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BackgroundAs user modification can alter the addictiveness and toxicity of electronic nicotine delivery systems (ENDS), more research is needed to understand the types, motivations, risks, and information sources that lead to these product alterations. YouTube has been identified as a major platform where ENDS users obtain and share information about ENDS products and modifications. However, a comprehensive study of ENDS modification videos on YouTube is lacking. ObjectiveThis study aimed to analyze the content of YouTube videos depicting modifications of ENDS. MethodsYouTube was searched in March 2019 to identify videos depicting ENDS modifications. Search terms were derived from interviews with ENDS users and current literature. We used 28 search phrases that combined the words vape and vaping with modification-related key terms (eg, custom build, modification, and dripping). The final sample included 168 videos. ResultsVideos were 1 to 108 min long (median 9.55). Presenters were largely male (117/168, 69.6%), white (94/168, 56.0%), and older than 25 years (94/168, 56.0%). Most videos gave how to instructions (148/168, 88.1%), but few offered warnings (30/168, 17.9%) or mentioned commercial alternatives to modifications they presented (16/168, 9.5%). The ENDS devices most often featured were drippers (63/168, 37.5%) and refillable tanks (37/168, 22.0%). The most often modified ENDS components were coils (82/168, 48.8%) and e-liquids (34/168, 20.2%), which included adding other substances, such as cannabis, to the e-liquids (6/168, 3.6%). Most videos portrayed ENDS modifications positively (106/168, 63.1% positive; 60/168, 35.7% neutral; and 2/168, 1.2% negative) and were either neutral or positive in their overall portrayal of ENDS devices (78/168, 46.4% positive; 89/168, 53.0% neutral; and 1/168, 0.6% negative). ConclusionsThis study identified several concerning trends in popular YouTube videos on ENDS modifications, including lack of warnings, the addition of marijuana derivatives to e-liquids, and the positive portrayal of ENDS devices and modifications. By identifying the types of modifications (coil and e-liquid being the most prevalent), this study sets an agenda for research on the effects of modifications.

BackgroundWith 15.6 million smokers, Vietnam is one of the top 10 largest cigarette-consuming countries in the world. Unfortunately, smoking cessation programs are still scarce in Vietnam. Mindfulness-based and text messaging–based interventions have been increasingly used in smoking cessation studies in developed countries, with promising results. Given the exponential growth of mobile phone usage in Vietnam in recent years, mobile health interventions could be a potential strategy to increase smoking cessation in Vietnam. However, substantial cultural adaptations are needed to optimize the effectiveness of these interventions among Vietnamese smokers. ObjectiveThis study aims to involve qualitative research to inform the development of a mindfulness-based text messaging smoking cessation intervention for Vietnamese smokers. MethodsA total of 10 focus groups were conducted with 71 Vietnamese male smokers aged between 18 and 65 years (5-9 participants per focus group). Overall, 5 focus groups were conducted with smokers who had the intention to quit (ie, preparation stage of change in the transtheoretical model), and 5 focus groups were conducted with smokers who did not have the intention to quit (contemplation or precontemplation stage). The focus groups were audio recorded, transcribed verbatim, and analyzed using NVivo 12 software (QSR International). ResultsThe major themes included smoking triggers, barriers and facilitators for quitting, the perceptions of text messaging and mindfulness approaches for smoking cessation, and suggestions for the development of a text messaging–based smoking cessation program. Common smoking triggers included stress, difficulties concentrating, and fatigue. Frequently encountering other people who were smoking was a common barrier to quitting. However, participants indicated that concerns about the harmful effects of smoking on themselves and their wives and children, and encouragement from family members could motivate them to quit. The participants preferred diverse message content, including information about the consequences of smoking, encouragement to quit, and tips to cope with cravings. They suggested that text messages be clear and concise and use familiar language. Most smokers perceived that mindfulness training could be useful for smoking cessation. However, some suggested that videos or in-person training may also be needed to supplement teaching mindfulness through text messages. ConclusionsThis study provides important insights to inform the development of a text messaging–based smoking cessation program that incorporates mindfulness for Vietnamese male smokers. The results could also be useful for informing similar programs in other low- and middle-income countries.

