their acute and long-term impact on brain function

Dr. Jessica Yingst

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Guest Editor

Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA 17033, USA
Interests: evaluating the impact of electronic cigarette use on current tobacco users in relation to behaviors, addiction potential, and health effects

Prof. Dr. Jonathan Foulds

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Guest Editor

Department of Public Health Sciences, Penn State Cancer Institute, Hershey, PA 17033, USA
Interests: clinical, policy and research aspects of tobacco addiction; the role of reduced nicotine cigarettes and electronic cigarettes in reducing the harms to health from tobacco

Special Issue Information

Dear Colleagues,

Electronic cigarettes (e-cigarettes), which were originally developed as a combustible cigarette alternative, have evolved considerably over the last two decades. E-cigarettes are called many different names, including e-cigs, vapes, vaporizers, and e-hookahs, and the technology is now used to deliver more than just nicotine. Pre-made or do-it-yourself e-liquids can contain solvents, nicotine, synthetic nicotine, flavorants, tetrahydrocannabinol (THC), cannabidiol (CBD), alcohol, and herbs, among many other ingredients. The rapidly changing device features and e-liquid ingredients make it difficult to keep up with their potential benefits and harms. Therefore, the public health impact of e-cigarettes and vaping is a dynamic issue that requires timely investigation from diverse perspectives.

For this Special Issue, we invite authors to contribute original research articles and reviews that highlight emerging trends in e-cigarette use, the use of vape technology for non-nicotine substances, and data describing the complex factors that influence vaping and e-cigarette use behaviors, knowledge, attitudes, and health outcomes. This Special Issue is seeking submissions that fit into the following areas:

Research that describes the motivations, contexts, use patterns, and consequences of emerging trends in e-cigarettes and vaping—for example, disposable e-cigarettes and e-liquids that contain synthetic forms of nicotine are rising in popularity. We are particularly interested in studies that can assess the effect of changes in amount of vaping of a drug (e.g., nicotine e-cigarette products) on the consumption of different modes of using that same drug (e.g., non-vaped nicotine products).
Investigations that describe the use and potential health consequences of vaping e-liquids that contain non-nicotine ingredients. For example, manufactured and self-made e-liquids can contain THC, CBD, and alcohol in addition to non-psychoactive ingredients like honey, food-grade oils, and herbs. The reasons, contexts, benefits, and risks of vaping with these alternative products is largely unknown.
Studies describing the nuanced and complex factors that influence e-cigarette use behavior, knowledge, attitudes, and health outcomes. This research may include qualitative investigations, surveys of unique populations or contexts, or experimental research isolating relevant moderators of use behavior. For example, changes in e-cigarette use and outcomes due to the influence of social norms and social media; and risk perceptions in light of (mis)information, stress, and the current pandemic and climate crisis.

Disclaimer: We will not accept research funded in part or full by any tobacco companies in this Special Issue. For more details, please check: https://www.mdpi.com/1660-4601/15/12/2831/htm.

Dr. Andrea Hobkirk
Dr. Jessica Yingst
Prof. Dr. Jonathan Foulds
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

electronic nicotine delivery systems
e-cigarette
vape
tobacco
nicotine
cannabis
e-liquid
smoking
aerosol

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Published Papers (9 papers)

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10 pages, 1029 KiB

Open AccessArticle

Racial/Ethnic Differences in Vaping Product Use among Youth: A State-Level Analysis

by Christopher Cambron

Int. J. Environ. Res. Public Health 2023, 20(9), 5729; https://doi.org/10.3390/ijerph20095729 - 5 May 2023

