Puffs: a risk of pediatric epidemic

Disposable electronic cigarettes (Puffs Bar type, from the brands Wpuff, Ma petite vape, Flawoor or VazeJet in France) are compact, ready-to-use and pre-filled vaping devices that can contain up to 20 mg/ml (2%) of nicotine salts. Some brands, produced outside the European Union but sold in France, can contain up to 50 mg/ml (5%). They deliver between 600 (or about two packs of cigarettes) and 2000 puffs per device and are thrown away once used up. These electronic cigarettes are sold at an attractive price (between €6 and €10 depending on the brand) and are available in many points of sale and in several dozen fruity and sweet flavors.

History : Electronic cigarettes first appeared around 2007 and have evolved several times since then. Older versions were designed to look like regular cigarettes, or had tanks that were often heavy and bulky. The most recent generations feature a system of pre-filled pods (such as JUUL or Vuse) containing nicotine salts and have quickly established themselves as flagship vaping products. These products with pre-filled pods arrived in France in the 2015s and their markets are evolving rapidly.

More recently, disposable e-cigarettes have entered the market, first in the United States in 2019 under the brand name "Puff bar" and then in France in 2021 under the brand name "Wpuff" mainly. Although pre-filled pods or cartridges remain the most popular type of device, the use of disposable e-cigarettes is rapidly gaining popularity among younger people, driven by social networks and very easily accessible outside of the usual distribution channels.

Products subject to the same regulations as other vaping products

In France, as vaping products, disposable devices such as “puffs” are required to meet the regulatory obligations associated with these products.[1] :

• Notification of products before their placing on the market to the competent authorities;
• Nicotine level less than 20mg/ml;
• Labeling with the affixing of a health warning;
• Prohibition of direct or indirect advertising and promotion with a very limited exception regarding the place of sale;
• Prohibition on sale to minors.

Any manufacturer of vaping products must submit, at least 6 months before placing on the market[2], a notification file for placing on the market by brand and by type of product to the French Agency for Food, Environmental and Occupational Health Safety (ANSES). As indicated on the website of the Ministry of Health, although some national and foreign manufacturers have fulfilled the obligation to notify their products intended for the French market, other products, not notified to the French authorities, are also accessible to the public, in particular via the Internet. Some of these products have nicotine levels higher than the level authorized for this type of product or have health messages that are not in French.

According to Article 1 of the decree of 19 May 2016 relating to the procedures for registering health warnings on the packaging units of tobacco products, vaping products, herbal smoking products other than tobacco and cigarette rolling papers: “Each packaging unit and any external packaging of tobacco products, vaping products, herbal smoking products other than tobacco and cigarette rolling papers shall bear the health warnings provided for in this decree. These warnings shall be in French.”

Figure 1 - Disposable electronic cigarette sold in a Parisian tobacconist in non-compliant packaging

There European Tobacco Products Directive has put forward several regulatory requirements for vaping products, including the nicotine level which must not exceed 20 mg/ml or 2% "Member States of the European Union shall ensure that nicotine liquid does not contain nicotine in excess of 20 mg/ml" - Article 20 DPT.

In France and Europe, vaping products containing more than 20 mg/ml of nicotine belong to the category of pharmaceutical products. Consequently, they are subject to a marketing authorization application (MAA).

However, there are many accounts on social networks or websites that offer disposable electronic cigarettes containing a very high level of nicotine (around 50 mg/ml).

Figure 2 - Screenshot of an account selling puffs containing 50 mg/ml nicotine

Last May, in Ireland, The Health Service Executive's National Tobacco Control Office issued RAPEX alerts to Safety Gate (the European Union's rapid alert system for dangerous non-food products) after discovering that some disposable e-cigarettes contained up to 50mg/ml (5%) of nicotine. These e-cigarettes were sold in packs that stated a nicotine concentration of 20mg/ml (2%).

In March, Swiss Association for the Prevention of Smoking (AT Suisse) had also alerted the Swiss federal authorities about the online sale of puffs containing nicotine concentrations well above the ceiling authorized by the regulations. The association had indicated that it had identified a website selling Puff Bars with a concentration of up to 60 milligrams, three times above the authorized ceiling, which itself already corresponds to a very strong dosage.

Rapid risk of nicotine addiction with puffs

In addition to the high nicotine levels, the very way in which these products are consumed facilitates nicotine addiction, especially among young people. Ready to use, requiring no prior refill or preparation, the product can be used straight away and the user does not realize how much they are actually consuming.

However, nicotine addiction develops much more quickly in adolescents and the consequences of exposing the brain to nicotine are particularly harmful at a time when brain maturity has not been reached. For Professor Yves Martinet, pulmonologist and president of the National Committee against Smoking, " Puffs are a new gateway to nicotine. The flavors help attract young people and the high nicotine level helps keep them loyal. " He specifies that " Nicotine is a hard drug and once you are addicted to it, it is hard to quit.. Consuming these puffs means getting more quickly into nicotine addiction and moving on to consuming even more dangerous products. ".

