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Abstract
Objective Retailers that primarily or exclusively sell electronic cigarettes (e-cigarettes) or vaping products represent a new category of tobacco retailer. We sought to identify (a) how vape shops can be identified and (b) sales and marketing practices of vape shops.
Data sources A medical librarian iteratively developed a search strategy and in February 2017 searched seven academic databases (ABI/INFORM Complete, ECONLit, Embase, Entrepreneurship, PsycINFO, PubMed/MEDLINE and Scopus). We hand searched Tobacco Regulatory Science and Tobacco Prevention & Cessation.
Study selection We used dual, independent screening. Records were eligible if published in 2010 or later, were peer-reviewed journal articles and focused on vape shops.
Data extraction We used dual, independent data abstraction and assessed risk of bias. Of the 3605 records identified, 22 were included.
Data synthesis We conducted a narrative systematic review. Researchers relied heavily on Yelp to identify vape shops. Vape shop owners use innovative marketing strategies that sometimes diverge from those of traditional tobacco retailers. Vape shop staff believe strongly that their products are effective harm-reduction products. Vape shops were more common in areas with more White residents.
Conclusions Vape shops represent a new type of retailer for tobacco products. Vape shops have potential to promote e-cigarettes for smoking cessation but also sometimes provide inaccurate information and mislabelled products. Given their spatial patterning, vape shops may perpetuate inequities in tobacco use. The growing literature on vape shops is complicated by researchers using different definitions of vape shops (eg, exclusively selling e-cigarettes vs also selling traditional tobacco products).
- non-cigarette tobacco products
- advertising and promotion
- electronic nicotine delivery devices
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Introduction
As the tobacco epidemic has grown to include greater use of e-cigarettes and other vaping products,1 a new type of retailer has emerged: vape shops. These retailers focus primarily or exclusively on the sale of e-cigarettes and other vaping products (eg, e-liquids) and differ from traditional tobacco product retailers like convenience stores or grocery stores. This recent change in the retail environment for tobacco products is important for four reasons. First, the retail environment plays an important role in normalising tobacco use and in exposing youth to tobacco products and their advertising.2 Second, vape shops—as specialty stores—can provide individually tailored information about e-cigarettes to consumers. Third, vape shops may use new forms of marketing that could promote cessation from more toxic combustible products, could draw more youth into nicotine addiction and could promote dual use of e-cigarettes and conventional cigarettes.3 Fourth, there are potential health equity issues around disproportionate marketing and presence in neighbourhoods given that e-cigarettes are, at an individual level, potential harm-reduction strategies for cigarette smokers.4–6 That is, if vape shops are less accessible to low-income smokers who would benefit from quitting cigarettes, this might contribute to inequities in smoking. Alternatively, if more vape shops are located in lower-income neighbourhoods, this may lead to disproportionate exposure to e-cigarettes and their marketing for lower-income youth.
Although there was a recent special issue on vape shops in Tobacco Prevention & Cessation,7 there has not yet been an attempt to synthesise the existing knowledge on vape shops. To address this gap, we conducted a systematic review of the existing literature to answer two questions: (1) What methods are used to find, enumerate or map vape shops? (2) What are the sales and marketing practices of vape shops?
Methods
Search
One author (KBS) iteratively developed keywords in the domains of ‘e-cigarettes’ and ‘marketing/shops’ based on prior research studies1 8 and combined keywords with controlled vocabulary (ie, Medical Subject Heading terms) from PubMed/MEDLINE. The search strategy is available (online supplementary file 1). On 27 February 2017, one author (KBS) mapped and implemented the search strategy in seven databases (ABI/INFORM Complete, ECONLit, Embase, Entrepreneurship, PsycINFO, PubMed/MEDLINE and Scopus) for peer-reviewed literature. Given that they have not been fully indexed in MEDLINE, we also hand searched all volumes and issues of Tobacco Regulatory Science and the abstracts of a special issue of Tobacco Prevention & Cessation on vape shops. We did not have any language or geographic restrictions for our search of databases. We set up article alerts to track new publications after our search; we address these new findings in the discussion. We followed Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines for observational studies.9 A protocol is available (online supplementary file 1).
