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Dorothy K. Hatsukami, Ph.D., University of Minnesota
Little systematic research has been conducted on the toxicity of emerging products and how these products
are being used. This presentation wil cover three types of products: 1) snus; 2) dissolvable tobacco and 3)
electronic cigarettes. Existing product constituent studies general y show lower tobacco specific nitrosamine
levels and other toxicants in these products compared to conventional tobacco products, which results or
most likely results in lower toxicant exposure levels. However, levels of exposure tend to be higher than
medicinal nicotine products, especial y when examining the snus products.
These emerging products vary in nicotine levels, although lower than observed in conventional products.
Chal enges associated with electronic cigarettes are the marked variability in nicotine levels due to the wide
differences in dose in the product and how the product is used. Emerging products come in varying flavors,
which can contribute to the appeal of the product, especial y among young adults. Our studies show a strong
preference for the mint-flavored snus and dissolvable products among smokers and survey studies show a
notable number of uses of e-cigarettes choosing the flavored variety. Several main principles and
observations may provide insight into how products are used: (1) uptake of a product is dependent on the
level of satisfaction derived from the product and based on individual preferences; (2) craving relief from oral
tobacco products is dose-dependent, while e-cigarettes provide craving relief even at very low doses; (3) the
ability to completely switch to a product is nicotine dose-dependent; (4) abuse liability and continued use of
the product are determined by nicotine dose and rate of nicotine absorption; (5) a significant number of
smokers engage in dual product use and this prevalence is likely to increase over time with the availability of
these alternatives for smoking. The impact of dual use could potential y be negative but is unknown. More
systematic and comprehensive studies need to be conducted for these products in al areas of tobacco
product evaluation.
Funding: R01 CA135884, R01CA141531, and HHSN26120100438P.
CORRESPONDING AUTHOR: Mitch Zel er, J.D., Senior Vice President, Pinney
Associates, 4800 Montgomery Lane, Bethesda, MD 20814, United States, Phone:
240-752-9052, Email: mzel
Martin J. Jarvis, Department of Epidemiology & Public Health, University Col ege
The 1998 government white paper, Smoking Kil s, marked the end of decades of official neglect of tobacco in
the UK and initiated a continuing move towards comprehensive tobacco control policies, including for the first
time reimbursement of pharmacological aids to cessation and the provision of NHS treatment services for
dependent smokers. By 2011, against the background of the strong association of smoking with inequalities
in health and recognition of that many smokers cannot or will not quit, the new tobacco control plan for
England, Healthy Lives, Healthy People, explicitly expanded help for smokers to include harm reduction as
an arm of policy, with a commitment to “encourage the manufacturers of safer sources of nicotine to develop
new types of nicotine products that are more affordable and that have increased acceptability for use in the
long term”. NICE is currently considering guidelines for the implementation of harm reduction approaches
within NHS smoking services, and is due to report in early 2013. Decisions on whether to include electronic
cigarettes within the MHRA’s regulatory framework are also pending. Important intermediate steps in the
evolution of policy were the 2005 move by the MHRA to adopt a public health approach to regulating nicotine
delivering products (and the change to viewing the effects of ongoing smoking as the appropriate comparator
in considering new products), and the 2007 report by the Royal Col ege of Physicians Harm reduction in
Nicotine Addiction: Helping people who can’t quit. A feature of the evolution of policy in the UK has been the
close co-ordination and col aboration between government officials, the medicines regulator, the advocacy
group ASH, and academic researchers, which has facilitated the opening of a space for innovative nicotine
products with the potential to replace cigarettes.
No funding.
CORRESPONDING AUTHOR: Mitch Zel er, J.D., Senior Vice President, Pinney
Associates, 4800 Montgomery Lane, Bethesda, MD 20814, United States, Phone:
240-752-9052, Email:
Mitch Zel er, Pinney Associates, Bethesda, MD
A series of profound changes to the marketplace for nicotine and tobacco products has been taking place
over the past decade. These changes have been accompanied by a morphing of the tobacco industry as
many companies are now sel ing nicotine in multiple forms, both as tobacco and pharmaceutical products. This presentation wil describe the evolution of the nicotine and tobacco marketplace to now include cigarettes, smokeless tobacco products, dissolvable tobacco products, electronic cigarettes, and nicotine replacement therapy products al being sold either by tobacco companies or their whol y-owned pharmaceutical subsidiaries. The marketplace for tobacco products in the United States is now under the regulatory control of the Food and Drug Administration. FDA has a historic opportunity to forge a comprehensive nicotine regulatory policy that cuts across the agency’s Tobacco and Drugs Centers. Experts agree that there is a distinct “continuum of risk” when it comes to products that deliver nicotine. FDA is uniquely poised to shift current tobacco users away from the deadliest form of nicotine delivery (conventional cigarettes) to the cleanest and safest (currently medicinal nicotine products). This presentation wil highlight the impact of the evolving marketplace and morphing tobacco industry on FDA’s ability to design an agency-wide nicotine regulatory policy.
M. Zel er is employed by Pinney Associates, a health policy consulting firm.
Pinney Associates provides consulting services to GlaxoSmithKline ConsumerHealthcare on issues related to the treatment of tobacco dependence.
CORRESPONDING AUTHOR: Mitch Zel er, J.D., Senior Vice President, PinneyAssociates, 4800 Montgomery Lane, Bethesda, MD 20814, United States, Phone:240-752-9052, Email: SYM24a
Bridget K. Ambrose, Ph.D., M.P.H.*, Blair N. Coleman, M.P.H., and Benjamin
J. Apelberg, Ph.D., M.H.S., Center for Tobacco Products, U.S. Food and Drug
Although some progress has been made in reducing cigarette smoking prevalence among youth, young
people in the United States remain highly susceptible to initiating tobacco use. Understanding youth
perceptions of the health risks associated with tobacco product use will provide insight into potential
determinants of initiation and continued use of traditional products as wel as non-traditional products such
as hookah, electronic cigarettes, and dissolvable tobacco products. We will examine data from the 2012
National Youth Tobacco Survey (NYTS), which for the first time, included questions pertaining to youth risk
perceptions of a variety of tobacco products. NYTS is a national y representative, school-based survey of
approximately 20,000 middle and high school students. Survey items col ected information on perceived
risks of non-traditional tobacco products compared to cigarette smoking (“Do you believe that electronic
cigarettes are less harmful, equal y as harmful, or more harmful than regular cigarettes?”) and perceived
harm from cigarettes and smokeless tobacco products, including dissolvables, based on frequency and
amount of use. We will report the latest findings of multivariate analyses assessing the correlation between
middle and high school students’ risk perceptions of tobacco products and demographic characteristics as
wel as reported experimentation, current and regular use of different types of tobacco products. These
findings wil help inform future research and regulatory policy development at the Food and Drug
Administration (FDA) in order to prevent tobacco use among young people, one of the core priorities of
FDA’s Center for Tobacco Products.
Funding: Center for Tobacco Products, Food and Drug Administration.
CORRESPONDING AUTHOR: Greta Tessman, MA, Social Scientist, U.S.
Food and Drug Administration, Center for Tobacco Products, 9200 Corporate
Blvd., Rockvil e, MD 20850, United States, Phone: 301-796-6722, Email: greta.

Maciej L. Goniewicz, Ph.D.*1, Jakub Knysak2, Leon Kosmider2, Marzena Zaciera,
Ph.D.3, Jolanta Kurek3, Andrzej Sobczak, Ph.D.3, Peyton Jacob III, Ph.D.4, and
Neal Benowitz, M.D.4, 1Queen Mary University of London, UK; 2Medical University
of Silesia, Sosnowiec, Poland; 3Institute of Occupational and Environmental
Health, Sosnowiec, Poland; 4University of California, San Francisco, USA
Significance: Acrolein (also known as propylene aldehyde or 2-propenal) is a highly reactive chemical that causes irritation to the nasal cavity, and damage to the lining of the lungs and is thought to contribute to car-diovascular disease in cigarette smokers. Electronic cigarettes (e-cigarettes) are battery-powered devices that deliver vaporized nicotine, usual y in propylene glycol or glycerin. Since acrolein may be formed as a result of heating glycerin, we examined the hypothesis that inhalation of e-cigarette vapor leads to exposure to acrolein. Aim of the study: The aim of this study was to assess exposure to acrolein from e-cigarette
smoking. Materials and methods: Vapors were generated from 12 brands of e-cigarettes in control ed labor-
atory conditions using modified smoking machine. Acrolein was extracted from aerosol to solid phase with
2,4-dinitrophenylhydrazine (DNPH) and analyzed with high-performance liquid chromatography with spectro-
photometric DAD detector. To compare levels of acrolein in e-cigarette aerosol and mainstream smoke of
conventional cigarette we assumed that 15 puffs from an e-cigarette (typical use pattern) would correspond
to smoking one conventional cigarette. S-(3-hydroxypropyl)mercapturic acid (3-HPMA), a metabolite of
arolein, was measured in urine of 20 e-cigarette users and 20 tobacco cigarette smokers with liquid chroma-
tography/tandem mass spectrometry method. Results: The levels of acrolein in e-cigarette vapor ranged
from 0.07 to 4.19 μg per 15 puffs, which about 4 times lower than levels in cigarette smoke. The average ur-
ine 3-HPMA concentration in e-cigarette users was 308 (IQR 134-516) ng/mg creatinine and was significantly
lower than in tobacco cigarette smokers (822 (IQR 464-1,423) ng/ mg creatinine; p<0.05). Conclusions: Our
findings suggest that e-cigarette vapor is a source of acrolein, however the level of exposure is less than that
from a conventional cigarettte. Substituting tobacco cigarettes with electronic cigarettes may substantial y re-
duce exposure to acrolein. Further research is needed to evaluate long term effects of inhalation exposure to
acrolein from e-cigarettes.
This study was conducted while the first author was at Medical University of Silesia, Poland and was suppor-
ted by the Ministry of Science and Higher Education of Poland under grant number N N404 025638. Analyt-
ical Chemistry at the University of California, San Francisco was supported by grants P30 DA012393 and
S10 RR026437 from the National Institutes of Health, and from the Flight Attendant Medical Research Insti-
tute Bland Lane Center of Excel ence on Secondhand Smoke at UCSF.
