Impact of flavours, device, nicotine levels and price on adult e-cigarette users’ tobacco and nicotine product choices

IntroductionTo understand the impact of e-cigarette devices, flavours, nicotine levels and prices on adult e-cigarette users’ choices among closed-system and open-system e-cigarettes, cigarettes and heated tobacco products (HTPs).MethodsOnline discrete choice experiments were conducted among adult (≥18 years) e-cigarette users (n=2642) in August 2020. Conditional logit regressions were used to assess the relative impact of product attributes and the interactions between product attributes and user characteristics, with stratified analyses to examine differences by smoking status and primarily used e-cigarette device and flavour.ResultsOn average, participants preferred non-tobacco and non-menthol flavours most, preferred open-system over closed-system e-cigarettes and preferred regular nicotine level over low nicotine level. However, the preference varied by demographics, smoking status and the primarily used e-cigarette device and flavour. The differences in preference among products/devices were larger than the difference among flavours or nicotine levels. Participants who primarily used closed-system e-cigarettes exhibited similar preferences for closed-system and open-system e-cigarettes, but those who primarily used open-system e-cigarettes preferred much more open-system over closed-system e-cigarettes. HTP was the least preferred product, much lower than cigarettes in general, but participants living in states where IQOS is being sold had similar preferences to cigarettes and HTPs.ConclusionsPeople are unlikely to switch to another product/device because of the restriction of flavour or nicotine level. If non-tobacco and non-menthol flavours were banned from open-system e-cigarettes, users may switch to menthol flavour e-cigarettes. Intervention strategies should be tailored to specific groups.

Nicotine level associated with decreasing Treg number in smoker healthy volunteers

The intensity of cigarette exposure is associated with the severity of the inflammatory reaction. Treg cell plays a role in suppressing the inflammatory response. There has been no clear evidence on the relationship between smoker behavior with the nicotine level and Treg number. We will investigate the relationship between smoking behavior with the nicotine level and Treg number. We conducted a cross-sectional study of 106 healthy volunteers in Yogyakarta. We interviewed the subjects and took their blood samples for hemogram, Treg number, nicotine level, and blood chemistry examination. The inclusion criteria were fit, male or female, aged 18 years or older, and willing to volunteer proven by completing and signing the informed consent. We collected the data on smoking habits through interviews guided by a questionnaire. We examined hemogram and blood chemistry using a spectrophotometer, while the levels of nicotine were measured using The enzyme-linked immunosorbent assay (ELISA). We described the characteristics of the subjects by univariate analysis. The bivariate analysis was to determine the relationship between cigarette smoking length with nicotine level and Treg number. The results show a connection between the range of tobacco and cigarette number with nicotine levels in the blood with a value of <em>r</em>=0.63 in the Pearson correlation test p&lt;0.00. It can be concluded that there is a relationship between behavior smoking with nicotine levels and Treg counts.

Flavor and product messaging are the two most important drivers of electronic cigarette selection in a choice-based task

Electronic cigarette use—vaping—is increasingly popular. Various product factors may influence an individual’s choice of e-cigarette. To provide an evidence base for e-cigarette regulation, a better understanding of the role different product attributes play in product preferences is needed. Here, we used conjoint analysis to quantify different factors that influence e-cigarettes choices, including flavors, nicotine level, customizability, or use of e-cigarettes to manage appetite/food craving. Young adults completed a set of choice-based conjoint tasks online. Choice Based Conjoint analysis (CBC) was used to determine utility scores for each attribute. Young adults (n = 587) who vaped at least once per week were included in analyses; gender differences were explored. Flavor was the most important attribute (48.1%), followed by product messaging (21.0%) and nicotine level (15.3%). Within flavor, confectionery and fruit flavors had the highest utility scores, while classic menthol and tobacco flavors had the lowest. Men and women differed in flavors, nicotine levels, and product messaging that appealed most. Among young adults who vape weekly, flavor is the most important factor in e-cigarette preferences. Gender also factors into e-cigarette preferences, especially for preferred nicotine level. Understanding why individuals choose particular e-cigarette products will help inform public health efforts and policy making.

Study on controlling nicotine release from snus by the SIPN membranes

Snus is one of the types of smokeless tobaccos, which is popular in many countries and regions. The nicotine level in the plasma samples obtained from snus users is similar to the nicotine level obtained from cigarette smokers; hence, the snus users find it difficult to quit. The aim of this study is to develop new semi-interpenetrating polymer (SIPN) membranes that control the stable release of nicotine from snus, achieving the purpose of quitting smoking. Here, the SIPN comprising a polyacrylate network and PEG chains was synthesized through in situ radical polymerization. The SIPN was characterized by Fourier transform infrared spectroscopy, contact angle, differential scanning calorimetry, scanning electron microscopy, cytotoxicity, and in vitro release experiments. Furthermore, this SIPN was used to evaluate the release properties of nicotine in different snus samples varying in moisture, pH, and the tobacco’s particle size. The results indicated that the new SIPN could control release of nicotine at a specific rate, and the release rate could be adjusted according to the customer requirements. Thus, the new SIPN was contributed to build a new nicotine replacement therapy that served the snus users.

