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More Ads for Menthol E-Cigarettes

When the U.S. Food and Drug Administration banned flavored tobacco products, email and mailed advertisements for those products fell; however, ads for menthol-flavored products more than doubled, according to the Truth Initiative citing a Tobacco Control study.
The study showed that partial flavor bans may not deter consumers, including youth, away from tobacco products. “Rather, manufacturers and consumers are adapting to new FDA regulations,” the study authors write. “The restriction of some flavored e-cigarette products has resulted in a shift of the sales and marketing of restricted flavored e-cigarette products toward other available flavored e-cigarette products.”
“A more comprehensive approach that includes the consideration of disposables, refillable devices and other flavored e-cigarettes not covered by the current FDA guidance is needed to offer the most benefit for prevention efforts among youth and young adults,” the authors write.
The FDA is expected to ban menthol-flavored products sometime this year.

April 1, 2022
PMI Gives Ukrainian Army Cigarettes

Photo: Exclusive Dn

Philip Morris International has given the Ukrainian Army 500,000 packs of cigarettes, reports the Washington Examiner.
“Philip Morris donated 500,000 packs of cigarettes to help the army,” said People’s Deputy of Ukraine Danylo Hetmantsev. “Lviv Tobacco Factory and JT International Ukraine also handed over cigarettes to the military today in all regions where there are logistics warehouses.”
PMI stopped most operations in Ukraine due to the invasion of Russian forces, and the company stopped marketing and product launches in Russia.
“This included sales, distribution, and manufacturing,” said Corey Henry, PMI’s Director of U.S. Communications. “The Ukrainian army approached our colleagues and asked for stock in our warehouse in one of the most heavily bombed regions. We complied with the authorities’ request.”
“Our focus and all our efforts over the last four weeks have been to ensure the safety and security of our Ukrainian colleagues,” said CEO Jacek Olczak in a statement. “We stand in solidarity with the innocent men, women and children who are suffering.”

April 1, 2022
Brazil Mulls Legalizing E-Cigarettes

Photo: Rmcarvalhobsb

E-cigarettes may become legal in Brazil later this year as ANVISA, the federal health sanitary agency, plans to revisit its regulations regarding the products. Proponents of vaping have been pushing the government to legalize the products to help smokers quit combustibles, but critics are concerned about youth usage as well as potential higher rates of vaping that could follow legalization.
Electronic tobacco products have been banned in Brazil since 2009, but there are currently shops that sell the products anyway, often with statements that the products are safe, according to The World.
“Once the product is legally allowed to be commercialized, it gets into the distribution network of the tobacco companies, which have one of the best distribution systems around,” said Stella Bialous, a Brazilian expert on tobacco issues and a professor from the University of California, San Francisco. She fears that more people would likely take up vaping if the products are allowed to be commercialized. In 2019, less than 1 percent of Brazilians used e-cigarettes. However, if the products are commercialized, they would become more easily available, and that percentage could quickly rise.
“Considering that these products are attractive to youth and that we can’t affirm that they really work for tobacco cessation, we believe that we must prioritize the public policies to prevent smoke initiation and also to promote health for the Brazilian population,” said Monica Andreis, the executive director from ACT Promocao da Saude, a nongovernmental organization that focuses on tobacco control policies.
“Brazil has a leadership role in Latin America and also around the world related to tobacco control policies. I believe that the decision from ANVISA has the potential to influence other countries in Latin America,” Andreis said.
ANVISA has not commented on the situation, stating that it is still analyzing data. “Up to this point, there are still uncertainties and controversies related to the risks attributed to these devices,” the agency stated in February.

April 1, 2022
The Promise of Innovation

Photo: Lezinav

Nicotine companies are helping tobacco users move from deadly combustible cigarettes to substantially reduced-risk products.
By Derek Yach
Over the past few decades, we have seen unprecedented progress across a wide range of technologies—digital and info tech, biotech, AgroSciences, material sciences and more. These are transforming many sectors considered “legacy,” “dirty” and simply out of fashion. The tobacco sector epitomizes many of the changes underway. The April 2022 edition of Tobacco Reporter highlights the diversity and speed of the change. From finding new uses for the tobacco plant, to ending exposure to toxic substances linked to combustion in cigarettes, to finding ways to design the emerging products to be biodegradable or recyclable, to limiting youth access—innovation pervades this classic, dirty legacy sector.

