Introducing a special issue of rapid research on disposable e-cigarettes

Abstract

Much has been written about e-cigarettes since they first started to become popular early in the 2010s. A PubMed search returns over 10 000 articles including the terms ‘e-cigarettes’ or ‘vaping’. Research has established that e-cigarettes are less harmful than cigarettes, effective for smoking cessation and were initially primarily used by people who had smoked cigarettes [1-4]. Since approximately 2021, new forms of disposable e-cigarettes rapidly became popular in many countries [5-12], including among never smokers, particularly adolescents and young adults [3-7]. These devices typically deliver nicotine more effectively than older types, are sold cheaply and are widely available (as opposed to only being sold in specialist vape shops).

This rapid growth in the availability and use of disposable e-cigarettes in many countries raises important new research questions. In outlining our call for research on disposable e-cigarettes, we sought submissions that assessed the harms of, and addiction to, new disposable devices; sought to understand their appeal, marketing and harm perceptions; evaluated effectiveness for reducing cigarette cravings, supporting quit attempts and smoking cessation; described the epidemiology of use, including prevalence by key subgroups, the profile of users over time, and characteristics relating to use; estimated the extent to which use is displacing smoking or use of other e-cigarettes; modelled the impact at a population-level under varying assumptions and policy or regulation scenarios; or estimated the environmental impact of the products [13].

Since our call, the world has already moved on with many governments acting to address the rapid growth in uptake of disposable e-cigarettes, with new regulations specific to the new devices. For example, the United Kingdom (UK) has announced the sale of disposables e-cigarettes will be banned from June 2025 (under environmental legislation). From January 2024, the importation of disposable vapes was prohibited in Australia [14], with a number of other countries implementing or considering similar measures. Rapid research to inform regulatory approaches is urgently required.

We received a number of high-quality submissions and are publishing 16 reports with three commentaries in this special issue, which we have grouped into the following themes: use and appeal of disposables in youth and young adults; the characteristics of disposables; and prevalence trends and harms.

On the topic of youth and young adults, Hammond et al. [15] documented an increase in the use of disposables from around 2020 to 2023 across Canada, England and the United States (US) among 19 710 16 to 19 year-olds who had vaped in the past 30 days, using data from the invaluable international tobacco control (ITC) project collected between 2017 and 2023. The study made it clear that although all three countries reported similar shifts to disposable devices among youth who vaped, the increases appeared to be driven by different brands at different times in each country. East et al. [16] also used ITC data to examine use and reasons for use among 1355 16 to 29 year-olds in England in 2022. This study established the most popular brand was Elf Bar, being used by approximately half those who vaped in England, and mainly chosen for subjective responses such as the flavour/taste, rather than for quitting smoking. Azagba et al. [17] analysed the 2022 US National Youth Tobacco Survey (NYTS) of 14 389 high school students in grades 9 to 12, and found that compared with non-use, use of disposables was more common among those who were female, older and/or identified as gay, lesbian or bisexual and those who smoked less frequently. Mattingly et al. [18] also used the NYTS, but focused only on the 4137 youth who vaped, and included both middle and high school students (9–18 years old) from 2021 and 2022. In this sample, older age, non-Hispanic Black race/ethnicity, nicotine vaping and flavoured e-cigarette use were associated with mainly using disposable e-cigarettes relative to other e-cigarette types. Chen-Sankey et al. [19] reported findings from a laboratory study that examined visual attention to 14 different marketing features of 32 social media posts for disposable e-cigarettes among 72 non-tobacco using and 42 cigarette smoking youth (18–29 years old). Viewing these post images, youth were particularly visually engaged by information about the social media account (e.g. account profile pictures, hashtags), product descriptions and by marketing features that enhanced the products' personal relatability. Positive perceptions of disposable e-cigarettes were associated with engagement with the product package features. Among youth who smoked, positive perceptions of disposables were associated with a fruit/candy descriptor and price promotion. In a convenience sample of 1313 young (15–24 years old) US users of disposable e-cigarettes, Donovan et al. [20] reported that approximately half threw their disposables into the regular trash/rubbish, at an average of around three devices per month, raising safety and environmental concerns. Notley et al. [21] qualitatively explored 29 young people's (16–20 years old) experiences and use of disposable vapes in the United Kingdom. The authors found disposable vapes were attractive, accessible and normalized in this population, despite being seen as potentially damaging to health. Further, the act of vaping and smoking were engaged in interchangeably. In this context, the authors raised the concern that strict regulation on e-cigarettes may risk the unintended consequence of prompting a switch from vaping to smoking.