KARAKTERISASI SABUN CAIR DENGAN VARIASI PENAMBAHAN EKSTRAK TEMBAKAU (Nicotiana tabacum L.)

Liquid soap is a kind of cleanser made from a chemical reaction of the potassium salt of fatty acids. The distribution of soap with natural ingredients is rarely available on a market. One of the best options that can be used as a natural active ingredient of soap is a tobacco leaf. This study aimed was to the best treatment concentration of tobacco extract on the physical, chemical, and microbiological properties of liquid soap. The formulations of tobacco extract were 5%, 10%, and 15% of base soap. The study showed that the addition of tobacco extract to liquid soap could decrease the viscosity, specific gravity, pH, and alkaline free. Meanwhile, the nicotine level and bacterial inhibition (clear zone) were higher. The best concentration of liquid soap was formulation with the addition of 5% tobacco extract, with characteristics of viscosity about 2498.1 cP, specific gravity about 1.0209 g/mL, the stability of foam about 180 mL/ 9 hours, foam power about 22.34 second, pH 10.14, alkaline free about 0.0824%, nicotine content about 128.69 mg/100g and the antibacterial of E. coli (clear zone) of tobacco liquid soap about 5.8 mm. Keywords: liquid soap, natural active ingredients, tobacco extract

Public attitudes towards e-cigarette regulations and policies in Taiwan

Background: There are various approaches to e-cigarette regulation globally. In Taiwan, the term “e-cigarette” is not found in existing regulations, but health authorities apply explanatory notes derived from standing laws to e-cigarette. Taiwan health authority is in the process of regulative reform to include “e-cigarette” in standing tobacco law. Our objective was to investigate the public’s attitudes towards potential policy options for e-cigarette regulations in Taiwan.Design and Methods: We conduct an anonymous online survey in the general public. A questionnaire in Mandarin was posted on the website Stop-tabac.ch between July and November 2017.Results: Participants (n=236) were mostly male, young, highly educated, employed, and smoked or had smoked cigarettes in the past. Half were e-cigarette users. Four measures banning e-cigarettes, labelling content and nicotine level and establishing a maximum-allowable nicotine level were supported by more than 70% of participants. Vaping status was strongly associated with support for most measures after controlling for other factors in multivariate models.Conclusion: We documented attitudes of a self-selected sample of the general public in Taiwan regarding e-cigarette regulations and policies. These results may be useful to design studies in more representative samples and to inform e-cigarette regulations, policies and education campaigns.

Effects of Reduced-Nicotine Cigarettes Across Regulatory Environments in the Experimental Tobacco Marketplace: A Randomized Trial

Introduction Cigarette smoking remains the leading preventable cause of death in the United States. Recent efforts have explored the potential health and policy benefits of reducing nicotine, an addictive component, in combustible cigarettes. To date, an experimental, prospective analysis directly comparing the effects of varying regulatory environments on purchases of multiple products has yet to be conducted. The present study compared real purchasing of conventional cigarettes, reduced-nicotine cigarettes, and a variety of other nicotine and tobacco products across a range of regulatory environments. Methods Participants were assigned to one of five groups, each associated with a different nicotine level (mg of nicotine to g of tobacco) in SPECTRUM investigational cigarettes (15.8mg/g, 5.2mg/g, 2.4mg/g, 1.3mg/g, and 0.4mg/g). Across sessions, participants made real purchases for nicotine/tobacco products in an Experimental Tobacco Marketplace. Each session corresponded with a distinct regulatory environment wherein different nicotine/tobacco products were available for purchase. Results Our results suggest that the primary drivers of cigarette and nicotine purchasing are regulatory environment and the presence/absence of alternative nicotine and tobacco products. Perhaps surprisingly, nicotine level does not appear to be such a driver of purchasing behavior under these experimental conditions. Investigational cigarette purchasing is lowest when other preferred combustible products are available and highest when investigational cigarettes are the only combustible product available for purchase. Conclusions If a reduced-nicotine policy is implemented, great care should be taken in determining and making available less harmful nicotine/tobacco products as the availability of preferred combustible products may result in undesirable levels of purchasing. Implications This is the first experimental study investigating different potential regulatory effects related to a reduced-nicotine policy by examining purchasing across a range of nicotine/tobacco products. Our results suggest the presence of affordable, highly preferred combustible products is likely to maintain tobacco purchasing at undesirable levels. To promote switching to less harmful products, affordable alternate nicotine and tobacco products should be readily available. Finally, our results suggest availability of noncigarette products, not cigarette nicotine level, will most likely affect purchasing of reduced-nicotine cigarettes.