Evolution of THR Technologies
In an insightful article, Mike Huml outlines the role of hobbyists and smokers in seeking solutions to cutting toxic exposures (see “Major Milestones”). Driven by their passion, an entire new set of products with myriad components, a new language and, later, vape stores have arisen. Their role has been crucial in showing what is possible, what is desired and what can be achieved when advances in electronics, aerosolization, batteries and coils are combined into new consumer products.
Thousands of miles away from where the first large groups of users of these new products live in Shenzhen, China, new companies have taken up the opportunity and drawn on the Silicon Valley-like spirit that pervades the city to develop core components and completed products now at the heart of the e-cigarette and heated-tobacco revolutions. Until recently, companies like Shenzhen Smoore Technology, ALD and other vapor hardware suppliers were unknown in Europe and the United States; today, they are household names in the nicotine business. Their investments in research will increasingly become visible as future products emerge.
As with any successful innovation, the larger established tobacco companies have invested billions of dollars to create tobacco harm reduction (THR) products that appeal to smokers and pass the muster of regulators, such as the U.S. Food and Drug Administration. Their continued investment in research, patent filings and product launches mean that we now have over 100 million users of reduced-risk products—but that is less than 10 percent of the real target! More progress requires that state monopolies, who together account for one in two cigarettes sold globally, join the innovators.

Next Frontiers for Farmers and the Environment?
Farmers. Advances in our understanding of plant genomics initially helped to produce more environmentally resilient and productive tobacco plants and the ability to adjust nicotine levels. This has now given way to using the tobacco plant to develop a Covid-19 vaccine, a range of pharmaceuticals, wound-healing products and a range of domestic products for clothing, skin care and more! In his article “The Virtuous Weed,” Taco Tuinstra gives a hint of what is to come. These advances, however, will provide only a few tobacco farmers with alternative livelihoods. The speed of switching away from combustibles and high levels of quitting combined with the growth of demand for synthetic nicotine come together to make it more urgent to support the most vulnerable tobacco farmers’ transition to alternative livelihoods.

THR and the Environment. The growing concern about the impact of plastic pollution on the environment has led to the start of negotiations of a new United Nations resolution on greening plastics. The initiative will take two years to three years, will be legally binding and will push the pace of change in addressing alternatives to plastics like never before. Electronic cigarettes and heated-tobacco products will not escape scrutiny. They contain a wide range of nonbiodegradable components, including plastics, batteries and heavy metals. The rapid increase in disposable vapes and pods has not been accompanied by serious efforts to tackle this problem—until now!
ALD Group, a Shenzhen-based company, has been actively reviewing various studies and found from the Truth Initiative that 51 percent of e-cigarette users throw their empty pods or disposable devices in the regular trash, 43 percent do the same with their empty batteries, about 17 percent put both in the regular recycling bin, and about the same percentage throw them away or send them for recycling.
ALD Group’s response is to use biodegradable materials whenever possible and to develop recycling solutions within an integrated environmental management approach based on international standards, such as ISO 14001. The company appears to be adapting best practices from Nespresso on pod design, recycling and disposal as well as from leading beverage companies that have shifted almost exclusively to biodegradable products in the sale of their beverages.
ALD’s investments in research and development in biodegradability are beginning to pay off. This comes at a time when consumer and regulatory concerns about the environmental impact of risk-reducing product waste have increased.

Continued Progress on the Transformation Road Demands More Private-Public Partnerships
In a recent editorial, Nature highlighted the value of industry- academic collaboration in the context of Covid-19 vaccines. This edition shows how massive investments by nicotine companies—large and small—in research, technology development and consumer insights are delivering alternatives to deadly combustibles and displacing them faster than ever before.
THR advocate David Sweanor mentions several areas that require additional attention if private-public collaboration is to be achieved: mechanisms for researchers to access industry data and how to apportion intellectual property (see “From Coercion to Empowerment”) None of these are impossible. All require individual companies to find ways to work together on issues of public health and environmental benefit.
The Nature editorial calls for barriers to collaboration to be dismantled as much as possible. That lesson has yet to penetrate the walls of leading groups like the World Health Organization, academic and research bodies and scientific journals in relation to THR. Bans, prohibitions and ad hominem attacks of tobacco industry and related scientists chills dialogue, slows innovation and seriously hampers progress toward ending smoking and the death and disease it causes.
This edition shows that despite these barriers, substantial, unstoppable progress is underway—that progress could accelerate if engagement replaced these barriers. The beneficiaries would be millions of smokers seeking better solutions and longer, healthier lives.

