The newest vape devices: disposable electronic cigarettes spread in Italy| Tabaccologia

Introduction

Electronic cigarettes (e-cigs), although marketed and promoted as “less harmful” or “safer” alternatives to conventional cigarettes, have been defined by the World Health Organization as undoubtedly harmful, due to the exposure to harmful and potentially harmful constituents and the toxic chemicals contained in their aerosols, including nicotine and substances that can cause cancer [1]. Regarding the effectiveness of e-cigs for smoking cessation, there is evidence that these products does not help smokers to quit; on the contrary, in a non-clinical setting, e-cig users are more likely to start (among never smokers) or relapse (among former smokers) smoking as compared to non-users [2].

E-cigs have undergone a rapid evolution in just a few years, evolving from cigarette-like disposable products (first generation) to cartridge systems (second generation), to tank systems (third generation), and finally to nicotine salt-based devices such as JUUL (fourth generation), which gained huge popularity among young users. Recently, new JUUL-like disposable e-cig devices have become popular, due to their wide range of flavors, attractive design and packaging, affordability, and ease of use [3, 4].

Unlike traditional nicotine e-cigs, which have a battery to be charged and a tank to be filled with e-liquid, and unlike refillable e-cigs with pre-filled cartridges, these new disposable e-cigs are pre-filled with e-liquid and are also equipped with a charged battery, thus they are ready to be used. Some types allow 400 or 600 puffs, some others 800 or 1200 puffs.

The first disposable e-cig was launched on the Italian market in 2021. Since then, new similar products have been marketed by different brands. The brands of disposable e-cigs available in the Italian market include Iwik, Dinner Lady, Elfbar, Geek Bar, Salt Switch, Eliquid France, Agebar, Lik Bar, X-Bar, Waka, Vaporart, and Puff Bar. Nowadays, there are more than 800 different types of disposable e-cigs in Italy, according to data from the Customs and Monopolies Agency, which differ by brand, flavor, and amount of nicotine [5].

Nicotine, S-Nicotine and R-nicotine

Disposable e-cigs, as often stated on the package itself, contain between 2% and 5% nicotine, either in the form of freebase nicotine or nicotine salts. In absolute terms, 2% nicotine (20 mg/ml) means that in a disposable e-cig filled with 2 ml of e-liquid there are 40 mg of nicotine. Therefore, by vaping a 600-puffs e-cig the user would absorb the same amount of nicotine as smoking the equivalent of approximately 40 conventional cigarettes. Some disposable e-cigs with higher e-liquid volume and nicotine concentration can even correspond to 160 conventional cigarettes.

The nicotine used in disposable e-cigs is not extracted from tobacco but is obtained by chemical synthesis using a process first developed by the disposable e-cigs company Puff Bar. The nicotine molecule exists in the form of two different spatial arrangements (called stereoisomers): S-nicotine and R-nicotine. Nicotine from tobacco leaves is 99% S-nicotine, while synthetic nicotine is 50% S-nicotine and 50% R-nicotine, with these values that can vary depending on the brand [6].

Currently, there is a knowledge gap regarding, in particular, three aspects of the nicotine contained in disposable e-cigs:

1. information on the composition of nicotine, whether natural or synthetic, is not reported on the package;
2. in the case of synthetic nicotine, the ratio between the two isomers is not stated;
3. the research has not yet clarified the effects on the body of varying the ratios of R-nicotine and S-nicotine.

Attractiveness to young people

Although disposable e-cigs, like regular e-cigs, should theoretically be directed to adult smokers who want to quit smoking, they turn out to be attractive to young people for a variety of reasons:

1. Ease of use – for a kid or an adolescent approaching nicotine, the possibility of having a ready-to-use product which does not need to be charged or refilled is appealing.
2. Discretion – kids may want to avoid drawing attention from parents or teachers when they are vaping, and this can be easily done with these products which look like markers, highlighters, or lip gloss. Moreover, unlike other vaping devices and conventional cigarettes, they produce minimal aerosol and no smell.
3. Affordable price – in Italy a 600-puff disposable e-cig costs approximately between €7 and €10, equivalent in terms of nicotine to two or three packs of conventional cigarettes, each of which costs €5 to €6.
4. Variety of flavors – these disposable devices also offer a wide array of flavors and nicotine intensities, including fruity and exotic options, appealing to kids with their cheerful and enjoyable taste experience.

