Reactions to a Hypothetical Ban of Open-System Electronic Cigarettes Among People Who Currently Use Electronic Cigarettes.

INTRODUCTION: Policies limiting electronic cigarette (ECIG) device and liquid characteristics have been considered to prevent dependence potential and youth product appeal. "Open-system" ECIGs allow people to adjust device and liquid characteristics, which may undermine these policies. This study examined anticipated reactions to a policy prohibiting the sale of open-system ECIG devices in the United States using concept mapping. METHODS: In 2020, adults who reported ECIG use in the past 30 days (n = 70; 45.1% women; mean age = 33.0, SD = 10.6) recruited from a research registry of individuals from across the United States provided statements into a shared list that completed a prompt: "If open-system vaping devices were no longer sold in the US and only closed-system vaping devices were available, what is a specific reaction or response you would have?" at a study website. Participants rated statements (1-7) on how true the statements were for them. Multidimensional scaling and hierarchical cluster analyses were used to identify thematic clusters. Mean ratings of statements were calculated and compared based on the type of ECIG used and current cigarette smoking status. RESULTS: Participants generated 85 unique statements. The analysis identified eight themes that were organized into two broad groups. The first group of five clusters described behavioral responses to the hypothetical policy (Loopholes, Switch to Closed-System ECIGs, Legal Approaches to Use Open-System ECIGs, ECIG Use Cessation, Switch to non-ECIG Products). The second group of three clusters described psychological responses to the hypothetical policy (Closed-System ECIG Cons, Psychological Responses, Policy Outcome Concerns). CONCLUSIONS: While a ban on open-system ECIG devices may have positive impacts on public health, policy loopholes, and consumer behaviors may undermine the policy. Efforts to support policy enforcement could increase policy effectiveness. IMPLICATIONS: Open-system electronic cigarettes (ECIGs) that allow people who use ECIGs to modify ECIG device and liquid characteristics may limit the effectiveness of policies that establish product standards which attempt to limit nicotine delivery and flavor content in ECIG liquids. This study identified predicted reactions to a hypothetical policy prohibiting the sale of open-system ECIGs in the United States. Results suggest that people who use ECIGs may view a policy prohibiting open-system ECIGs unfavorably, but would be willing to use closed-system ECIGs. However, many ECIG users may attempt to find loopholes in the policy or alternative sources to purchase open-system ECIGs if open-systems were banned. Future research should identify strategies for tobacco regulatory policy enforcement to increase effectiveness.

Electronic Cigarette Users' Reactions and Responses to a Hypothetical Nicotine Concentration Reduction in Electronic Cigarette Liquids.

Background: Regulations limiting nicotine in electronic cigarettes (e-cigarettes) have been proposed or implemented. Little is known about e-cigarette users' reactions to reducing e-cigarette liquid nicotine concentration. Methods: We used concept mapping to describe e-cigarette users' reactions to a 50% reduction in the nicotine concentration of their e-cigarette liquids. In 2019, current e-cigarette users who used e-cigarette liquid with greater than 0 mg/ml nicotine concentration completed an online study. Participants (n = 71, mean age = 34.9 (SD = 11.0), 50.7% women), brainstormed statements completing a prompt: "If the e-liquid that I use now in my e-cigarette/vaping device was only available in half the nicotine concentration or amount that I use now, a specific action I would take or a specific reaction I would have is…", Participants then sorted a final list of 67 statements into piles of similar content and rated statements on how true the statements would be for them. Multidimensional scaling and hierarchical cluster analyses identified thematic clusters. Results: Eight clusters were identified: (1) Replacement Product Seeking, (2) Mental Preparations and Expectations, (3) Use the New Liquid, (4) Information Seeking, (5) Compensation Behaviors, (6) Opportunity for E-Cigarette Reduction, (7) Physical and Psychological Effects, and (8) Replacement with non-E-Cigarette Products and Behaviors. Cluster ratings suggested many participants would search for other e-cigarette products/liquids to replace their current liquids, but using other tobacco products (e.g., cigarettes) may be less likely. Conclusions: If nicotine concentrations were decreased in e-cigarette liquids, e-cigarette users may attempt to purchase different e-cigarette products or modify their products to achieve desired effects.

