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WHO'S SMOKING THESE DAYS: A DESCRIPTIVE ANALYSIS OF THE VAPING CONSUMER ABSTRACT Vaping entered the U.S. market in the 2000s and is now one of the most- demanded products available. The objective of the current research is to paint a picture of nicotine users including both those that consume nicotine from the tobacco plant (combustible delivery) and those who vape (non-combustible, aerosol inhalers). A review and synthesis of existing literature is employed in this research. Grounded in the theory of non-suicidal self-injury (NSSI), findings identify perceptions, attitudes and beliefs about ENDS (electronic nicotine delivery system), the psychological underpinning contributing to probability of use/ceasing, and behavior patterns. Differences among age groups, gender, ethnicity, behavior type (i.e., never users, users, non-users, and poly-users), education and income levels are identified. A closing discussion includes significant findings, support for the importance of the research, managerial implications, and limitations of the study. INTRODUCTION The commercialization of tobacco in the early 20th century integrated smoking into the fiber of American culture (Brandt, 2007). The tobacco industry of the 1940s shaped the public meaning of smoking. From the Camel Man to Hollywood celebrity endorsements, cigarettes took its place as the social persona of American society. However, the status of the cigarette would fall from grace with the rise of public health concerns. In the 1960s, the intervention of government to regulate marketing (promotions) of tobacco products crippled the industry. Arms with a strategy of casting doubt on medical findings, supporting a consumer's right to choose, and the addictive nature of tobacco Page 1 of 41
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Page 1: €¦  · Web view(non-combustible, aerosol inhalers). A review and synthesis of existing literature is employed in this research. Grounded in the theory of non-suicidal self-injury

WHO'S SMOKING THESE DAYS: A DESCRIPTIVE ANALYSIS OF THE VAPING CONSUMER

ABSTRACT

Vaping entered the U.S. market in the 2000s and is now one of the most-demanded products available. The objective of the current research is to paint a picture of nicotine users including both those that consume nicotine from the tobacco plant (combustible delivery) and those who vape (non-combustible, aerosol inhalers). A review and synthesis of existing literature is employed in this research. Grounded in the theory of non-suicidal self-injury (NSSI), findings identify perceptions, attitudes and beliefs about ENDS (electronic nicotine delivery system), the psychological underpinning contributing to probability of use/ceasing, and behavior patterns. Differences among age groups, gender, ethnicity, behavior type (i.e., never users, users, non-users, and poly-users), education and income levels are identified. A closing discussion includes significant findings, support for the importance of the research, managerial implications, and limitations of the study.

INTRODUCTION

The commercialization of tobacco in the early 20th century integrated smoking into the fiber of American culture (Brandt, 2007). The tobacco industry of the 1940s shaped the public meaning of smoking. From the Camel Man to Hollywood celebrity endorsements, cigarettes took its place as the social persona of American society. However, the status of the cigarette would fall from grace with the rise of public health concerns. In the 1960s, the intervention of government to regulate marketing (promotions) of tobacco products crippled the industry. Arms with a strategy of casting doubt on medical findings, supporting a consumer's right to choose, and the addictive nature of tobacco products, the industry survived the loss of market share. Advances in technology in the form of heating (non-combustion, chemical aerosols) versus burning (combustion) delivery systems gave the tobacco industry a second bit of the apple.

The core product of tobacco companies is nicotine, although it may be delivered in a variety of ways. Nicotine delivery includes combustible cigarettes, smokeless tobacco, cigars, and dipping/crewing. Vaping is the electronic delivery systems using chemical heating, known as ENDS (electronic nicotine delivery system). The unique feature of ENDS is the absence of tobacco; ENDS use a chemical nicotine and is delivered through a wide-variety of devices such as "e-cigarettes (e-cigs)," "e-hookahs," "mods," "vape pens," "vapes" and "tank systems" (2019f). For purposes of the current study, "cigarette" refers to tobacco delivery methods (traditional smoking), "e-cigarette" refers to ENDS, and "smoking" refers to nicotine consumption.

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Two unique characteristics of the 1.1 billion smokers worldwide are noteworthy. First, smokers desire to become non-smokers (Pisinger, 2015). Seen as a healthier alternative to burning and a means of cessation, consumer adoption of e-cigarettes has soared since their introduction in the United States (USA) in 2012 (Pisinger, 2015). Second, the extraordinary use of e-cigarettes by children and adolescents is alarming. Twenty-one percent (21%) of high school students and 5% of middle school students report using e-cigarettes in the last 30 days; an increase of 1.5 million from 2017-2018.

Research of e-cigarettes is sparse in the marketing literature. Between 2003 and 2015, research of e-cigarette studies of product awareness, previous use, current use, and perception of safety totaled only 28 articles (Xu, Guo, Liu, Liu & Wang, 2016). A comprehensive model of the e-cigarette "user" has yet to be developed. Based on current marketing philosophy, the consumer is at the heart of all marketing activities, and a comprehensive understanding is of the consumer market is essential. The current study draws on existing literature to develop a picture of e-cigarette users through identifying characteristics and behaviors patterns.

The importance of the current study include: 1) addresses a gap in the literature, 2) is timely and relevant (e.g., "getting ahead" of megatrends), 3) introduces the concept of non-suicidal self-injury (NSSI) in marketing smoking, and 4) provides a framework that guides marketing management. The following narrative provides the theoretical foundation of smoking, NSSI, the tobacco industry, methodology, findings, and discussion.

THEORETICAL FOUNDATION

The theoretical framework that addresses the use of products that jeopardized physical health (e.g., nicotine) is embedded in the concept of non-suicidal self-injurious behaviors (NSSI). NSSI is defined as the "deliberate, self-inflicted destruction of body tissue that is not socially sanctioned and without suicidal intent" (Slesinger, Hayes & Washburn, 2019, p. 3). A matter of extensive research in health disciplines, self-injurious behavior has perplexed psychologist for decades (Hooley & Franklin, 2017), and remains a topic of considerable attention by scholars. Although the psychological understanding of why people engage in NSSI is not within the scope of this research, the wide-spread practice of NSSI in American society accentuates its importance; 17.2% of adolescents and 13.4% of college-age adults engage in NSSI (Hooley & Franklin, 2017).

THE TOBACCO INDUSTRY

The tobacco industry refers to companies and individuals who engage in business activities of tobacco and tobacco-related product. The tobacco industry is not a seller of cigarettes or vaping devices, it’s a seller of nicotine, a chemical that is cancer causing, cancer promoting, and poisonous (Brandt, 2007). E-cigarettes contain purified nicotine (not tobacco), and are not regulated by the FDA (Takematsu, 2019). Nicotine is what addicts people to the product, but it is the mix of chemicals (additives) that causes serious disease. Cigarettes contain more than 7,000 chemicals and render the maximum addition potential (FDA, 2019a). Nicotine can change the way the brain works by delivery the chemical to the brain within seconds (FDA, 2019a). Younger consumers (e.g., children, adolescents) are more susceptible to addiction to nicotine, because their brains are still developing.

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Tobacco MarketsThe global tobacco market is expected to reach $647.47 billion by 2021. By region, the

USA is the second largest market behind China (Grand View Research, 2018b). Reynolds American, Inc. and Phillip Morris International, Inc. are among the top tobacco companies in the global market. Tobacco companies spend billions each year marketing their products. The top five companies spent $759.3 million in 2016 on smokeless tobacco advertising, compared to $684.9 billion in 2015 (CDC, 2019a). This level of investment represents approximately $25 million each day. In 2017, 14% of all adults or 34.3 million people were cigarette smokers (CDC, 2019b). The three most heavily advertised brands, Marlboro, Newport and Camel, were the preferred brands of middle and high school users in 2016 (CDC, 2019a). In order of preference, the trend among USA middle school students and high school students is consistent, with most preferring Marlboro, followed by Newport and Camel.

Transformation of SmokingE-cigarettes have changed the social norm of smoking in American culture. E-cigarettes

are the new face of nicotine propelled by their novelty and lack of federal oversight (Duffy & Jenssen, 2014). Void of the negative elements associated with cigarettes (e.g., odor, teeth staining, prohibition in public areas), e-cigaretters offer an alternative that speaks to the technology savvy consumers of Generation Y. Adapting to the new smoker segment, the tobacco industry demonstrated astonishing resilience. In the 1960s, governmental regulations that limited marketing of tobacco products resulted in a massive decline in cigarette sales. Faced with the scientific evidence that consuming nicotine is likely to lead to numerous health issues including death, the tobacco industry in the USA adopted a three-prong strategy: 1) create doubt about the health damage without actually denying it, 2) advocating the public's right to smoke, and 3) encouraging more scientific research (Brandt, 2007). The diversification of product lines, international trade, and a deliberate and steady price increase, the tobacco industry not only survive federal regulation, but was profitable in the years following.

In the 2000s, technology advances offered the tobacco industry a second bit of the apple, e-cigarettes. Not classified as a "cigarette" by the federal government, e-cigarettes are not subject to the stringent regulations placed on cigarettes (e.g., no advertising on television). Interestingly, USA tobacco companies' strategies have remained relative unchanged with one noteworthy difference. E-cigarette companies targets a much younger (e.g., children and adolescents) consumer; laissez faire, the addictive nature of nicotine ensures a higher consumer lifetime value as compared to cigarettes.

Young Consumers E-cigarettes have grown rapidly particularly among youth and young adults (American

Academy of Pediatrics, 2019). E-cigarettes are the most commonly used by younger consumers in combination with cigarette products (CDC, 2019c). Middle and high school students represented 3.62 million e-cigarette users in 2018 (FDA, 2019a). The use of e-cigarette among middle and high school students increased between 2017 and 2018; 78% increase among high school students (11.7% to 20.8%) and 48% increase among middle school students (3.3% to 4.9%) (FDA, 2019a). In 2018, e-cigarettes were most common among youth, followed by cigarettes, cigars, smokeless tobacco, hookah, and pipes (CDC, 2019c).

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Nicotine Delivery SystemsThe cigarette is the most commonly-used method of delivering nicotine. These delivery

systems include cigarettes, smoking tobacco, smokeless tobacco (e.g., chewing tobacco, nicotine gum), cigars, and cigarillos (Grand View Research, 2018a). The unique feature of e-cigarettes is the absence of tobacco; e-cigarettes use a chemical nicotine, not the tobacco plant. E-cigarettes incorporate a variety of products including "e-cigarettes (e-cigs)," "e-hookahs," "mods," "vape pens," "vapes" and "tank systems" (CDC, 2019d). Although it varies across products, components of ENDS include e-liquids, glass or plastic vial container, cartridges, atomizers, batteries, clearomizer, digital display, tank system, drip tips, flavoring, programmable software (FDA, 2019b) (refer to Figure 1).