Additionally, these types of devices use nicotine salts that make the products easier to use. According to a 2018 Surgeon General's advisory on youth e-cigarette use, nicotine salt technology allows users to inhale high levels of nicotine more easily and with less irritation than products that use freebase nicotine.

Teenagers: Targets of the marketing of these products

These disposable electronic cigarettes come in around fifteen sweet or fruity flavors (marshmallow, iced grape, ice cream mango, choco hazelnut, etc.) in colorful and attractive packaging, reminiscent of the candy packaging that is very popular with minors and young adults. These products often resemble the JUUL electronic cigarette in terms of aesthetics, comparable to a USB key, and a design that refers to new technologies. They have quickly gained popularity among teenagers, propelled by social networks, particularly TikTok, Snapchat or Instagram. Influencers, through videos, praise the ease of use of these cigarettes as well as the multitude of flavors available, creating a fashion effect in middle and high schools. These products are often presented in equally attractive packaging, reminiscent of certain famous candies and which use these flavors.

By using a graphic charter, a logo, visual symbols, a font and very specific colors, the packaging allows to quickly recognize the brand and to build consumer loyalty. Some brands, like the tobacco industry, release limited editions of their products in order to encourage customers to collect products.

Figure 3 - Limited edition of the disposable electronic cigarette "wpuff" from the French manufacturer Liquidéo

These packages are also designed to reduce the effectiveness of health warnings and mislead consumers. For example, based on the colours and elements of the package that associate e-cigarettes with confectionery, consumers believe that some brands are less harmful than others.

These products are also available without nicotine. The "0 nicotine" is a marketing argument from manufacturers who indicate that consuming these products that do not contain nicotine is not harmful and that there is no risk of addiction. Some manufacturers do not hesitate to "reassure" potential customers wondering if these products are dangerous, indicating "If you take the ones with 0% nicotine, there is no risk."

Figure 4 - Screenshot of the official TikTok account of the wpuff manufacturer - Liquidéo

In reality, nicotine-free liquids lead young people to find vaping normal. This trivialization of the act is likely to facilitate the next step, which is experimenting with the product with nicotine, with the risk of becoming dependent. This offer of products thus makes young people enter into a consumption "pattern".

Many promotions are also set up for these products, both online and at points of sale. Manufacturers offer decreasing prices (One puff for €7.90, three for €20 for example), or products offered from a certain quantity purchased (One free puff for three purchased). This type of promotion, illicit, is particularly intended for a young audience receptive to promotions.

Figure 5 - Advertisements present in a Parisian tobacco shop

Some associations, including the National Committee Against Smoking (CNCT), denounce the aggressive marketing of puff manufacturers who do not respect the ban on advertising for vaping products at points of sale. The CNCT recalls that in terms of advertising, the prevailing principle is that of a general ban on all advertising and promotion in favor of vaping products. According to the public health code " Only posters relating to electronic cigarettes and their refill bottles, not visible from the outside, are authorized inside the places of sale. ".

A diversification of sales locations accessible to minors

According to the latest " Point-of-sale advertising barometer » of the CNCT, which visits a panel of points of sale in France every month, these disposable electronic cigarettes have invaded many points of sale and raise the question of compliance with protective prohibitions such as the "strict supervision of advertising at the point of sale and the ban on sales to minors". According to the association, which visited more than 80 points of sale in the second quarter of 2022, the sale of one or more brands of puff was noted in 70% of the points of sale visited. Although they are mainly sold in tobacco shops and specialist vaping product stores, the retail sale of these products is also growing rapidly. They can be found, for example, in Parisian kiosks and large retail chains (GIFI), and even decoration stores. The multiple methods of distributing these products at retail acutely raise the question of compliance with the ban on sales to minors.

The online sale of these products also raises this issue. In addition to the official merchant sites of the brands that offer these products without any age verification, many accounts on social networks popular with teenagers sell them, often at attractive prices and even offer home delivery. Foreign sites also offer the possibility of having puffs delivered with nicotine levels well above the limit authorized in the European Union. Often, these sites do not provide any information on the ingredients contained in the products.

A major ecological disaster

The rapid growth in the consumption of electronic cigarettes in general poses a new environmental problem. These are produced in large quantities and include batteries composed of heavy metals, electronic circuits, plastic and residues of liquids and nicotine which become massive and dangerous sources of waste. When they are abandoned in nature, they decompose, releasing micro-plastics, polluting waterways, fauna and flora.

Disposable e-cigarettes generate even higher environmental costs because they are used for a short period of time, do not recharge, either the battery or the liquid. Single-use, they are thrown away after consumption. Finally, these types of products often do not provide any indication as to how to dispose of them after use and the possibilities for recycling materials.

Keywords: puff, disposable e-cigarettes, marketing, youth, vaping

AE

[1] The Ministry of Solidarity and Health is attentive to “Puff” type vaping products and to compliance with legal obligations concerning advertising and sales to minors, Ministry of Health website, published March 17, 2022, consulted July 5, 2022

[2] Notification of placing on the market of vaping products (Online procedure)