Tracking the Rise of Electronic Nicotine Delivery Systems

Background: Public interest in electric cigarettes (ENDS) is undocumented.

Purpose: By monitoring search queries, ENDS popularity and correlates of their popularity wereassessed in Australia, Canada, the United Kingdom (UK), and the U.S.

Methods: English-language Google searches conducted from January 2008 through September 2010 were compared to snus, nicotine replacement therapy (NRT), and Chantix® or Champix®.Searches for each week were scaled to the highest weekly search proportion (100), with lower values indicating the relative search proportion compared to the highest-proportion week (e.g., 5050% of the highest observed proportion). Analyses were performed in 2010.

Results: From July 2008 through February 2010, ENDS searches increased in all nations studied except Australia, there an increase occurred more recently. By September 2010, ENDS searches were several-hundred-fold greater than searches for smoking alternatives in the UK and U.S., and wererivaling alternatives in Australia and Canada. Across nations, e-cigarette searches were highest in theU.S., followed by similar search intensity in Canada and the UK, with Australia having the fewest ENDS searches. Stronger tobacco control, created by clean indoor air laws, cigarette taxes, and anti-smoking populations, were associated with consistently higher levels of ENDS searches.

Conclusions: The online popularity of ENDS has surpassed that of snus and NRTs, which havebeen on the market for far longer, and is quickly outpacing Chantix or Champix. In part, the association between ENDS’s popularity and stronger tobacco control suggests e-cigarettes are used to bypass, or quit in response to, smoking restrictions. Search query surveillance is a valuable, real-time,free, and public method to evaluate the diffusion of new health products. This method may begeneralized to other behavioral, biological, informational, or psychological outcomes manifested onsearch engines.

Electronic nicotine delivery systems (ENDS), or“electronic cigarettes,” consist of a plastic tube, electronic heating element, and liquid nicotine cartridge. When activated, the heating element vaporizes the liquid nicotine, and the steam is absorbed orally.ENDS do not always resemble cigarettes, and flavorsrange from bubblegum to tobacco. ENDS are an adaptation to the health, legal, and social consequences of smoking. ENDS are promoted as a safer, fashionable, and tech-savvy alternative that are Smokefree and can be“smoked anywhere”—so smokers need not curtail their habit.

In an August 2009 Zogby poll, almost half of U.S. adults believed ENDS should be an available cessation option. A study group of smokers preferred ENDS to an inhaler for cessation. Among smoking alternatives, e-cigs have likely received the greatest advocacy, policy, and media attention and the popularity of ENDS remains unmatched. Because ENDS are promoted online, search queries are auseful signal of their popularity. It was hypothesized ENDS searches would be greater in the context of stronger tobacco control, because ENDS may be used for cessation in the face of, or circumvention of, tobacco control.

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