METHODOLOGY

A descriptive research design is employed. A systematic summary of the literature is conducted to develop a picture of smokers. The scope of this study is defined as: 1) peer-reviewed academic articles, 2) published on or before April 1, 2019, and 3) available in the English language. The current study specifically includes research across countries, both qualitative and empirical studies, and literature across disciplines. A search of all academic sources was conducted using two the Boolean criteria: 1) e-cigarettes or electronic cigarettes or vaping cigarettes, and 2) marketing. The presence of criteria in the text (TX) of the document is the condition for inclusion.

Figure 1: Example of E-Cigarette Components

Research satisfying the criteria of the scope and Boolean parameters were classified and coded by topic (e.g., behavior patterns and/or psychological underpinnings). Next, an analysis of the samples was conducted and research classified by age (e.g., adolescents, young adults, adults) and other demographics (e.g., ethnicity), geographical location, exposure and knowledge of e-cigarettes, and the psychographic underpinnings (consumers' perceptions, attitudes, beliefs) of e-cigarettes use. Finally, a systematic review to cross-classify research was conducted.

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FINDINGS

The findings of the current study are categorized and presented in three major topics: 1) behavior patterns (BP), 2) exposure and knowledge (E&K), and 3) psychological underpinnings (OU). Behavior patterns examines similarities and differences in behaviors as to current behaviors (i.e., never users, users, non-users, and poly-users) and traits (i.e., demographics). Exposure and knowledge looks at exposure to marketing communications and knowledge of e-cigarettes. Finally, the psychological underpinnings considers perceptions, attitudes, and beliefs of consumers as to e-cigarettes.

Never-Users, Non-users, Users, and Dual-/Poly-Users (BP)Data shows that e-cigarette users and non-users share some common characteristics, but

dissimilarities are more common in the literature (refer to Table 1). In a study of the Chinese population, most users and non-users did not perceive e-cigarettes as an effective means on quitting (Wang et al., 2015). The increase in use of e-cigarette was much higher for current smokers (61%) compared to non-smokers (34%) (Gorzkowski et al., 2015). The largest age group that never tried e-cigarettes/cigarette are 8-14 years old (Schoenborn & Gindi, 2015).

Users and non-users demonstrate differences in preferences of nicotine delivery systems and frequency of use. Current smokers, compared to non-smokers, were more likely to try e-cigarettes (Hwang & Park, 2016; Regan, Promoff, Dube & Arrazola, 2013). As to specific types of devices, there is a low probability that non-users will try cigarettes, cigar, e-cigarettes, Hookah, or smokeless/dip/chewing (Gilreath et al., 2016). Snuff users were more than twice as likely to be infrequent smokers than daily users (Wang et al., 2018). Poly-users more often attempt to quit smoking and use nicotine replacement therapy; they are highly receptive to e-cigarette advertising (Guydish et al., 2016).

Disparity in information seeking and perceptions are also evident in the literature. Smokers are five times more likely to search for e-cigarette information and share that information than non-smokers (Guydish et al., 2016). Smokers, as compared to non-smokers, maintain a positive attitude toward e-cigarettes and have a high potential to become dual users (Dutra & Glantz, 2014; Lee, Grana & Glantz, 2013). In a study of the Chinese population, non-users did not perceive e-cigarettes as an effective means of cessation (Wang et al., 2015). Hwang and Park (2016) found several dissimilarity between users and non-users among Koreans: 1) rate of increase in e-cigarette use is more prevalent in never users than in former users, 2) current and ever e-cigarette users increased significantly with the increase in the number of smoking friends, 3) former smokers are less likely to be influenced by the number of close smoking friends.

Table 1THE VAPING CONSUMER

Behavior Patters of E-Cigarette Users/Non-UsersDESCRIPTION NEVER USERS USERS NON-USERS POLY-USERS

Never tried e-cigarettes

Greatest among 18-24 year old

(Schoenborn & Gindi, 2015)

More likely to try e-cigarettes

More so than non-users(Hwang & Park, 2016;

Regan et al., 2013)

More likely to use e-cigarettes

More so than other users(Hwang and Park, 2016;

Regan et al., 2013)

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Table 1THE VAPING CONSUMER

Behavior Patters of E-Cigarette Users/Non-UsersDESCRIPTION NEVER USERS USERS NON-USERS POLY-USERS

Most likely to attempt to quit smoking

More so than other users

(Guydish et al., 2016)Increase in use of e-cigarettes

More so than non-users (Gorzkowski et al., 2015)

Snuff user

More likely to be infrequent users than daily

users(Wang et al., 2018)

Most likely to search for information about e-cigarettes

Five times more likely than non-users

(Guydish et al., 2016)Maintain positive attitude about e-cigarettes

More so than other users(Dutra & Glantz, 2014;

Lee et al., 2013)Did not perceivee-cigarettes to be effective means of cessation

More so than users(Wang et al., 2015)

High probability of becoming poly-users

More likely than non-users(Gilreath et al., 2016;

Dutra & Glantz, 2014; Lee et al., 2013)

Higher rate of increase in e-cigarette use

More so than former users

(Hwang & Park, 2016)

Number of smoking friends impact behaviors

Increased significantly with increase in friends

who smoke(Hwang & Park, 2016)

Not influenced by number of friends

Less likely than users(Hwang & Park, 2016)

Age (BP)The use of e-cigarettes by younger consumers is a matter of great concern among health

care professionals (CDC, 2019e). The evidence of differences in smoking patterns among age groups is summarized in Table 2. Behavior patterns across age groups suggest that cigarette users are more likely to use e-cigarettes, reducing use of cigarettes. E-cigarettes poly-users are prevalent among youth/adolescents; use of e-cigarettes is associated with peer use. Dual product use is most commonly associated with young adults. Experimentation with e-cigarettes among young adults in Romania was associated with current cigarette use and use by friends. Adults use of e-cigarettes is higher for individuals that currently use hookah or e-cigarettes. For adults, the active use of e-cigarettes is influenced by concern for others (e.g., safety of children) and need to conceal the habit.

Table 2THE VAPING CONSUMER

Behavior Patterns by Age Group

CATEGORY BEHAVIORS SAMPLE YOUTHYOUNG ADULTS ADULTS

ACROSS GROUPS

Types of E-Cigarettes

Most common users of hookah and water pipes (Gilreath et al., 2016) USA X

Types ofE-Cigarettes

Preferred non-cigarette combustible only and dual use (El-Toukhy & Choi, 2016)

USAMiddle &

high school students

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Table 2THE VAPING CONSUMER

Behavior Patterns by Age GroupTypes of E-Cigarettes

Associated with multiple product use (Guydish et al., 2016) USA X

Types ofE-Cigarettes

Popularity and preference of e-liquid features are not correlated; nuts and cream emerged as favorite flavors and fruit and cream as most popular (Chen & Zeng, 2017)

N/A X

Types ofE-Cigarettes

Smokeless tobacco use associated with adults (Jones et al., 2017) USA X

E-Cigarettes vs. Cigarettes

Use of dual cigarettes and at least one other product; ages 14-17 years (Gorzkowski et al., 2015)

USA Significant Most common

E-Cigarettes vs. Cigarettes

Use of multiple products (Guydish et al., 2016) USA X

E-Cigarettes vs. Cigarettes

Never smoked cigarettes or tried e-cigarettes; ages 8-14 years (Schoenborn & Gindi, 2015)

USA Highest

E-Cigarettes vs. Cigarettes

Cigarette smokers use e-cigarettes (Schoenborn & Gindi, 2015) USA X

E-Cigarettes vs. Cigarettes

Concurrent use of cigarettes and e-cigarettes may contribute to nicotine dependence (Vijayaraghavan, Hurst & Pierce, 2017)

USA X

E-Cigarettes vs. Cigarettes

Smokers who use e-cigs demonstrate a reduction in use of tobacco cigarettes (Adkinson et al., 2013; Caponnett et al., 2014)

USA X

E-Cigarettes vs. Cigarettes

Smokeless tobacco use higher in current users of hookah or e-cigarettes (Jones et al., 2017)

USA X

E-Cigarettes vs. Cigarettes

Peer cigarette smoking affects lifetime e-cigarette use (Hanewinkel & Isensee, 2015)

Germany X

Influencing Conditions

When to use e-cigarettes; respect for others, keeping habit a secret, safety of children, prohibiting minors from using (Gowin, Cheney & Wann, 2017)

USAStraight-to-work adults

Influencing Conditions

Use of bodily sensation to gauge risk and benefits (McDonald & Ling, 2015) USA X

Influencing Conditions

Close friends who smoked associated with e-cigarette use (Hwang & Park, 2016)

Korea X

Influencing Conditions

Correlated between e-cigarette experimentation and friends who experiment with e-cigarettes (Lotrean, 2015)

Romania University students

Influencing Conditions

Correlated with e-cigarette experimentation being user of traditional cigarettes (Lotrean, 2015)

Romania University students

Gender, Marital Status, and Sexual Orientation (BP)

Differences between men and women is common in scientific research. Several tendencies emerged in the literature as to gender: 1) although men, more so than women, have ever tried e-cigarettes (Schoenborn & Gindi, 2015; Choi & Forster, 2013), the current use of e-cigarettes was not significantly different between men and women (Schoenborn & Gindi,

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2015), 2) males, compare to females, have twice the probability of being poly-users (Gilreath et al., 2016), 3) compared to cigarettes, men are more likely to use only e-cigarettes, 4) USA adult males, compared to their counterpart, are more likely to use smokeless tobacco (Jones et al., 2017), 5) among university students in Romania, males, more so than females, will experiment with e-cigarettes, 6) there is no significant difference in sharing information between males and females (Emery, Vera, Huang & Szczypka, 2014), and 7) ever-users of e-cigarettes are most common among women (Regan et al., 2013).

Few studies investigate marital status and sexual orientation as it relates to smoking behaviors. A study by Wang and colleagues (2018) found that single, divorced, and widowed users, compare to married smokers, trend to be infrequent smokers versus daily smokers. Emery and colleagues (2014) found no statistical difference as to sexual orientation (LGBT) and patterns of information search of e-cigarettes.