Marketing, social media and influencers

In Italy the market of disposable e-cigs relies on the physical network of tobacco and e-cig stores, but also on digital distribution with a multitude of websites selling the products to anyone who claims to be of legal age (i.e., 18 years, in Italy). Contrary to conventional cigarettes packages, which remind the consumer of the dramatic outcomes of smoking, disposable e-cigs packaging features cheerful images and colors associated with nature and its fruits.

The e-cig industries early realized that the most successful promotion of their products is the one which becomes viral on social media. A study on the promotion of e-cigs in social media revealed that the majority of the contents represented e-cig use as positive (66% of YouTube videos and 87% of Instagram posts), while only a few represented them as negative (29% for YouTube, 1% for Instagram) [7]. Studies on Tik Tok contents revealed a Puff Bar culture mainly targeted at young users who in many cases are unaware of the health consequences of addiction, revealing that this kind of social media content has the potential to shape attitudes and intentions to use nicotine among TikTok’s very young user base [8,9].

Health and environmental risks

Disposable e-cigs, just like other e-cigs, are very popular among the very young, leading them into nicotine addiction, with the risk of a gateway effect that would bring them to switch to conventional cigarettes. Even if users do not switch to conventional tobacco products, there are still health consequences they can face by using disposable e-cigs. In fact, several studies found that these products contain harmful chemicals and metals documented to result in respiratory problems [10,11]. Moreover, no evidence is still available about the mid- to long-term effects of these products on human health.

Disposable e-cigs also pose a great threat to the environment because, after use, the plastic casing and lithium-ion battery composed of lithium, cobalt and nickel must be disposed of, producing pollution. In addition to their batteries and plastic, they generally contain harmful chemical compounds that can leak into the environment and pose a biohazard [12]. In Italy, between January and April 2023, over 31.9 million ml of liquid were sold in disposable e-cigs, equating to approximately 16 million devices sold in just four months, most of which were probably disposed of improperly [13]. The issue of disposable e-cigs being improperly discarded into either general waste or plastic recycling is a matter of substantial significance. If disposed of with general waste, these devices end up in incinerators or landfills, introducing hazardous substances and heavy metals into the environment. If mistakenly placed in plastic recycling, they can contaminate the plastic recycling process, posing a significant environmental concern.

Regulation

In European Union countries, Article 20 of the Tobacco Products Directive (2014/40/EU) establishes rules for e-cigs. The Directive sets various safety and quality criteria for e-cigs, such as maximum nicotine concentration and volume for liquids. In addition, mandatory health warnings must alert consumers that the product contains nicotine and should not be used by non-smokers.

In Italy, Article 21 of Legislative Decree No. 6 of 2016 regulates the pre-sale control of e-cigs, advertising bans, consumer information, prohibition of sales to minors, web-based and cross-border sales, prohibitions on vaping in schools and other educational facilities, tax-advantaged regime, and monitoring [14].

The European and Italian legislators did not foresee the rapid development of e-cigs, which through four different generations of products have evolved to disposables. This makes this regulatory framework insufficient for a phenomenon that has gotten out of hand.

Conclusions

To date, the scientific literature on disposable e-cigs remains limited, particularly concerning their health effects and their public health implications, since they are products which have been only recently introduced in the market. The scarcity of knowledge on this topic underscores an urgent need for more independent and comprehensive studies to shed light on the safety and efficacy of these products [15]. Until scientific evidence is available, it is crucial to implement stricter and more targeted national and European regulations, in particular to disincentivize the use of disposable e-cigs among the young population through measures such as banning flavors and imposing stricter controls on targeted advertising and marketing, in particular on social media.

References

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