In 2022, the global market for e-cigarettes was estimated to be worth $22.8 billion, projected to rise at an annual rate of 4.3% from 2022 to 2027 [1]. Although there are no precise figures for the number of people using e-cigarettes, that figure has been estimated to be in the region of 81.9 m in 2021 [2]. As the number of people using e-cigarettes has increased, so too has the commitment on the part of national and international regulatory bodies in determining whether these devices are having a positive or negative impact on public health, and how they ought to be regulated [3]. In a review undertaken by the internationally respected Cochrane Centre, the capacity of e-cigarettes to assist adults who smoke in quitting was clearly recognized:
An earlier review of the evidence on the health impact of e-cigarettes undertaken by the US National Academies of Science Engineering and Medicine similarly concluded that:
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Recent research has shown that where adults who smoke have access to e-cigarettes, their use is associated with an increased number of quit attempts and an increased likelihood that those quit attempts will have been successful [6,7,8,9]. While the long-term harms associated with e-cigarettes remain unknown at present, and are likely to remain so for many years to come, these devices have been judged to be substantially less harmful than combustible tobacco products by a range of respected public health bodies, including: the UK Office for Health Improvement and Disparities, the UK Royal College of Physicians, and the Royal College of General Practitioners, and Cancer Research UK [10,11,12].
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On the basis of what is now a substantial body of evidence, e-cigarettes have the potential to reduce smoking-related harm at the population level and at the level of the individual who is smoking. Importantly, that capacity exists wherever smoking combustible tobacco products occur, irrespective of the population group involved, and independently of the cultural context within which that smoking is occurring. However, whether these devices will achieve that potential relies to a large extent on the degree to which they are available for use by those who are smoking, and the extent to which those who are smoking choose to use these devices as an alternative to combustible cigarettes. The fact that the estimated total number of people using e-cigarettes is less than 10% of the estimated total number of people smoking globally (1.1B) is an illustration of how far e-cigarettes are from realizing that potential [13].
There are multiple reasons why these devices remain unavailable to millions of adults who smoke globally, and there are many reasons why, even in those areas where these devices are widely available, a large proportion of adults who smoke choose not to use these devices. One factor explaining why some people may choose not to use these devices is the erroneous perception that e-cigarettes are as harmful, if not more harmful, than combustible tobacco products. Research has shown that where such misperceptions occur, there is a reduced likelihood that these products will be used by those who are smoking [14, 15].
In relation to the degree to which e-cigarettes are available for use by those who are smoking, one of the major determinants is the question of how these devices are regulated by national and international bodies. In some countries (e.g., Brazil, Singapore, and India), access to these devices is entirely prohibited, while in other countries, access is limited to those in receipt of a medical prescription (e.g., Australia). In striking contrast to such restrictive regulatory action, some countries (e.g., Switzerland and the UK) have opted to ensure that adults who are smoking have relatively easy access to these products. Within the UK, so convinced is the government of the positive impact these devices in assisting adults who smoke in quitting that a scheme was recently announced enabling adults who are smoking to exchange their combustible cigarettes for e-cigarettes free of charge [16].
If there is one thing that has shaped the regulatory environment around these products more than any other, it is the use of these devices by young people. Within the US, the growth in the numbers of young people using e-cigarettes has been described by public health leaders as an “epidemic.” [17]. Although the number of the US youth reporting having used an e-cigarette in the past 30 days has recently reduced, nevertheless concern remains high at the overall level of e-cigarette use among youth and the marked recent growth in popularity of disposable e-cigarettes [18, 19]:
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According to the 2022 National Youth Tobacco Survey (NYTS), the Puff Bar disposable flavored e-cigarette has become the most popular device used by middle and high school pupils within the US. Among those pupils who report having used an e-cigarette in the past 30 days, 29.7% identified the Puff Bar device as the e-cigarette they had used [20]. In advance of the 2022 NYTS, and following publication of the survey findings, there has been mounting concern at the increasing appeal and use of disposable e-cigarettes by the US youth to the point that these products have become virtually synonymous with youth vaping and public health harm [21,22,23,24]. Within much of the critical commentary around disposable e-cigarettes, there is an assumption: a) that all disposable e-cigarettes pose the same level of harm in terms of youth use, and b) that these products offer no notable public health benefit in terms of their capacity to assist adults who smoke in quitting. Within a context of mounting concern, the US Food and Drug Administration (FDA) has issued warning letters to the manufacturers of disposable e-cigarette products:
In addition to such warning letters, the FDA has issued “Marketing Denial Orders” to a range of disposable e-cigarette manufacturers on the basis that these products are judged to not be “appropriate for the protection of the public health” [26]. Disposable e-cigarettes, it could be said, have become the “new JUUL,” characterized by influential political figures, public health leaders, the media, and local lobby groups as the driver of public health harm and youth vaping [27,28,29].
Within a context of such heightened fears, it has become increasingly important to establish the extent to which individual, named, e-cigarette devices including disposable devices and e-liquids, are being used by youth and underage young adults within the US. While the NYTS has reported on the extent to which the Puff Bar device is being used by the US youth, other brands of disposable e-cigarette devices are included within this survey only as a “write-in” category, requesting information on “some other brands not listed here.” As a result, there is a serious lack of information as to how widely specific brands of e-cigarettes are being used by youth and underage young adults within the US—information which is essential to establishing the public health impact of these devices.
In the remainder of this paper, we report on research designed to estimate the prevalence with which the second most popular disposable e-cigarette within the US (BIDI® Stick) is being used by youth and underage young adults. According to recent estimates, the BIDI® Stick range of flavored disposable e-cigarettes occupies 24.2% of the disposable e-cigarette market within the US [30]. The manufacturer of this product received a Marketing Denial Order in 2021 which, in 2022, was set aside following a decision by the US Court of Appeals for the Eleventh Circuit, to request the FDA to reassess the evidence which the original Marketing Denial Order was based upon [31].
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