CORRESPONDING AUTHOR: Maciej Goniewicz, Ph.D., Research Fel ow,
Queen Mary University of London, Tobacco Dependence Research Unit, 55
Philpot Street, London, E1 2JH, United Kingdom, Phone: +447783780606, Fax:
+442073777237, Email:
Jan Czogala, Ph.D.1, Maciej L. Goniewicz, Ph.D.*2, Bartlomiej Fidelus1, Wioleta
Zielinska-Danch, Ph.D.1, and Andrzej Sobczak1, 1Medical University of Silesia,
Poland; 2Queen Mary University of London, UK
Background: Electronic cigarettes (e-cigarettes) are battery-powered devices that deliver vaporized nicotine,
usual y in propylene glycol or glycerin. When a user inhales through the device, air flow is detected by a
sensor, which activates a heating element that vaporizes a nicotine solution contained in a cartridge.
Although no vapor is generated during puff breaks, some vapor is exhaled by e-cigarette user. It is unknown
whether e-cigarettes release potential toxic compounds into the indoor environment. Aim: The aim of this
study was to evaluate the passive exposure to aerosol from e-cigarettes. Materials and methods: We
compared passive exposure produced from ‘vaping’ e-cigarette, smoking conventional cigarettes, and no-
smoking. Five dual-product users were recruited for the study and asked to use both electronic and tobacco
cigarettes subsequently in a ventilated experimental room. After baseline measurements were taken, each
of the subjects was asked to use e-cigarette twice during the one-hour period fol owing smoking of two
conventional cigarettes for the next hour. Concentrations of air constituents including respirable aerosol
(PM2.5), carbon monoxide (CO), nicotine, and volatile organic compounds (VOCs) were measured. Results:
Passive exposure to nicotine from electronic cigarettes was about 10-times lower than from tobacco
cigarettes (3.3±2.5 vs 31.6±6.9 microgram/cu m., p=0.0081). Concentrations of PM2.5, CO and VOCs were
substantial y reduced when volunteers were using e-cigarettes as compared to smoking conventional
cigarettes (p<0.05). Second-hand exposure to CO and VOCs from e-cigarette was in the same range as
nonsmoking. Conclusions: E-cigarettes are a secondhand source of exposure to nicotine, but to much lower
extend than tobacco cigarettes. Further research is needed to evaluate long term effects of passive exposure
to vapor from e-cigarette, including using the products to reduce harmful tobacco smoke exposure to others
and to get around smoke-free policies.
This study was conducted while the presenting author was at the Medical
University of Silesia, Poland and was supported by the Ministry of Science and
Higher Education of Poland under grant number N N404 016939.
CORRESPONDING AUTHOR: Maciej Goniewicz, Ph.D., Research Fel ow,
Queen Mary University of London, Tobacco Dependence Research Unit, 55
Philpot Street, London, E1 2JH, United Kingdom, Phone: +447783780606, Fax:
+442073777237, Email:
Shu-Hong Zhu, Ph.D.*, Anthony Gamst, Ph.D., Madeleine Lee, B.A., Sharon
Cummins, Ph.D., Lu Yin, M.S., and Leslie Zoref, Ph.D.
E-cigarettes have generated controversy in the tobacco control field similar to that of Swedish snus, which
came to the U.S. market six years earlier. Some argue that e-cigarettes have great potential to help smokers
quit regular cigarettes while others contend they should be banned for lack of safety and efficacy data. We
conducted a population survey in the U.S. with a national probability sample (N=10,041) from February 24 to
March 8, 2012, and compared the use of e-cigarettes with that of snus. Survey respondents were asked if
they had heard about e-cigarettes, where they had heard about them, whether they had used e-cigarettes or
snus, how often they used them, and why they used them. Responses were weighted to represent the entire
U.S. population, and data were compared with another population survey conducted in 2010. The main
findings are: A high proportion, 75.4%, reported having heard about e-cigarettes. Television ranked as the
number one source of information, fol owed by “heard in person” and “Internet.” About 8.1% had tried e-
cigarettes, and 1.4% were current users. These rates were twice those of snus (4.3% and 0.8%,
respectively). Among current smokers, 32.2% had tried e-cigarettes, and 6.3% were current users.
Compared to the survey data in 2010, the proportion of smokers who have experimented with e-cigarettes
has increased by 182%, and the current use of e-cigarettes by 54%. Women were significantly more likely to
have tried e-cigarettes than men, even though they were less likely to have heard about them. Those who
had tried e-cigarettes were more likely than those who tried snus to report their products being safer than
regular cigarettes (49.9% vs. 10.8%). Almost half (49.5%) of current smokers were susceptible to using e-
cigarettes in the future. Conclusions: That e-cigarettes have surpassed snus in adoption rate, despite there
being no promotion of e-cigarettes before this national survey by major tobacco companies, suggests that
the former have tapped into smokers’ intuitive preference for potential y harm-reducing products, probably
due to the product design. E-cigarette use is likely to increase in the next few years.
Supported by a grant from National Cancer Institute U01 CA154280.
CORRESPONDING AUTHOR: Shu-Hong Zhu, Ph.D., Professor, University of
California, San Diego, Family and Preventive Medicine, 9500 Gilman Drive, MC
0905, La Jol a, CA 92093, United States, Phone: 858-300-1056, Email: szhu@
Andrew Hyland, Ph.D.*, Jennifer Delmerico, M.P.H., K. Michael Cummings, M.P.H.,
Ph.D., Deepa R. Camenga, M.D., M.H.S., Grace Kong, Ph.D., Dana Caval o,
Ph.D., Amanda Liss, B.S., and Suchitra Krishnan-Sarin, Ph.D., Roswel Park
Cancer Institute, Yale School of Medicine, Medical University of South Carolina Electronic Nicotine Delivery
Systems (ENDS) have been gaining in popularity recently.Prevalence studies in adults have found that most
ENDS users are current or former smokers. The objectives of this study were to estimate the prevalence of
ENDS usage in adolescents over time, and examine the correlates of use.Surveys assessing tobacco use
were conducted multiple times in two suburban Western New York high schools between 2010 and 2011. In
School A, grades 9-12 were surveyed three times: February 2010, October 2010, and June 2011. In School
B, students were surveyed in October 2010 and June 2011. The survey included questions on ever use of
ENDS and past 30 day use. Correlates examined included grade, gender, race, survey year, cigarette use in
the 30 days prior to the survey, and susceptibility to smoking. Descriptive statistics on prevalence of ever and
past 30-day use and logistic regression to assess correlates of past 30-day use were conducted. Three
findings are observed from the results: (1) the prevalence of ENDS use increased in each school over time
[Ever use was 2.9% in Spring 2010, 4.2% in Fal of 2010, and 5.7% in Spring 2011. Past 30 day use was
1.1% in Spring 2010, 1.0% in Fal of 2010, and 2.0% in Spring 2011]; (2) ENDS use is mostly concentrated in
current smokers or those susceptible to smoking; and (3) no demographic differences in ENDS use were
observed. These data indicate that in this sample, the use of ENDS more than doubled over 14 months, and
there were no demographic differences in use. ENDS use is almost exclusively concentrated in current
smokers and non-smoking youth who are more susceptible to become cigarette smokers in the future. Youth
not otherwise susceptible to smoking appear to have little interest in ENDS. Important unanswered questions
are whether dual use of ENDS with cigarettes increases or diminishes future likelihood of smoking cessation,
and whether use of ENDS in those susceptible to smoking increases or decreases future likelihood of
becoming smokers among adolescents. Prospective data are needed to understand these critical potential
consequences of youth ENDS use when trying to estimate the net population health impact of ENDS.
Supported by R01DA026450.
CORRESPONDING AUTHOR: Jennifer Delmerico, MPH, Roswel Park Cancer
Institute, Carlton House Rm. A102, Buffalo, NY 14263, United States, Phone:
Jidong Huang, Ph.D., Dianne Barker, M.H.S.*, and Frank J. Chaloupka, Ph.D.
Tobacco control environment has changed rapidly in the past few years. The federal taxes on tobacco
products were increased in 2009. The Family Smoking Prevention and Tobacco Control Act of 2009 gave
FDA authority to regulate tobacco product production, distribution and marketing. In addition, many state
and local governments have adopted or strengthened smoking free policies and other tobacco control
policies. Tobacco industry has responded by focusing on, among other things, product design and
development. This study examines the sales trend of new and emerging tobacco products using the
quarterly market level Nielsen store scanner data between 2010 and 2011. The Nielsen store scanner data
contain detailed information on retail prices, sales, and price-related promotions for al tobacco products.
Data were directly gathered from participating retailers’ tapes in 52 U.S. markets defined by Nielsen. The
markets consist of groups of counties centered on a major city (similar to metropolitan statistical areas).
Participating retailers include mass stores, drug stores, grocery stores, and convenience stores. Our
analyses show a dramatic increase in electronic cigarettes sales between 2010 and 2011. Sales volume of e-
cig kit increased 9 times from about half a mil ion pieces in 2010 to more than 4.5 mil ion pieces in 2011. E-
cig refil cartridge increased more than 14 times during the same time period (from about half a mil ion pieces
to more than 7 mil ion pieces). Sales volume of dissolvable lozenges/tablets has increased 20% from less
than 50 mil ion pieces to more than 60 mil ion pieces. The sales volume of dissolvable strips and sticks were
low compared to that of lozenges/tablets, less than half a mil ion pieces annual y and their sales volume has
been declining since the first quarter of 2010. Dissolvable orbs sales have also declined between 2010 and
2011, from approximately 13,000 ounces to less than 4,000 ounces. Snus sales have declined steadily since
early 2010. Our results revealed a rapidly changing landscape of new and emerging tobacco products and
have important implications on government regulations targeting these products.
Support for this project was provided by a National Cancer Institute-funded
grant (Grant #1U01CA154248), titled “Monitoring and Assessing the Impact of Tax
and Price Policies on U.S. Tobacco Use.” The opinions expressed here are those
of the authors, and do not necessarily reflect those of the sponsors. None of the
funding agencies played any role in study design; in the col ection, analysis and
interpretation of data; in the writing of the report; and in the decision to submit the
paper for the conference.
CORRESPONDING AUTHOR: Jidong Huang, PhD, Research Specialist,
University of Il inois at Chicago, Institute for Health Research and Policy, 1747
West Roosevelt Road, Chicago, IL 60608, United States, Phone: (312) 413-0099,
Rachel A. Grana, Ph.D.*, and Pamela M. Ling, M.D., University of California, San
Francisco, CA, USA
Background: Electronic cigarettes (e-cigarettes) are battery-powered nicotine delivery products advertised
widely on the internet, and increasingly, in retail stores. The products are not evaluated by any regulatory
authority before going to market and their availability and promotional marketing are currently unregulated in
the U.S., though other countries have partial y or completely restricted their sale and use (e.g., Brazil).