Supplementary file 1
Screening
After software and manual de-duplication of records, two of three authors (JGLL, ENO, KBS) independently screened the title and abstract of each identified record for inclusion. Irrelevant records were removed from the pool, and potentially relevant records were each independently reviewed in their full text form by two of three authors (JGLL, ENO, KBS). Records were eligible for inclusion if they were published during or after 2010 (as there were few studies on e-cigarettes published before that time1 and the first newspaper article indexed by LexisNexis about vape shops was published in October 201210), were peer-reviewed journal articles, focused on vape shops and not just tobacco retailers (ie, retailers whose primary product is e-cigarettes) and addressed one of two questions of interest: (a) What are methods used to find, enumerate or map vape shops? (b) What are the sales and marketing practices of vape shops? We defined marketing to include price, promotion, product and placement.11 Covidence cloud-based software (covidence.org) was used to manage the coding process.
Abstraction
Eligible articles were independently read by two authors (JGLL, ENO) who recorded the studies’ research questions, vape shop definitions, sampling unit, sampling frame, sampling strategy, mode of data collection, analysis strategy, findings, funding source and risk of bias (RoB) measures into separate data abstraction tables. As no existing RoB tool fit our needs, we developed seven RoB measures focused on the internal and external validity of each article including use of multiple geographic areas, use of random or census sampling, sample size (ie, having over 100 vape shops included in the study), having an unrestricted sample (eg, the sample was not limited to vape shops with prior youth sales violations), analysis appropriate to the research question, not having industry funding and not having conflicts of interest. The two authors met to identify disagreements in the data abstraction process. A third author (KMR) resolved points of disagreement, and then the two data abstraction tables were merged into one evidence table.
Analysis
We conducted a narrative review of the identified literature as study heterogeneity in research question, design, outcomes, and reporting precluded quantitative meta-analysis. We created an evidence table following the three aims. First, we report methodological considerations. Second, we report marketing strategies. Third, we report attitudes and beliefs of owners or staff. We report marketing results by the 4 P’s (product, price, promotion and placement).11 Product included e-liquids, generation of e-cigarette product (ie, first-generation ‘cig-a-like’ products that are low cost, disposable and ubiquitous; second-generation products that often include refillable tanks and rechargeable batteries; and third-generation products that are highly customisable5). Price included discounts, buy-one-get-one sales, and so on. Promotion included signage, marketing philosophy, strategies and gifts with purchase. Placement included self-service displays and marketing materials in child’s height or line of vision. We separately report results relating to retailer density and proximity.
Results
The search identified 3605 unique records. Following the screening process, 3565 records were deemed irrelevant to the research questions and excluded. The remaining 40 records were reviewed in their full text form. This resulted in 22 eligible records included in this systematic review. This process is shown in figure 1. An evidence table is available in online supplementary file 2 .
Supplementary file 2
Preferred Reporting Items for Systematic Review and Meta-Analyses flow diagram, 27 February 2017.
The first identified record was published in 2014.12 Tobacco Prevention & Cessation and Tobacco Control had the largest number of records with five and three, respectively. One paper was published with Canadian data,13 1 with South Korean data14 and the remaining 20 were from the USA. Our RoB index ranged from 0 to 3 (M=1.64, SD=0.90) out of a possible 7, which indicated the most risk.
How are researchers defining vape shops?
Our inclusion criteria required that the record report data about vape shops. We thus excluded studies of e-cigarettes sold in convenience stores,15 for example. Nonetheless, there was important variability in how researchers defined vape shops. These largely fell into two groups: (1) studies that defined vape shops as selling e-cigarettes and not selling combustible tobacco products16–22 and (2) studies that defined vape shops as primarily selling e-cigarettes.12–14 23–34 As many authors were not clear about the definition used, we coded those not reporting explicitly excluding vape shops carrying combustible tobacco products into the second category. One study stratified results by type of retailer: Kong and colleagues found important differences in the marketing used by type of vape retailer by separately analysing (a) vape shop/vape kiosk and (b) vape shops that double as smoke shops or head shops.31
How are researchers identifying vape shops?