Derek Yach has been a global health expert and anti-smoking advocate for more than 30 years. Throughout his career, he has supported and led smoking cessation research and policy development and has been a strong proponent of harm reduction policies,

Previously, Yach was the director of the Foundation for a Smoke-Free World, and a World Health Organization cabinet director and executive director for noncommunicable diseases and mental health. He was deeply involved with the development of the Framework Convention on Tobacco Control.

April 1, 2022
The Virtuous Weed

Artwork: Dan Kurtz

When tobacco heals instead of hurts
By Taco Tuinstra
The health consequences of tobacco use have been well documented. According to the World Health Organization, more than 8 million people worldwide succumb to tobacco-related illnesses, such as lung cancer, heart disease and chronic obstructive pulmonary disease, every year. For every person who dies due to tobacco, at least 30 people live with a serious tobacco-related illness, according to a 2019 policy brief by Tobacconomics.
Tobacco also carries a significant economic toll. A report prepared by the World Bank Group Global Tobacco Program expected the worldwide economic cost of smoking to reach $1.4 trillion in 2017, equivalent to 1.8 percent of the world’s gross domestic product that year. Little wonder, then, that many view the tobacco plant as evil.
Yet there is another, decidedly more benign, side to the Wicked Weed. When dried, set on fire and inhaled, the tobacco plant wreaks havoc; when deployed as a “green bioreactor,” the golden leaf has the potential to help address some of the world’s most vexing public health challenges, including, ironically, certain respiratory afflictions.

Baiya Phytopharm is currently developing a new generation of its vaccine for the omicron variant of Covid-19 and expects to conduct Phase 1 trials in April 2022.
(Photo: Baiya Phytopharm).

Among the most striking examples of tobacco’s potential to heal rather than hurt are recent endeavors to develop an inoculation against the novel coronavirus. In February, Health Canada approved Covifenz, a tobacco plant-based Covid-19 vaccination developed by pharmaceutical giant GlaxoSmithKline and Medicago, a biopharmaceutical company backed by Philip Morris International. According to Health Canada, Covifenz is the world’s first vaccine approved for human use that utilizes a plant-based protein technology.
As it turns out, plants—and especially tobacco plants (see sidebar)—lend themselves exceptionally well to developing pharmaceutical compounds. In many ways, they are better suited to the task than the man-made bioreactors used in traditional vaccine development.
To create a vaccine, scientists must produce antigens—molecules that trigger an immune response to a specific virus or bacteria. Antigens for conventional vaccines are made by infecting cells from insects, monkeys, hamsters or other sources in the laboratory with a virus or a bit of viral genetic code that tricks the cells into making copies of the virus or antigen. The cells incubate in bioreactors for extended periods of time and then undergo a complex purification process before being packaged into vials.
Bioreactors are expensive, however, and their operation requires trained personnel. They are also susceptible to contamination, forcing vaccine developers to keep bioreactors growing different types of antigens far apart and under sterile conditions.
Dahlia Garwe
Plants are natural bioreactors, according to Dahlia Garwe, the former CEO of the Kutsaga Tobacco Research Station in Zimbabwe. “They are able to perform eukaryotic post-translational modifications that are often essential for biological activity of many mammalian proteins,” she explains. When infected with DNA from Covid-19 or other viruses, plant cells will make millions of copies of virus-like particles that can serve as antigens without being infectious.
Using plants instead of mechanical bioreactors offers many benefits, notes Garwe. Plants are cheap to grow, easy to manipulate and resistant to contaminations that could present problems for humans. “Green bioreactors do not suffer the same risk of pathogen contamination as seen in mammalian cell culture as there are no known cross-kingdom pathogens,” she says.
With light as their primary energy source, plants are less expensive to work with than traditional cell culture systems, allowing for inexpensive and nearly unlimited scalability. Because plant systems are robust and inert, they are also easier to handle and purify than other systems.