Income and Education (BP)Consistent patterns emerged as to behaviors among educational levels (e.g., tendency to

share information about e-cigarettes) (El-Toukhy & Choi, 2016) and income level (i.e., use of smokeless tobacco) (Jones et al., 2017). Findings by Wang and colleagues (2015) found notable differences: 1) individuals with at least some college education and those of high income are more likely to be infrequent users, compared to daily users, 2) use of smokeless tobacco devices was associated with income, 3) higher family income is associated with e-cigarette awareness, and 4) tertiary education is related to lower levels of attempts to quit. Homeless adults living in a shelter reported dual or poly-tobacco use contribute to nicotine dependence and increase difficulty with quitting (Vijayaraghavan et al., 2017).

Ethnicity (BP)Although often used interchangeably, race applies to all humans (i.e., everyone belongs

to one), whereas ethnicity is the "us and them" duality and is not subject absolute assignment (Tokin, McDonald & Chapman, 1996). Ethnic groups share cultural "givens" (e.g., religion, language, race, nationality, and customs), which influence perceptions, attitudes, and beliefs (Hutchinson & Smith, 1996). Differences in cultural "givens" are often investigated in the marketing literature as a comparative analysis. Such is the case for the sparse research of e-cigarettes, which suggest differences among races.

Comparison between the broad categorization of Whites (e.g., non-Hispanic American Indian or Alaska Native, ALAN, non-Hispanic Whites) and people of color (e.g., Hispanics, non-Hispanic Blacks, non-Hispanic Asians) emerged in the literature. African-Americans are more aware of e-cigarettes than other ethnic groups (Ganz et al., 2015). In the USA, trying e-cigarettes and e-cigarette use is greater among Whites than people of color (Schoenborn & Gindi, 2015). Non-Hispanic Whites, more so than non-Hispanic Blacks, tend to be infrequent users versus daily users; users of color, more so than Whites, are higher users of e-cigarettes (Wang et al., 2018). Non-cigarette combustible products (e.g., chewing tobaco) are more frequently used by people of color than Whites, and dual use is more prevalent among Whites (El-Toukhy & Choi, 2016). Among people of color, Blacks are less likely to be poly-users than Hispanics (El-Toukhy & Choi, 2016).

Differences among ethnic association in non-USA countries is spare in the literature. Kong and colleagues (2017) found that members of the Tatar/Bashkir ethnic group, more so than Russians, are lifetime cigarette users, have greater odds of being lifetime e-cigarette users, and

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use hookah and alcohol (Kong, Idrisov, Galimov, Masagutov & Sussman, 2017). The rate of e-cigarette use is not significantly different as to ethnicity and race (Jones et al., 2017).

Sources of Information (E&K)The vast majority of adults (84%) report seeing or hearing information about e-cigarettes

on a variety of media (television being most common); users are twice as likely than non-users to seek information (Emery et al., 2014). Adolescents and young adults (13-25 years) report that e-cigarette marketing and advertising, especially in malls and television, are main sources of information (Johnson, Mays, Hawkins, Denzel & Tercyak, 2017; Wagoner et al., 2016). Straight-to-work adults (i.e., entering work force directly after high school; ages 19-45 years) most commonly obtain information about nicotine delivery device from retail owners and social networks (Gowin et al., 2017). These same consumers report spending little time exploring information (Gowin et al., 2017).

Communications (E&K)Hébert and colleagues (2017) report a weak correlation between perceived and actual

exposure frequency and marketing and message exposure. Adolescents report that knowledge of smoking includes potential harms, product features (e.g., novelty, flavoring), are less addictive, and health care providers are main source of e-cigarettes information (Johnson et al., 2017). Adolescents report a deep understanding of the potential advantages (e.g., quit smoking) and disadvantages (e.g., re-normalization of smoking-like behavior, socialization of adolescents into nicotine consumptions) of e-cigarette use (Weishaar, Trevisan & Hilton, 2016).

Sanders-Jackson and colleagues (2015) found a significant correlation between exposure to adverting and knowledge of smoking products. Less than half (48%) of the participants in this study did not know if e-cigarettes contain toxic chemical and more than half (61%) did not report knowledge of regulations associated with e-cigarettes. A counterintuitive finding emerged in research of physicians, specifically, cancer specialist. Shin and colleagues (2017) report that cancer specialists learn about e-cigarettes from advertisements or patient conversations as opposed to professional scientific resources. Furthermore, these doctors (82.2%) would not recommend e-cigarettes to patients who were previously unsuccessful in quitting.

Consumer Perceptions, Attitudes and Beliefs (PU)Consumer perceptions, attitudes and beliefs (CPBA) relating to e-cigarettes is apparent

across studies (e.g., USA, Canada, and Hong-Kong) and mostly focuses on risk assessment, e-cigarette use intentions, and intervening governmental regulations (refer to Table 3). Overall, younger consumers (adolescents and young adults) report a positive attitude toward e-cigarettes, and evaluate e-cigarettes as one more "toy" of the digital age. Positive CPBA is supported by perceived advantages of e-cigarettes as compared to tobacco products (e.g., novelty, relatively low costs, portable, discreet). In assessing risk, consumers report that e-cigarettes, as compared to cigarettes, are less harmful and less addictive. Consumers also consider warnings of negative outcomes of e-cigarettes in assessing risk. As with risk assessment, consumers look to information (advertising) about potential negative outcomes of e-cigarette use when forming cessation intentions. Finally, consumers are consistent with supporting government intervention to regulate e-cigarettes to protect vulnerable consumers.

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Psychological States and Traits (PU)Although the underlining variables and antecedents of an individual's mental position is

beyond the scope of the current research, several investigations in the marketing literature address psychological states/traits. A psychological states is a temporary way of being such as thinking, feeling, and behaving; a psychological trait is more stable and enduring pattern of behavior (Buczkowski et al., 2017). A summary of the findings is presented in Table 3.

Attachment Style (PU)Attachment style theory speaks to how adults attach to others and is strongly related to

how one attached as a child (Levy et al., 2017). There are four attachment styles: 1) secure-autonomous, 2) avoidance-dismissing, 3) anxious-preoccupied, and 4) disorganized-unresolved (Levy et al., 2017). Wise and colleagues (2017) found significant differences between smokers and non-smokers as to secure-autonomous, anxious-preoccupied, and disorganized-unresolved, but no significant difference as to avoidance-dismissing. Finding suggest that individuals in the secure-autonomous attachment style are less likely to engage in smoking.

Sensation Seeking (PU)Sensation seeking is a personality trait and is the "degree to which an individual seeks

novel and highly stimulating activities and experiences" (Psychology Today, 2019). Individuals high on sensation seeking seek out the unknown, and subsequently look for new, varied, and unpredictable behaviors (Psychology Today, 2019). Case and colleagues (2017) found that high sensation seeking is associated with increased odds of both susceptibility to e-cigarette use and ever e-cigarette use. These research did not find significant relationship between current e-cigarette use and sensation seeking.

Decision-Making (PU)Consumers use a variety of product elements when engagement in trial and purchase

behaviors. Taste and price rate high as factors that influence e-cigarette experimentation among Europeans (Laverty, Vardavas & Filippidis, 2016). Younger consumers, 15-24 years old, are more likely to use design and price in decision-making (Laverty et al., 2016). Other factors influencing youth decision-making include modernity, increase social status, enhanced social activity, romance, and celebrities endorsements (Grana & Ling, 2014). Wong and colleagues (2016) found nine reasons for e-cigarette use versus cigarette use: 1) e-cigarettes vapor is not polluting or intrusive, 2) e-cigarettes aid in cessation of cigarette use, 3) healthier and less harmful, 4) can be used in public, 5) gaining popularity, 6) relatively cheaper, 7) cool, new, and trendy, 8) replicate feeling of smoking tobacco, and 9) no limitation on purchase.

Table 3THE VAPING CONSUMER

Consumer Perceptions, Attitudes, and Beliefs (CPAB)CATEGORY CONSUMER PERCEPTIONS, ATTITUDES, AND BELIEFS SAMPLE

CPAB towards E-Cigarettes

Young adults perceive e-cigarettes as one more 'toy' among other technologies integrated into their everyday lives (McDonald & Ling, 2015) USA

CPAB towards E-Cigarettes

Adolescents and young adults (13-25) report positive attributes of ENDS (e.g., portable, discreet, novel, relatively low costs (Wagoner et al., 2016) USA

CPAB towards E-Cigarettes

Beliefs about e-cigarettes influenced by industry marketing, contradictory information, and lack of public health information may contribute to beliefs about e-cigarettes; (Gowin et al., 2017)

USA

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Table 3THE VAPING CONSUMER

Consumer Perceptions, Attitudes, and Beliefs (CPAB)CPAB towards E-Cigarettes

E-cigarette users have position perception of e-cigarettes, hold a liberal views on future cigarette smoking, and high potential to become dual users (Dutra & Glantz, 2014; Lee et al., 2013)

USA

CPAB towards E-Cigarettes

Occasional smokers do not perceive themselves as smokers (denier); predictive characteristics include less harm from secondhand smoke, few days smoking, and fewer cigarettes daily (Lee et al., 2013)

USA

CPAB towards E-Cigarettes

Denial of use of any tobacco product was highest among roll-your-own, single product users (82.2%), followed by e-cigarettes (59.7%), cigars (56.6%), hookah (44%), smokeless tobacco (38.5%), cigarettes (28.5%), and poly-tobacco users (12.7%) (Agaku, Odani, Vardavas & Neff, 2018)

USA

CPAB towards E-Cigarettes Cessation is declining as a reason for vaping (Ayers, et al., 2017) USA

CPAB towards E-Cigarettes Did not perceive e-cigarettes as effective means in cessation (Wang et al., 2015) Hong-Kong

Availability and Source of Information

Lack of information about ENDS (McDonald & Ling, 2015) USA

Availability and Source of Information

Adolescents report most preferred source of information about potential risks of e-cigarettes is health care providers (Johnson et al., 2017). USA

Availability and Source of Information

Beliefs about e-cigarettes influenced by industry marketing, contradictory information, and lack of public health information may contribute to knowledge (Gowin et al., 2017)