The most common source for identifying vape shops is Yelp,12 13 16 19–24 28 30–33 which was used by 14 of the 22 records. Google was used by eight records,16 21 23 25–27 31 34 Google Maps by five,13 21 30 33 34 Yellowpages.com by five,16 24 28 30 33 one used licensing lists30 and one used ground truthing (ie, physically travelling a predefined area and canvassing streets to identify vape shop locations).33 Ten records included other sources of information: vaporsearchusa.com,25–27 31 33 Vapeabout.com,21 33 local health department reports,17 18 e-cigarette-store-reviews.com,33 Facebook,21 guidetovaping.com,28 ReferenceUSA,33 snowball sampling,31 thevapormap.com,31 vapestores.com,33 Whitepages.com 24 and an undefined convenience sample.14
The heavy reliance on Yelp likely stems from Sussman’s early work using Yelp as a primary source of data12 and work by Kim et al to validate online searches.30 Given the existing studies, it appears that Yelp is likely one of the best single sources for identifying vape shops in the USA.30 33 Yet, Yelp is imperfect; when used alone it missed almost 20% of vape shops in one small study in North Carolina.33 That same study found the sensitivity of four vaping web sites (Vapeabout.com, vaporsearchusa.com, vapestores.com and e-cigarette-store-reviews.com) to be poor (ie, <56). Both Kim et al and Lee et al found substantial numbers of false positives using Yellowpages.com.30 33 Based on the records identified in this review, we suggest using Yelp in combination with another online source, such as Google Maps, at least for studies in the USA.30 33
What do we know about marketing practices of vape shops and their locations?
Promotion was most commonly discussed in the records identified (n=14),12 13 19 20 22–27 29 31 32 34 followed by product (n=6),13 14 18–20 31 price (n=2)19 31 and place (n=2).20 31 Three records looked at the density and proximity of vape shops.16 21 28
Promotion
Vape shop promotions show some differences from traditional tobacco retailer promotions, including some promotional activities that are prohibited for other regulated tobacco products.11 One article went into detail about the differences in product promotion.25 Cheney et al found a clear difference: traditional tobacco product retailers rely on marketing and merchandising materials (eg, signage, display racks, price promotions) that are created and printed by multinational tobacco companies with billions of dollars in marketing and promotion expenditures each year.35 However, vape shops often develop their own local strategies to market their products themselves. Because of this, resources like Yelp are very important for vape shop retailers. Positive customer reviews could attract business in circumstances where marketing budgets are weak compared with tobacco industry spending for cigarettes and smokeless tobacco.25 Further, due to the unique positioning of vape shop retailers at the point of sale, they are often in a position to provide information to customers.25 29 This information, a form of promotion, does not necessarily match the current evidence base of e-cigarettes as shown in this literature.19 25 Vape shop staff were frequently characterised as former smokers who often were current e-cigarettes users, and staff shared their personal experiences using the products to transition away from cigarettes.23 29 31 34
Product
Product availability in this context includes discussion of e-liquids19 20 (including handling practices in vape shops,20 31 packaging/labelling14 18 31 and nicotine content/concentration levels13 14 18–20), as well as the tobacco and e-cigarette products available in vape shops.31 Product availability mirrors increasing preference away from first-generation devices in vape shops and toward second-generation and third-generation devices that offer the opportunity to refill e-liquids and modify the devices.19 31 While records were limited in their geographic reach, they identified substantial problems with labelled nicotine concentration being inaccurate,14 18 lack of childproofing18 and customer mixing of e-liquids.20 For example, in a study of 70 e-liquids purchased in North Dakota, 51% had 10% more or less nicotine than the label indicated.18 The Canadian study found non-compliance with limits on e-cigarette products.13
Price
Two articles discussed price. In San Francisco, when buying more than one liquid, devices and/or e-liquids were often discounted (96% and 87% of vape shops, respectively).19 E-liquids, not the devices themselves, were the primary source of revenue and profit for these businesses.19 In New Hampshire, over 70% of stores had price promotions on their products, which was more common in vape shops than stores selling both vape and combustible products.31 Cross-product promotions (promoting an e-cigarette and combustible products) were rare.31
Placement
Two articles discussed findings regarding placement of vape products, namely, self-service displays.20 31 Studies in Los Angeles and New Hampshire noted rates of e-liquid self-service at 83% and 16% respectively, illustrating a large discrepancy between vape shops.31 At the time of the literature search, vape product placement was not yet regulated by the Food and Drug Administration (FDA).