Methods: This presentation wil include examples of marketing from several countries, information about the
regulatory status of e-cigarettes and selected results from a content analysis of the marketing on 55 e-
cigarette retail websites. Results: The results of our content analysis indicated that most prevalent
advertising appeals focused on health benefits, cessation-related benefits, use of the product to circumvent
smoke-free policies and reduction of secondhand smoke exposure. Sites contained imagery of doctors and
celebrities that imply endorsement of the product and videos or sponsorships that overtly promote the
product, as wel as testimonials, branded social networking sites, and programs recruiting consumers to
become sel ers of the products. Products came in various nicotine strengths that differed widely in
corresponding nicotine content (e.g., products marked “high” corresponded with a range of nicotine content
from 6-24mg). Products were offered in various flavors; most commonly tobacco, mint, candy, fruit and coffee
flavors. In many countries, advertising techniques also include television and radio commercials, newspaper
advertisement, pointof-sale displays and direct email marketing. Conclusions: E-cigarette marketing with
unsubstantiated health, cessation and secondhand smoke exposure claims could result in negative
population health effects if they deter or undermine cessation or encourage uptake by youth. Product
content, labeling and safety should be evaluated and assured by a government regulatory authority.
Consumer perceptions of e-cigarette marketing should be a required component of regulation development in order to determine potential public health impact of the products.
Supported by NIH grant R25T: CA 113710.
CORRESPONDING AUTHOR: Maciej Goniewicz, Ph.D., Research Fel ow,Queen Mary University of London, Tobacco Dependence Research Unit, 55Philpot Street, London, E1 2JH, United Kingdom, Phone: +447783780606, Fax:+442073777237, Email: POS2-130
Katrina A. Vickerman, Ph.D.*, Susan M. Zbikowski, Ph.D., Ken Wassum, and
Tamara M. Altman, Ph.D., Alere Wel being, Inc.
Little is known about the prevalence of e-cigarette use, reasons for use, and
whether e-cigarettes impact a user’s ability to successful y quit tobacco. Each
year nearly 450,000 tobacco users cal free state quitlines for help with quitting.
Information regarding e-cigarette use among quitline cal ers is needed to better
understand cal ers’ cessation-related behaviors and to inform how e-cigarettes
should be addressed in treatment protocols. We evaluated e-cigarette use among
tobacco users who received cessation services through one of five state tobacco
quitlines. Surveys were administered by phone seven months after participants
cal ed the quitline. Participants were asked about their past and current e-cigarette
use, reasons for using e-cigarettes, and current quit status. Among 1,233
respondents, 30.0% reported ever using an e-cigarette and 8.7% reported current
use of e-cigarettes. The majority of e-cigarette users reported using or trying
e-cigarettes for a short period of time (62.2% for one month or less). Notably, more
than half reported using e-cigarettes to quit or cut down on tobacco use. Other
reasons included: switched from other tobacco, use when can’t smoke, curious/
tried once, healthier/safer, and cost. Characteristics of e-cigarette users will be
presented. Thirty-day point prevalence responder quit rates at the 7-month survey
for current, past, and never e-cigarette users were 15.9%, 20.7%, and 30.9%,
respectively; e-cigarette users (current or past) were significantly less likely to be
quit for 30 or more days compared to participants who had never tried e-cigarettes
(ps<0.01). This data shows that a significant proportion of state quitline participants
reported using e-cigarettes and e-cigarettes are being used as cessation aids,
despite the fact that the FDA has not approved them for therapeutic use. Policy
and research implications of e-cigarette use wil be addressed. For example, are
tobacco users who quit other tobacco but still use e-cigarettes considered quit?
Do treatment protocols, including NRT dosing, need to be altered to address
e-cigarette use? Should quitlines provide treatment to e-cigarette users?
The five participating states provided funding for data col ection. Alere Wel being
sponsored the data analysis for this submission.
CORRESPONDING AUTHOR: Katrina Vickerman, Ph.D., Lead Program
Evaluator, Alere Wel being, Inc., Research, Training and Evaluation, 999 Third
Ave, Seattle, WA 98104, United States, Phone: 206-876-2363, Email: Katrina.

Theodore L. Wagener, Ph.D.*1,2, El en Meier, M.S.3, Maggie L. Warner, B.S.1, Leslie
M. Quinalty, M.S.1, Elisha Oliver, M.S.4, Stephen R. Gil aspy, Ph.D.1, Daniel e M.
Wierenga1, Michael B. Siegel, M.D.5, and Steven B. Foster, Ph.D.4, 1University
of Oklahoma Health Sciences Center; 2Oklahoma Tobacco Research Center;
3Oklahoma State University; 4University of Oklahoma; 5Boston University School
of Public Health
What effect e-cigarette (EC) use will have on smoking behavior and motivation
and confidence to quit smoking is currently in question. To examine this question,
we recruited 20 non-treatment seeking smokers (80% white, 60% female,
Mage=40.1y, Mcpd=18.6, Mfagerstrom=5.1), naïve to ECs, to participate in a
three-phase, exploratory study. In phase 1 (Baseline), participants completedbaseline demographic, smoking history, and smoking thoughts and behaviorsquestionnaires; phase 2 (Sampling) included sampling 3 different popular ECbrands (bluCig, ProSmoke, and SmokeTip) and own brand cigarette (OBC), withpre- and post-measures of product liking/satisfaction and motivation/confidence;during phase 3 (ad libitum use), participants were sent home with a 1-week supplyof their preferred EC and asked to use it ad libitum and then completed fol ow-upquestionnaires 1-week post sampling. 16 participants completed al phases of thestudy. During sampling, on a scale from 1 “not at al ” to 10 “very much”, OBC wererated as being the most liked/enjoyed (M=8.6, SD=1.8), satisfying (M=7.3, SD=3.3),and effective in reducing urges/craving (M=8.7, SD=1.7), p<.05. Of the ECs,no significant differences were found between brands but general y bluCig wasfound to be the preferred brand across al three domains: like/enjoy [bluCig M=6.6(SD=2.4), ProSmoke M=4.7(SD=2.5), SmokeTip M=5.2 (SD=2.7)], satisfying[bluCig M=6.6 (SD=2.6), ProSmoke M=5.2(SD=2.9), SmokeTip M=5.0 (SD=2.8)],and effective [bluCig M=7.2 (SD=2.1), ProSmoke M=6.2(SD=2.4), SmokeTipM=6.1 (SD=2.4)]. bluCig was the brand that was selected by the most participantsfor the ad libitum phase (bluCig=63.2%, ProSmoke=26.3%, SmokeTip=10.5%).
EC sampling led to a significant increase (p=.001) in “confidence to quit” smokingbut not in “wanting to quit.” However, ad libitum use of preferred EC brand for1-week led to a significant increase in “wanting to quit” (p=.01). Confidence to quitalso continued to increase from end of sampling to end of ad libitum use, but it wasnot significant. Number of cigarettes per day decreased significantly (p=.001) frombaseline (M=16.5, SD=5.0) to end of ad libitum use (M=9.3, SD=6.7).
Funding: Oklahoma Tobacco Research Center Seed Grant.
CORRESPONDING AUTHOR: Theodore Wagener, PhD, Assistant Professor,OUHSC, Pediatrics, 1200 Children’s Ave., Oklahoma City, OK 73104, UnitedStates, Phone: 405-271-4407, Email: POS2-132
Deepa R. Camenga, M.D., M.H.S.*1, Grace Kong, Ph.D.1, Dana Caval o, Ph.D.1,
Amanda Liss, B.S.1, Suchitra Krishnan-Sarin, Ph.D.1, Andrew Hyland, Ph.D.2,
Jennifer Delmerico, M.P.H.2, and K. Michael Cummings, Ph.D.3, 1Yale School of
Medicine; 2Roswel Park Cancer Institute; 3Medical University of South Carolina
Electronic cigarettes are emerging tobacco products that are marketed
as harm-reducing products and smoking cessation aids. The prevalence of
e-cigarette use in adolescent populations is largely unknown. We ascertained
whether adolescents who smoke e-cigarettes in addition to cigarettes (ECS) differ
from cigarette smokers only (CS) in their tobacco and other drug use behaviors.
We analyzed data from a cross-sectional survey of students attending 4 high
schools in Connecticut and New York (n=3,912) in 2010. We col ected information
regarding current cigarette, e-cigarette, and other tobacco use. Alcohol, binge
drinking and marijuana use was assessed in a subsample of students (n=1,957).
We used multivariate linear regression to determine whether EC predicted use of
a higher number of other tobacco products. Eleven percent of students reported
current use of only cigarettes (n=421), and 1.4% (n=58) also reported current
e-cigarette use. Only 0.4% (n=19) used e-cigarettes without cigarettes. The ECS
and CS groups did not differ in their gender, grade, race, age of cigarette smoking
initiation, days smoked cigarettes in past month, and cigarettes smoked per day. A
larger proportion of ECS than CS reported current use of cigars (43.1% vs. 28.0%;
p=0.02), bidis/kreteks (13.8% vs. 2.9%; p=0.01), hookahs (31.0% vs. 8.8%;
p=0.01), cigars (43.1% vs. 28.0%; p=0.02), and blunts (69.0% vs. 53.0%; p=0.02)
but the two groups did not differ in their alcohol, binge drinking or marijuana use
patterns. Only 5% (n=4) of al e-cigarette users did not use any additional tobacco
products. Multivariate regression showed that ECS independently predicted
use of a higher number of other tobacco products (ß=0.59, t=3.75, p=0.0002)
when adjusted for gender, grade, race, days smoked cigarettes in past month,
and cigarettes smoked per day. Adolescents who smoke electronic cigarettes in
addition to cigarettes did not differ in their cigarette smoking frequency or intensity,
marijuana, and alcohol use from adolescents who only smoke cigarettes. But,cigarette smokers who also smoke e-cigarettes were more likely to use othertobacco products.
Supported by NIH grant #R01DA026450.
