ObjectiveTo explore patterns in flavoured e-cigarette sales following Juul Labs’ 2019 removal of mint-flavoured products and the Food and Drug Administration’s (FDA) 2020 e-cigarette flavour guidance which prohibits flavoured cartridge-based sales, but allows for the sale of tobacco-flavoured and menthol-flavoured cartridges, open-system and disposable e-cigarettes.MethodsWe examined Nielsen Retail Scanner data from September 2013 to March 2020. Inflation-adjusted sales dollars for e-liquid-containing products were classified into five flavour categories (fruit, menthol, mint, tobacco and other).ResultsFollowing the Juul Labs 2019 and FDA 2020 actions, total e-cigarette sales declined; however, menthol-flavoured e-cigarette sales dollars increased, while mint-flavoured e-cigarette sales dollars decreased in both instances. Juul Labs’ removal of mint-flavoured products was followed by a 59.4% increase in the market share of menthol-flavoured e-cigarettes over 4 weeks. The FDA’s 2020 guidance was followed by a 54.5% increase in the market share of menthol-flavoured e-cigarettes over 4 weeks and a 82.8% increase over 8 weeks.ConclusionsJuul Labs’ self-regulation and the current FDA flavour guidance were followed by a shift towards menthol-flavoured e-cigarettes. Industry self-regulation and current federal guidance appear insufficient in reversing the youth vaping epidemic. E-cigarettes must be fully regulated as a tobacco product including the removal of flavoured e-cigarettes, including menthol, from the market to reduce youth e-cigarette use.
ObjectivesComprehensive tobacco control policies with minimal exemptions can reduce tobacco use and sales. Many states and localities have adopted flavoured tobacco product (FTP) sales restrictions. This study describes the development and application of a schema to characterise the comprehensiveness of these FTP sales restrictions.DesignWe coded state and local FTP sales restrictions enacted June 2007–March 2021 for retailer, tobacco product, and flavour inclusions and exemptions. Guided by FTP literature, legal resources and meetings with FTP policy experts, we developed a six-level classification scheme to characterise coded FTP policies from least to most comprehensive. We present descriptive statistics of FTP policy features and comprehensiveness.ResultsAs of 31 March 2021, 7 state-level and 327 local-level FTP sales restrictions were enacted in the USA. Most state-level policies (71.4%) were categorised in the second lowest comprehensiveness category; local policies most commonly fell within the lowest (48.9%) or highest (26.0%) comprehensiveness categories. Across jurisdictions, adult-only retailers were most frequently exempted from the FTP sales restrictions (state: n=1, 14.3%; local: n=184, 56.3%); and most jurisdictions included electronic cigarettes (e-cigarettes) as a banned product (state: n=6, 87.5%; local: n=227, 100%). While just over half of state (n=4, 57.1%) and local (n=169, 51.7%) sales restrictions included menthol e-cigarettes, most excluded menthol cigarettes and/or menthol smokeless tobacco.ConclusionsComprehensiveness of FTP sales restrictions in the USA varies widely. Current and future FTP policies would be strengthened by including all flavours and all tobacco products—particularly menthol cigarettes—and by avoiding exemptions for certain retailers, particularly adult-only retailers.
Electronic cigarette (e-cigarette) use, including JUUL, has risen to epidemic levels among high school and middle school students in the United States. Schools serve as a key environment for prevention and intervention efforts to address e-cigarette use, yet little is known about the awareness of and response to e-cigarettes in schools. This national survey of middle and high school teachers and administrators ( n = 1,420) measured JUUL awareness, e-cigarette policies, and barriers to enforcement in schools. While two thirds of respondents had heard of a product called JUUL (67.6%), less than half accurately identified a photo of a JUUL as a vaping device/e-cigarette (47.3%). Awareness of JUUL (80.9%) was higher among high school teachers (83.3%) than among middle school teachers (78.3%). A large majority of respondents reported that their school had an e-cigarette policy (82.9%), but less than half of the sample worked in a school with a policy that specifically included JUUL (43.4%). Those working in a school with an e-cigarette policy in place noted that e-cigarettes’ discreet appearance (65.6%) and difficulties in identifying origin of vapor or scent (46.1%) made the policy difficult to enforce. Efforts to increase middle and high school staff awareness of the ever-evolving e-cigarette market are essential to help prevent youth use. Adoption and enforcement of policies will be critical to ensure that schools remain tobacco-free spaces.
Background As youth e-cigarette use has surged in the last several years, teachers and school administrators have reported challenges addressing student use of emerging e-cigarette products on school property. While federal policy prohibits smoking in U.S. schools that receive federal funding, school e-cigarette bans only exist where states or localities have acted. Little is known about school staff experiences with implementing these relatively new policies; this study examines associations between school e-cigarette policies and trainings on school staff awareness and intervention on student e-cigarette use. Methods A national convenience sample of 1,526 U.S. middle- and high-school teachers and administrators was surveyed in November-December 2018. Among respondents who provided their job title and indicated that they worked in a school rather than a district (n = 1,480, response rate = 97.0%), separate logistic regressions examine associations of school policies and policy training with e-cigarette awareness and intervention on student e-cigarette use. Results Despite being the most popular e-cigarette at the time, fewer than half (47.5%) of respondents identified an image of a JUUL device as an e-cigarette. However, respondents reporting the presence of e-cigarette policies in their schools had higher odds of recognizing e-cigarettes (OR = 3.85, p<0.01), including photo recognition of JUUL (OR = 1.90, p<0.001). Respondents reporting e-cigarette policies also had higher odds of reporting intervention on student e-cigarette use (communicating with students about e-cigarette avoidance: OR = 2.32, p<0.001; reporting students had been caught using e-cigarettes at school: OR = 1.54, p<0.05). Among respondents reporting a school e-cigarette policy, those trained on the policy had higher odds of JUUL photo recognition (OR = 1.54, p<0.01). Respondents trained on e-cigarette policies also had higher odds of reporting intervention (communicating: OR = 3.89, p<0.001; students caught using e-cigarettes: OR = 2.71, p<0.001). Conclusions As new tobacco products enter the market, school policies may be important tools to raise school personnel awareness of and intervention on emerging e-cigarette product use. However, policy adoption alone is not sufficient; policy training may further aid in recognition and intervention upon student use of e-cigarettes at school.
Objectives: The Food and Drug Administration (FDA) is required under the Family Smoking Prevention and Tobacco Control Act to communicate the risks of tobacco use to the public. Little research exists about methods to communicate the constituents of tobacco in a media campaign. This research examines specific strategies to increase effectiveness of a media campaign for cigarette smoking adults about tobacco constituents by including engagement text about smoking cessation and FDA as the source of the campaign. Methods: In an eye tracking study of 211 current cigarette smokers, participants randomly viewed 4 cigarette constituent messages that varied engagement text for quitting (benefits of quitting and quitline number, presence, absence) and by FDA source (presence, absence). After the eye tracking session, participants were asked about recall of the national quitline number and the source of message. Results: Participants in conditions with engagement text were significantly more likely than those in the no engagement conditions to recall the national quitline number. Few participants saw or recalled the FDA source. Conclusions: Engagement text for smoking cessation on constituent communication campaign messages significantly increases recall of the quitline, an important resource for smokers.
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