Discrete product choices made by young adults who vape regularly reveal segments of flavor and nicotine focused users

Introduction: Electronic cigarette ("eCig") use, or "vaping," is increasingly prevalent. Factors such as flavor and nicotine level may influence selection and use of eCigs. A better understanding of the role product attributes play in eCig preferences is necessary to inform evidence-based regulation of electronic nicotine delivery systems (ENDS). Methods: Here, we used choice-based conjoint (CBC) analysis to quantify different attributes that influence eCig preferences, including flavors, nicotine level, cooling/"ICE" properties, and user reviews. Young adults aged 18 to 25 who had vaped at least once in the past 7 days completed 18 choice tasks, as well as the Penn State Electronic Cigarette Dependence Index (PSECDI). They also answered questions about other nicotine product use and perceived eCig risk. CBC analysis was used to determine utility scores for each attribute.Results: Flavor was the most important attribute, followed by nicotine level. Sweet flavors, particularly candy ones, had the highest utility scores. Two segments of participants were identified via latent class analysis. The first segment was influenced predominately by nicotine level (with 5% nicotine receiving the highest utility score), whereas the second segment placed greater importance on sweet flavors. Segment 1 membership was associated with higher nicotine dependence, as well as greater likelihood of cigarette or cigar use.Conclusion: In young adults who vape regularly, flavor is the most important factor in eCig preferences, and sweet flavors – especially candy themed–were most preferred. We also found evidence of two segments: one that appeared more nicotine-focused, and one that appeared more flavor-focused.Implications: A discrete choice experiment revealed segments of flavor-focused and nicotine-focused eCig users. Strikingly, the more nicotine-focused users, defined strictly via their behavior in a choice task, were also more dependent and more likely to use combustible tobacco. Understanding why individuals choose particular eCig products can help inform public health efforts and policy making.

Changing Exposure Perceptions: A Randomized Controlled Trial of an Intervention with Smoking Parents

Children who live with smokers are at risk of poor health, and of becoming smokers themselves. Misperceptions of the nature of tobacco smoke exposure have been demonstrated among parents, resulting in continued smoking in their children’s environment. This study aimed to change parents’ perceptions of exposure by providing information on second- and third-hand exposure and personalised information on children’s exposure [NIH registry (NCT02867241)]. One hundred and fifty-nine families with a child < 8 years and at least one smoking parent were randomized into intervention (69), control (70), and enhanced control (20) groups. Reported exposure, parental smoking details, and a child hair sample were obtained at the start of the study and 6–8 months later. Parental perceptions of exposure (PPE) were assessed via a questionnaire. The intervention consisted of motivational interviews, feedback of home air quality and child’s hair nicotine level, and information brochures. PPE were significantly higher at the study end (94.6 ± 17.6) compared to study beginning (86.5 ± 19.3) in intervention and enhanced control groups (t(72) = −3.950; p < 0.001). PPE at study end were significantly higher in the intervention group compared to the regular control group (p = 0.020). There was no significant interaction between time and group. Parallel changes in parental smoking behaviour were found. Parental perceptions of exposure were increased significantly post intervention, indicating that they can be altered. By making parents more aware of exposure and the circumstances in which it occurs, we can help parents change their smoking behaviour and better protect their children.

E-Cigarette Quality Control: Impurity and Nicotine Level Analysis in Electronic Cigarette Refill Liquids

This work targets mainly the quality control of electronic cigarette liquids. It relies on an analytical control of a “32-product” sample made of several types of e-cigarette liquids taken from various supermarkets and tobacconist’s offices in Morocco. All along this study, we made sure to check both the conformity of the nicotine level indicated in the packaging of each product and the existence of any other components inside the product, especially toxic or unknown impurities. The method used for this study is known under the name of high-performance liquid chromatography. For statistical analysis, we used Student’s t-test for a single sample in order to analyze the relative differences between nicotine quantity reported in the product and the one measured during our experiment. Finally, we used linear regression test to determine the relationship between the nicotine level accuracy on the packaging and the level of toxic impurities in the products. The differences between the nicotine concentrations reported in the packages and the measured ones varied from −100% to +3.3%. The study showed that 31% of analyzed products have an accurate indication of the level of nicotine on the packaging. However, 47% of the studied products showed more than 20% difference between measure and packaging indication. In all analyzed samples, the level of impurities altered from 0 to 32.6%. Furthermore, the level of the nicotine breakdown products did not exceed 2% of the nicotine content in pretty much all of the samples. The actual nicotine content of electronic cigarette refill liquids is not always as precise as what is stated on the packaging; in addition to the level of impurities detected in several brands and that exceeds the European Pharmacopoeia standards, some may even present a risk of causing toxicological damage.