Electronic Cigarette Nicotine Flux, Nicotine Yield, and Particulate Matter Emissions: Impact of Device and Liquid Heterogeneity.

INTRODUCTION: Electronic cigarettes (ECIGs) heat a nicotine-containing liquid to produce an inhalable aerosol. ECIG power (wattage) and liquid nicotine concentration are two factors that predict nicotine emission rate ("flux"). These factors can vary greatly across devices and users. AIMS AND METHODS: The purpose of this study was to examine ECIG device and liquid heterogeneity in "real world" settings and the association with predicted nicotine flux, nicotine yield, and total particulate matter (TPM) emissions. Past 30-day ECIG users (n = 84; mean age = 23.8 years [SD = 9.6]) reported device and liquid characteristics. Device power was measured via multimeter, device display screens, or obtained via labeling. Liquid nicotine concentration was obtained via labeling or through chemical analysis. Predicted nicotine flux, nicotine yield, and TPM associated with 10 4-second puffs were calculated for participants' primary devices. RESULTS: Participants' primary devices were box mods (42.9%), disposable vapes (20.2%), and pod mods (36.9%). Most participants (65.5%) reported not knowing their primary device wattage. Rebuildable/box mods had the greatest power range (11.1-120.0 W); pod mod power also varied considerably (4.1-21.7 W). Unlike device wattage, most participants (95.2%) reported knowing their liquid nicotine concentration, which ranged from 3.0 to 86.9 mg/ml (M = 36.0, SD = 29.3). Predicted nicotine flux varied greatly across products (range =12.0-160.1 µg/s, M = 85.6 µg/s, SD = 34.3). Box mods had the greatest variability in wattage and predicted nicotine flux, nicotine yield, and TPM yield. CONCLUSIONS: ECIG device and liquid heterogeneity influence nicotine and other toxicant emissions. Better measurement of ECIG device and liquid characteristics is needed to understand nicotine and toxicant emissions and to inform regulatory policy. IMPLICATIONS: ECIG device and liquid heterogeneity cause great variability in nicotine flux and toxicants emitted. These data demonstrate the need to examine device and liquid characteristics to develop empirically informed, health-promoting regulatory policies. Policies may include setting product standards such that ECIG products cannot (1) have nicotine fluxes much greater than that of a cigarette to decrease the risk of dependence, (2) have nicotine fluxes that are very low and thus would have minimal appeal to cigarette smokers and may serve as starter products for youth or nontobacco users, and (3) emit large amounts of particulate matter and other toxicants.

Electronic cigarette users' reactions and responses to a hypothetical ban of flavoured electronic cigarette liquids.

BackgroundRegulations have been proposed to limit e-cigarette flavours, but limited research has examined potential impacts of such policies. This study examined adult e-cigarette users' reactions to a hypothetical e-cigarette flavour ban. METHODS: In 2019, a convenience sample of current e-cigarette users in the USA (n=81, 53.1% women, mean age=37.6, 59.3% dual users of cigarettes) completed an online concept mapping study. Participants provided statements describing anticipated reactions to a hypothetical policy in which only tobacco, menthol or unflavoured e-cigarettes were available for purchase. Seventy-one unique statements were generated. Participants sorted statements into thematic groups and rated statements on how likely they would be to have each reaction. Multidimensional scaling was used to identify thematic clusters of statements. RESULTS: Twelve clusters were identified: negative reaction, take action against flavour limitation, youth prevention effectiveness perception, tolerance, acceptance, willingness to try new flavours, maintain vaping, reduce vaping, new flavours as vaping cessation transition, alternative sources for banned flavours, do-it-yourself mixing behaviours and alternative tobacco products. The highest rated cluster (negative reaction) described being angry or upset that flavours were banned, while the lowest rated clusters related to quitting/reducing e-cigarette use or switching to other tobacco products. Non-tobacco or non-menthol/mint flavoured e-cigarette users had higher ratings for clusters describing negative sentiment for the hypothetical policy. CONCLUSIONS: Some e-cigarette users may dislike an e-cigarette flavour ban; however, some e-cigarette users would likely be willing to use tobacco, menthol or unflavoured e-cigarette liquids with lower likelihood of quitting vaping or switching to other tobacco products.