BackgroundThe video-sharing website, YouTube, has become an important avenue for product marketing, including tobacco products. It may also serve as an important medium for promoting electronic cigarettes, which have rapidly increased in popularity and are heavily marketed online. While a few studies have examined a limited subset of tobacco-related videos on YouTube, none has explored e-cigarette videos’ overall presence on the platform. ObjectiveTo quantify e-cigarette-related videos on YouTube, assess their content, and characterize levels of engagement with those videos. Understanding promotion and discussion of e-cigarettes on YouTube may help clarify the platform’s impact on consumer attitudes and behaviors and inform regulations. MethodsUsing an automated crawling procedure and keyword rules, e-cigarette-related videos posted on YouTube and their associated metadata were collected between July 1, 2012, and June 30, 2013. Metadata were analyzed to describe posting and viewing time trends, number of views, comments, and ratings. Metadata were content coded for mentions of health, safety, smoking cessation, promotional offers, Web addresses, product types, top-selling brands, or names of celebrity endorsers. ResultsAs of June 30, 2013, approximately 28,000 videos related to e-cigarettes were captured. Videos were posted by approximately 10,000 unique YouTube accounts, viewed more than 100 million times, rated over 380,000 times, and commented on more than 280,000 times. More than 2200 new videos were being uploaded every month by June 2013. The top 1% of most-viewed videos accounted for 44% of total views. Text fields for the majority of videos mentioned websites (70.11%); many referenced health (13.63%), safety (10.12%), smoking cessation (9.22%), or top e-cigarette brands (33.39%). The number of e-cigarette-related YouTube videos was projected to exceed 65,000 by the end of 2014, with approximately 190 million views. ConclusionsYouTube is a major information-sharing platform for electronic cigarettes. YouTube appears to be used unevenly for promotional purposes by e-cigarette brands, and our analyses indicated a high level of user engagement with a small subset of content. There is evidence that YouTube videos promote e-cigarettes as cigarette smoking cessation tools. Presence and reach of e-cigarette videos on YouTube warrants attention from public health professionals and policymakers.

Although numerous studies have examined the impact of cigarette prices on cigarette demand, research examining the impact of e-cigarette and cigarette prices on e-cigarette demand is relatively limited. This study estimated the impact of e-cigarette and cigarette prices on e-cigarette and cigarette sales in California. Using the 2012-2017 Nielsen Retail Scanner Data, we constructed e-cigarette prices, cigarette prices, and per capita e-cigarette and cigarette sales by year, quarter, and Nielsen scantrack market in California. E-cigarettes were categorized as disposable or reusable. Separate fixed-effects models estimated the impact of e-cigarette and cigarette prices on per capita disposable e-cigarette, reusable e-cigarette, and cigarette sales controlling for year, quarter, market, and smoke-free air law coverage. Average prices were $5.86 per pack of 20 cigarettes, $9.80 per disposable e-cigarette, and $19.11 per reusable e-cigarette. When prices of disposable e-cigarettes, reusable e-cigarettes, and cigarettes increased by 1%, per capita sales of the products decreased by 0.37%, 0.20%, and 0.21% respectively. Cigarette prices were positively associated with per capita sales of reusable e-cigarettes, indicating reusable e-cigarettes are substitutes for cigarettes. Reusable e-cigarette prices were positively associated with per capita sales of disposable e-cigarettes, indicating disposable e-cigarettes are substitutes for reusable e-cigarettes. No statistically significant association was found between disposable/reusable e-cigarette prices and cigarette sales. Our results suggest that raising prices of disposable e-cigarettes, reusable e-cigarettes, and cigarettes such as via tobacco excise tax increases would result in reduced sales for the products. Policymakers should consider the substitution between e-cigarettes and cigarettes when designing tobacco control policies.

ObjectivesIn this study, we used a discrete choice experiment (DCE) conducted August-October 2017 to examine electronic nicotine delivery systems (ENDS) product preferences in a national sample of adult smokers (N = 1154) who were also using ENDS or had not ruled out future use.MethodsThe DCE evaluated 5 ENDS attributes: relative harm; effectiveness for helping smokers quit; nicotine strength; flavor; and price. We asked participants to choose among their own cigarettes, 2 ENDS products whose attributes varied across tasks, or none. We analyzed ENDS preferences using multinomial, nested, and mixed logit regressions.ResultsSmokers preferred ENDS that are less harmful than cigarettes, are effective in helping smokers quit, are lower priced, and are not menthol-flavored. The marginal willingness to pay for an ENDS product was $8.40 when less harmful than cigarettes, $4.13 when of unknown effectiveness in helping quitting ($13.90 when effective), and $3.37 when ENDS are not menthol-flavored. Furthermore, the overall flavor preference is driven by tobacco smokers, not by menthol cigarette smokers who do prefer menthol-flavored ENDS.ConclusionsPolicies that affect perceptions of ENDS effectiveness in promoting cessation and their relative harm may alter smokers' ENDS preferences. Regulating flavors and price also may influence adult smokers' ENDS preference.