Cited by 4 | Viewed by 2476

Abstract

National data suggest that non-Hispanic, White youth engage in electronic cigarette (e-cigarette) use at the highest rates. These results are not likely to be mirrored across regional contexts. State-representative data from Utah in 2019 (N = 58,689) were used to estimate the odds of lifetime and past 30-day vaping across seven racial/ethnic categories. Youth in grades 8, 10, and 12 (mean age 15.2; 52% female) self-reported race/ethnicity and vaping product use history, including e-cigarettes, vape pens, or mods. A Cox proportional hazards model estimated the cumulative probabilities for initiating vaping product use. The results indicated that American Indian or Alaskan Native, Black or African American, Hispanic/Latino, Multiracial, and Native Hawaiian or other Pacific Islander youth had significantly higher odds of both lifetime and past 30-day vaping compared to non-Hispanic White youth. The results showed significant variation in the cumulative probability of initiation by race/ethnicity, with Hispanic/Latino youth reporting the highest odds of initiation at each age. The regional patterns of vaping across racial/ethnic groups may not mirror national trends. State- and community-level data should be used to inform efforts to reduce e-cigarette use and promote health equity among youth. Full article

(This article belongs to the Special Issue Emerging Trends in Electronic Cigarette Use and Vaping)

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16 pages, 2923 KiB

Open AccessArticle

Using Moralization as a Persuasion Strategy in Public Health Messages: A Cross-Sectional, Experimental Study on Vaping

by Laura Arhiri, Mihaela Alexandra Gherman and Andrei Corneliu Holman

Int. J. Environ. Res. Public Health 2022, 19(22), 14859; https://doi.org/10.3390/ijerph192214859 - 11 Nov 2022

Cited by 1 | Viewed by 2721

Abstract

Using moralization in anti-vaping public health messages as a persuasion strategy was recently recommended to address the current vaping epidemic. However, previous findings indicated this could lead to moralized attitudes in the general population, which can be very difficult to change and could severely affect social cohesion and distort risk perception. Since the safety and efficiency of using electronic cigarettes as smoking cessation devices are still being investigated, we conducted a cross-sectional, experimental study on a convenience sample of 612 Romanian never vapers, never smokers to assess how exposure to moralizing public health messages about vaping might influence their trust in future scientific results about this topic. Participants were randomized into six groups according to the type of message (“moral,” “immoral,” “neutral”) and the type of effects of vaping on smokers’ health, documented in a future fictitious study (“health benefits,” “health risks”). Results showed that the type of message moderated trust in future scientific results after controlling for participants’ general trust in science. When vaping was framed as immoral, trust in future scientific results showing health benefits was decreased, and vice versa. Implications are discussed for using moralization strategically in public health messaging to curtail or promote certain health behaviors. Full article

(This article belongs to the Special Issue Emerging Trends in Electronic Cigarette Use and Vaping)

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12 pages, 635 KiB

Open AccessArticle

Consumption of JUUL vs. Other E-Cigarette Brands among U.S. E-Cigarette Users: Evidence from Wave 5 of the PATH Study

by Yu Wang, Zongshuan Duan, Scott R. Weaver, Lucy Popova, Claire A. Spears, David L. Ashley, Terry F. Pechacek, Michael P. Eriksen and Jidong Huang

Int. J. Environ. Res. Public Health 2022, 19(17), 10837; https://doi.org/10.3390/ijerph191710837 - 31 Aug 2022

Cited by 11 | Viewed by 4007

Abstract

This study examines the use of JUUL vs. other e-cigarette brands among U.S. youth (12–17 years), young adult (18–24 years), and adult (25 years and above) e-cigarette users. Data were from the Population Assessment of Tobacco and Health (PATH) study Wave 5 survey (2019). The study population was past 30-day e-cigarette users who knew the brand of e-cigarettes they usually/last used (N = 2569). JUUL use was reported by 65.2% of youth, 60.7% of young adult, and 25.6% of adult e-cigarette users in our study sample. The share of JUUL consumed in the past 30 days, measured by the total number of puffs, was 15.4% by youth, 55.5% by young adults, and 29.1% by adults. By contrast, the share of other e-cigarettes consumed was 4.2% by youth, 28.9% by young adults, and 66.9% by adults. Youth JUUL users were more likely to use e-cigarettes within 30 min after waking (aOR = 2.30, 95% CI: 1.12–4.75) than youth users of other brands of e-cigarettes. Additionally, youth e-cigarette users who currently smoked cigarettes were less likely to use JUUL (aOR = 0.55, 95% CI: 0.30–0.99). This study concludes that JUUL consumption was disproportionally higher among youth and young adults in the U.S. in 2019. Full article