CORRESPONDING AUTHOR: Deepa Camenga, MD, Instructor, Yale School ofMedicine, Pediatrics, 330 Cedar Street, New Haven, CT 06520, United States,Phone: 203-737-8310, Fax: 203-785-7584, Email: POS2-133
Blair N. Coleman, M.P.H.*, Eva Sharma, M.P.H., Magdalena Ignaczak, B.S., and
Pamela I. Clark, Ph.D., University of Maryland-Col ege Park
Background: Electronic nicotine delivery devices (ENDS; or e-cigarettes)
have surged in popularity in recent years, however further research is needed
to determine consumer perceptions of their acceptability as smoking cessation
aids. The aim of this pilot study was to explore smokers’ perceptions of the
effectiveness of using ENDS during a 2-week cessation attempt. Methods: After
a laboratory-based study that had the advantage of familiarizing participants with
use of the ENDS, smokers motivated to quit were provided with an e-cigarette and
a 2-week supply of cartridges in the style (menthol or non-menthol) of their choice.
They received two in-person behavioral counseling sessions and two telephone
counseling sessions. At the end of the two-week quit attempt, in-depth qualitative
interviews were conducted to assess the subjects’ perceptions of the effectiveness
of using ENDS as a cessation tool. Sessions were audio-recorded and the data
transcribed and analyzed using a thematic approach. Results: Themes that
emerged included lower perceptions of nicotine content compared to own brand
cigarettes, a higher sense of control with regards to nicotine self-administration
compared to other cessation mechanisms (e.g., nicotine gum, patch), and an
ease of transition to the e-cigarette to assist with a quit attempt. Additional y,
similarities between own brand of cigarettes and e-cigarettes general y included
similar smoking patterns (in terms of duration and time of day), but participants
found greater resistance to draw with the e-cigarette compared to conventional
cigarettes, and reported that they often failed to provide the level of satisfaction
produced by conventional cigarette. Lastly, participants noted that the e-cigarette
drew attention from by-standers who were interested in knowing more about the
product, and some were uncomfortable with the attention the product elicited,
opting to use the e-cigarette in private locations only. Conclusions: Understanding
the consumer acceptability of using ENDS has important implications as to how
these products could be used as smoking cessation devices and how they could
potential y be prescribed to help smokers quit.
Supported by NIH/NIDA Grant #5R21DA030622.
CORRESPONDING AUTHOR: Blair N. Coleman, MPH, University of Maryland,
Behavioral and Community Health, 2387 SPH Building, Val ey Drive, Col ege Park,
MD 20742, United States, Phone: 3014058740, Email:
Amy M. Wermert, M.P.H.*, Nancy E. Hood, Ph.D., Sherry T. Liu, M.P.H., and Mary
El en Wewers, Ph.D., The Ohio State University, Col ege of Public Health
Electronic cigarette (ecig) use is growing in popularity. Little is known about the
use of ecigs among adult smokers in Appalachian Ohio. The purpose of this study
was to describe the use of ecigs among participants living in Appalachian Ohio
enrol ed in a group randomized cessation trial (n=467 participants) that included
behavioral counseling and free nicotine replacement therapy (NRT) (i.e., 21 mg
patch) over a 10 week protocol. Study eligibility criteria included: resident of a
participating Appalachian county, 18 years or older, self-reported daily cigarette
use, wil ing to quit in the next 30 days, no medical contraindication to NRT use,
and if female, not pregnant. Data col ection started in November 2010; items to
assess ecig use were added to the existing survey in April 2012. As a result, eciguse was not col ected for al participants. This abstract reports on a subset of thesample (n=252 participants) and includes data col ected at baseline, 3, 6, or 12months post-intervention. Of the subset of participants, 10% reported currentlyusing an ecig every day or some days. Most ecig users were between 25-54 yearsold (54%), female (65%) and had more than a HS/GED education (50%). Mostwere not employed (69%) but had health care coverage (77%). Most ecig userswere living at 200% below poverty (77%). For those interviewed post-intervention,5.9% (n=15 participants) reported use of ecigs, primarily to assist in efforts to quitsmoking. Most were using ecigs with nicotine (67%) and most believed that ecigsare less harmful than regular cigarettes (87%). The primary reasons given for eciguse included: “they make it easier for you to cut down on the number of cigarettesyou smoke” (53%), “they might help you quit” (47%). These findings supportprevious studies that demonstrate ecigs being used as a smoking cessationaid. Limitations of this study include a smal sample size and a homogenousstudy population (i.e., those trying to quit, living in Appalachia, Ohio). This studyemphasizes the importance of continued research into the efficacy and safety ofthe use of ecigs as a long-term smoking cessation aid.
This study was conducted while the first author was at The Ohio State University.
Supported by NIH grant # R01 CA129771.
CORRESPONDING AUTHOR: Amy Wermert, MPH, Program Manager, The OhioState University, Col ege of Public Health, Health Behavior Health Promotion,359-4 Cunz Hal , Columbus, OH 43210, United States, Phone: 614-292-8193,Email: POS2-135
Pal av Pokhrel, Ph.D., M.P.H.*, Pebbles Fagan, Ph.D., M.P.H., Melissa Little,
Ph.D., Crissy Terawaki Kawamoto, B.S., and Thaddeus A. Herzog, Ph.D., Cancer
Prevention & Control Program, University of Hawai Cancer Center, Honolulu, HI
Electronic cigarettes or e-cigarettes are commonly marketed as smoking
cessation aids and their popularity appears to be on the rise. But little is known
about the characteristics of smokers who use e-cigarettes to quit smoking,
including their motivation to quit, quitting self-efficacy, and experience with Food
and Drug Administration (FDA) approved cessation aids. In this study, we tested
the associations between smokers’ ever use e-cigarettes for cessation and their
demographic characteristics (e.g., gender, ethnicity), motivation to quit, and
other smoking- and cessation-related characteristics. Cross-sectional data were
obtained from 1567 adult daily smokers in Hawai using paper-and-pencil survey
in 2010-2012, as part of a smoking cessation study. Participants represented 50%
women, 21% Asian, 31% Native Hawaiian, 34% White, and 14% Other ethnicity.
e-Cigarette use was significantly associated with age (OR= 0.98, 95% CI [0.97,
0.99]), Native Hawai an ethnicity (OR= 0.68, 95% CI [0.45, 0.99]), motivation to
quit (OR= 1.14, 95% CI [1.08, 1.21]), quitting self-efficacy (OR= 1.18, 95% CI
[1.06, 1.36]), and the use of conventional cessation products or medications such
as nicotine replacement gum (OR= 3.72, 95% CI [2.67, 5.19]) and Bupropion
(OR=2.29, 95% CI [1.38, 3.79]). Our data suggests that smokers who use
e-cigarettes appear to be serious about wanting to quit. Research is needed to
clarify the effectiveness of e-cigarette use in smoking cessation. Clinicians and
public health practitioners need to be prepared to clearly communicate the risks
and benefits of e-cigarette use to smokers who are highly motivated to quit.
This study was supported by an R01 grant (# CA2079905) from the National
Cancer Institute to T.A. Herzog.
CORRESPONDING AUTHOR: Pal av Pokhrel, Ph.D., M.P.H., Assistant Professor,
University of Hawai Cancer Center, Cancer Prevention & Control, 677 Ala Moana
Blvd., Suite 200, Honolulu, HI 96813, United States, Phone: 8084417711, Email:
ppokhrel@cc.hawai .edu

Kelvin Choi, M.P.H., Ph.D.*, and Jean L. Forster, Ph.D., M.P.H., University of
Objective: Young adults are experimenting with new tobacco products like
snus and electronic cigarettes (e-cigarettes), and exposure to pro-snus and
pro-e-cigarette messages may contribute to this phenomenon. We conducted
the first analysis to examine young adults’ exposure to these messages and its
associations with trying these products. Methods: Young adults (ages 20-25)
from the U.S. upper Midwest region were surveyed in 2009 and again in 2011
(n=2339). In 2011, participants were asked if they have received advertisements
and coupons for non-cigarette products in the mail, have seen Facebook pages/
groups and advertisements for snus and e-cigarettes, and have seen kiosks in
shopping mal s promoting e-cigarettes. Ever use of these products was assessed
in 2011. Baseline tobacco use behaviors were assessed in 2009 (before these
products were available nationwide). Using multivariate logistic regression
models, we assessed characteristics associated with exposure to different types
of pro-snus and pro-e-cigarette messages in 2011, and the associations between
message exposure and ever use of these products in 2011. Results: Regarding
snus, 8% and 7% of the participants had received advertisements and coupons
for non-tobacco products in the mail, respectively; <1% had seen snus Facebook
pages/groups. Regarding e-cigarettes, 14% of the participants had seen kiosk
at shopping mal s promoting e-cigarettes; 7% and 1% had seen e-cigarettes
advertisements and pages/groups on Facebook, respectively. Male, less educated
participants, those who had friends who smoke, tobacco users were more likely
to have received advertisements and coupons for non-cigarette products in the
mail (p<.05). For every additional type of exposure to pro-snus and pro-e-cigarette
messages, there was a 79% and 96% higher odds that participants had used
snus and e-cigarettes, respectively, adjusted for demographics, peer smoking and
tobacco use behaviors (p<.05). Conclusions: Exposure to pro-snus and pro-ecigarette
messages were associated with experimenting with these products in our
sample. Longitudinal studies are needed to confirm our findings.
This research was funded by the National Cancer Institute (R01 CA86191; J.
Forster - PI).
CORRESPONDING AUTHOR: Kelvin Choi, M.P.H., Ph.D., Research Associate,
University of Minnesota, Division of Epidemiology and Community Health, 1300
South Second Street, Minneapolis, MN 55454, United States, Phone: 612-626-
1799, Email:
Tobias Rüther, M.D., Ph.D.*, Franziska Wissen, Andrea Linhardt, M.D., Désirée
Aichert, Oliver Pogarel , M.D., Ph.D., and Hein de Vries, Ph.D.
Introduction: The use of an electronic-cigarette (e-cigarette) resulted in some
previous studies in reduction and cessation of conventional cigarette smoking.
Therefore, this study aims to examine the reasons of using e-cigarettes instead of
and in addition to conventional cigarettes in Germany. Furthermore it is determined
to what extent e-cigarettes are used as a smoking cessation tool. Method: A
cross-sectional study was conducted in April – May 2012 in Munich, Germany. The
I-Change Model was used as theoretical framework and existing questionnaires
were used to build up the present questionnaire. 320 Smokers participated
in the study, divided in three groups: E-cigarette smokers (e-smokers) (33%),
conventional cigarette smokers (c-smokers) (37%) and smokers of both cigarettes
(b-smokers) (30%). Pearson Chi Square tests and analyses of variance were used
to assess differences among the group of smokers on demographic variables,
smoking behaviour and the constructs of the I-Change Model. Results: About half
of the e-cigarette users used the e-cigarette in addition to c. cigarettes and the
other half instead of c. cigarettes. It seemed that e-smokers and b-smokers had
the same reasons for using e-cigarettes overal . E-cigarette users were most often
men, were less addicted to nicotine and had a higher motivation to stop smoking
than c-smokers. In addition, e-smokers reported a more positive health and had
a lower carbon monoxide concentration compared to c-smokers. Furthermore,
e-smokers had a more positive attitude towards e-cigarettes, a higher self-efficacyin terms of being abstinent from c. cigarettes in certain situations and a higherself-efficacy of using an e-cigarette instead of c. cigarettes. E-cigarettes were usedmore frequently if the social environment of a person vaporized as well or preferredthe respondent to vaporize e-cigarettes instead of c. cigarettes. Discussion: Theresults confirmed most of the hypotheses and also important results of previousstudies. In addition, a wel -conducted randomized-control trial is needed to confirmthe efficacy of e-cigarettes as a smoking cessation aid.