Purpose: To understand changes in purchasing behaviors and use of tobacco products such as e-cigarettes and cigarettes among different tobacco user groups during the COVID-19 pandemic using a mixed methods approach. Methods: A quantitative online survey was conducted in October-November 2020 using a national probability sample of US adults (N = 1,460) comprising exclusive cigarette smokers (n = 1,080), dual users of both cigarettes and e-cigarettes (n = 143), and exclusive e-cigarette users (n = 237). Simultaneously, ten online focus groups were conducted with 61 adults in the Atlanta, GA area including exclusive smokers (n = 16), current E-cigarette users (n = 22), and transitioning (recently quit or currently quitting) smokers and/or E-cigarette users (n = 23). Results: From the survey, dual users vs. exclusive smokers had higher odds of buying cheaper cigarette brands (adjusted odds ratio (aOR) 2.50, 95% confidence interval (CI) = 1.49, 4.20), buying cigarettes online (aOR = 2.79; 95% CI = 1.02, 7.69), buying from Indian Reservations (aOR = 3.99; 95% CI = 2.07, 7.69), buying fewer cigarettes than normal (aOR = 4.01; 95% CI = 2.42, 6.65) and buying other tobacco products (aOR = 4.44; 95% CI = 2.24, 8.79). From the focus groups, participants perceived reduced accessibility, fear of contracting COVID-19, rising prices, and convenience to influence their purchasing behaviors and tobacco use. Conclusions: Exclusive and dual users differed in their tobacco purchasing behaviors during the COVID-19 pandemic, such that dual users were more likely to change their purchasing behaviors (e.g., buying other tobacco products) than exclusive users. Educational campaigns and public health workers may promote interventions targeting dual users either to switch to reduced-risk products or quit smoking, particularly during stressful societal situations such as the COVID-19 pandemic. Implications: The findings inform public health educators and policymakers to develop policies and interventions carefully tailored for tobacco user groups targeting the perceived factors influencing purchasing behaviors during challenging situations affecting tobacco product availability. [ABSTRACT FROM AUTHOR]

Van der Waals (vdW) heterostructures comprising of transition metal dichalcogenides (TMDs) and hexagonal boron nitride (h‐BN) are promising building blocks for novel 2D devices. The vdW epitaxy provides a straightforward integration method for fabricating high‐quality TMDs/h‐BN vertical heterostructures. In this work, the vdW epitaxy of high‐quality single‐crystal HfSe2 on epitaxial h‐BN/sapphire substrates by chemical vapor deposition is demonstrated. The epitaxial HfSe2 layers exhibit a uniform and atomically sharp interface with the underlying h‐BN template, and the epitaxial relationship between HfSe2 and h‐BN/sapphire is determined to HfSe2 (0001)[12¯${\mathrm{\bar{2}}}$10]//h‐BN (0001)[11¯${\mathrm{\bar{1}}}$00]//sapphire (0001)[11¯${\mathrm{\bar{1}}}$00]. Impressively, the full width at half maximum of the rocking curve for the epitaxial HfSe2 layer on single‐crystal h‐BN is as narrow as 9.6 arcmin, indicating an extremely high degree of out‐plane orientation and high crystallinity. Benefitting from the high crystalline quality of HfSe2 epilayers and the weak interfacial scattering of HfSe2/h‐BN, the photodetector fabricated from the vdW epitaxial HfSe2 on single‐crystal h‐BN shows the best performance with an on/off ratio of 1 × 104 and a responsivity up to 43 mA W−1. Furthermore, the vdW epitaxy of other TMDs such as HfS2, ZrS2, and ZrSe2 is also experimentally demonstrated on single‐crystal h‐BN, suggesting the broad applicability of the h‐BN template for the vdW epitaxy. [ABSTRACT FROM AUTHOR]