Medicago is not the only company that has grasped the promise of plants in the development of vaccines and therapeutics. At least three other organizations are using Nicotiana benthamiana, a close relative of the tobacco plant used in cigarettes, to develop Covid-19 vaccines. In December 2020, the U.S. Food and Drug Administration approved an investigational new drug application for a Covid-19 vaccine by BAT subsidiary Kentucky Bioprocessing (KBP, now part of KBio). The company is currently conducting Phase I clinical trials, which are the first steps in testing the safety and side effects of a pharmaceutical in humans.
According to BAT, plant-based vaccines have several advantages over serums developed with conventional technologies, including speed and thermostability. Whereas traditional methods can take months to yield the desired vaccine ingredients, KBP’s tobacco plants do so within six weeks. And unlike some of the existing Covid-19 vaccines, KBP’s vaccine candidate has the potential to be stable at room temperature, an important benefit, especially for public health networks in countries with warm climates and few refrigerated trucks and warehouses.
Fearing supply constraints and “vaccine nationalism” at the start of the pandemic, scientists in Thailand have joined the race as well. Baiya Phytopharm, a plant-produced biologics company, is working with tobacco in part because that crop can be easily and inexpensively cultivated domestically, thus reducing Thailand’s reliance on foreign-made vaccines. According to the Bangkok Post, Thailand has more than 10,000 tobacco growers.
Waranyoo Phoolcharoen
In an email exchange, Baiya Phytopharm co-founder Waranyoo Phoolcharoen told Tobacco Reporter that the company had finished Phase 1 clinical trials and was happy with the data. Baiya Phytopharm is currently developing a new generation of its vaccine for the omicron variant of Covid-19 and expects to conduct Phase 1 trials this month (April). If the vaccine candidate does well in subsequent trials, it could be available in Thailand by the end of the year, according to Phoolcharoen.
Meanwhile, Akdeniz University in Turkey is using a protein produced by tobacco plants to develop a Covid-19 vaccine. Its technology is based on an angiotensin-converting enzyme 2 and can be administered as an injection or through a spray. According to an April 2021 report in Hurriyet Daily News, tests on mice have demonstrated a high level of inhibition of the Covid-19 virus from entering the cell. At the time of publication, Akdeniz University was seeking funding to conduct clinical trials in humans.

In addition to Covid-19, scientists have sought to tackle many other diseases with the help of tobacco. In response to concerns about bioterrorism following the September 11 attacks in the United States, researchers at the University of Central Florida used tobacco plants to create a protective antigen against anthrax. According to an article published in Environmental Health Perspectives, mice immunized with the agent survived anthrax injections of 1.5 times the deadly dose.
In 2014, KBP, working in cooperation with the U.S. Biomedical Advanced Research and Development Authority, developed, tested and used ZMapp, an antibody cocktail to treat infection from the Ebola virus, which was raging in west Africa at the time. In under six weeks, KBP completed cGMP manufacturing of each of the three monoclonal antibodies comprising the ZMapp cocktail, which received temporary emergency authorization from the FDA.
Pushing the envelope further still, Collplant of Israel is using tobacco to generate human tissue and organs. Collplant’s technology allows for the production of large quantities of medical grade human collagen, which is a primary building block for the human body and essential for tissue repair. Physicians use collagen products to treat chronic wounds, burns and other afflictions. Deriving collagen from tobacco rather than from traditional sources, such as cadavers, cows or pigs, offers several advantages, including stable fibrillates, pure molecular structures and no immunogenic responses, according to Collplant.
While the endeavors described above are only a sample of the many ways in which tobacco is deployed to produce pharmaceutical and other useful compounds, they vividly illustrate the potential of the golden leaf to help solve rather than create problems—a side that is often overlooked due to the health toll extracted by smoking.