(This article belongs to the Special Issue Emerging Trends in Electronic Cigarette Use and Vaping)

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24 pages, 433 KiB

Open AccessArticle

A Comparison of Vaping Behavior, Perceptions, and Dependence among Individuals Who Vape Nicotine, Cannabis, or Both

by Savreen K. Saran, Kalin Z. Salinas, Jonathan Foulds, Övgϋ Kaynak, Brianna Hoglen, Kenneth R. Houser, Nicolle M. Krebs, Jessica M. Yingst, Sophia I. Allen, Candace R. Bordner and Andrea L. Hobkirk

Int. J. Environ. Res. Public Health 2022, 19(16), 10392; https://doi.org/10.3390/ijerph191610392 - 20 Aug 2022

Cited by 3 | Viewed by 3474

Abstract

Background: Electronic delivery systems (e.g., vapes, e-cigarettes) are now popular modes of cannabis and nicotine administration that are often used by the same individuals; however, we still know little about dual nicotine and cannabis vaping. Materials & Methods: An online convenience sample of adult nicotine and/or cannabis vape users residing in the United States completed a 60 min survey on sociodemographic characteristics, cannabis and/or nicotine vape use behaviors and dependence, reasons for vape use, and perceptions of benefits and harms. After data cleaning, we compared dual vs. nicotine-only and cannabis-only vape users with univariate statistics and step-wise hierarchical linear regression analyses. Additionally, we assessed the factor structure, internal consistency, and criterion and convergent validity of the Penn State Cannabis Vaping Dependence Index (PSCVDI). Results: The final sample included 357 dual, 40 cannabis, and 106 nicotine vape users. Compared to nicotine- and cannabis-only vapers, dual vapers started using their nicotine and cannabis vapes at a younger age (p < 0.001), used them for more years (p < 0.001), and were less likely to use their nicotine vape to replace combustible cigarettes (p = 0.047). Dual users vs. single-substance users did not have significantly higher nicotine or cannabis vape dependence scores after controlling for sociodemographic and use behaviors. The PSCVDI showed adequate validity for measuring cannabis vape dependence. Conclusions: This survey is the first to highlight important differences in vape use behaviors and reasons for use between dual vs. cannabis- and nicotine-only vape users. Full article

(This article belongs to the Special Issue Emerging Trends in Electronic Cigarette Use and Vaping)

12 pages, 472 KiB

Open AccessArticle

Message Source Credibility and E-Cigarette Harm Perceptions among Young Adults

by Donghee N. Lee and Elise M. Stevens

Int. J. Environ. Res. Public Health 2022, 19(15), 9123; https://doi.org/10.3390/ijerph19159123 - 26 Jul 2022

Cited by 5 | Viewed by 2198

Abstract

This study examined the effect of message source credibility on e-cigarette harm perceptions among U.S. young adults. An online experimental study was conducted where young adults (n = 302, Mage = 23.7) were randomized to an e-cigarette public health education message from an expert or a peer young adult. Then, participants answered questions about their perceptions about the message source and e-cigarettes. Results suggest that young adults rated experts as a more credible source (vs. peer) (b = −0.39, SE = 0.15, 95% CI [−0.67, −0.10], p < 0.01). Young adults reported greater perceived credibility of the expert message (vs. peer), which was associated with increased e-cigarette harm perceptions. Increased perceived source credibility mediated the association of increased e-cigarette absolute harm perceptions from viewing an expert message (b = −0.11, SE = 0.04, 95% CI: −0.20, −0.02). Source credibility should be considered when designing e-cigarette education messages for young adults. Full article