No funding.
CORRESPONDING AUTHOR: Tobias Rüther, MD PhD, Physician, Universityof Munich Department of Psychiatry, Tobacco Dependence Outpatient Clinic,Nussbaumstr.7, Munich, 80336, Germany, Phone: +49-89-5160-5707, POS2-138
Jill Murphy*1, Sarah Beshers1, Brian Fix2, and Martin Mahoney2, 1State University
of New York at Cortland, Cortland, NY; 2Roswel Park Cancer Institute, Buffalo, NY
Electronic cigarettes (e-cigarettes) have been available in the United States
for about five years. Recent studies have found that awareness and ever use
of e-cigarettes among adults is increasing. To our knowledge, to date there are
no published reports of e-cigarette awareness and use among col ege students
in the United States. Some tobacco control advocates express concerns with
e-cigarettes, including that e-cigarettes could be used as a starter product for
younger or never smokers or they could delay cessation and result in a pattern
of dual use of tobacco products. The objective of this study was to assess
col ege students’ awareness, use, and perceptions of e-cigarettes. In October
and November of 2011, we conducted a cross-sectional survey among 1,187
undergraduate students attending two public universities in New York State.
Participants completed an online survey that included questions on demographics,
cigarette smoking behavior, smokeless tobacco use, awareness and use of
e-cigarettes, beliefs about the harmfulness of e-cigarettes, and interest in using
an e-cigarette. The prevalence of current cigarette smoking was 10.5%, and the
prevalence of smokeless tobacco use (including chewing tobacco, snuff, or snus)
was 2.7%. Current cigarette smokers were more likely than non-smokers to have
heard of e-cigarettes (86% vs. 71%, p<0.01), ever try an e-cigarette (47% vs.
5%, p<0.01), and use an e-cigarette in the past month (4% vs. 0.1%, p<0.01),
respectively. Only one participant reporting daily use of the e-cigarette. The vast
majority (97%) of col ege students perceived that e-cigarettes were either less
harmful or no different in terms of harm when compared to regular cigarettes.
Among participants who had not tried an e-cigarette, cigarette smokers were more
likely than non-smokers to report they would be interested in trying an electronic
cigarette (39% vs. 5%, p < 0.01). We found the majority of col ege students were
aware of e-cigarettes. While ever use of e-cigarettes was much more common
in current cigarette smokers than non-smokers, past month use was much less
common in the sample overal , and daily use was rare.
No funding.
CORRESPONDING AUTHOR: Jil Murphy, PhD, Associate Professor, SUNY
Cortland, Health, PO Box 2000 Graham Ave, Cortland, NY 13045, United States,
Phone: 6077535613, Email:
Pasquale Caponnetto, Ph.D.1,2, Davide Campagna, M.D.1,2, Fabio Cibel a, Ph.D.3,
Jaymin B. Morjaria, M.D.4, Cristina Russo, M.D.1,2, and Riccardo Polosa, M.D.,
Ph.D.*1,2, 1Centro per la Prevenzione e Cura del Tabagismo, Azienda Ospedaliero-
Universitaria “Policlinico-V. Emanuele”, Università di Catania, Catania, Italy;
2Institute of Internal Medicine, S. Marta Hospital, Azienda Ospedaliero-Universitaria
“Policlinico-V. Emanuele”, Università di Catania, Catania, Italy; 3Istituto diBiomedicina e Immunologia Molecolare del Consiglio Nazionale del e Ricerche,Palermo, Italy; 4IIR Division, School of Medicine, University of Southampton,Southampton General Hospital, Southampton, UKE-cigarettes are becoming increasingly popular with smokers worldwide.
Careful y conducted research on e-cigarettes is urgently needed in order to ensurethat the decisions of regulators, healthcare providers and consumers are basedon science. We designed a prospective 12-month double-blind, randomized,control ed trial to evaluate smoking reduction, smoking abstinence and adverseevents in 300 smokers not intending to quit experimenting 2 different nicotinestrengths of a very popular brand compared to the non nicotine alternative fromthe same brand. Study Group A (n =100) used 7.2 mg nicotine cartridges, GroupB (n =100) used 5.4 mg nicotine cartridges and Group C (n =100) was givenno-nicotine cartridges. Study participants were invited to attend a total of 9 studyvisits during which number of cigarettes smoked, and eCO levels were measured.
Smoking reduction and abstinence rates were calculated. Adverse events andproduct preferences were also reviewed. Lastly, classic and novel static anddynamic factors predicting abstinence and reduction rates will be investigated.
A significant reduction (p<0.001) cig/day use and eCO levels from baseline wasobserved at each study visits in al 3 study groups. By and large, no differencebetween study groups was observed in terms of changes in cig/day use and ineCO levels. A mean of 2.0 cartridges/day was used in each study group up to the3-month time point, but fal ing thereafter. Smoking reduction was shown in 21%and 9% participants in group A, in 16% and 8% in group B and in 19% and 10% ingroup C, at 3- and 12-months respectively. Smoking abstinence was observed in11 % and 13% participants in group A, in 17% and 9% in group B and in 4% and4% in group C, at 3- and 12-months respectively. Only minor and transient adversewere reported, including mouth and throat irritation, and dry cough. They seemto attenuate over time. By and large, participants’ perception and acceptance ofthe product was positive. In smokers not intending to quit, the use of e-Cigarettedecreased cigarette consumption and elicited enduring tobacco abstinence at 1-yrwithout causing significant side effects.
No funding.
CORRESPONDING AUTHOR: Pasquale Caponnetto, University of Catania, c/oPoliclinico Vittorio Emanuele, Catania, 95123, Italy, Phone: 0039 7436413, Email: POS2-147
Jidong Huang, Ph.D., Dianne Barker, M.H.S.*, Frank J. Chaloupka, Ph.D., and
Sandy Slater, Ph.D.
Point of sale is the least regulated tobacco marketing channel in the U.S. Given
the evidence of the causal role of marketing in the tobacco epidemic and FDA’s
recently-charged role in regulating tobacco product marketing, it is important to
examine the current status of retail tobacco marketing in the U.S. This research
address this topic using the observational data from af national sample of tobacco
outlets focusing on the availability of various tobacco products, point-of-sale
promotions and marketing. Cross sectional data were col ected in 2010 in 154
sites (in 43 states) and in 2011 in 157 sites (in 42 states) surrounding a national
sample of public 8th-, 10th-, and 12th-grade schools . For this study, sites were
defined as the area from which the schools drew the majority of their students
(the school enrol ment zone). A random sample of retail outlets in each site were
selected for observation. Our analyses revealed that close to 80% of the observed
retail outlets sold tobacco products. Differences exist in availability across different
types of tobacco products. Availability also differs within each product type across
sites with different racial/ethnic compositions and income levels. Availability of
electronic cigarettes, pipe tobacco, dissolvable tobacco products, and cigaril os
increased from 2010 to 2011. The percent of stores with promotions declined in
2011 in three promotional types (multi-pack discount, cents off coupon, and special
price). Presence of promotions was higher in minority communities, presence of
menthol cigarettes with special price was higher in communities with low-andmiddle-income levels. Cigarette and snus ads were ubiquitous in stores sel ingthese products in 2010, however, a reduction was observed in those ads in 2011across al sites regardless racial/ethnic compositions or income levels. Thisstudy provided insights on the current status of tobacco retail marketing and hasimportant implications for policies targeting point-of-sale marketing.
Support for this project was provided by the Robert Wood Johnson Foundationas part of the Bridging the Gap: Research Informing Practice and Policy forHealthy Youth program; and by a National Cancer Institute-funded grant (Grant#1U01CA154248), titled “Monitoring and Assessing the Impact of Tax and PricePolicies on U.S. Tobacco Use.” The Monitoring the Future study is funded by theNational Institute on Drug Abuse. The opinions expressed here are those of theauthors, and do not necessarily reflect those of the sponsors. None of the fundingagencies played any role in study design; in the col ection, analysis and interpretationof data; in the writing of the report; and in the decision to submit the paper forthe conference.
CORRESPONDING AUTHOR: Jidong Huang, PhD, Research Specialist,University of Il inois at Chicago, Institute for Health Research and Policy, 1747West Roosevelt Road, Chicago, IL 60608, United States, Phone: (312) 413-0099,Email: POS3-73
Madeleine Lee, B.A.*, Shu-Hong Zhu, Ph.D., Yifei Huang, M.A., Antonio Mayoral,
M.S., and Michael A. Conway, Ph.D., University of California, San Diego
Electronic Cigarettes (E-Cigarettes) are an emerging tobacco product with a
large presence on the Internet. To compile a list of e-cigarette brands, we performed
keyword searches on the three most popular US search engines (Google, Bing,
and Yahoo!). Review sites which were found during this process were also used to
add to the list of e-cigarette brands. Brand websites were examined for specifics
about each product (composition of starter kits, flavor and nicotine strength options
for cartridge and e-Liquid refil s), ingredients in their products, claims about the
product such as whether they were safer than conventional cigarettes. During the
survey process, a cataloging system for starter kits was developed. Prices were
recorded for al parts and kits. We identified over 80 discrete flavor categories and
27 different nicotine strengths across the more than 250 brands found through this
search. A partial or, in some cases, ful list of ingredients was found for 71.7% of
brands, with the most common ingredients being nicotine, propylene glycol, and
water. More than half of the brands (64%) explicitly stated that their product could
not be used as a smoking cessation device, while 27.2% gave no information on
the topic. Almost 9/10ths of brands (89%) claimed that their product was healthier
or safer than a conventional cigarette, with only 1.8% stating that their product
was not safer. Most brands (80.2%) advertised their products as being suitable
for use in places where conventional cigarettes would be banned. Final y, 65.8%
of brands claimed that their product would save the user money. The results of
this study provide a good starting point for researchers when considering further
studies on this emerging tobacco product.
