Exploring the opinions and potential impact of unflavoured e-liquid on smoking cessation among people who smoke and smoking relapse among people who previously smoked and now use e-cigarettes: findings from a UK-based mixed methods study.

BACKGROUND: Although electronic cigarettes (e-cigarettes) appear to be effective in helping people who smoke to stop smoking, concerns about use of e-cigarettes among young people have led to restrictions on non-tobacco flavoured e-liquids in some countries and some US states. These restrictions could reduce the appeal of these products to non-smoking youth but could have negative consequences for people who smoke or use e-cigarettes. METHODS: In this mixed methods study, we recruited UK adults who smoked or used to smoke and subsequently vaped to explore their opinions of unflavoured e-liquids and their beliefs about how they would be impacted by hypothetical e-liquid flavour restrictions. Participants trialled an unflavoured e-liquid instead of their usual nicotine product for four hours and completed a survey and an online interview. RESULTS: Using Interpretive Phenomenological Analysis and graphically presented data, we found differences in participants' opinions of unflavoured e-liquid. If only unflavoured, tobacco flavoured, and menthol flavoured e-liquids remained on the UK market, some people who smoke or vape may be unaffected, but some may relapse to smoking or continue smoking. Despite most wanting to prevent young people from initiating vaping, participants had varying opinions on whether flavour restrictions would be an effective method. CONCLUSIONS: The findings highlight that people who smoke and vape could be impacted by flavour restrictions in a range of ways, some of which could have a potential adverse impact on harm reduction efforts in the UK (e.g., by making smoking more appealing than vaping).

Online popularity of JUUL and Puff Bars in the USA: 2019-2020.

BACKGROUND: The US Food and Drug Administration (FDA) announced a flavour ban on cartridge-based e-cigarettes in January 2020. It is unclear whether e-cigarette users will switch to disposable vaping products with a variety of kids-appealing flavours available. METHODS: We performed piece-wise regression and autoregressive integrated moving average (ARIMA) algorithms to compare the relative search volume (RSV) of JUUL and Puff Bar (a disposable vaping product) using the 1-year Google Trends data from 24 February 2019 to 20 February 2020, separated by three events that may have spurred changes in RSV for each product. RESULTS: The RSV for JUUL was relatively stable before Trump Administration announced plans to ban flavoured e-cigarettes. After that, the RSV for JUUL dropped sharply (rate of change=-8.8 per week) from 11 September 2019 to 17 October 2019 when JUUL Labs announced to halt online sales of some flavoured products, and the RSV resumed the decreasing trend after FDA announced enforcement policy of cartridge-based e-cigarettes on 2 January 2020. In comparison, the RSV for Puff Bar started to increase after 11 September 2019 with a low rate of change (0.6) until 17 October 2019. After that, the increase in RSV for Puff Bar accelerated. The RSV of puff bars surpassed that of JUUL during the week of 2 February 2020. CONCLUSION: The popularity of Puff Bar on Google Search suggests that users may replace cartridge-based vaping products with disposable e-cigarettes in the circumvention of the partial flavour ban. Continuous surveillance and further assessment are needed to prevent potential loopholes in tobacco regulation.

Vaping control in Nova Scotia: using research to catalyze change.

The tobacco, and now vaping, industries are skilled at creating falsification campaigns that leave policymakers and the public confused and distracted. As Nova Scotia saw youth vaping rates rise, a non-profit conducted a youth and young adult survey to discover why, what, and how often youth and young adults vape. They discovered that almost 96% of youth prefer flavours, and 48% believed they would quit if flavours were removed. This research was pivotal in capturing the voices of youth, gathering stakeholders, and countering industry opposition. On April 1, 2020, the Nova Scotian government implemented Canada's first ban on flavoured vaping products. This was followed by a nicotine cap of 20 mg/ml and a revamped taxation structure. The survey allowed non-profits to band together and align messages. It also provided government with information to take actions that reduce the prevalence and potential harms of vaping among youth. This commentary describes the advocacy process and opposition faced when advocating for vaping control measures. This approach can serve as a guide for assisting other jurisdictions in advocating for policy changes.

RéSUMé: Les industries du tabac, et maintenant du vapotage, sont habiles à créer des campagnes de falsification qui embrouillent les responsables des politiques et le public et qui distraient leur attention. Avec la hausse des taux de vapotage chez les jeunes en Nouvelle-Écosse, un organisme sans but lucratif a mené une enquête auprès des jeunes et des jeunes adultes pour découvrir pourquoi ils vapotent, à quelle fréquence et avec quels produits. L'enquête a révélé que près de 96 % des jeunes préféraient les arômes, et que 48 % croyaient qu'ils cesseraient de vapoter si ces arômes étaient retirés. Cette étude a été déterminante pour capter les voix des jeunes, réunir les acteurs et contrer l'opposition de l'industrie. Le 1er avril 2020, le gouvernement néo-écossais a mis en œuvre la toute première interdiction des produits de vapotage aromatisés au Canada. Il a ensuite limité la nicotine à 20 mg/ml et repensé la structure fiscale. L'enquête a permis aux organismes sans but lucratif de se regrouper et d'harmoniser leurs messages. Elle a aussi procuré au gouvernement les informations nécessaires pour prendre des mesures qui réduisent la prévalence et les préjudices potentiels du vapotage chez les jeunes. Notre commentaire décrit le processus de plaidoyer et l'opposition rencontrée lorsque l'on défend des mesures de contrôle du vapotage. Cette approche peut servir de guide pour aider d'autres administrations à préconiser des changements de politiques.