USA

Advantages &Disadvantages

E-cigarettes can be used in places that prohibit cigarettes, do not affect those around you, and safe alternative to cigarettes (Farrelly et al., 2015) USA

Advantages &Disadvantages E-cigarette users view e-cigarettes as an aid to avoid relapse (Etter & Bullen, 2014) USA

Advantages &Disadvantages

E-cigarettes associated with lower perceived harm (Reinhold, Fischbein, Bhamidipalli, Bryant & Kenne, 2017) USA

Advantages &Disadvantages

Young adults perceive 12 reasons for positive attitude (liking) e-cigarettes (i.e., smoking cessation and reduction, health improvement, sensory satisfaction, self-regulation, convenience, discreet smoking, professional benefits, recreation, social enhancement, cleaner, control over intake, and cost effectiveness) and 6 reasons for a negative attitude (liking) (i.e., product-related problems, poor smoking experience, excess use/addiction, negative health consequences, high expenditure, and negative social consequences) (Pokhrel, Herog, Muranaka & Fagan, 2015)

Advantages &Disadvantages

Adolescents rated hookah, followed by e-cigarettes, most likely to make them look cool or fit in - cigars and chew as least (Roditis, Delucchi, Cash & Halpern-Felsher, 2016) USA

Advantages &Disadvantages E-cigarettes use as means of smoking cessation (Lotrean, 2015; Volesky et al., 2016) Romania

Canada

Risk & Risk Assessment

Perceived e-cigarettes as less harmful and less addictive than cigarettes (Choi & Forster, 2013; Johnson et al., 2017; Pulvers, Sun, Zhuang, Holguin & Zhu, 2017; Tomashefski, 2016)

USA

Risk & Risk Assessment

Formed attitude that e-cigarettes are a safer (healthier) alternative to cigarettes (Gowin et al., 2017; Pokhrel, et al., 2016; Wagoner et al., 2016) USA

Risk & Risk Assessment

People aware of e-cigarettes perceive them to be less harmful and less addictive than cigarettes (Choi & Forster, 2013) USA

Risk & Risk Assessment

Cancer treatment physicians believe e-cigarettes are not safer than conventional tobacco cigarettes or smokeless tobacco and not an effective cessation treatment (Shin et al., 2017) USA

Risk & Risk Assessment

Perceive secondhand vapor exposure to be moderately harmful to health (Mello, Bigman, Tan & Bigman, 2016)

Risk & Risk Assessment

Most e-cigarette users and non-users did not perceive e-cigarettes as effective in quitting (Wang et al., 2015) Hong-Kong

Risk & Risk Assessment

The presence of addiction warnings in e-cigarette advertising influence consumers' risk beliefs (Berry, Burton & Howlett, 2017) USA

Risk & Risk Assessment

Adolescents rate cigarettes as most risky, followed by cigars and chew; hookah and e-cigarettes rated least risky; older adolescents and those that have experience with tobacco reported lower perception of risks (Roditis et al., 2016)

USA

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Table 3THE VAPING CONSUMER

Consumer Perceptions, Attitudes, and Beliefs (CPAB)Risk & Risk Assessment

Participants who did not experience side effects of e-cigarette use are approximately 3.2 times higher odds of perceiving e-cigs as harmless (Volesky et al., 2016) Canada

Intention to Start/Quit E-Cigarettes

No significant differences between smokers that had tried ENDS and those who did not as to intention to quit smoking (Regan et al., 2013) USA

Intention to Start/Quit E-Cigarettes

Cigarette users viewing e-cigarette advertisements are more likely, as compared to non-users, interest in trying e-cigarettes (Smith, Bansl-Travers, O'Connor, Goniewicz & Hyland, 2015)

USA

Intention to Start/Quit E-Cigarettes

For college students, risks are negatively associated with intentions to use e-cigarettes and perceived advantages positively associated with intentions use e-cigarettes; government labels more effective in reducing intentions; warning labels no influence on beliefs about intention to use e-cigarettes (Lee, Lin, Seo & Lohrmann, 2018)

USA

Intention to Start/Quit E-Cigarettes

Absence of explicit health claims, addiction warnings have potential to indirectly influence consumers' intentions to use cigarettes and e-cigarettes (Berry et al., 2017) USA

Intention to Start/Quit E-Cigarettes

Participants intent to stop using e-cigarettes at some point (Volesky et al., 2016) Canada

Attitude toward Comparable Products

Participants exposed to e-cigarette advertisements reported more favorable attitude toward snus (a moist powder smokeless tobacco product originating from a variant of dry snuff), as compared to snuff advertisements (Smith et al., 2015)

USA

E-Cigarette Regulation

Banning vaping in public areas in USA is positively associated with perceived health harms of secondhand e-cigarettes; current e-cigarette users who have a high school or less demonstrated less support for regulations in public areas (Mello et al., 2016)

USA

E-Cigarette Regulation

Some degree to regulation is needed to protect youth, standardized products and inform the public (Uger, Baker, Sussman, Soto & Baezconde-Garbanati, 2017) USA

E-Cigarette Regulation

Support for FDA regulations highest among smokers with high quit intentions; high education and income and previous exposure to e-cigarettes demonstrated higher positive attitude toward new FDA regulations (Kowitt, Goldstein, Schmidt, Hall & Brewer, 2017)

USA

E-Cigarette Regulation

High support for policies to protect youth, required labeling (nicotine harmful to health), addiction warnings, and prohibition of sales to youth; banning use of flavors least important (Tan, Lee & Bigman, 2015)

USA

E-Cigarette Regulation

Adolescents ample awareness of difficulties of making regulatory decisions(Weishaar et al., 2016) USA

E-Cigarette Regulation

Students recall indoor e-cigarette use polices, even with low awareness of policies (Brown Henes & Olson, 2016) USA

MARKETING E-CIGARETTES

Types of MediaTypes of media used to advertise tobacco and related products include both traditional

(e.g., magazines) and non-traditional venues (e.g., social media), with research of digital marketing dominating the literature. Vendor websites, of which 57% sold exclusively online and 95% are located in the U.S., use a variety of promotional strategies and most often social networks (70.2%) (Mackey, Miner & Cuomo, 2015). Videos and online banners are used to advertise e-cigarettes and cigars in the USA and Canada (Richardson, Ganz & Vallone, 2015). In a longitudinal study of tweets related to e-cigarettes, the vast majority (90%) are commercial tweets, motivated by small group of highly active accounts (Huang, Kornfield, Szczypka & Emery, 2014).

Two studies examine e-cigarette advertising in magazines. Advertisements in magazines most often (76.5%) target 31-40 years old; similar pattern emerged for cigarette advertisements (approximately 50%) (Basch, Mongiovi, Hillyer, Ethan & Hammond, 2016). This trend is not

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consistent as to income; 75% of e-cigarette ads target higher household income compared to balanced income for traditional cigarettes (Basch et al., 2016). Emotional appeal is most often used in cigarette advertisements that appear in magazines compared to logic/fact appeal for e-cigarettes (Banerjee, Shuk, Greene & Ostroff, 2015).

Advertising ContentAdvertising content of e-cigarette promotions focus on product attributes, health issues,

and cessation. Positive attributes contained in e-cigarette advertising include cleaner, cheaper, can smoke anywhere, can be used to circumvent clean air policies (Grana & Ling, 2014). E-cigarette retailers' website use youthful appeal (e.g., modernity, social status, romance) and most often promote availability of flavors (Banerjee et al., 2015; Grana & Ling, 2014; Yao, Jiang, Grana, Ling & Glantz, 2016).

Health issues relating to nicotine are most prevalent in the literature. The vast majority of e-cigarette retailers' websites (95%) made implicit and explicit claims that e-cigarettes are healthier, a tools for smoking cessation (65%), and do not create a risk from secondhand smoke (76%) (Grana & Ling, 2014).

In a content analysis of e-cigarette vendors, 68.4% display one or more health warnings, but often in smaller font or in their terms and conditions; slightly over one-third (35.1%) did not include any detectable age verification process (Mackey et al., 2015). Less than one-third of online advertisements in the USA and Canada include price promotions and incentives (coupon); sellers most likely to use harm reduction and cessation in the message (Richardson et al., 2015).

Similar findings emerged in international markets. Eighty-nine percent (89%) of Chinese manufacturers' websites make claims of health-related benefits of e-cigarettes, dismiss concerns about secondhand smoke (78%), and promote e-cigarettes as a tool for cessation (Yao et al., 2016). Research in Great Britain found e-cigarette advertising content promotes the product as a safer and cheaper way to satisfy nicotine addiction, as well as a means for quitting (de Andrade, Hastings & Angus, 2013) .

Almost all (22 out of 23) leading e-cigarette brands use cessation-themed advertisements (Ramamurthi, Gall, Ayoub & Jackler, 2016). However social media conversations (tweets) suggest little attention paid to smoking cessation. Only 10% of observed tweets over a one-month period show attention to cessation (Huang et al., 2014)

Ethnic Minority TargetingMarketing activity to promote e-cigarette consumption to ethnic minorities is a matter of

research by Ganz and colleagues (2015) and Roberts and colleagues (2015). Researchers observed the unusual commonness of point-of-sale e-cigarette advertising in Central Harlem, NY. Furthermore, African-Americans demonstrate higher awareness of e-cigarettes compared to other racial/ethnic groups. (Ganz et al., 2015). Roberts and colleagues (2015) found point-of-sale activities to be disproportionately used in urban areas, economically-disadvantaged locations, and African American communities with e-cigarettes and menthol cigarettes, cigarillos, and cigars point-of-sale advertisements most prevalent in African-Americans communities.

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DISCUSSION

The current study is the first know synthesis of e-cigarette research published in the marketing literature and supporting scholarly contributions from other disciplines. The findings identify antecedents of attitudes towards e-cigarettes broadly categorized as past behaviors (i.e., never users, users, non-users, poly-users), risk assessment, and product awareness. Demographic variables that moderate the relationship between attitudes and intentions to use are identified as gender, ethnicity, age, and income/education. The following discussion addresses the major findings and direction for future research.

Behavior PatternsThe tendency to be a poly-user is consistent across several demographic characteristic: 1)

current users are more likely than non-users, 2) younger consumers as compared to adults, 3) prevalent among Whites (Blacks are less likely to be poly-users than Hispanics), and 4) males are twice as likely than females. In summary, White, young males who are current users are more likely to become poly-users. The relationship between poly-users and increased consumption of tobacco products has yet to be explored. If poly-use is positively related to consumption, these consumers represent a potentially lucrative segment for the tobacco industry. However, the potential is tempered by education/income levels (higher education, higher income consumers are more likely to be infrequent versus daily users), ethnicity (Whites, more so than people of color, tend to be infrequent users), and age (largest group of never users is 8-14 years).