ObjectiveSpending on cigarettes may deprive households of other items like food. The goal of this study was to examine the prevalence of and factors associated with this smoking-induced deprivation among adult smokers in China.MethodsThe data came from Waves 1-3 of the International Tobacco Control (ITC) China Survey, conducted from 2006 to 2009 among urban adults aged 18 years or older in China. We focus on the samples of current smokers from six cities (N=7981). Smoking-induced deprivation was measured with the survey question, "In the last six months, have you spent money on cigarettes that you knew would be better spent on household essentials like food?" We examined whether sociodemographic factors, smoking intensity and price paid per pack of cigarettes were associated with smoking-induced deprivation using generalised estimating equations modelling.Findings7.3% of smokers reported smoking-induced deprivation due to purchasing cigarettes. Low-income and middle-income smokers were more likely to have smoking-induced deprivation compared with high-income smokers (adjusted OR (AOR)=2.06, 95% CI 1.32 to 2.31; AOR=1.44, 95% CI 1.10 to 1.69); smokers living in Shenyang (AOR=1.68, 95% CI 1.25 to 2.24) and Yinchuan (AOR=2.50, 95% CI 1.89 to 3.32) were more likely to have smoking-induced deprivation compared with smokers living in Beijing. Retired smokers were less likely to have smoking-induced deprivation compared with employed smokers (AOR=0.67, 95% CI 0.52 to 0.87). There was no statistically significant relationship between smoking intensity, price paid per pack of cigarettes and smoking-induced deprivation.ConclusionsOur findings indicate that certain groups of smokers in China acknowledge spending money on cigarettes that could be better spent on household essentials. Tobacco control policies that reduce smoking in China may improve household living standards by reducing smoking-induced deprivation.

Emerging evidence suggests bisexual populations are at increased risk for a variety of negative health outcomes, including tobacco use. Lesbian, gay, and bisexual (LGB) populations are at increased risk for cigarette smoking, but research on LGB subpopulations' use of tobacco products beyond cigarettes and tobacco use differences across LGB subgroups is in its infancy. This study explores differences in use of tobacco products across LGB subgroups, including gender differences among bisexuals.This study reports results from a 2013 nationally-representative cross-sectional online survey of US adults (N = 17 087). Weighted tobacco use prevalence and adjusted logistic regression results are reported.LGB populations reported higher current use of any tobacco product (35.7%) and current use of cigarettes (32.0%), e-cigarettes (8.9%), regular (5.5%) and small cigars (11.6%), compared with non-LGB. Bisexual (odds ratio [OR] = 2.6, 95% confidence interval [CI]: 1.7-3.9) and lesbian (OR = 1.7, 95% CI: 1.0-2.7) women have higher odds of any tobacco use than heterosexual women; including greater odds of regular (OR = 2.9, 95% CI: 1.2-7.0 and OR = 2.2, 95% CI: 1.3-3.9; respectively) and small cigar use (OR = 2.4, 95% CI: 1.4-4.1 and OR = 3.2, 95% CI: 2.0-5.1; respectively). Gay men had lower odds of cigar use (OR = 0.4, 95% CI: 0.2-0.8) than heterosexual men.This is the first US adult population study to assess differences in use of various tobacco products across adult LGB subpopulations and by gender, confirming their increased risk of use and illuminating differences by subgroup and gender. Exploring LGB as a unified population appears inadequate to accurately characterize LGB tobacco use risk. Tobacco-related LGB health inequities, particularly among bisexual and lesbian women, may be greater than previously indicated.This manuscript provides important contributions to the field of tobacco control and prevention, and more specifically to LGB tobacco-related health disparities research. This is among the first population level studies to explore various tobacco use across LGB populations and across genders, comparing results to non-LGB populations in a national study. We provide novel evidence that bisexual women in particular, have a higher risk for use of various tobacco products, compared with other LGB subpopulations. In order to address this disparity, tobacco control professionals need to be made aware of these important differences in tobacco use behavior.

ObjectiveThe availability of cigarettes from cheaper sources constitutes a major challenge to public health throughout the world, including China, because it may counteract price-based tobacco control policies. The goal of this study was to identify factors associated with purchasing cigarettes from cheaper sources among adult smokers in China.MethodsData were analysed from Waves 1 to 3 of the International Tobacco Control China Survey conducted in 2006-2009 among adult smokers in six cities in China (N=7980). One survey question asked, "In the last 6 months, have you purchased cheaper cigarettes than you can get from local stores for economic reasons?" We examined whether sociodemographic factors and smoking intensity were associated with purchasing cigarettes from cheaper sources using the general estimating equations model. Sociodemographic factors considered were gender, age, marital status, monthly household income, education, employment status and city of residence.Results15.6% of smokers reported purchasing cigarettes from cheaper sources. After controlling for other covariates, the associations of the behaviour of purchasing cigarettes from cheaper sources with age (adjusted OR (AOR)=1.49, 95% CI 1.17 to 3.92 for age 18-24 compared with age 55+) and with income (AOR=2.93, 95% CI 2.27 to 3.79 for low income compared with high income) were statistically significant, but there was no statistically significant relationship with smoking intensity.ConclusionsOur findings indicate that young and low-income smokers are more likely than older and high-income smokers to purchase cigarettes from cheaper sources in China. Tobacco control policies that reduce the availability of cigarettes from cheaper sources could have an impact on reducing cigarette consumption among young and low-income smokers in China.