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Google shopping queries for vaping products, JUUL and IQOS during the E-cigarette, or Vaping, product use Associated Lung Injury (EVALI) outbreak
  1. Eric C Leas1,
  2. Natalie H Moy1,
  3. Alicia L Nobles2,
  4. John Ayers2,
  5. Shu-Hong Zhu1,
  6. Vidya Purushothaman3
  1. 1 Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
  2. 2 Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, USA
  3. 3 Department of Anesthesiology, University of California, San Diego, La Jolla, CA, USA
  1. Correspondence to Dr Eric C Leas, Department of Family Medicine and Public Health, School of Medicine, University of California San Diego, La Jolla, CA 94304-1334, USA; ecleas{at}


Objectives To assess whether the late 2019 US outbreak of pulmonary disease linked to vaping (‘E-cigarette, or Vaping, product use Associated Lung Injury’ (EVALI)) impacted online shopping queries for vaping products and the Philip Morris ‘IQO’ brand of heated tobacco.

Methods We tracked online shopping queries for vape(s), JUUL and IQOS by analysing rates of Google queries indicative of shopping (eg, buy IQOS) after news of the outbreak was first reported (the week of 29 July 2019) until hospitalisations ceased (the week of 16 February 2020). We compared observed rates of shopping during the outbreak to counterfactual expected rates that were predicted using an autoregressive iterative moving average model fit to queries from 1 January 2014 to the week of 21 July 2019.

Results During the outbreak, vape shopping queries were 34% (95% CI 30% to 38%) lower than expected and JUUL shopping queries were 39% (95% CI 34% to 45%) lower than expected, translating into about 7.2 and 1.0 million fewer searches. IQOS shopping queries were 58% (95% prediction interval (PI): 34–87) higher than expected, translating into 35 000 more searches. Moreover, IQOS shopping queries reached a historic high the week they were discussed as a potentially safe alternative to vaping (the week of 29 September 2019), when they were 382% (95% PI: 219–881) above expected rates for the week.

Conclusions These results suggest that unplanned events, such as the EVALI outbreak, can provoke changes in the epidemiology of product usage. Tobacco companies should be prohibited from using events such as disease outbreaks to position their products as less harmful without prior approval.

  • smoking caused disease
  • social marketing
  • surveillance and monitoring
  • media
  • advertising and promotion

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  • Contributors ALN, ECL and NM designed data collection tools, wrote the statistical analysis plan and cleaned the data. All authors analysed the data and drafted and revised the paper. ECL is the guarantor.

  • Funding This work was supported in part by the Burroughs Wellcome Fund, grant R21DA051356 from the National Institute on Drug Abuse, grant R01CA234539 from the National Cancer Institute and grants 28IR-0066, 28KT-0004 and T31IR1584 from the California Tobacco-Related Disease Research Program.

  • Disclaimer The study sponsors took no part in the study design; collection, analysis and interpretation of data; the writing of the manuscript; or the decision to submit the manuscript for publication.

  • Competing interests Dr. Ayers owns equity positions in Directing Medicine, Health Watcher, and Good Analytics. Drs. Leas and Nobles have received consulting fees from Health Watcher and Good Analytics for related work outside those conducted in this manuscript. All other authors have no competing interests to declare.

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