To thoroughly understand relationships among identified variables, further research is warranted. Without a depth of understanding about such relationships, implications for marketing manager is limited to media choices; promotional strategies that include digital campaigns are prescribed. This is of particular importance for poly-users as they are highly receptive to cigarette advertising.

Preferences as to type of tobacco products is sparse. People of color, more so than Whites, prefer e-cigarettes. Tartar/Bashkir ethnic group, more so than Russians, are more likely to use hookah. Non-users are not likely to try cigarettes, cigar, e-cigarettes, Hookah, or smokeless/dip/chewing. Use of smokeless tobacco devices is positively associated with income. The disjointed and limited research makes logical patterns as to types of product preferred not possible. The infancy of the e-cigarette market creates a wealth of topics for future research, including but not limited to 1) comparison of use patterns across cultures/nations (e.g., China commercialized e-cigarettes many years before USA), 2) investigation of common themes across psychological traits (e.g., personality), 3) relationship among various NSSI behaviors (e.g., tattoos, alcohol use, cutting), and 4) long-term impact of e-cigarettes, psychological and physical.

Consumer Perceptions, Attitudes, and Beliefs An interesting finding is the presence of "denial" among users. Occasional cigarette users do not perceive themselves as smokers. Denial of any tobacco use was also detected in the literature. Although consistent across types of products, denial is highest among roll-your-own users. These findings suggest that the stigma of smoking is embedded in American culture, although renormalization of smoking emerged with the introduction of e-cigarettes (Fairchild, Bayer & Colgrove, 2014). Anti-tobacco advertising campaigns capitalize on various stigmas of smoking and lung cancer to promote cessation, but while effective in decreasing smoking rates,

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these advertisements might create a new stigma of negative self-appraisal/self-devaluation (Riley, Ulrich, Hamann & Ostroff, 2017). The presence of negative stigmas associated with smoking is also supported by consumers' perceptions of advantages and disadvantages of e-cigarettes. E-cigarette users report e-cigarettes as opposed to cigarettes are a discreet activity that avoids negative social consequences.

The renormalization of smoking relates to the notion of decision framing. Tversky and Kahneman (1981) argue that behaviors are a matter of rationality (requires consistency and coherence), however, humans systematically violate the requirements of rationality. The frame adopted by a decision-maker is a matter of norms, habits, and personal characteristics, among others (Tversky & Kahneman, 1981). The framing of e-cigarettes becomes an important element in marketing management. Considering the pressure to regulate e-cigarettes advertising (consistent with cigarette regulations), it is suggested that circuitous activities be aggressively pursued. The existence of vaping in video games, movies, video sharing services (e.g., Youtube), and social platform communications are all potential sources for normalizing smoking. This approach offers several advantages: 1) it reinforces the already held perception that vaping is less harmful than cigarettes, 2) it enhances social image (e.g., cool), and 3) has the potential to reduce perceived risk and increase intention to use. Further research is required to investigate decision-making in the realm of choosing the lesser of two evils. Furthermore, external factors (e.g., public pressure to regulate e-cigarettes, number of children/adolescents) suggest federal intervention may be coming. Research of agile marketing strategies to quickly adapt to change in the environment is warranted.

Psychological States and TraitsBoth psychological states and traits impact e-cigarette use. Attachment style (i.e., state)

speaks to how individuals relate to others. Essential to this process is mentalizing defined as the "capacity to understand one's own and others' behaviors as meaningful based on mental state" (Møhl, 2020, p. 73). Reduced mentalizing (Bateman & Fonagy, 2004) and non-secure attachment styles (Yates, 2009) are associated with higher probability of engaging in NSSI.

The personality trait sensation seeking is manifested in the quest for experiences that are new, varied, and unpredictable. The newness of e-cigarettes suggest that this product is well-suited for individuals high in sensation seeking. Intuitively, research finds no relationship between current e-cigarette use and sensation seeking. However high sensation seekers increases the odds of e-cigarette use and transition to ever e-cigarette use.

The underline psychological factors that predict e-cigarette behaviors are extensive, but research of such is almost non-existent in the marketing literature. The overreaching idea of self-concept and related variables (i.e., self-consciences) offer an opportunity to reveal a richer understanding of consumer behaviors (Elliott, 1984). This is a challenging endeavors as humans are in a constant state of change (Elliott, 1984). However, a key to capturing existing and potential consumers lies with the predictive quality of psychological underpinning. This may be of significant importance for the study of adolescents, as this time of the life cycles is characterized by a great disturbance in self-concept development (Elliott, 1984).

The ParadoxSmokers want to be non-smokers and they perceive addition or increase in less-potent

nicotine consumption (i.e., e-cigarettes) as a viable strategy for cessation (i.e., more nicotine consumption leads to cessation). Although the notion that more, less powerful nicotine

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consumption helps user to stop smoking is a perception, medical evidence show the fallacies in the paradox. Nicotine is a highly addictive, the consumption of which results in an immediate release of glucose followed by depression and fatigue, leading the user to seek more nicotine (Trimarchi & Meeker-O'Connell, 2019). To stop smoking, users seek a less-potent alternative (i.e., e-cigarettes), but often do not demonstrate reciprocal behaviors (i.e., stop using cigarettes and move to only e-cigarettes). Why? It is all about the "fix." Nicotine is delivered to the brain in just 10 seconds after inhaled (also absorbed through the skin, nose, mouth, and lungs) and delivers a "hit." However, cigarettes provide a greater boost (hit) than do e-cigarettes (Yingst, et al., 2019). If an immediate, strong hit is desired and such is not delivered by e-cigarette use, users return to cigarette use; hence, dual-usage is observed.

The promotion of e-cigarettes is as a mean of smoking cessation is an effective value proposition for companies as the benefit of increased e-cigarette market share out-weighs any change in cigarette market share. This provides an opportunity for net market share growth. However, companies must develop promotional strategies that forward subtle messages of e-cigarette as means of cessation. Considering the target market (e.g., younger consumers), one such marketing activity to consider is customer-generated content on social media (e.g., word-of-mouth). Companies should be conscience of the legal environment and potential regulation when developing promotional campaigns. Legal issues have occurred challenging "means of cessation claims" as the USA public and activist groups move to restrict e-cigarettes. However, this social movement is more focused on protecting younger consumers by removing the sale of flavoring additives (e.g., candy flavors) that attract these consumers than product claims.

Emphasis on Internal VariablesCustomer-centric is not just a buzzword - it is the key to success in today's

hypercompetitive markets. Klepic (2015) suggest that companies do not truly understand why consumers act in a certain way, how they share information with each other, and the influence of culture in shaping perceptions. Research patterns of consumer behaviors suggest that the increased importance of understanding what internal (i.e., psychological factors) motivators drive behavior is paramount in scientific research of consumers. A study examining 12 years of academic articles published in top journals (e.g., Journal of Marketing, Journal of Consumer Research) found that 43% (534) of consumer behavior articles focused on internal factors with interest gradually increasing over time (Peighambari, Sattari, Kordestani & Oghazi, 2016). Internal factors most often researched in the work by Peighambari and colleagues (2016) are perceptions (12%) and attitudes (11.5%). A profound understand of the "consumer" is essential for marketing management to develop successful strategies. The current study is a first step to providing new insight of the behavioral and psychological characteristics of e-cigarette users, but additional research is needed.

Marketing Myopia The tobacco industry must heed the danger of marketing myopia as put forth by

Theodore Levitt (2004). Tobacco companies are not just a provider/producer of tobacco products, but a industry that facilitates brain-function alteration (FDA, 2019a). Brain altering is associated with nicotine, as well as delta-9-tetrahydrocannabinol (THC), the chemical found in cannabis (NIH, n.d.), among other products. Tobacco companies are positioned to expand vaping to a wide range of chemicals (e.g., pain killers) and should move to investigate new product markets that offer growth opportunities.

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As vaping devices do not display what is being inhaled, these devices offer privacy for consumers who wish to protect their social persona. Because e-cigarette use is not restricted in physical locations (e.g., restaurants), they may encourage consumers to take medications as prescribed and avoid skipping dosages, particularly in older users.

Ethics in MarketingCompanies routinely face ethical conflicts between corporate interest and interest of

customers and stakeholders (Chonko & Hunt, 1985). The business of brain-altering, although a source positive outcomes in treatment of some disease, is more likely associated with negative outcomes, mainly physical and mental harm. How do marketers of self-injurious products address this ethical issue? Generally, tobacco companies rely on legal regulations, erroneously equating legal standards as ethical standards. In the case of e-cigarettes, it is not a dichotomous situation of good versus bad; it is a matter of degree. So, while research suggest that e-cigarettes are detrimental to health, it is an alternative to tobacco. Marketers must take care in both presenting information as research shows that positive aspects (e.g., cleaner) are often highlighted and negative aspects are dismissed.

Marketing to vulnerable consumers (e.g., young, ethnic minorities, low income/low educated) is a considerable ethical issue for the tobacco industry. Evidence support the disproportionate participation of vulnerable consumers worldwide (Maurer Foundation, 2012) : 1) almost 80% of people who die from tobacco-related reside in low- and middle-income countries, 2) cigarettes are approximately 21.7% cheaper in low- and middle-income countries, 3) 39% of low- and middle-income countries do not provide cessation support services in the offices of health professionals. Attention to societal harm (e.g., people committing crimes to support their nicotine addiction) must be exercise the honor the ethical guidelines for marketing

Importance and Contributions of ResearchThe tobacco industry is too big to overlook. Tobacco is one of the most profitable

industries in the world with the global market expected to reach $647.47 billion by 2021 (Grand View Research, 2018b). Tobacco in the U.S. is consistent with world trends and a growth rate of 3% between 2014-2019 and total revenues of $46 billion in 2019 (IBIS World, 2019). Despite a fall in volume sales, the combined profits of the six leading tobacco reached $35.1 billion in 2010, equal to the combined profits of Coca-Cola, Microsoft, and McDonald's in the same year (Maurer Foundation, 2012). Philip Morris USA, Reynolds American, Inc., ITG Brands, and Liggett account for 92% of USA cigarette sales (CDC, 2019d). This research provide the first know synthesis of research of e-cigarettes and address a gap in the existing literature.