Density and proximity
We identified three records about density or proximity.16 21 28 These records found that vape shops are more likely to be concentrated near college and university campuses28 and are patterned in opposite ways of conventional tobacco retailers (ie, they are more likely to be present in neighbourhoods with a higher proportion of White residents) in New Jersey.21 Similar to conventional tobacco retailers, there are substantial numbers of primary and secondary schools that have a vape shop present nearby (but that the presence of a vape shop was not associated with use of e-cigarettes among youth at the school).16
Staff and owner attitudes and beliefs
Seven articles discuss perspectives from owners and staff members of vape shops.19 23 24 26 27 29 34 Interviews with these retailers, as illustrated by this literature, show a positive view of e-cigarettes, reflected from the interviewee’s own experience and often conveyed to the customer.19 23 27 29 34 Vape shop retailers want to help smokers quit combustible cigarettes but showed little interest in addressing nicotine addiction.22 27 29 34 As salespeople of a fairly new product, the retailers have the unique positioning to share their knowledge to an interested consumer. Their knowledge, however, is primarily limited to what they have read on the internet, as opposed to science-based evidence.27 34 For instance, in one record, an important source of information reported was YouTube videos from the vaping industry.27 Finally, vape shop retailers reported mixed feelings about FDA regulation: they appreciated limits that reduced unscrupulous competitors and safety concerns but worried about FDA regulations limiting innovation and being co-opted by the tobacco industry.26
Discussion
Principal findings
Vape shops differ from tobacco retailers as they are often individually owned, receive no or few resources from the major tobacco companies and sell a relatively new product that is only recently subject to regulations. There are, however, some similarities of marketing practices between traditional tobacco product retailers and vape shops. These included use of price promotions and loyalty programmes. Although vape shop staff and owners frequently report caring deeply about helping people quit smoking cigarettes, they placed little emphasis on reducing addiction to nicotine. Information provided on products, which can often be customised or mixed on premises, may be misleading. The identified research, which is limited and may be subject to change as more studies emerge, suggests that vape shops are disproportionately concentrated in areas with more White residents and in higher-income areas. In as much as vape shops are purveyors of a potential harm-reduction product for individual smokers, this disparity, if confirmed in future studies, represents a potential health equity issue. Alternatively, vape shops do market a product that, when containing nicotine, is both addictive and detrimental to health. Greater presence of vape shops in one area versus another may come with consequences. These could include increased youth initiation and increased dual use of vaping products with conventional cigarettes.
Study findings in context
Defining and finding vape shops
Yelp, used in combination with other data sources such as licensing lists or Google Maps, is recommended for identifying vape shops in the USA. When vape shops were defined in the literature, they were classified in two groups: (1) retailers who sell e-cigarettes without selling any traditional, combustible tobacco products and (2) those retailers who primarily sell e-cigarettes but may still sell some combustible tobacco products. From the existing literature, we believe it is clear that future studies should be inclusive of multiple types of e-cigarette retailers but should stratify results by type of e-cigarette retailer. We return to this point below in reference to studies of tobacco retailer density.
Marketing
Like other tobacco retailers, vape shops use the 4 P’s of marketing to drive sales. While tobacco promotions are common at tobacco retailers (eg, an average tobacco retailer has 29.5 marketing materials),36 vape shops often rely on word-of-mouth referrals, discounts and customer service approaches to driving sales. This is likely due to the focus on second-generation and third-generation e-cigarette products and the limited sale of increasingly tobacco-industry owned cig-a-like products (or first generation) products. The different combinations of marketing strategies should be monitored as the tobacco industry acquires and markets newer e-cigarette products.37 One study from Los Angeles, California, published after the date of our search found differences in marketing practices by the predominant ethnicity of the neighbourhood. This 2014 study of 77 vape shops found more self-service samples in predominantly Korean and non-Hispanic White neighbourhoods than in African-American or Hispanic neighbourhoods.38
Regarding the location of vape shops, the included records suggested (1) substantial presence of vape shops near primary/secondary schools16; (2) clustering near colleges and universities28; and (3) in a study from New Jersey, that vape shops do not follow the general patterning of tobacco retailers (ie, with more retailers in neighbourhoods with higher proportions of African-American residents).21 This last finding is consistent with the sale of e-cigarettes at traditional tobacco retailers.15 It conflicts with a national study published after our search showing that vape shop density is similar to tobacco retailer density (ie, positively correlated with proportion African-American residents)39; however, this may be the result of inclusion of tobacco retailers that sell e-cigarette products.40
As noted by Giovenco in a research letter published after our search, different definitions of vape shops can lead to quite different results in density/proximity studies.40 Inclusion of vape shops that also sell conventional tobacco products may explain differences regarding neighbourhood correlates of vape shop presence or density. It is clear that both the definition of vape shops and the construction of vape shop density datasets require attention as the field moves forward. We suggest the use of clear definitions and stratification of results by definition used.