This work was supported a grant from the National Cancer Institute (5 U01
CORRESPONDING AUTHOR: Shu-Hong Zhu, Ph.D., University of California, San
Diego, Family & Preventive Medicine, 9500 Gilman Drive MS 0905, La Jol a, CA
92093-0905, United States, Phone: 858-300-1056, Email:
Leon Kosmider1, Maciej L. Goniewicz, Ph.D.*2, Marcin Delijewski3, Jakub
Knysak3, and Andrzej Sobczak, Ph.D.1, 1Institute of Occupational Medicine and
Environmental Health, Sosnowiec, Poland; 2Queen Mary University of London,
UK; 3Medical University of Silesia, Sosnowiec, PolandBackground: The amendment to the Act on Prevention of Negative HealthConsequences of Tobacco Use was introduced in Poland on November 15,2010, prohibiting smoking in almost al enclosed public places. Studies suggestthat smoke-free laws are associated with decrease in smoking prevalence andincreases in quit attempts. Electronic cigarettes (e-cigarettes) are battery-powereddevices that deliver vaporized nicotine. They are promoted as a stop-smokingaid or as an alternative to conventional cigarettes. Aim of the study: This studyinvestigates the impact of the smoke-free law on the popularity and time series ofe-cigarette sales pre and post implementation of smoking-ban in Poland. Materialsand methods: Polish-language Google searches conducted from January 2009through May 2011 were analyzed. We used two key words: ‘e-cigarette’ and‘electronic cigarette’. Searches for each week were scaled to the highest weeklysearch proportion. The fol owing search filters were applied: various countrysub-regions, dates, and categories. Since it is unclear whether search queriesindicate curiosity or shopping, we analyzed sale offers of e-cigarettes through thebiggest Polish auction service al Results: Six months before the smokingban the mean relative search volume of e-cigarettes was 20.6%±5.2%. Six monthspost implementation of the ban the mean value was 25.1%±8.0% (p>0.05). Werecorded consistently higher numbers of e-cigarettes searches between Januaryand March 2010 (74.7%±15.0%). We did not observed any significant changesin e-cigarette sales during six months after the introduction of the 2010 Polishsmoke-free legislation (p>0.05). Conclusions: Real-time monitoring of Internetsearches and sales of e-cigarettes can help assess the effects of public policieson popularity of the alternative nicotine products. Implementation of smoking banin public places was not associated with increased popularity of e-cigarette inPoland.
No funding.
CORRESPONDING AUTHOR: Maciej Goniewicz, Ph.D., Research Fel ow,Queen Mary University of London, Tobacco Dependence Research Unit, 55Philpot Street, London, E1 2JH, United Kingdom, Phone: +447783780606, Fax:+442073777237, Email: POS3-94
Rachel Grana, Ph.D., M.P.H.*, and Pamela M. Ling, M.D., M.P.H., University of
California San Francisco
Dual use of cigarettes and other tobacco products has been increasing in
recent years, particularly among young people. This may be due in part to tobacco
industry responses to increased tobacco taxes and clean indoor air policies in
the U.S. and in other countries, which include advertising messages promoting
the use of smokeless tobacco products in addition to cigarettes. To identify
promotional messages that may encourage dual use, we identified historical and
current themes from print magazine ads, direct mail advertising, and branded
websites for smokeless tobacco products and compared to themes identified in
a formal content analysis of electronic cigarette retail websites sampled between
May to July 2012. Results show that marketing of smokeless tobacco products,
particularly snus and dissolvable tobacco products, has been explicitly targeted
at smokers. Most marketing messages promoted temporary or situational use
of smokeless tobacco, which may result in dual use of smokeless tobacco and
cigarettes rather than complete switching from cigarettes to smokeless tobacco.
Ad text and imagery contained both overt and subtle appeals to use the smokeless
product when users were unable to smoke. Smokeless tobacco products bearing
cigarette brand names and contests such as the “camel pleasure switch chal enge”
that promote switching for several days may also encourage adoption and dual
use of both products among smokers. Electronic cigarette companies also
include appeals on their retail websites that may result in dual product use, such
as promoting the product for circumventing clean indoor air laws and using the
product in specific indoor environments (e.g., an office). Marketing that promotes
dual or poly tobacco use patterns may exacerbate the total tobacco use burden
and have negative public health impact due to effects on addiction, deterred quitattempts and decreased effectiveness of successful tobacco control policies.
This work is supported by grants R25T CA 113710 and R01-CA141661.
CORRESPONDING AUTHOR: Rachel Grana, PhD, Postdoctoral Scholar, UCSF,530 Parnassus Ave. Suite 366, San Francisco, CA 94143, United States, Phone:415-476-1570, Email: POS3-102
Coral E. Gartner, Ph.D.*1, Wayne D. Hal , Ph.D.1, and Ron Borland, Ph.D.2, 1UQ
Centre for Clinical Research, The University of Queensland, Australia; 2Cancer
Council Victoria, Australia
Twenty-six of 40 invited tobacco harm reduction experts completed a survey
on what factors should be considered in setting a price for tobacco and nicotine
products. The aim was to explore the possibility of creating a rational pricing policy
to encourage smokers away from cigarettes to less harmful products (LHPs)
while minimising uptake among non-smokers. Most participants (92.3%) agreed
that it was a good idea to use price to encourage smokers to use LHPs, with the
remainder unsure. Al supported encouraging use of medicinal nicotine products,
fol owed by non-smoked recreational clean nicotine (N=25), low toxin smokeless
tobacco (SLT) (N=23), electronic nicotine delivery systems (ENDS) (N=22), then
very low nicotine content cigarettes (N=7). None wanted to encourage use of
pipes or cigars. Desirable attributes of LHPs included: containing only medicinal
quality nicotine (N=25), able to be used discreetly (N=18), being an acquired taste
(N=11), not tasting like candy (N=7). Undesirable attributes included: being easy
to consume a large quantity quickly (N=25), looks like candy (N=22), and taste
appealing to young people (N=20). Participants were split on whether a cigarettelike
appearance was good (N=6) or bad (N=6), half were unsure or thought it
unimportant. Most favoured a large price discount for medicinal nicotine but split
between a large and a smal discount for ENDS and dissolvable SLT. Half felt
snus should have a smal discount. Five were uncertain about and six thought
nicotine lol ipops should be banned. Assuming that a cigarette pack costs $15,
82% of participants accepted a suggested price of $7.50 for medicinal nicotine
(9% suggested lower prices and 9% gave no alternative price); 68% accepted
$10 for non-smoked recreational nicotine (14% suggested lower) and SLT (9%
suggested lower, 5% higher); 64% accepted $10 for ENDS (9% suggested lower,
5% suggested higher); and 27% accepted $10 for low nicotine cigarettes (9%
suggested lower, 41% higher and 23% gave no alternative price). The idea of
differential pricing was accepted and, apart from low nicotine cigarettes, the model
we presented was considered appropriate.
This project was supported by an NHMRC Project Grant (GT1020123). CG is
supported by an NHMRC Early Career Research Fel owship (GT519783) and WH
is supported by an NHMRC Australia Fel owship (GT569738).
CORRESPONDING AUTHOR: Coral Gartner, PhD, Research Fel ow, The
University of Queensland, UQCCR, Building 71/918, Herston, Qld 4029, Australia,
Phone: 61 7 3346 5478, Fax: 61 7 3346 5598, Email:
Andrew B. Seidenberg, M.P.H., Weiwei Hong, M.B.B.S., M.P.H., JiaYue Liu, M.D.,
M.P.H., Jonathan K. Noel, M.P.H., and Vaughan W. Rees, Ph.D.*, Center for
Global Tobacco Control, Harvard School of Public Health, Boston, MA
BACKGROUND: New tobacco control policies have been introduced in
some U.S. jurisdictions which restrict tobacco product sales in pharmacies.
This study aimed to outline the scope of pharmacy involvement in a state-wide
tobacco market by assessing the availability and range of tobacco productssold in Massachusetts pharmacies. METHODS: Public listings of licensedpharmacies and tobacco retailers in Massachusetts were examined to determinethe proportion of pharmacies licensed to sel tobacco, and the proportion oftobacco retailers that possessed a pharmacy license. Telephone interviewswere conducted with a random sample (n=70) of pharmacies that held a tobaccolicense, to assess the availability and range of tobacco products for sale. Theavailability of NRT products was assessed as a comparison. RESULTS: Themajority of pharmacies in Massachusetts possessed a tobacco license (69%),and pharmacies made up 9% of licensed tobacco retailers. Among pharmaciesthat reported sel ing tobacco (90%), cigarettes were the most available tobaccoproduct for sale (100%), fol owed by cigars (69%), little cigars/cigarillos (66%),moist snuff (53%), pipe tobacco (49%), rol -your-own tobacco (34%), snus (14%),dissolvable tobacco (11%), and electronic cigarettes (2%). Nearly al pharmaciesthat sold tobacco offered the nicotine patch (100%), gum (100%), and lozenge(98%) CONCLUSIONS: In Massachusetts, a tobacco-free pharmacy policy wouldaffect a majority of pharmacies and remove a wide range of tobacco products fromstore shelves. Further, nearly one in ten tobacco retailers would be eliminated bya ban on tobacco sales in Massachusetts pharmacies.
No funding.
CORRESPONDING AUTHOR: Vaughan Rees, PhD, Lecturer, Harvard Schoolof Public Health, Center for Global Tobacco Control, Kresge Building, 6th Floor,Boston, MA 02115, United States, Phone: 617-432-6345, Email: vrees@hsph. POS3-121
Christine D. Czoli, Ph.D.(c)*1, David Hammond, Ph.D.1, and Christine M. White,
M.Sc.2, 1School of Public Health & Health Systems, University of Waterloo,
Canada; 2Propel Centre for Population Health Impact, University of Waterloo,
Background: Electronic cigarettes (e-cigarettes) are a type of potential y reduced
exposure product (PREP) that deliver vaporized nicotine without the harmful
chemicals and carcinogens found in tobacco smoke formed during pyrolysis.