Finding of the current study offer insight into the role of digital marketing in the tobacco industry. E-cigarettes penetrate new markets (e.g., adolescents and youth) and move emphasis of marketing communications to the digital arena. E-cigarettes are among the most in-demand consumer products available (Alexander, 2013). The decline in cigarette smoking after massive federal regulations in the 1960s has been replaced with an increase in e-cigarette use, particularly among younger consumers (U.S. Department of Health and Human Services, 2019). In 2014, e-cigarette use surpassed cigarettes products among youth (Porter, et al., 2015). With a 2018 U.S. population of more than 327 million, the youth market (ages 6-18 years) represents 15.3% or approximately 51 million potential consumers (U.S. Census Bureau, 2018). The youth market makes e-cigarettes an Internet phenomenon with online stores and virtual user communities ever more present on the digital highway (Yamin, Bitton & Bates, 2010). Twitter emerged as a social

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media platform used to spread product information (e.g., flavors) and experiences that support e-cigarette use (Ayers, et al., 2017; Chu, Uger, Cruz & Soto, 2015). The current study is relevant, timely, and forward looking honoring the current marketing philosophy for scholarly endeavors quality.

This study provides new insight into the concept of NSSI and its relationship with e-cigarettes. As the theoretical foundation of e-cigarette use, the current study integrates disciplines (marketing, psychology, sociology) to offer an enhanced knowledge of the topic. The integration of disciplines may be applied to a wide-variety of products and services such as tattooing, body modification, engaging in competitive sports that result in physical harm, and reckless driving (Møhl, 2020).

LimitationsAlthough the current study makes important contributions to the marketing literature,

there are limitations to the current research. This research is a descriptive analysis, which suggest further qualitative and quantitative investigation. Because e-cigarette is an infancy industry in the USA, continuous research is prescribed to update and supplement the findings rendered in this study. Finally, the inconsistencies of conceptualizations of variables must be resolved.

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REFERENCES

Adkinson, S. E., O'Connor, R. J., Bansal-Travers, M., Hyland, A., Borland, R., Yong, H. H., Cummings, K. M., McNeill, A., Thrasher, J. F., Hammond, D., & Fong, G. T. (2013). Electronic nicotine delivery systems: International tobacco control four-country survey. American Journal of Preventive Medicine, 44, 207-215. DOI: 10.1016/j.amepre.2012.10.018.

Agaku, I., Odani, S., Vardavas, C., & Neff, L. (2018). Self-identified tobacco use and harm perceptions among US youth. Pediatrics, 141, 1-9. DOI: 10.1542/peds.2017-3523.

Alexander, S. H. (2013). Electronic Cigarettes: My Research, Findings and Switch, 2nd Edition. San Bernardino, CA: CreateSpace Independent Publishing Platform.

American Academy of Pediatrics (2019). E-cigarettes. American Academy of Pediatrics. Retrieved from https://www.aap.ort.en-us/advocacy-and-policy/aap-health-initiatives/Richmond-Center/Pages?Electronic-Nicotine-Delivery-Systems.aspx.

Ayers, J. W., Leas, E. C., Allem, J-P., Benton, A., Dredze, M., Althouse, B. M., Cruz, T. B., & Unger, J. B. (2017). Why do people use electronic nicotine delivery systems (electronic cigarettes)? A content analysis of Twitter, 2012-2015. POLS ONE, 12(3). DOI: 10.1371/journal.pone.0170702.

Banerjee, S., Shuk, E., Greene, K., & Ostroff, J. S. (2015). Content analysis of trends in print magazine tobacco advertisements. Tobacco Regulatory Science, 1, 103-20.

Basch, C. H., Mongiovi, J., Hillyer, G. C., Ethan, D, & Hammond, R. (2016). An analysis of electronic cigarette and cigarette advertising in US women's magazines. International Journal of Preventive Medicine, 7, DOI: 10.4103/2008-7802.190089.

Bateman, A., & Fonagy, P. (2004). Psychotherapy for borderline personality disorder: Mentalization-based treatment. Oxford, England: Oxford University Press.

Berry, C., Burton, S., & Howlett, E. (2017). The impact of e-cigarette addition warnings and health-related claims on consumers' risk beliefs and use intentions. Journal of Public Policy & Marketing, 36, 59-69. DOI.org/10.1509/jppm.15.024.

Brandt, A. M. (2007). The Cigarette Century: The Rise, Fall, and Deadly persistence of the Product that Defined America. New York, NY: Basic Books.

Brown, E. M., Henes, A. L., & Olson, L. T. (2016). E-cigarette policies on college campuses: Student use behaviors, awareness, and policy support. Journal of Community Health, 41, 1110-1115.

Buczkowski, K., Basinska, M. BG., Ratajska, A., Lewandowska, K., Luszkiewicz, D., & Sieminskia, A. (2017). Smoking status and the five-factor model of personality: Results of a cross-sectional study conducted in Poland. International Journal of Environmental Research and Public Health, 14, 126. DOI: 10.3390/ijerph14020126.

Caponnett, P., Campagna, D., Cibella, F., Morjaria, J. B., Caruso, M., Russo, C., & Polosa R. (2014). Efficiency and safety of an electronic cigAreTte (ECLAT) as tobacco cigarettes substitute: A prospective 12-month randomized control design study. PLOS ONE, 8, e66317. DOI: 10.1371/journal.pone.0066317.

Case, K. R., Harrell, M. B., Pérez, A., Loukas, A., Wilkinson, A. V., Springer, A. E., Creamer, M. R., & Perry, C. L. (2017). The relationship between sensation seeking and a spectrum of e-cigarette use behaviors: Cross-sectional and longitudinal analyses specific to Texas adolescents. Addictive Behaviors, 73, 151-157.  DOI: 10.1016/j.addbeh.2017.05.007.

CDC (2019a). Tobacco industry marketing. Centers for Disease Control and Prevention, Retrieved from https://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/marketing/index.htm.

CDC (2019b). Smoking and tobacco use. Centers for Disease Control and Prevention Fast Facts. Retrieved from https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm.

CDC (2019c). Vital signs. Centers for Disease Control and Prevention, Retrieved from https://www.cdc.gov/tobacco/data_statistics/vital_signs/index.htm.

CDC (2019d). Economic trends in tobacco: Tobacco-related spending. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/tobacco/data_statistics/fact_sheets/economics/econ_facts/index.htm.

CDC (2019e). Know the risks: A youth guide to e-cigarettes. Center for Disease Control and Prevention, Retrieved from https://www.cdc.gov/tobacco/basic_information/e-cigarettes/pdfs/Ecigarette-youth-deck-talking-points-508.pdf.

Chen, Z., & Zeng, D. Z. (2017). Mining online e-liquid reviews for opinion polarities about e-liquid features. BMC Public Health, 17, 633. DOI: 10.1186/s12889-017-4533-z.

Page 19 of 25

Page 20: €¦  · Web view(non-combustible, aerosol inhalers). A review and synthesis of existing literature is employed in this research. Grounded in the theory of non-suicidal self-injury

Choi, K., & Forster, J. (2013). Characteristics associated with awareness, perceptions, and use of electronic nicotine delivery systems among young US Midwestern adults, American Journal of Public Health, 103, 556-561. DOI: 10.2105/AJPH.2012.300947.

Chonko, L. B., & Hunt, S. D. (1985). Ethics and marketing management: An empirical examination. Journal of Business Research, 30, 339-359. DOI.org/10.1016/0148-2963(85)90006-2.

Chu, K-H., Uger, J. B., Cruz, T. B., & Soto, D. W. (2015). Electronic cigarettes on Twitter - spreading the appeal of flavors. Tobacco Regulatory Science, 1, 36-41. DOI: 10.18001/TRS.1.1.4.

de Andrade, M., Hastings, G., & Angus, K. (2013). Promotion of electronic cigarettes: Tobacco marketing reinvented? British Medical Journal, 347, 15-17. DOI: 10.1136/bmj.f7473.

Duffy, E. K., & Jenssen, B. P. (2014). Electronic cigarettes: The new face of nicotine. Pediatrics, 134, 1-3.  DOI: https://doi.org/10.1542/peds.2013-3182.

Dutra, L. M., & Glantz, S. A. (2014). Electronic cigarettes and conventional cigarette use among U. S. adolescents : A cross-sectional study. JAMA Pediatrics, 168, 610-617. DOI:10.1001/jamapediatrics.2013.5488.

Elliott, G. C. (1984). Dimensions of the self-concept: A source of further distinctions in the nature of self-consciousness. Journal of Youth and Adolescence, 13, 285-307. DOI:10.1007/BF02094866.

El-Toukhy, S., & Choi, K. (2016). A risk-continuum categorization of product use among US youth tobacco users. Nicotine and Tobacco Research, 18, 1596-1605.  DOI: 10.1093/ntr/ntw008. 

Emery, S. L., Vera, L., Huang, J., & Szczypka, G. (2014). Wanna know about vaping? Patters of message exposure, seeking and sharing information about e-cigarettes across media platforms. Tobacco Control, 23, iii17-iii25. DOI:10.1136/tobaccocontrol-2014-051648.

Etter, J. F., & Bullen C. (2014). A longitudinal study of electronic cigarette users. Addictive Behaviour, 39, 491-494. DOI: 10.1016/j.addbeh.2013.

Fairchild, A. L., Bayer, R., & Colgrove, J. (2014). The renormalization of smoking? E-cigarettes and the tobacco "endgame." The New England Journal of Medicine, 370, 293-95. DOI: 10.1056/NEJMp1313940.

Farrelly, M. C., Duke, J. C., Crankshaw, E. C., Eggers, M. E., Lee, Y. O., Nonnemaker, J. M., Kim A. E., & Porter, L. (2015). A randomized trial of the effect of e-cigarette TV advertisement on intentions to use e-cigarettes. American Journal of Preventive Medicine, 49, 686-693. DOI: 10.1016/j.amepre.2015.05.010.

FDA (2019a). Nicotine: The addictive chemical in tobacco products. FDA. Retrieved from http://www.fda.gov/ tobacco-products/health-information/nicotine-addictive-chemical-tobacco-products

FDA (2019b). Vaporizers, e-cigarettes, and other electronic nicotine delivery systems (ENDS). FDA, Retrieved from https://www.fda.gov/tobacco-products/products-ingredients-components/vaporizers-e-cigarettes-and-other-electronic-nicotine-delivery-systems-ends.