The Green Bioreactor

While despised in the court of public opinion, tobacco is highly valued among plant scientists.
For starters, the species has good physiology for research. “Seeds are easily sterilized, and germination is very quick, so generating experimental material is easy,” says David Norman, senior scientist at Demeetra AgBio, a company that is using gene editing for crop trait development and that also works with tobacco (see “Genetic Scissors,” Tobacco Reporter, August 2021). “Tobacco grows fairly fast compared to many plants, to where flowering and mature seeds can be attained in just a couple months.”
The soft tobacco leaf is ideal for transfection, allowing researchers to easily introduce DNA or RNA into its cells. What’s more, regeneration mechanisms from callus in tobacco are extremely efficient. In addition to allowing genetic modifications on leaf material, tobacco is also easily propagated as a cell culture or protoplast culture.
The fact that tobacco is neither a food nor a feed crop makes it even more attractive as a plant for conducting research, according to Dahlia Garwe, the former CEO of the Kutsaga Tobacco Research Station in Zimbabwe. Using tobacco, she says, reduces the likelihood of transgenic material contaminating food or feed supply chains—an important consideration when many consumers remain wary of genetically manipulated foods.
Tobacco is also well understood from a genetic engineering and molecular biology standpoint; it has been more characterized than any other plant system. Scientists have been researching and genetically modifying tobacco since the early 20th century.
Meanwhile, biochemists have been able to produce many recombinant proteins in tobacco, with the plants serving as bioreactors for largescale production of pharmaceutical and industrial compounds. “Tobacco can easily take in DNA to produce these compounds when injected into the leaf or through vacuum infiltration of whole plants,” says Norman.
The vacuum infiltration method, in particular, can be scaled up to infect many plants at one time, according to Norman. “After infiltration, tobacco transiently expresses the DNA introduced for a short while and makes the protein of interest in the leaves.
“While the protein production in plants may not be that impressive on a per plant scale, up to a few percent depending on the protein of interest, you have to consider the yield per acre for tobacco. On an average acre of tobacco, the yield can be several tons of leaf material. With that scale of leaf material per acre, suddenly those small protein yields add up to being significant and potentially economically viable.”–T.T.

The Plant-Based Vaccine: A Late Bloomer?

In February, Medicago’s Covifenz Covid-19 vaccine received the green light from Health Canada, making it the world’s first plant-based vaccine approved for human use. Considering how long scientists have known about the potential of plant-based vaccines—the proof of concept dates back some 30 years—it may seem surprising that the first regulatory approval for such a product was granted only this year.
While the U.S. Department of Agriculture in 2006 gave the thumbs-up to a plant-derived vaccine to inoculate chickens against the lethal Newcastle disease, most of the projects targeted at human vaccines never even made it to end-stage clinical trials. The FDA did approve Protalix’s plant-based drug to treat Gaucher’s disease in humans in 2012 and in 2014 gave emergency authorization to ZMapp, a plant-based biological medicine manufactured by KBP (now part of KBio) to treat Ebola, but the first was not a vaccine, and the second was approved under special conditions.
Dahlia Garwe, the former CEO of the Kutsaga Tobacco Research Board in Zimbabwe, suspects the “delay” in approving plant-based vaccines is due to regulatory issues and public perceptions of genetically modified organisms (GMOs). “Most vaccines produced in plants would most likely be classified as GMOs, which automatically makes them ‘undesirables,’” she ventures.
Kathleen Hefferon, who teaches microbiology at Cornell University, acknowledges that public perception may be part of the problem but believes that many consumers would accept plant-made vaccines just as they have accepted vaccines produced in eggs and mammalian cells. “They are familiar with the GM technology when used for medical purposes,” she says. “It is when it comes to genetic modification in food products that some people seem to raise concerns.”
Hefferon suspects that the absence of a clear regulatory path represents the greatest obstacle as it may have made pharmaceutical companies wary of investing in this technology. The carrot suspension cell culture that Protalix used for its Gaucher’s disease drug somewhat resembles Chinese hamster ovary cell culture, she notes. “That made it a little easier for regulators.”
Patrick Doyle, CEO of KBio Holdings, a company set up by BAT to accelerate the development and production of novel treatments with plant-based technology, says it is important to remember that in a normal R&D cycle, medicines and vaccines on average take over 10 years, even when using a proven technology or approach.
“In fact, as a result of the global health crisis presented by Covid[-19], development, regulatory review and approval timelines were accelerated to support the delivery of much-needed vaccines,” he says. “Before gaining approval for any vaccine, manufacturers must generate sufficient data to demonstrate the efficacy and safety of the candidate and technology, which takes time. For example, the mRNA platform, first discovered in the early 1960s, was a genetic technology that had long held huge promise but only received the first FDA [Food and Drug Administration] emergency use authorization for the prevention of Covid-19 disease in individuals 16 years of age and older on Dec. 20.”
According to Doyle, the positive data generated and the subsequent approval of Medicago’s vaccine is both a positive in terms of creating another approved treatment option for Covid-19 and reinforcing the potential of plant-based vaccines.
Hefferon agrees that Medicago’s success could set the stage for plant-made pharmaceutical commercialization in future years, and her optimism appears to be shared by others. Research and Markets expects the value of the global plant-based vaccines market to reach $2.62 billion by 2028—more than double the 2021 figure. Tobacco companies seem well attuned to the potential as evidenced by PMI’s investment in Medicago and by BAT’s creation of KBio. Doyle says KBio will explore new opportunities to develop its plant-based production system, which has the potential to offer greater speed, thermostability and scale-up opportunity and.
Hefferon says she’s very happy about the growing momentum for plant-based vaccines. “Too bad it took a pandemic to make it happen.” –T.T.

