E-cigarettes may have the potential to reduce smoking, but big tobacco’s involvement and a general lack of restriction to youth access are cause for concern, according to a university study.

Professor Greta Hsu of the University of California, Davis, and her co-authors urge attention to regulating youth access to the product and promoting models that are tied to higher rates of smoking cessation.

Their recommendations come from tracking the changes in e-cigarette designs and website marketing as the industry has grown for a study recently published in the Journal of Medical Internet Research.

“A surprising theme was how stark the difference was between the products sold by major tobacco brands and independent brands,” said Hsu, a professor in the Graduate School of Management at UC Davis.

The U.S. Food and Drug Administration is looking at whether certain design features and product marketing practices are fueling youth use and has requested information from several manufacturers/importers, including JUUL Labs. In mid-September, the agency plans to launch a full-scale public education campaign to persuade youths against using e-cigarettes.

E-cigarette websites compared

Hsu and co-authors Jessica Sun and Shu-Hong Zhu, both of the Department of Family Medicine and Public Health at UC San Diego, looked at e-cigarette brand websites in 2013-14 and 2016-17. They compared product designs, marketing claims and age-based warnings presented by e-cigarette producers, including major tobacco companies, independent vape shops and independent internet-only companies.

Among the sites surveyed in 2016-17, a dozen were owned by major tobacco companies, 162 operated a physical vape shop and 259 were internet-only operations.

Tobacco companies offer the most limited range of products. The type of e-cigarettes they tend to sell, called “cigalikes,” have a look and feel that mimic the experience of actual cigarettes.

Vape shops and online retailers, on the other hand, tend to have more advanced open-system designs that allow customization and come in many nontraditional flavors that include fruits, desserts and candies.

Product design and flavors

“The type of e-cigarette product design and flavors matters in terms of the reception of the different audiences,” Hsu said.

The study found that online retailers allow youths just as much access as ever to a wide variety of these nicotine products.

“Policies should be designed to discourage youths from starting e-cigarettes and exposing themselves to any potentially negative health effects of nicotine,” Hsu and her co-authors advised. “Currently, regulatory requirements do not provide clear guidance regarding specific processes needed to effectively prevent sales to minors.”

The study documented the industry’s shift toward newer, less traditional e-cigarette products, from both established and newer brands.

Tobacco-owned brands and smoking cessation

The greater dominance of major tobacco-owned brands and the exit of smaller, independent brands might ultimately limit smokers’ access to the e-cigarette models that are associated with higher smoking cessation rates, Hsu said.

The authors also noticed a significant decrease in website claims that e-cigarettes are healthier than cigarettes and that they are cheaper, cleaner and more socially accepted.

Hsu, now working on a study about the history of the e-cigarette industry, has also published research on how the tobacco industry raised the levels of tar and nicotine in “light” cigarettes for decades without a regulatory crackdown — despite mounting proof of health hazards.