Attitudes and beliefs
Perhaps the single biggest contrast between vape shops and traditional tobacco retailers is in the clearly articulated belief and desire to help people stop smoking conventional cigarettes. In one study published after our search, data collectors posing as customers asked questions about vaping products in 18 vape shops in Southern California and recorded marketing claims. Frequent claims included e-cigarettes’ potential as cessation devices and about health benefits of switching.41 However, in qualitative research identified in our study, this desire to help customers stop smoking cigarettes did not extend to reductions in nicotine addiction. Given that quitting all forms of tobacco and nicotine use is desirable for population health, this is a substantial concern. It also represents an important consideration for future efforts to leverage the harm-reduction potential of vape shops.
Vape shop retailers were also concerned with both regulation (its limits on their business practices and co-option by the tobacco industry) and the lack of regulation (unscrupulous competitors and poor product quality and safety).
Regulation
The included records have several important implications for regulators. First, given challenges in identifying vape shops, vape shops should be considered for inclusion in tobacco retailer licensing programmes. Such licensing programmes should be able to identify retailers that sell only vaping products (ie, do not sell combustible or smokeless tobacco). New York City, for instance, licenses retailers that sell e-cigarettes separately from stores that sell other tobacco products. One could estimate the number of shops selling vaping products by comparing the lists. Second, given problematic accuracy of labelling and self-service of e-liquids, regulators should consider additional requirements, enforcement and inspection protocols in these areas. Third, youth access inspection programmes for vape shops may need to be different from those of traditional tobacco retailers. In one study published after our search, rates of sales to youth of e-cigarettes and cigarettes were similar; however, vape shops were not specifically examined.42 Further research on sales to youth is likely needed. Fourth, as the evidence of benefits versus risks to population health from the presence of vape shops becomes clearer, policies regarding retailer proximity and density should either seek to promote the equitable presence of vape shops or limit their presence in vulnerable areas.
Limitations
This systematic review is limited by the recent emergence of literature on vape shops. Thus, data in some areas are still thin. We did not search the grey literature, and this review, like all reviews, is subject to publication bias. Nonetheless, our search was developed by a professional medical librarian, we implemented the search in multiple academic databases, we used rigorous dual coding for inclusion and abstraction and we assessed RoB in the included studies. The literature is still young and does not reflect the increasing ownership of vaping manufacturers by the tobacco industry. As industry ownership increases, some home-grown marketing efforts may be replaced by the sophisticated calibration of the tobacco industry and product innovations may take different directions.37 Vape shop practices and regulations are in flux and may continue to evolve. Additionally, many of the papers covered limited geography, predominantly US-based (eg, a single region in California, North Carolina or Oklahoma), and almost a quarter of all the included studies (23%) came from the same research group using data on vape shops in Los Angeles, California.12 20 22 23 32 These studies may not generalise to other locations both in and outside of the USA.
Conclusion
The emergence of vape shops represents an interesting challenge for policymakers seeking to promote harm reduction among smokers while also seeking to limit the dissemination of inaccurate information, inaccurately labelled products and marketing that could lure youth or sustain harmful addiction through dual use. Vape shops also challenge researchers to critically assess what constitutes a vape shop and how to accurately identify vape shops with sensitivity and specificity. Continued surveillance of vape shop marketing practices is warranted as are efforts to assess the equity effects of vape shop marketing, density and proximity.
What this paper adds
E-cigarettes are an emerging product with potential for individual harm reduction but also with risks to population health. Vape shops are a new form of retailer selling addictive products.
The evidence about the sales and marketing practices of vape shops, as well as methodological concerns about their identification, has not been synthesised.
This study identifies best practices in vape shop identification and marketing strategies used by vape shops and considers potential equity concerns given where vape shops are located.
Acknowledgments
An earlier version of this manuscript was presented at the 2017 National Conference on Tobacco or Health in Austin, Texas. Kurtis G Kozel kindly provided his editing skills to the manuscript.
References
Footnotes
Twitter @Joseph_GL_Lee
Contributors KMR originated the study. All authors designed the study and wrote the protocol. KBS conducted the searching. JGLL, ENO and KBS conducted the screening and data abstraction. JGLL, ENO and KBS drafted the article. All authors provided critical feedback and edits to the article and approved the final version.
Funding Research reported in this publication was supported by the National Cancer Institute of the US National Institutes of Health under Award Number U01CA154281. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Competing interests KMR serves as an expert consultant in litigation against cigarette manufacturers. JGLL and KMR have a royalty interest in store mapping and audit systems owned by the University of North Carolina at Chapel Hill, but these systems were not used in this study.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All data are contained within the online supplemental file.