E-cigarettes containing nicotine are prohibited for sale in Canada, although
e-cigarettes without nicotine are widely available for sale and are becoming
increasingly prominent. To date, there is very little evidence on prevalence and
patterns of use of e-cigarettes in Canada. Methods: A sample of 1,211 young
adults aged 16-30 (456 smokers and 755 non-smokers), were recruited from an
online panel of Canadians. After viewing an image of an e-cigarette, respondents
answered questions regarding use and perceptions of e-cigarettes. Results: Close
to half of young adults (43.6%) had seen e-cigarettes advertised or for sale. A total
of 16.0% reported “ever tried” e-cigarettes (32.8% smokers vs. 5.9% non-smokers);
5.7% reported use in the past 30 days (13.8% smokers vs. 1% non-smokers).
Approximately 13.7% reported purchasing e-cigarettes from: “regular” stores in
Canada (69.4%), the internet (33.3%), sources outside of Canada (8.3%), and
other sources (6.9%). Although 77.2% of al respondents perceived e-cigarettes
as at least somewhat harmful to their health, approximately half (48.5%) reported
at least some interest in trying e-cigarettes. Among smokers who had tried
e-cigarettes, between 77.5% and 81.0% indicated “yes” or “maybe” to using
e-cigarettes as an alternative or replacement for cigarettes or as a cessation tool.
A total of 11.9% of e-cigarette “ever users” reported side-effects of use. Among
previous users, only 9.5% were “not at al likely” to recommend e-cigarettes to
their friends. Conclusions: Despite a ban on the sale of e-cigarettes containing
nicotine in Canada, awareness of e-cigarettes among young adults is quite high.
Approximately one third of young adult smokers reported trying e-cigarettes, with
evidence of use among non-smokers. Future research should examine the content
and design of e-cigarettes in Canada to determine compliance with the ban on
This research was supported by the Canadian Institutes of Health ResearchTraining Grant in Population Intervention for Chronic Disease Prevention: A Pan-Canadian Program (Grant #: 53893) (Czoli), the Ontario Tobacco Research UnitAshley Studentship for Research in Tobacco Control (Czoli), the Ontario GraduateScholarship (Czoli), the Propel Centre for Population Health Impact, a CIHRNew Investigator Award (Hammond), and a Canadian Cancer Society ResearchInstitute Junior Investigator Research Award (Hammond).
CORRESPONDING AUTHOR: Christine Czoli, PhD(c), University of Waterloo,School of Public Health & Health Systems, 44 Young St W, Waterloo, ON N2L2S3,Canada, Phone: 4164534865, Email: POS3-122
Sarah E. Adkison, M.A.1, Richard J. O’Connor, Ph.D.*1, Maansi Bansal-Travers,
Ph.D.1, Andrew Hyland, Ph.D.1, Ron Borland, Ph.D.2, Hua-Hie Yong, Ph.D.2, K.
Michael Cummings, M.P.H., Ph.D.3, Ann McNeill, Ph.D.4, James F. Thrasher,
Ph.D.5, David Hammond, Ph.D.6, and Geoffrey T. Fong, Ph.D.6,7, 1Roswel Park
Cancer Institute, Buffalo, NY, USA; 2The Cancer Council Victoria, Carlton, VIC,
Australia; 3Medical University of South Carolina, Charleston, SC, USA; 4University
of Nottingham, UK and UK Center for Tobacco Control Studies, Nottingham, UK;
5University of South Carolina, Columbia, SC, USA; 6University of Waterloo, ON,
Canada; 7Ontario Institute for Cancer Research, Toronto, ON, Canada
Background: Electronic cigarettes (e-cigarettes) initial y emerged in 2003
and have since become widely available global y, particularly over the internet.
Purpose: Because e-cigarettes are relatively new, data on usage patterns are
limited. The current study examines patterns of e-cigarette awareness, trial,
use, and product-associated beliefs among current and former smokers in four
countries. Methods: Data come from Wave 8 of the International Tobacco Control
Four-Country Survey, col ected from July 2010 to June 2011 and analyzed through
to June 2012. Respondents included 5,939 current and former smokers in Canada
(N=1581), US (N=1520), UK (N=1325), and Australia (N=1513). Results: Overal ,
47% were aware of e-cigarettes (US: 73%, UK: 54%, Canada: 40%, Australia:
20%), 7.6% had tried e-cigarettes (16% of those aware of e-cigarettes), and 2.9%
were current users (39% of triers). Awareness of e-cigarettes was higher among
younger, non-minority smokers with higher incomes who were heavier smokers.
Prevalence of trying e-cigarettes was higher among younger, non-daily smokers
with a high income and among those who perceived e-cigarettes as less harmful
than traditional cigarettes. Current use was more likely among both non-daily and
heavy (20+ cigarettes per day) smokers. Nearly 80% reported using e-cigarettes
because they were considered less harmful than traditional cigarettes, 75.4%
stated that they used e-cigarettes to help them cut down, and 85.1% reported using
e-cigarettes to help them quit smoking. Conclusions: Awareness of e-cigarettes is
high, especial y in countries where they are legal (i.e., US and UK). Because trial
was associated with non-daily smoking and a desire to quit smoking, e-cigarettes
could potential y serve as cessation aids once enforceable product standards are
developed and efficacy and safety are firmly established. Future research should
evaluate whether e-cigarette use effectively reduces the number of cigarettes
smoked and/or improves cessation efforts and how the marketing of these devices
influences usage patterns among both tobacco users and nonusers.
The ITC Four Country Project was supported by the U.S. National Cancer
Institute (RO1 CA100362 and P01 CA138389), Canadian Institutes of Health
Research (79551 and 115016), National Health and Medical Research Council of
Australia (450110, APP1005922), Cancer Research UK (C312/A11943), Ontario
Institute for Cancer Research (Senior Investigator Award to GTF), and Canadian
Cancer Society Research Institute (Prevention Scientist Award to GTF).
CORRESPONDING AUTHOR: Maciej Goniewicz, Ph.D., Research Fel ow,
Queen Mary University of London, Tobacco Dependence Research Unit, 55
Philpot Street, London, E1 2JH, United Kingdom, Phone: +447783780606, Fax:
+442073777237, Email:
Pamela I. Clark, Ph.D.*1, Craig G. McDonald, Ph.D.2, Blair N. Coleman, M.P.H.1,
Eva Sharma, M.P.H.1, and George Buzzel , B.S.2, 1University of Maryland Col ege
Park; 2George Mason University
Background: Despite drastic increase in awareness and use, scientific
evidence is inconclusive on the efficacy of electronic nicotine delivery systems
(ENDS), better known as “e-cigarettes.” The aim of this study was to determine
the abuse liability potential of ENDS in a sample of smokers using event-related
brain potentials (ERPs). ERPs provide a convenient and objective index of
regional cortical arousal that can be associated with varying levels of nicotine
administration. The primary ERP component of interest was the parietal P3b, as
this component has previously been linked to addiction liability. Methods: In this
within subjects study, cigarette smokers, during four separate laboratory visits,
smoked ENDS, ENDS placebo, their own brand cigarettes, and “sham” smoked
their own brand cigarette in a Latin-square order. During smoking sessions, ERPs
elicited by stimuli presented in the context of a two-stimulus oddbal task were
recorded. ERPs were recorded immediately before and after smoking, as were
subjective measures (relief of craving/withdrawal). Results: Preliminary results
suggest that the P3b component of the ERP was elevated fol owing smoking
ENDS, but not participants’ own brand of cigarette. However, the P3a component,
an index of the involuntary orienting of attention, appeared to be increased
fol owing smoking own brand but not ENDS. Thus, there appears to have been
a double dissociation between which of these ERP components were affected
by ENDs or cigarettes. Conclusions: These preliminary findings suggest that
ENDS may produce qualitatively different neurocognitive effects as compared to
cigarettes. This suggests that product acceptability of ENDS and cigarettes may
be determined by different cognitive mechanisms.
This study was conducted while the first author was at the University of
Maryland. Supported by NIH/NIDA grant #5R21DA030622.
CORRESPONDING AUTHOR: Blair N. Coleman, MPH, University of Maryland,
Behavioral and Community Health, 2387 SPH Building, Val ey Drive, Col ege Park,
MD 20742, United States, Phone: 3014058740, Email:
Lois Biener, Ph.D.*, and Scott McInerney, B.A., Center for Survey Research,
University of Massachusetts Boston
Background: Since 2006 when RJ Reynolds and Philip Morris started promoting
snus, there has been considerable research directed at snus and its controversial
status as a potential harm reduction strategy for cigarette smokers. Studies of
snus trial have been published, showing robust interest primarily among young
adult male smokers, but little has been learned about the rate of progression to
regular use. Electronic cigarettes, which appeared on the American market at
about the same time as snus, have received much less attention. We carried
out a population-based study in 2011 and 2012 in the two US metropolitan areas
where the Camel and Marlboro Snus have been available the longest. The survey
included questions on trial and current use of electronic cigarettes, al owing us
to compare the appeal of both of these novel tobacco products at the population
level. Methods: Data are from a telephone survey of a dual frame, representative
address-based sample of 3364 adults in Indianapolis and Dal as/Fort Worth,
supplemented by a mail survey of 1786 adults for whom no phone numbers could
be obtained. Results: Among males, snus trial was slightly higher than e-cigarette
trial (29.9% vs 22.7%); but current use of snus was only half that of current
e-cigarette use (4.2% vs 8.6%). Among females, trial of snus is only one third that
of e-cigarettes(8.5% vs 25.5%; p<.05) and while almost no females are current
snus users, 6% of female smokers reported current use of e-cigarettes. There
is a clear age gradient for snus trial and use among male smokers with younger
men much more receptive to snus than older. For e-cigarette use, smokers 50
to 65 years of age show the highest rates of current use. Conclusions: Smokers
seem more receptive to adoption of e-cigarettes than snus. The very different
demographic profile of snus and e-cigarette users suggests different motivations
for use. These findings underscore the importance of devoting more attention to
the e-cigarette phenomenon in the future.
The research was supported by a grant from the National Cancer Institute.
CORRESPONDING AUTHOR: Lois Biener, Ph.D., Senior Research Fel ow,
University of Massachusetts Boston, Center for Survey Research, 100 Morrissey
Blvd., Boston, MA 02125, United States, Phone: 6172877200, Fax: 6172877210,
Alan L. Shihadeh1 and Thomas Eissenberg*2, 1American University of Beirut;
2Virginia Commonwealth University
Background: “Electronic cigarettes” (ECIGs) heat a nicotine-containing solution
to produce a vapor for inhalation. There is considerable variability in device
characteristics and puff topography and each of these factors may be related to
vapor toxicant content. Method: We investigated the role of device voltage and
puff duration on vapor toxicant content. We examined total particulate matter,
nicotine, and volatile aldehyde emissions from 15 consecutive puffs of V4L™
ECIG cartridges (18 mg/ml nicotine) while varying device voltage (3.7 vs 5.2 volts)
and machine-produced puff duration (1.8 vs 3.6 s). We used a puff velocity of
38.8 ml/s and 10 s interpuff interval (Goniewicz et al., 2012). In another study,
we investigated a non-cartridge ECIG use method that involves dripping nicotinecontaining
liquid directly onto a heating element and inhaling the resulting vapors.
