Revisiting the Rise of Electronic Nicotine Delivery Systems Using Search Query Surveillance

Abstract

Introduction: Public perceptions of electronic nicotine delivery systems (ENDS) remain poorly understood because surveys are too costly to regularly implement and, when implemented, there are long delays between data collection and dissemination. Search query surveillance has bridged some of these gaps. Herein, ENDS' popularity in the U.S. is reassessed using Google searches.

Methods: ENDS searches originating in the U.S. from January 2009 through January 2015 were disaggregated by terms focused on e-cigarette (e.g., e-cig) versus vaping (e.g., vapers); their geolocation (e.g., state); the aggregate tobacco control measures corresponding to their geolocation (e.g., clean indoor air laws); and by terms that indicated the searcher's potential interest (e.g., buy e-cigs likely indicates shopping)-all analyzed in 2015.

Results: ENDS searches are rapidly increasing in the U.S., with 8,498,000 searches during 2014 alone. Increasingly, searches are shifting from e-cigarette- to vaping-focused terms, especially in coastal states and states where anti-smoking norms are stronger. For example, nationally, e-cigarette searches declined 9% (95% CI=1%, 16%) during 2014 compared with 2013, whereas vaping searches increased 136% (95% CI=97%, 186%), even surpassing e-cigarette searches. Additionally, the percentage of ENDS searches related to shopping (e.g., vape shop) nearly doubled in 2014, whereas searches related to health concerns (e.g., vaping risks) or cessation (e.g., quit smoking with e-cigs) were rare and declined in 2014.

Conclusions: ENDS popularity is rapidly growing and evolving. These findings could inform survey questionnaire development for follow-up investigation and immediately guide policy debates about how the public perceives the health risks or cessation benefits of ENDS.

Figure 1. National trends for electronic nicotine delivery systems Google searches, 2004–2014

Both panels display the national trend for all electronic nicotine delivery systems (ENDS) searches as derived from searches originating in the U.S. that included the keywords as described in the text (e.g., “buy e-cigarettes”). Panel (a) compared ENDS searches to searches for snus, Chantix, and nicotine replacement therapies. Panel (b) compared among ENDS searches that included terms indicative of vaping (e.g., “best vaping cigarettes”) or e-cigarettes (e.g., “best e-cigarettes”). Both panels present relative search volumes (100=highest search proportion, 50=50% of the highest search proportion for all Google searches on ENDS). Forecasted values through 2015 are described in the text but not shown here.

Figure 2. The spread of electronic nicotine delivery systems Google searches by U.S. states, 2009–2014

Each map shows the mean annual relative search volume for all electronic nicotine delivery systems (ENDS) searches. All panels present relative search volumes (100=highest search proportion, 50=50% of the highest search proportion for all Google searches on ENDS). Years prior to 2009 were not presented because searches were near or at zero volume.

Figure 3. Longitude predicts electronic nicotine delivery systems Google searches, 2014

Panel (a) compared all ENDS searches by state to the median state longitude. Searches were measured using the mean relative search volumes (100=highest search proportion, 50=50% of the highest search proportion for all Google searches on ENDS) for all of 2014. Panel (b) compared the proportion of all ENDS searches that included terms indicative of vaping (e.g., “best vaping cigarettes”) by state to the median state longitude.

Figure 4. Electronic nicotine delivery systems Google searches by select predictors for tobacco control and smoking social norms, 2014

Panels (a, c, e, and g) compared all ENDS searches in 2014 by state according to the smoking prevalence, social unacceptability of smoking,(20) cigarette excise tax, and clean indoor air grade –as detailed in the text. Searches were measured using the mean relative search volumes (100=highest search proportion, 50=50% of the highest search proportion for all Google searches on ENDS) for all of 2014. Panels (b, d, f, and h) replicate the same analyses but using the proportion of all ENDS searches that included terms indicative of vaping (e.g., “best vaping cigarettes”) by state as the outcome.

Figure 5. Electronic nicotine delivery systems Google searches including shopping, health, or cessation, 2014

Each line shows the proportion of all ENDS searches that also included terms consistent with shopping (e.g., “buy”), health (e.g., “harmful”), or cessation (e.g., “quit”), as detailed in the text. Cessation is shown on a separate scale, given searches were rare in this category.