Uphill Battle: Tobacco-Backed Vaccines Continue To Face Skepticism From Health Authorities

While tobacco plants lend themselves exceptionally well to the creation of pharmaceutical compounds, vaccinations and treatments developed by tobacco-backed organizations still face an uphill battle as demonstrated by recent World Health Organization actions.
During a March 16 media briefing, the WHO’s assistant director-general for drug access, vaccines and pharmaceuticals, Mariangela Simao, said the global health body had paused the process for pre-qualification of Medicago’s new Covifenz Covid-19 shot due to the biopharmaceutical firm’s link to Philip Morris International, which owns about one-third of the Canadian company.
“The WHO and the U.N. have a very strict policy regarding engagement with the tobacco and arms [industries], so it’s very likely it won’t be accepted for emergency use listing,” said Simao. The WHO persists in its opposition despite Health Canada’s February approval of Covifenz for adults between the ages of 18 and 64.
In a statement published by the CBC, Medicago said it believes authorization decisions should be based on the quality, efficiency and safety of the vaccine, not who owns shares in the manufacturer.
“It is our understanding that the WHO has made a decision to pause the approval of the vaccine and that this decision is related to Medicago’s minority shareholder and not to the efficacy and safety of the vaccine, which was demonstrated with the approval by Health Canada,” the statement reads.
Derek Yach, a global health consultant, was aghast by the WHO’s suggestion that it might reject Medicago’s vaccine based on the company’s relationship with PMI.
“‘Pikuach nefesh’ is the ethical principle in Jewish law that the preservation of human life overrides virtually any other religious rule,” he said. “Most other religions support a variant of this. WHO violates this ethical principle when it denies people access to a lifesaving vaccine.”
If the WHO follows through, the vaccine would be the first Western-manufactured Covid-19 shot to be rejected by the global health body, according to Bloomberg. —T.T.

Taco Tuinstra is Tobacco Reporter’s editorial director. Based in Raleigh, North Carolina, USA, he coordinates the work of staff writers and contributors. On his watch, Tobacco Reporter has won several awards for editorial excellence. Since joining the magazine in 1997, Taco has visited more than 75 countries to meet industry representatives in their markets and to report tobacco news firsthand.

April 1, 2022
Major Milestones

Photo: Uwell

Vaping technology has come a long way. Here are the most impactful breakthroughs from the past 15 years.
By Mike Huml
The e-cigarette, which may very well be the most effective harm reduction device ever conceived to address preventable diseases, is built upon the simplest circuit possible. In essence, an e-cigarette is a resistor, a switch and a power source. From this simple circuit, thousands of variations arose over the course of about 15 years. During this Golden Age of regulatory limbo, the vapor industry exploded, and with that came endless innovation and constant refinement, transforming that little cig-a-like into all the products vapers enjoy today. Throughout this process, several innovations stand out as milestones. These innovations would improve the quality, consistency or convenience of the vaping experience. The nature of these changes necessarily contributed to reduced risk and increased uptake among populations.