We measured aldehyde emissions from dripping 3 drops of e-liquid (16 microL,
similar to the amount of e-liquid consumed in 15 e-cig puffs) onto a 300 C heater
surface. Results: The higher voltage tripled vapor nicotine content, and doubling
puff duration doubled nicotine content. We also found that longer puffs resulted
in greater cartridge temperatures, and that, for a given puff duration, higher puff
velocities resulted in lower temperatures. Dripping liquid onto a heater surface
produced more than 200 micrograms of formaldehyde, compared to 0.03
micrograms for 15 puffs of an ECIG cartridge (V4L™cartridge, topography of
Goniewicz et al., 2012). We also measured 2-20 fold greater emissions of other
aldehydes (9 species in total). Conclusions: Overal , these results demonstrate
that device characteristics (e.g., voltage), puff topography, and use behavior (i.e.,
“dripping”) can influence vapor toxicant content. Indeed, these findings suggest
that ECIG aficionados who take longer duration, slower puffs (Hua et al., 2011)
are working to obtain higher nicotine doses and that those who drip liquid directly
on the heater (McQueen et al., 2011) risk significant exposure to formaldehyde
that is a human carcinogen and is associated with COPD in conventional tobacco
product users.
This work was supported by USPHS grants R01CA120142 and R01 DA025659.
CORRESPONDING AUTHOR: Thomas Eissenberg, Ph.D., Professor, Virginia
Commonwealth University, PO BOX 980205, Richmond, VA 23298, United States,
Phone: 804-827-4617, Email:
Andrzej Sobczak, Ph.D.*1,2, Leon Kosmider1,2, Maciej L. Goniewicz, Ph.D.3,4, Jakub
Knysak2, Marzena Zaciera, Ph.D.5, and Jolanta Kurek5, 1Institute of Occupational
Medicine and Environmental Health, Sosnowiec, Poland; 2Medical University
of Silesia, Katowice, Poland;3Queen Mary University of London, UK; 4Roswell
Park Cancer Institute, Buffalo, USA; 5Institute of Occupational Medicine and
Environmental Health, Sosnowiec, PolandSignificance: Electronic cigarettes (ECs) are purported to deliver nicotine vaporwithout any toxic substances generated from tobacco combustion. However, usingECs involves heating a nicotine solution to high temperatures. This may inducechemical reactions which result in the possible formation of carbonyl compounds(CCs) and volatile organic compounds (VOCs). Many CCs and VOCs are commontobacco-specific toxicants with proven carcinogenic and cardiotoxic properties. Aimof the study:The aim of the study was to quantify and compare the levels of selectedCCs (formaldehyde, acetaldehyde, acrolein, acetone, propanal, butanal) and VOCs(benzene, toluene, etylobenzene and ortho-, meta-, para-xylene) in EC nicotinerefil solutions, vapors generated from ECs,and mainstream smoke from tobaccocigarettes. Methods: Six commercial y available nicotine refil solutions for ECs(Chic Group Ltd. Poland) were examined. Three solutions contained a mixture ofpropylene glycol and glycerin (Volish brand) as a solvent for nicotine, while theother three contained only propylene glycol (Mild brand). Thirtypuffs were takenusing an automatic smoking machine. Mainstream smoke was generated froma3R4F reference tobacco cigarette. CCs were extracted from vapor and smoke tosolid phase with 2,4-dinitrophenylhydrazine, and analyzed using HPLC/DAD. VOCswere absorbed on activated carbon and analyzed with GC/MS. Results:Traces ofacetaldehyde were detected in al examined EC solutions(0.081±0.042 μg/mL).
Acetaldehyde was found in al EC vapors (0.153±0.116 μg/30 puffs), but at levelsmore than a thousand-fold lower than in tobacco smoke. Formaldehyde and acroleinwere only found in vapors generated from glycerin-based solutions (0.116±0.022and0.110±0.190μg/30 puffs) and in tobacco smoke (12 and 32-fold higher levels,respectively).None of the examined VOCs were detected in the vapors, while alwere found in tobacco smoke. Conclusions: In contrast to tobacco smoke, thevapors generated from ECs does not contain VOCs. Exposure to CCs from ECs issignificantly reduced compared to tobacco smoke and may be attributable to theglycerin content in the nicotine refil solution.
The study was supported by research funds received from Chic Group LTD,manufacturer of electronic cigarettes in Poland, and paid to the Institute ofOccupational Medicine and Environmental Health.
CORRESPONDING AUTHOR: Andrzej Sobczak, PhD, Head of Department,Institute of Occupational Medicine and Environmental Health, Chemical Hazardsand Genetic Toxicology, Koscielna 13, Sosnowiec, 41-200, Poland, Phone:+4832266088, Fax: +48322661124, Email: POS4-70
Randolph C. Grace, Ph.D.1, Aimee Richardson, B.Sc.(Hons)1, Donna Ritchie,
B.A.1, Murray Laugesen, FNZCPHM*2, Bronwyn Kivel , Ph.D.3, and Nathan
Cowie, M.P.H.4, 1University of Canterbury NZ; 2Health New Zealand Ltd; 3Victoria
University of Wel ington; 4University of Auckland
BACKGROUND: Nicotine electronic cigarettes (NECs) were illegal to sel
or advertise in New Zealand during 2012, where 17% of adults smoke tobacco
cigarettes daily. METHODS: Smokers age 18 and over who purchased their own
cigarettes were recruited on worksites and by newspaper publicity; 343 were
interviewed face to face in four cities and rewarded with a voucher for $15 (NZ$; 1
NZ$ = 0.85 USD) and a chance to win an electronic tablet. Participants completed
the Cigarette Purchase Task (CPT; MacKillop et al., 2008) in which they reported
how many cigarettes per day they would smoke at various price points. Then they
sampled an NEC and rated preference for it against their own brand on a 10-point
scale. The NEC used was SafeCig 18mg (SafeCig LLC. Los Angeles), notional y
priced at $5 per day. RESULTS: Participants smoked a mean 14.9 cigarettes per
day (cpd) and spent $8.72 daily on cigarettes, 33% paying $0.38 per rol -your-own
(RYO) tobacco cigarette, 67% paying $0.72 per factory-made (FM) cigarette. After
3 puffs from the NEC, smokers liked it 83% as much as their own brand: average
preference ratings for NEC and own brand were 6.26 and 7.51, respectively. If
cigarettes cost $0.70 each, smokers estimated they would smoke 14.5 cpd, but
only 7.08 cpd if they could buy NECs (t[312] = 15.39, p < .001). Using NECs,
31.6% said they would quit smoking their own brand completely. If cigarette pricedoubled to $1.40, 59.5% of smokers estimated they would quit, and a further11.1% would quit by using NECs if NECs were on sale. Those continuing to smokeat this price would smoke 10.63 cpd; but if NECs were on sale, would smoke 6.34cpd (t[125] = 4.29, p < .001). CONCLUSIONS: If cigarettes cost $0.70 each (20%above the mean 2012 price), and NECs cost 36% of this ($5 a day), three in tensmokers would use NECs to switch off tobacco smoking entirely. If the price ofcigarettes doubled, price would be the main motivator of quitting, but even moreintended to quit if NECs were on sale. Most smokers liked the NEC and given itsprice advantage, especial y as tobacco excise increases, many would switch toNECs and stop smoking tobacco, if NECs were available.
Funding: End Smoking NZ from Canterbury Community Trust; Univ. ofCanterbury, Tobacco Control Research Turanga Fund, University of Auckland.
CORRESPONDING AUTHOR: Murray Laugesen, FNZCPHM, Public HealthMedicine Specialist, Health New Zealand Ltd, 36 Winchester St Lyttelton,Christchurch, 8082, New Zealand, Phone: +64 3 3288 688, Email: hnz@healthnz. POS4-165
Nathan Cobb*, Jody Brookover, and Caroline O. Cobb, Schroeder Institute for
Tobacco Research and Policy Studies, Legacy, Washington, DC
INTRODUCTION: Marketing of electronic cigarettes (e-cigs) by making
therapeutic claims remains il egal in the US. We sought to describe complex
networks of online e-cig marketing and to examine the connections between online
advertisers of e-cig products (“affiliates”) and companies that sel the devices
(“sellers”). METHODS: To identify online e-cig sel ers, four keywords were entered
into Google search and the first two pages of results were examined. Eligible
webpages were archived and coded by two researchers. Coding included age
verification, sale of nicotine liquid, therapeutic claims, health or toxicant exposure
claims, and availability of an affiliate program. To examine the relationships
between affiliates and sel ers we manual y identified three forms of marketing:
SMS/text message, email-based, and banner advertisements. The forensic web
proxy software Charles, was used to log an entire browsing session including
identifiable objects (eg webpages, source files, servers) and their ties to each
other via links, redirection or shared physical resources. The network analysis
software ORA was used to graphical y examine the relationship between affiliates
and sel ers. RESULTS: 20 unique e-cig sel ers were identified. 6 used an age
verification mechanism, al sold nicotine liquid, 4 made explicit therapeutic claims,
11 made health/toxicant exposure claims, and 12 offered an affiliate program.
Forensic analysis of 4 ads revealed a multi-level relationship between consumers
who received advertising and the sel er, with logs demonstrating multiple layers of
redirection. Textual analysis of advertising by these marketers, but not their linked
sel ers, included both misleading health and therapeutic claims. DISCUSSION:
Misleading marketing claims are present on both affiliate advertisements and the
websites of some e-cig sel ers. Forensic analysis demonstrates that e-cig sel ers
also may be using a shadow network to distance potential y illegal marketing efforts
from legal sales. These mechanisms, often used to market other unregulated
health products, may attenuate efforts to regulate the health claims of nicotine
based products.
No funding.
CORRESPONDING AUTHOR: Caroline Cobb, Ph.D., Postdoctoral fel ow, Legacy,
Schroeder Institute for Tobacco Research and Policy Studies, 1724 Massachusetts
Avenue NW, Washington, DC 20036, United States, Phone: 2024545917, Email:


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