(This article belongs to the Special Issue Emerging Trends in Electronic Cigarette Use and Vaping)

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14 pages, 326 KiB

Open AccessArticle

Opinions and Practices Regarding Electronic Cigarette Use among Middle School Students from Rural Areas of Romania

by Tania Elena Tudor and Lucia Maria Lotrean

Int. J. Environ. Res. Public Health 2022, 19(12), 7372; https://doi.org/10.3390/ijerph19127372 - 16 Jun 2022

Cited by 2 | Viewed by 2233

Abstract

Background: The objectives of the study were to assess awareness, opinions, and practices regarding electronic cigarette (e-cigarette) use, as well as factors associated with their use, among middle-school aged students from rural areas of Romania. Methods: The study sample included 748 middle-school students aged 13–14 years from 24 schools from rural areas situated in two counties from Romania, after receiving parental consent. A cross-sectional study using confidential questionnaires which assessed smoking-related behaviors, and also opinions and practices related to e-cigarettes use, was performed in 2019 among the participating middle-schoolers. Results: 96.3% of the middle schoolers have heard about e-cigarettes. A percentage of 72.7% of the smokers, 50.8% of the ex-smokers, and 15.4% of the non-smokers had tried e-cigarettes at least once in their life; 20.3% of the smokers, 4.8% of the ex-smokers, and 4.5% of the non-smokers reported using e-cigarettes in the last month. The results of multivariate logistic regression analysis pointed out that e-cigarette use at least once during lifetime was associated with having friends who tried e-cigarettes, having stronger beliefs that they can help quit smoking and that they are less dangerous than traditional cigarettes. The intention to use e-cigarettes in the next year and smoking behavior were also correlated with e-cigarettes experimentation, while no gender differences were found. Conclusions: The results underline the importance of having prevention programs and interventions concerning e-cigarettes consumption, since e-cigarettes consumption is spread among Romanian adolescents from rural areas. Full article

(This article belongs to the Special Issue Emerging Trends in Electronic Cigarette Use and Vaping)

15 pages, 651 KiB

Open AccessArticle

The Impact of Recent Tobacco Regulations and COVID-19 Restrictions and Implications for Future E-Cigarette Retail: Perspectives from Vape and Vape-and-Smoke Shop Merchants

by Zongshuan Duan, Katelyn F. Romm, Lisa Henriksen, Nina C. Schleicher, Trent O. Johnson, Theodore L. Wagener, Steven Y. Sussman, Barbara A. Schillo, Jidong Huang and Carla J. Berg

Int. J. Environ. Res. Public Health 2022, 19(7), 3855; https://doi.org/10.3390/ijerph19073855 - 24 Mar 2022

Cited by 11 | Viewed by 4402

Abstract

Background: Tobacco regulations and COVID-19 state orders have substantially impacted vape retail. This study assessed vape retailers’ perspectives regarding regulations and future retail activities. Methods: In March–June 2021, 60 owners or managers of vape or vape-and-smoke shops (n = 34 vs. n = 26) in six US metropolitan areas completed an online survey assessing: (1) current and future promotional strategies and product offerings; and (2) experiences with federal minimum legal sales age (T21) policies, the federal flavored e-cigarette ban, and COVID-19-related orders. Quantitative data were analyzed descriptively; qualitative responses to open-ended questions were thematically analyzed. Results: Most participants had websites (65.0%), used social media for promotion (71.7%), offered curbside pickup (51.7%), and sold CBD (e.g., 73.3% vape products, 80.0% other); many also sold other tobacco products. Knowledge varied regarding state/local policies in effect before federal policies. Participants perceived tobacco regulations and COVID-19 orders as somewhat easy to understand/implement and perceived noncompliance consequences as somewhat severe. Qualitative themes indicated concerns regarding regulations’ negative impacts (e.g., sales/customer loss, customers switching to combustibles), insufficient evidence base, challenges explaining regulations to customers, and concerns about future regulatory actions. Conclusions: Surveillance of tobacco retail, consumer behavior, and regulatory compliance is warranted as policies regarding nicotine and cannabis continue evolving. Full article