The Cig-a-Like

Photo: Wabeno

While more an invention than an innovation, the e-cigarettes that were available circa 2008 were not based on a revolutionary concept. Patents for similar but rudimentary e-cigarettes date back as far as the 1930s, but it wasn’t until the new millennium that all the pieces came together into a marketable product. Early adopters of the technology readily admit that first-generation e-cigarettes left much to be desired. What these pioneers agreed on, however, was the potential of these products. By improving the hardware and e-liquids—which could be accomplished with relatively inexpensive and readily available components—those early e-cigarettes could be turned into truly viable alternatives to their combustible counterparts.
Cig-a-likes provided brutally short battery lives, weak but perceptible vapor, questionable flavor reproduction and a penchant for leaking and “spitback.” Almost immediately, e-cigarette users began tinkering with modifications to these products to mitigate the negative aspects. Cartridge “polyfill” was replaced with aquarium filter to increase absorption and prevent stray fibers from sticking to the bridge of the atomizer. Some wouldn’t be bothered with cartridges at all, nor the inconsistent draw and spitback associated with them, and replaced the cartridge with a “drip tip.” With one or two drops of e-liquid applied directly to the atomizer, the experience became more consistent at the cost of convenience. Longer batteries were soon made available to increase battery life, but it wasn’t until an increase in girth was an option that vapers and manufacturers collectively had an epiphany that would change everything: E-cigarettes don’t need to look like cigarettes.

The eGo

Photo: Joyetech

The eGo, and other similar variations like the Riva, resembled a cigar more than anything. As battery life was a primary turnoff to curious parties, the idea that a battery could last a full day jump-started an entire era of e-cigarette popularity. The eGo could be found in affordable kits at almost every e-cigarette retailer, and it was available in different colors with different atomizers to match. Cartomizers and clearomizers largely replaced the old cartridge-plus-atomizer combination, and with inconvenience slowly becoming alleviated and customization increasing, the e-cigarette market saw a remarkable boom. There was still work to be done, however, as each starter kit required a tutorial and a certain degree of patience. Investment in new technology was still minimal and mostly took the form of variety instead of quality. Customization of appearance was great, but there was still hardly any customization of the vape experience itself. Atomizers of varying resistances were available, and small batch “modding” filled a niche need for higher power with different voltages by stacking batteries in series, but the gap between these two progressions was still wide.

The Provari and Variable Voltage

Photo: onVaping

The Provari from Provape was in a class of its own. Coveted by all vapers, this device was the Cadillac of vaping. It single-handedly popularized the concept of variable voltage. Instead of trying and buying atomizers of multiple resistances, the Provari provided a range of output voltages, effectively allowing the user to adjust the amount of vapor and heat generated by atomizers of most any resistance available at the time. Unfortunately, the Provari was expensive, rare and much larger than the eGo. However, the Provari was rugged, durable and made in America—all features in high demand and low supply. Any mod from the variable voltage era took its cues from the Provari in terms of both performance and aesthetic. Eventually, variable voltage technology worked its way all the way down to the eGo in a new variation known mainly as the eGo Twist. Rampant cloning and intellectual property theft became a real issue during this time, but for better or worse, it led to countless variations of variable voltage devices, including the eGo Twist, eGo Spinner, eGo VV and many others.

The Tank

Photo: Uwell

Up until this point, e-liquid was dripped directly onto an atomizer or absorbed by some type of filler. As power and performance increased, e-liquid was being consumed at a faster rate, and a larger supply was required in order to avoid constant refilling and dry hits. By modifying cartomizers by punching a hole in the casing and inserting it into a clear plastic cylinder, the “carto tank” was born. Early versions had trouble with both leaking and dry hits due to wicking inconsistencies, but again, there was potential. The idea of free-floating liquid in a reservoir changed how innovators thought about e-liquid delivery, leading to popular products such as the clearomizer, which was smaller than a tank but paired perfectly with the eGo’s size, came in a variety of fun colors and could be filled up much faster than a standard cartomizer. At this time, sides were chosen. Team Cartomizer enjoyed more vapor production and a draw that more closely resembled that of a traditional cigarette at the cost of convenience while Team Clearomizer had a range of colors to choose from and a smooth draw at the cost of leaking and dry hits. As time went on, the technologies and methods used to create these early tanks improved into the sub-ohm tanks that we enjoy today. Almost all common sub-ohm tanks take inspiration from both camps, with a vertically oriented coil surrounded by a filler material (cartomizer) housed in a clear tank with free-floating e-liquid. Although a range of preset resistances were available to pair with variable voltage devices during this time, due to generally poor quality-assurance standards, even multiple coils with the same advertised resistances could perform drastically differently from one another, even when fired at the same voltage. To combat this, a new technology had to emerge.

