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- advertising and promotion
- electronic nicotine delivery devices
- low/middle-income country
- non-cigarette tobacco products
Electronic cigarette (e-cigarette) availability and use has increased worldwide since they were first introduced around 2007 and became increasingly popular among youth starting around 2014.1 2 In the USA, Mexico and Guatemala, the prevalence of last 30-day use of e-cigarettes among adolescents is higher than for conventional cigarettes.3–5 In Guatemala, in a sample of 2870 adolescents, 28% were current users of e-cigarettes.3 Experimental evidence suggests that e-cigarettes appeal to adolescents due to their variety of flavours and lower perceived harm than cigarettes.6 7 Furthermore, the e-cigarette market (eg, nicotine content, flavours, voltage, device type) is rapidly evolving making it challenging to regulate.8–10 E-cigarettes are also highly accessible by youth, through friends, e-cigarette shops and the internet and social media.11 12
Guatemala, an upper-middle-income country, ratified the WHO Framework Convention on Tobacco Control (FCTC) in 2005. Nevertheless, tobacco control policies are weak, poorly enforced and only smoke-free environments comply with the FCTC.13 14 Regarding e-cigarettes, as in many other countries, there are no sales restrictions, marketing regulations or taxation.15 In addition, they are now advertised and strategically placed at the point-of-sale (POS) where cigarettes are sold.14 Tobacco vending machines, a historically important distribution and sales channel for the industry, have been banned in most high-income countries.16 However, they remain a marketing strategy in many countries, as in Guatemala. In addition to increasing availability and reaching customers, they pose additional challenges such as minimum purchase age verifications.17 18
As of October 2021, in Guatemala, disposable e-cigarettes are sold through vending machines in three of the most popular shopping centres in Guatemala City (figure 1). In addition to placement next to the parking payment machine, vending machines lack any age verification system (only a sign that reads ‘exclusive use for adults’). The machine accepts credit cards and cash, and prices range between US$7 and US$25 (most expensive cigarette pack US$4). All the e-cigarettes available are disposable, shaped like a Universal Serial Bus (USB) and have nicotine salts with relatively high nicotine concentrations.19 Customers can choose between three brands (Puff Bar, Masking and Wonder) and liquid amounts. Those with more liquid deliver more puffs (ranging from 300 to 2000 puffs, figure 2). The machine offers a variety of flavours, including mint, strawberry donut and ice coke (one machine had 23 different flavours). Information on how to franchise the machines and links to social media were also included on the side of the machine.
E-cigarette vending machine located in a high socio-economic status shopping center. Guatemala City, 2021.
Different flavors and prices (1 USD = 7.71 GTQ) for disposable e-cigarettes sold in a vending machine. Guatemala City, 2021.
As of October 2021, there are no laws that regulate e-cigarettes in Guatemala. Additionally, there is no regulation on vending machine sales of either tobacco or e-cigarettes (only sales tax). Given that adolescents are currently experimenting with e-cigarettes,3 policies are urgently needed to restrict access and advertising exposure, including at the POS, internet, and now, vending machines.14 Although other countries have implemented age verification systems on tobacco vending machines, these are not effective.17 18 Therefore, selling e-cigarettes through vending machines should be banned (as for conventional cigarettes). Otherwise, they will continue to undermine an already weak tobacco control program in this upper-middle-income country, particularly among adolescents. Furthermore, e-cigarette vending machines have recently appeared in Mexico, where e-cigarettes are banned. Systematic research is needed to better characterise this emerging phenomenon and its impact.
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This study does not involve human participants.
References
Footnotes
Twitter @mishoo8
Contributors JB conceived the idea to write this manuscript. SM wrote the first draft. JM, JT, JB and SM contributed to the revision and edits of this manuscript.
Funding This study was funded by Fogarty International Center of the National Institutes of Health (R01 TW010652).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.