(This article belongs to the Special Issue Emerging Trends in Electronic Cigarette Use and Vaping)

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10 pages, 326 KiB

Open AccessArticle

Policy and Behavior: Comparisons between Twitter Discussions about the US Tobacco 21 Law and Other Age-Related Behaviors

by Page D. Dobbs, Jason B. Colditz, Shelby Shields, Anna Meadows and Brian A. Primack

Int. J. Environ. Res. Public Health 2022, 19(5), 2613; https://doi.org/10.3390/ijerph19052613 - 24 Feb 2022

Cited by 4 | Viewed by 2455

Abstract

To combat the e-cigarette epidemic among young audiences, a federal law was passed in the US that raised the minimum legal sales age of tobacco to 21 years (commonly known as Tobacco 21). Little is known about sentiment toward this law. Thus, the purpose of our study was to systematically explore trends about Tobacco 21 discussions and comparisons to other age-restriction behaviors on Twitter. Twitter data (n = 4628) were collected from September to December of 2019 that were related to Tobacco 21. A random subsample of identified tweets was used to develop a codebook. Two trained coders independently coded all data, with strong inter-rater reliability (κ = 0.71 to 0.93) found for all content categories. Associations between sentiment and content categories were calculated using χ² analyses. Among relevant tweets (n = 955), the most common theme—the disjunction between ages for military enlistment and tobacco use—was found in 17.8% of all tweets. Anti-policy sentiment was strongly associated with the age of military enlistment, alcohol, voting, and adulthood (p < 0.001 for all). Opposition to Tobacco 21 propagates on social media because the US federal law does not exempt military members. However, the e-cigarette epidemic may have fueled some support for this law. Full article

(This article belongs to the Special Issue Emerging Trends in Electronic Cigarette Use and Vaping)

15 pages, 339 KiB

Open AccessArticle

“When I Don’t Have a Cigarette It’s Helpful, but It Really Don’t Satisfy:” Qualitative Study of Electronic Nicotine Delivery Systems (ENDS) Use among Low-Income Smokers

by Claire A. Spears, Dina M. Jones, Cherell Cottrell-Daniels, Hala Elahi, Courtney Strosnider, Jackie Luong, Scott R. Weaver and Terry F. Pechacek

Int. J. Environ. Res. Public Health 2022, 19(3), 1157; https://doi.org/10.3390/ijerph19031157 - 20 Jan 2022

Cited by 4 | Viewed by 2919

Abstract

Background: Little is known about the use of electronic nicotine delivery systems (ENDS) among low-income adult cigarette smokers, who experience severe tobacco-related health disparities. Methods: This study conducted interviews to examine experiences and perceptions associated with ENDS use among predominantly low-income adult smokers (n = 30; mean age 30.2 ± 12.9; 60% male, 46.7% African American, 30% white, 10% more than one race; 76.7% annual household income ≤USD 24,000). Interviews were transcribed verbatim and coded in NVivo 11. Results: Overall, participants reported complementing rather than substituting their smoking with ENDS use (e.g., using ENDS only when smoking is not allowed). Predominant reasons for vaping were convenience, smoking reduction/cessation, stress management, social acceptability, lower long-term costs than smoking, and appealing flavors. Common reasons for not switching to exclusive vaping were that ENDS did not satisfy cigarette cravings and concerns about ENDS health effects. Participants indicated higher likelihood of switching to exclusive ENDS use if the products were more affordable, perceived as substantially less harmful, tasted and felt more like smoking a cigarette, and more effective for reducing cravings. Conclusions: Continued research is needed to maximize any harm reduction potential of ENDS and ensure that these products do not contribute to worsening health disparities. Full article

(This article belongs to the Special Issue Emerging Trends in Electronic Cigarette Use and Vaping)

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