Ganz, O., Cantrell, J., Moon-Howard, J., Aidala, A., Kirchner, T. R., & Vallone, D. (2015). Electronic cigarette advertising at the point-of-sale: A gap in the tobacco control research. Tobacco Control, 24, e110-e112. http://dx.doi.org/10.1136/tobaccocontrol-2013-051337.

Gilreath, T. D., Leventhal, A., Barrington-Trimis, J. L. Unger, J. B., Cruz, T. B., Berhane, K., Huh, J., Urman, R., Wang, K., Howland, S., Pentz, M. A., Chou, C. P., & McConnell, R. (2016). Patters of alternative tobacco product use: Emergence of hookah and e-cigarettes as preferred products amongst youth. Journal of Adolescents Health, 58, 181-85. DOI: 10.1016/j.jadohealth.2015.10.001.

Gorzkowski, J., Harris, D., Kaseeska, K., Shaefer, R. W., Moreno, M., Pbert, L., Wasserman, R., & Klein, J. (2015). Trends in youth use of e-cigarettes and alternative tobacco products. 2015 Pediatric Academic Societies Annual Meeting, San Diego, CA: American Academy of Pediatrics.

Gowin, M. G., Cheney, M. K., & Wann, T. F. (2017). Knowledge and beliefs about e-cigarettes in straight-to-work young adults. Nicotine & Tobacco Research, 19, 208-214. http://dx.doi.org/10.1136/tobaccocontrol-2013-051337/

Grana, R. A., & Ling, P. M. (2014). "Smoking revolution:" A content analysis of electronic cigarette retail websites. American Journal of Prevention Medicine, 46, 395-403. DOI: 10.1016/j.amepre.2013.12.010.

Grand View Research (2018a). Tobacco market size worth $694.47 billion by 2021: CAGR: 2.8%. Grand View Research. Retrieved from https://www.grandviewresearch.com/press-release/global-tobacco-market.

Grand View Research (2018b). Tobacco market size, share & trends analysis report by type (cigarettes, smoking tobacco, smokeless tobacco, cigars & cigarillos, by region (U.S., Canada, U. K., China), and segment forecasts, 2012-2021. Grand View Research. Retrieved from https://www.grandviewresearch.com/industry-analysis/tobacco-market.

Guydish, J., Tajima, B., Pramod, S., Le, T., Gubner, N. R., Campbell, B., & Roman, P. (2016). Use of multiple tobacco products in a national sample of persons enrolled in addiction treatment. Drug and Alcohol Dependence, 166, 93-99. DOI: 10.1016/j.drugalcdep.2016.06.035. 

Page 20 of 25

Page 21: €¦  · Web view(non-combustible, aerosol inhalers). A review and synthesis of existing literature is employed in this research. Grounded in the theory of non-suicidal self-injury

Hanewinkel, R., & Isensee B. (2015). Risk factors for e-cigarette, conventional cigarette, and dual use in German adolescents: A cohort study. Preventive Medicine, 74, 59-62. DOI: 10.1016/j.ypmed.2015.03.006. 

Hébert, E. T., Vandewater, E. A., Businelle, M. S., Harrell, M. B., Kelder, S. H., & Perry C. L. (2017). Feasibility and reliability of mobile tool to evaluate exposure to tobacco product marketing and messages using ecological momentary assessment, Addictive Behaviors, 73, 105-110. DOI: 10.1016/j.addbeh.2017.05.004.

Hooley, J. M., & Franklin, J. C. (2017). Why do people hurt themselves? A new conceptual model of nonsuicidal self-injury. Clinical Psychological Science, 6, 428-451. : https://doi.org/10.1177/2167702617745641 .

Huang, J., Kornfield, R., Szczypka, G., & Emery, S. L. (2014). A cross-sectional examination of marketing of electronic cigarettes on Twitter. Tobacco Control, 23, iii26-iii30. DOI:10.1136/tobaccocontrol-2014-051551.

Hutchinson, J., & Smith, A. D. (1996). Theories of ethnicity. In J. Hutchinson & A. D. Smith (eds.), Ethnicity. New York, NY: Oxford University Press, 32-34.

Hwang, J. H., & Park, S-W. (2016). Association between peer cigarette smoking and electronic cigarette smoking among adolescent nonsmokers: A national representative survey. POLS ONE, 1-12. DOI:10.1371/journal.pone.0162557.

IBIS World (2019). Cigarette & tobacco manufacturing industry in the US - market research report. IBIS World, Retrieved from https://www.ibisworld.com/united-states/market-research-reports/cigarette-tobacco-manufacturing-industry/,

Johnson, A. C., Mays, D., Hawkins, K. B., Denzel, M., & Tercyak, K. P. (2017). A qualitative study of adolescent perceptions of electronic cigarettes and their marketing: Implications for prevention and policy. Children's Health Care, 46, 379-392. DOI: 10.1080/02739615.2016.1227937.

Jones, D. M., Majeed, B. A., Weaver, S. R., Sterling, K., Pechacek, T. F., & Eriksen, M. P. (2017). Prevalence and factors associated with smokeless tobacco use, 2014-2016. American Journal of Health Behavior, 41, 608-617. DOI: 10.5993/AJHB.41.5.10.

Index Mundi (2019). United States demographics profile 2019. Index Mundi, Retrieved from https://www.indexmundi.com/united_states/demographics_profile.html.

Kong, G., Idrisov, B., Galimov, A., Masagutov, R., & Sussman, S. (2017). Electronic cigarette use among adolescents in the Russian Federation. Substance Use & Misuse, 52, 332-339.  DOI: 10.1080/10826084.2016.1225766. 

Kowitt, S. D., Goldstein, A. O., Schmidt, A. M., Hall, M. G., & Brewer, N. T. (2017). Attitudes toward FDA regulation of newly deemed tobacco products. Tobacco Regulatory Science, 3, 504-515,  DOI: 10.18001/TRS.3.4.10. 

Laverty, A. A., Vardavas, C. I., & Filippidis, F. T. (2016). Design and marketing features influencing choice of e-cigarettes and tobacco in the EU. The European Journal of Public Health, 25, 838-841. DOI: 10.1093/eurpub/ckw109.

 Lee, H-Y., Lin, H-C., Seo, D-C., & Lohrmann, D. K. (2018). The effect of e-cigarette warning labels on college students' perception of e-cigarettes and intention to use e-cigarettes. Addictive Behaviors, 76, 106-112. DOI: 10.1016/j.addbeh.2017.07.033. 

Lee, S., Grana, R. A., & Glantz, S. A. (2014). Electronic cigarette use among Korean adolescents: A cross-sectional study of market penetration, dual use, and relationship to quite attempts and former smoking. Journal of Adolescent Health, 54, 684-690. DOI: 10.1016/j.jadohealth.2013.11.003.

Levitt, T. (2004). Marketing myopia. Harvard Business Review. Available from https://hbr.org/2004/07/marketing-myopia.

Levy, D. T., Cummings, K. M., Villanti, A. C., Niaura, R., Abrams, D. B., Fong, G. T., & Borland, R. (2017). A framework for evaluating the public health impact of e-cigarettes and other vaporized nicotine products. Addiction, 112, 8-17. DOI: 10.1111/add.13394.

Lotrean, L. M. (2015). Use of electronic cigarettes among Romanian university students: A cross-sectional study. BMC Public Health, 15. DOI: 10.1186/s12889-015-1713-6.

Mackey, T. K., Miner, A., & Cuomo, R. E. (2015). Exploring the e-cigarette e-commerce marketplace: Identifying Internet e-cigarette marketing characteristics and regulatory gaps. Drug and Alcohol Dependence, 156, 97-103. DOI: 10.1016/j.drugalcdep.2015.08.032. 

Maurer Foundation (2012). Tobacco industry profits estimated $35 billion with almost 6 million annual deaths. Maurer Foundation, Retrieved from https://www.maurerfoundation.org/tobacco-industry-profits-estimated-35-billion-with-almost-6-million-annual-deaths/,

McDonald, E. A., & Ling, P. M. (2015). One of several 'toys' for smoking: Young adult experiences with electronic

Page 21 of 25

Page 22: €¦  · Web view(non-combustible, aerosol inhalers). A review and synthesis of existing literature is employed in this research. Grounded in the theory of non-suicidal self-injury

cigarettes in New York City. Tobacco Control, 24, 588-593. DOI: 10.1136/tobaccocontrol-2014-051743.Mello, S., Bigman, C. A., Sanders-Jackson, A., & Tan, A. S. L. (2016). Perceived harm of secondhand electronic

cigarette vapors and policy support to restrict public vaping: Results from a national survey of US adults. Nicotine and Tobacco Research, 18, 686-693. DOI: 10.1093/ntr/ntv232. 

Møhl, B. (2020). Assessment and Treatment of Non-Suicidal Self-Injury: A Clinical Perspective. New York, NY: Routledge.

Peighambari, K., Sattari, S., Kordestani, A., & Oghazi, P. (2016). Consumer behavior research: A synthesis of the recent literature. Sage Open, April-June, 1-9. https://doi.org/10.1177/2158244016645638.

Pisinger, C. (2015). A systematic review of health effects of electronic cigarettes. Research Centre for Prevention and Health. Retrieved from https://www.who.int/tobacco/industry/product_regulation/BackgroundPapersENDS3_4November-.pdf.

Pokhrel, P., Fagan, P., Herzog, T. A., Chen, Q., Muranaka, N., Kehl, L., & Uger, J. B. (2016). E-cigarette advertising exposure and implicit attitudes among young adult non-smokers. Drug & Alcohol Dependence, 163, 134-140. DOI: 10.1016/j.drugalcdep.2016.04.008.

Pokhrel, P., Herzog, T. A., Muranaka, N., & Fagan, P. (2015). Young adult e-cigarette users' reasons for liking and not liking e-cigarettes: A qualitative study. Psychological Health, 30, 1450-1469. DOI: 10.1080/08870446.2015.1061129.

Porter, L., Duke, J., Hennon, M., Dekevich, D., Crankshaw, E., Homsi, G., & Farrelly, M. (2015). Electronic cigarette and traditional cigarette use among middle and high school students in Florida, 2011-2014. PLOS ONE, 10, e0123385. DOI: 10.1371/journal.pone.0124385.

