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Sources of flavoured e-cigarettes among California youth and young adults: associations with local flavoured tobacco sales restrictions
  1. Shivani Mathur Gaiha1,
  2. Lisa Henriksen2,
  3. Bonnie Halpern-Felsher1,
  4. Todd Rogers3,
  5. Ashley L Feld3,
  6. Jennifer Gaber3,
  7. Elizabeth Andersen-Rodgers4
  1. 1 Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
  2. 2 Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA
  3. 3 Center for Health Analytics, Media, and Policy, RTI International, Research Triangle Park, North Carolina, USA
  4. 4 California Tobacco Control Branch, California Department of Public Health, Sacramento, California, USA
  1. Correspondence to Dr Lisa Henriksen, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA 94305, USA; lhenriksen{at}


Purpose This study compares access to flavoured JUUL and other e-cigarettes from retail, online and social sources among underage and young adult e-cigarette users who live in California jurisdictions that restrict sales of flavoured tobacco with the rest of the state.

Methods An online survey used social media advertisements to recruit participants (n=3075, ages 15–29) who lived in one of nine jurisdictions that restrict sales (n=1539) or in the rest of state, and oversampled flavoured tobacco users. Focusing on past-month e-cigarette users (n=908), multilevel models tested whether access to flavoured JUUL and other e-cigarettes from retail, online and social sources differed by local law (yes/no) and age group (15–20 or older), controlling for other individual characteristics.

Results The percent of underage users who obtained flavoured JUUL and other e-cigarettes in the past month was 33.6% and 31.2% from retail, 11.6% and 12.7% online, and 76.0% and 70.9% from social sources, respectively. Compared with underage and young adult users in the rest of California, those in localities that restrict the sales of flavoured tobacco were less likely to obtain flavoured JUUL from retail sources (Adjusted OR=0.54, 95% CI 0.36 to 0.80), but more likely to obtain it from social sources (Adjusted OR=1.55, 95% CI 1.02 to 2.35). The same pattern was observed for other brands of flavoured e-cigarettes.

Conclusion Although local laws may reduce access to flavoured e-cigarettes from retail sources, more comprehensive state or federal restrictions are recommended to close the loopholes for online sources. Dedicated efforts to curtail access from social sources are needed.

  • electronic nicotine delivery devices
  • public policy
  • priority/special populations

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  • Contributors LH, TR, AF, BH-F and EA-R designed the study. TR, AF and JG supervised data collection and management. SMG led the analysis and drafted the manuscript. All authors contributed critical revisions and final approval. EA-R obtained funding.

  • Funding Funding for this study was provided by the Centers for Disease Control and Prevention Grant #5 NU58DP005969-04-00 and the California Department of Public Health under contract from Stanford Prevention Research Center to RTI International (Contract #17-10041). Additional funding for LH was provided by the National Cancer Institute (5R01-C067850). Additional funding for BH-F was through grant number U54 HL147127 from the National Heart, Lung, and Blood Institute (NHLBI) and the Food and Drug Administration (FDA) Center for Tobacco Products and from the Taube Research Faculty Scholar for BH-F and SMG.

  • Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the California Department of Public Health, NCI, NHLBI or FDA. The contents are the responsibility of the authors alone.

  • Competing interests BH-F provides expert witness testimony for some e-cigarette litigation.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.