On the subject of the characteristics of disposables, Jackson et al. [22] reported on trends in nicotine strength used in e-liquids among a sample of 7314 vapers (≥18 years old) who completed the nationally representative Smoking Toolkit Study (STS) in England between 2016 and 2024. Use of high-strength (≥20 mg/mL) nicotine e-liquids in England increased sharply from approximately 4% in 2021 to approximately 33% in 2024. This coincided with when disposables became popular and the rise was most pronounced among those using disposable e-cigarettes, those 18 to 24 years and across all smoking statuses (including never smokers) except long-term (≥1 year) ex-smokers. Nottage et al. [23] performed a content analysis of the packaging of popular disposable vapes and e-liquid bottles in brick-and-mortar and on-line shops in England, Canada and the United States. They found popular disposable vapes and e-liquid bottles had varying compliance with local packaging regulations and inconsistent labelling of nicotine and product characteristics. In response to the use of colourful designs, evocative descriptors and appealing graphics to promote flavours, the authors called for improved packaging regulation and enforcement. Ma et al. [24] identified key characteristics of 2320 unique on-line disposable e-cigarettes and estimated associations with pricing and consumer preferences, scraped from the websites of five US on-line vape shops. Consumers appeared to prefer disposable e-cigarettes with lower capacity batteries, high nicotine concentrations, no synthetic nicotine and fruit/sweet flavours. Disposables with greater volume were also associated with lower standardized price. Leigh et al. [25] compared the differences in nicotine content and form, aerosol emissions and flavouring chemicals in a convenience sample of eight US and UK Elfbar disposable e-cigarettes with the same flavour labels. Likely reflecting different national regulatory requirements, the authors reported that people using Elfbar sold in the United States were estimated to receive a dose of nicotine delivered per puff four times higher from than for the UK Elfbar. Keller-Hamilton et al. [26] reported a human laboratory assessment of nicotine delivery, vaping topography and subjective effects of usual brand electronic cigarette use among 96 youth (18–25 years old) in the United States. Nearly half of participants used disposable e-cigarettes, and the e-cigarettes used delivered large quantities of nicotine (similar to cigarettes), significantly relieved withdrawal symptoms and were appealing.

For the theme of prevalence trends and harms, East et al. [27] assessed an on-line convenience sample to examine the features and types of vaping products that 494 adults in the United Kingdom, who currently smoked and/or vaped at least monthly, believed could negatively impact their health. Higher nicotine concentrations, more e-liquid consumed and salt (vs. freebase) nicotine were most commonly perceived by participants to increase the health harms of vaping. Disposables were perceived as slightly more harmful than reusable devices. Jackson et al. [28] reported on the source of purchase among a sample of 6507 adult (≥18 years old) current vapers (daily or non-daily) collected by the STS in England between 2016 and 2023. They found that supermarkets and convenience stores superseded vape shops as the primary source of purchase of e-cigarettes from approximately 2021 onward. This change appeared to be driven by the rising popularity of disposable e-cigarettes among younger adults, who tended to buy disposables from supermarkets/convenience stores. Craft et al. [29] aimed to detect and quantify synthetic cannabinoids in seven illicitly sourced disposable vape samples that were sold as cannabis products in the United Kingdom and closely resembled legal, regulated nicotine-based disposable products. These products were obtained from a single individual presenting to a drug and alcohol service in the United Kingdom. The authors detected a synthetic cannabinoid (SC 5F-MDMB-PICA) in all seven vapes. Klosterhalfen et al. [30] reported on prevalence trends in the use of different types of e-cigarettes in people 14 years old and over in Germany, collected by the nationally representative DEBRA study between 2016 and 2023. The use of e-cigarettes increased over this time period, especially disposables. The timing of the observed shift was similar to that seen in the United Kingdom and United States, but started from a lower baseline, increasing from 0.1% to 0.8%. Users of disposable vapes were also younger than users of other types of e-cigarettes. However, the overall vaping prevalence in Germany (2.2% in 2023) remained much lower than the prevalence of tobacco smoking (~30%).

In summary, this special issue pulls together a collection of cutting-edge research reports on key topics relating to the rapid growth in the use of disposable e-cigarettes. There remain important research gaps on comparative harms and addiction; comparative effectiveness for smoking cessation and long-term relapse prevention; and observed or modelled estimates on the extent to which use of disposable vapes is displacing smoking in different national and regulatory contexts. In those countries banning disposables, or planning to, a key future challenge will be how to define and regulate new products that circumvent such legislation [31] by becoming technically reusable whilst retaining other key product features and branding, and may still be treated as disposable in practice (i.e. ‘reusable disposables’).

J.B. has received (most recently in 2018) unrestricted funding to study smoking cessation from J&J and Pfizer, who manufacture medically licensed smoking cessation treatments. S.M.C. has no competing financial interests or personal relationships that could have appeared to influence this editorial. NW reports grants from the Health Research Council (HRC) of New Zealand (NZ) and the Australian National Health and Medical Research Council to undertake clinical trials on: 1) e-cigarettes for smoking cessation (e-cigarettes were purchased from e-cigarette retailers), 2) cytisine for smoking cessation (cytisine supplied at no cost by Achieve Life Sciences), and 3) NRT for smoking cessation (NRT supplied at no cost by the NZ Government via their contract with Novartis). NW is currently leading a HRC-funded vaping cessation trial where nicotine patches are supplied at no cost by the NZ Government via their contract with Haleon, and nicotine mouth spray is purchased from Kenvue).