Psychology Today (2019). What is sensation seeking? Psychology Today, Retrieved from https://www.psychologytoday.com/us/basics/sensation-seeking.

Pulvers, K., Sun, J. Y., Zhuang, Y-L., Holguin, G., & Zhu, S-H. (2017). Internet-based advertising claims and consumer reasons for using electronic cigarettes by device type in the US. Tobacco Regulatory Science, 3, 516-524. DOI: 10.18001/TRS.3.4.11

Ramamurthi, D., Gall, P. A., Ayoub, N., & Jackler, R. K. (2016). Leading-brand advertisements of quitting smoking benefits of e-cigarettes. American Journal of Public Health, 106, 2057-2063.

Regan, A. K., Promoff, G., Dube, S. R., & Arrazola, R. (2013). Electronic nicotine delivery systems: Adult use and awareness of the 'e-cigarette' in the USA. Tobacco Control, 22. 19-23.

Reinhold, B., Fischbein, R., Bhamidipalli, S. S., Bryant, J., & Kenne, D. R. (2017). Associations of attitudes toward e-cigaretters with advertisement exposure and social determinants: A cross sectional study. Tobacco Induced Disease, 1. DOI:10.1186/s12971-017-0118-y.

Richardson, A., Ganz, O., & Vallone, D. (2015). Tobacco on the web: Surveillance and characterisation of online tobacco and e-cigarette advertising. Tobacco Control, 24, 341-347.

Riley, K. E., Ulrich, M. R., Hamann, H. A., & Ostroff, J. S. (2017). Decreasing smoking but increasing stigma? Anti-tobacco campaigns, public health, and cancer care. AMA Journal of Ethics, 19, 475-485. DOI: 10.1001/journalofethics.2017.19.5.msoc1-1705.

Roberts, M. E., Berman, M. L., Slater, M. D., Hinton, A., & Ferketich, A. K. (2015). Point-of-sale tobacco marketing in rural and urban Ohio: Could the new landscape of tobacco product widen inequalities? Preventive Medicine, 81, 232-235. DOI: 10.1016/j.ypmed.2015.08.024. 

Roditis, M., Delucchi, K., Cash, D., & Halpern-Felsher, B. (2016). Adolescents' perceptions of health risks, social risks, and benefits differ across tobacco products. The Journal of Adolescent Health, 58, 558-566. DOI: 10.1016/j.jadohealth.2016.01.012.

Schoenborn, C. A., & Gindi, R. M. (2015). Electronic cigarette use among adults: United States, 2014, NCHS Data Brief, 217, 1-8.

Shin D. W., Kim, Y., II, Kim, S. J., Kim, J. S., Chong, S., Park, Y. S., Song, S-Y., Lee, J. H., Ahn, H. K., Kim, E. Y., Yang, S. H., Lee, M. K., Cho, D. G., Jang, T. W., Son, J. W., Ryu, J-S. and Cho, M-J (2017, February 24), Lung cancer specialist physicians' attitudes toward e-cigarettes: A nationwide survey. POLS ONE, 12. e0172568. DOI: 10.1371/journal.pone.0172568.

Slesinger, N. E., Hayes, N. A., & Washburn, J. J. (2019). Nonsuicidal self-injury: The basics. In J. J. Washburn (ed.), Nonsuicidal Self-Injury: Advances in Research and Practice. New York, NY: Routledge, 3-18.

Smith, D. M., Bansl-Travers, M., O'Connor, R. J., Goniewicz, M. L., & Hyland, A. (2015). Association between perceptions of e-cigarette advertising and interest in product trial amongst US adult smokers and non-smokers: Results from an internet-based pilot survey. Tobacco Induced Diseases, 13. DOI: 10.1186/s12971-015-0039-6.

Page 22 of 25

Page 23: €¦  · Web view(non-combustible, aerosol inhalers). A review and synthesis of existing literature is employed in this research. Grounded in the theory of non-suicidal self-injury

Takematsu, M. (2019). What is nicotine and what forms of nicotine are available. American College of Medical Toxicology, Retrieved from https://www.acmt.net/_Library/Public_Affairs/ACMT_FAQ_Nicotine_.pdf.

Tan, A. S., Lee, C. J., & Bigman, C. A. (2015). Public support for selected e-cigarette regulations and associations with overall information exposure and contradictory information exposure about e-cigarettes: Findings from a national survey of U.S. adults. Preventive Medicine, 81, 268-274.

Tokin, E., McDonald, M., & Chapman, M. (1996). History and ethnicity. In J. Hutchinson & A. D. Smith (eds.), Ethnicity. New York, NY: Oxford University Press, 18-24.

Tomashefski, A. (2016). The perceived effects of electronic cigarettes on health by adult users: A staqte orf the science systematic literature review. Journal of the American Association of Nurse Practitioners, 28, 510-515. DOI: 10.1002/2327-6924.12358. 

Trimarchi, M., & Meeker-O'Connell, A. (2019). How nicotine works. Science. Available at https://science.howstuffworks.com/nicotine1.htm.

Tversky, A., & Kahneman, D. (1981). The framing of decisions and the psychology of choice. Science, 211, 453-458, Retrieved from https://www.uzh.ch/cmsssl/suz/dam/jcr:ffffffff-fad3-547b-ffff-ffffe54d58af/10.18_kahneman_tversky_81.pdf.

Uger, J. B., Baker, D. C., Sussman, S., Soto, D. W., & Baezconde-Garbanati, L. (2017). E-cigarette regulatory attitudes in groups with low policy support. Tobacco Regulatory Science, 3, 408-423. DOI: https://doi.org/10.18001/TRS.3.4.3.

U.S. Census Bureau (2018). Estimates of U.S. population by age and sex: April 1, 2010 to July 1, 2017. U. S. Census Bureau, Retrieved from https://www.census.gov/newsroom/press-releases/2018/pop-characteristics.html.

U.S. Department of Health and Human Services (2019). E-cigarette use among youth and young adults. A report of the Surgeon General, Atlanta, GA. US Department of Health and Human Services, CDC, Retrieved from https://www.cdc.gov/tobacco/data_statistics/sgr/e-cigarettes/index.htm.

Vijayaraghavan, M., Hurst, S., & Pierce J. P. (2017). A qualitative examination of smoke-free policies and electronic cigarettes among sheltered homeless adults. American Journal of Health Promotion, 31, 243-250. DOI: 10.4278/ajhp.150318-QUAL-781. 

Volesky, K. D., Maki, A., Scherf, C., Watson, L. M., Cassol, E., & Villeneuve, P. J. (2016). Characteristics of e-cigarette users and their perceptions of the benefits, harms and risks of e-cigarette use: Survey results from a convenience sample in Ottawa, Canada. Health Promotion and Chronic Disease Prevention in Canada, 36, 130-138.

Wagoner, K. G., Cornacchione, J., Wiseman, K. D., Teal, R., Moracco, K. E., & Sutfin, E. L. (2016). E-cigarettes, hookah pens and vapes: Adolescent and young adult perceptions of electronic nicotine delivery systems. Nicotine & Tobacco Research, 18, 2006-2012. DOI: 10.1093/ntr/ntw095. 

Wang, M. P., Li, W. H. C., Jiang, N., Chu, L. Y., Kwong, A., Lai, V., & Lam, T. H. (2015). E-cigarette awareness, perceptions and use among community-recruited smokers in Hong Kong. PLOS ONE, 26, e0141683. DOI: 10.1371/journal.pone.0141683.

Wang, Y., Sung, H. Y., Yao, T, Lightwood, J., & Max, W. (2018). Infrequent and frequent nondaily smokers and daily smokers: Their characteristics and other tobacco use patterns. Nicotine and Tobacco Research, 20, 741-748. DOI: 10.1093/ntr/ntx038.

Weishaar, H., Trevisan, F., & Hilton, S. (2016). 'Maybe they should regulate them quite strictly until they know the true dangers': A focus group study exploring UK adolescents' view of e-cigarette regulations, Addiction, 111, 1637-1645.  DOI: 10.1111/add.13377.

Wise, M. H., Weierbach, F., Cao, Y., & Phillips K. (2017). Tobacco use and attachment style in Appalachia, Issues in Mental Health Nursing. 38. 562-569.  DOI: 10.1080/01612840.2017.1312651.

Wong, L. P., Mohamad-Shakir, S. M. M., Alias, H., Aghamohammadi, N., & Hoe, V. C. W. (2016). Reasons for using electronic cigarettes and intentions to quit among electronic cigarette users in Malaysia. Journal of Community Health, 41,1101-1109.

Xu, Y., Guo, Y., Liu, K., Liu, Z., & Wang, X. (2016). E-cigarette awareness, use, and harm perception among adults: A meta-analysis of observational studies. PLOS ONE, 11, e0165938. DOI: 10.1371/journal.pone.0165938.

Yamin, C. K., Bitton, A., & Bates, D. W. (2010). E-cigarettes: A rapidly growing Internet phenomenon. Annuals of Internal Medicine, 153, 607-609. DOI: 10.7326/0003-4819-153-9-201011020-00011.

Yao, T., Jiang, N., Grana, R., Ling, P. M., & Glantz, S. A. (2016). A content analysis of electronic cigarette

Page 23 of 25

Page 24: €¦  · Web view(non-combustible, aerosol inhalers). A review and synthesis of existing literature is employed in this research. Grounded in the theory of non-suicidal self-injury

manufacturer websites in China. HHS Tobacco Control, 25,188-194.

Page 24 of 25

Page 25: €¦  · Web view(non-combustible, aerosol inhalers). A review and synthesis of existing literature is employed in this research. Grounded in the theory of non-suicidal self-injury

Yates, T. M. (2009). Developmental pathways from child maltreatment to nonsuicidal self-injury. In M. K. Nock (ed.), Understanding Nonsuicidal Self-Injury: Origins, Assessment, and Treatment. Washington, DC: American Psychological Association, 117-137.

Yingst, J. M., Foulds, J., Veldheer, S., Hrabovsky, S., Trushin, N., Eissenberg, T. T., Williams, J., Richie, J. P., Nichols, T. T., Wilson, S. J., & Hobkirk A. A. (2019). Nicotine absorption during electronic cigarette use among regular users. POLS ONE, 25. DOI: 10.1371/journal.pone.0220300,

Page 25 of 25


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