"Taking Up a New Problem": Context and Determinants of Pod-Mod Electronic Cigarette Use Among College Students.

In this article, we explore the context and determinants of pod-mod electronic cigarette (ECIG) use among college students aged 18 to 24 in the United States. We conducted semi-structured interviews with 55 students (M age = 20 years, 56% female, 65% White) on three campuses in the Northwest, Midwest, and Southeast. We performed a thematic analysis. Students described ECIG use by peers, increased ECIG exposure and prevalence in college, and school-related stress as reasons for vaping. Pod-mod features such as convenience, design, easy concealment, and flavors made vaping more appealing. Negative aspects of vaping included addiction, cost, and possible health consequences. Most viewed vaping as a college behavior and intended to quit after graduation. Our results show that the college environment plays a major role in young adult ECIG use. These findings can inform the development of targeted interventions to prevent and control uptake of ECIGs by young adults.

Impacts of COVID-19 on Electronic Cigarette Purchasing, Use and Related Behaviors.

Background: COVID-19 has caused health impacts and disruptions globally. Electronic cigarette (ECIG) users may face additional impacts. This study examined impacts of COVID-19 on ECIG users. Methods: Concept mapping, a mixed-methods approach, was used to identify COVID-19 impacts on adult ECIG users. ECIG users (n = 93) provided statements completing a prompt: "A specific way Coronavirus/COVID-19 has affected my vaping/e-cigarette use, my vaping/e-cigarette related purchasing, or other vaping/e-cigarette related behaviors or issues is…". Participants generated 85 unique statements, sorted statements into groups of similar content and rated each statement on how true they were. Multidimensional scaling and hierarchical cluster analysis identified thematic clusters. Mean cluster ratings were compared between sample subgroups. Results: Ten clusters were identified: Stocking up and Bulk Purchasing, Challenges in Obtaining ECIG Supplies, Alternative Purchasing Procedures, Increased ECIG use, Disruption of Routine and ECIG Use, Efforts to Decrease ECIG Use, Improving ECIG Skills, COVID-19 Health Concerns, Perceptions of ECIG Use and COVID-19, and COVID-19 Protection. More dependent ECIG users and dual users of ECIGs and cigarettes rated clusters higher than less dependent ECIG users and non-dual users. Conclusions: ECIG users may experience or perceive they face additional COVID-19 impacts, such as increased exposure, financial burdens, stress, and health risks.

Normal masticatory function of girls and young women: mandibular masticatory movements.

Mandibular masticatory movements were evaluated in 10 young adult women and 12 young girls. All subjects had normal occlusion with minimal overjet. Masticatory movements of the incisors were recorded in three dimensions with an Optotrak® camera system while subjects chewed gum in a habitual manner for 20 seconds. A masticatory analysis program divided each masticatory cycle into four phases and averaged the duration, excursions, and velocities of all cycles for each subject. Duration of the total cycle was longer in women because they had longer slow opening and slow closing phases than girls. Women had a significantly larger vertical component of opening during slow opening and the power stroke than girls. Women also had a significantly larger posterior component of opening during slow opening and the power stroke than did girls. At maximum opening, women also tended to have the incisors in a more posterior position. There were no differences between the groups for the amount of maximum lateral excursion during chewing. Vertical velocity during fast opening and fast closing was slower for women, but there were no age-related differences during the slow open and slow close phases. Am. J. Human Biol. 10:53-62, 1998. © 1998 Wiley-Liss, Inc.