The Darwin and Variable Wattage

The Darwin from Evolv flew under the radar, mostly due to its boxy appearance, unique design that favored cartomizers specifically and a general lack of electrical knowledge among nonhobbyist vapers. But make no mistake, the Darwin was a game-changer, and its technology was enthusiastically copied by other manufacturers. To simplify: With a variable wattage device, atomizer resistance no longer mattered. Once a user decided that they enjoyed vaping at 10 watts, an atomizer of any resistance could be attached, and it would always vape the same way. Even minor inconsistencies between atomizers of the same resistance had no noticeable impact on the vaping experience. As variable wattage technology slowly made variable voltage obsolete, stores no longer had to carry extensive varieties of identical cartomizers, clearomizers or other atomizers with different resistances. Vapers no longer had to stalk their favorite retailer in the hopes that their favorite 2.5-ohm cartomizer would finally be restocked. Most importantly, variable wattage directly led to a blanket increase in overall consistency of vapor products.

The Road Less Traveled—Mechanical Mods, Rebuildable Atomizers and Sub-Ohm Vaping

Photo: Bedya

While mainstream vaping was evolving, another phenomenon was taking place. While features, gadgets and color variety appealed to the mainstream, technology simply wasn’t moving fast enough for the hobbyist vaper. They wanted one thing: vapor. Nothing else mattered. Convenience? Safety? What are these words? By removing the internals from the mod formula in order to provide the cleanest, most direct pathway for electricity to flow from the battery to the coil and dropping coil resistance to below 1 ohm, sub-ohm vaping was born. The chips used to regulate mainstream mods provided too many amperage limitations, and hobbyist vapers spent ludicrous amounts of money because they favored craftmanship over new gizmos and pure performance over convenience. Of course, no premade atomizer was available at a resistance below even 1.25 ohms, so the DIY crowd began to, in fact, DIY. Small operations began manufacturing limited runs of solid metal mods and large atomizers in which the coil could be built by the end user. This allowed for maximum performance customization but minimal convenience. Additionally, this setup inherently presented the highest risk potential as there was no board to protect from pulling too many amps from a battery that wasn’t designed with vaping in mind. As such, surprisingly large leaps in battery efficiency and safety resulted from a spike in the demand for high-amperage batteries.

The DNA Board

Seeing multiple factions form in the vaping community, Evolv recognized a need. Some mainstream vapers wanted to “chuck clouds” safely and without the hassle of rebuilding and using a mechanical mod, which could be prohibitively expensive. Conversely, some hobbyist vapers ashamedly admitted that it would be nice to be able to enjoy some of the conveniences of “normie” mods without sacrificing too much performance. The DNA20 board finally proved that it was possible to vape sub-ohm coils on a regulated device and to do it safely. Any atomizer with a resistance down to 0.8 ohms could be used up to a maximum power of 20 watts—a far cry from the triple-digit wattages some mechanical mod users were accustomed to, but the DNA20 was a successful first step toward uniting a community that was just beginning to coalesce.
Around this same time, vaping could no longer be ignored by the media and health officials. Partly exaggeration and partially due to the uptick in the popularity of vaping, reports of varying credibility started making headlines, with media outlets reporting on battery explosions, “popcorn lung” and heavy metal toxicity. Some of those health concerns turned out to be spurious, often due to flawed study designs.
“This study was conducted by firing a two-ohm clearomizer from three years ago at six volts and measuring the levels of heavy metals and other pollutants,” researchers of such materials might write. “The results show an abundance of heavy metals, formaldehyde and silica particulates.”
Yes, all vapers knew that dry hits were bad, but they were also repulsive to experience, and so these studies didn’t accurately reflect how users were using vapor products in the real world. However, it brought up a decent point. Vaping was regarded as safer than smoking, but it could always be safer. Having gone through a couple iterations of their DNA board, Evolv released their newest chipset that would change the industry yet again.

Temperature Control

Photo: EcigaretteDirect

The DNA40 was an improvement over the DNA20 and the DNA30 in terms of power output and other functionality, but more than that, it was the progenitor of every temperature control device available today. When using a coil comprised of nickel, the DNA40 could calculate the temperature of the coil by measuring the change in resistance due to heat. Since it could calculate the temperature, it could maintain said temperature by adjusting the wattage by way of voltage in order to effectively eliminate dry hits. The chemical changes caused by overheating e-liquid, wire and wicking material now had a safeguard in the form of temperature control. This technology was naturally copied and can be found on almost every modern vaping device. Even pod systems use a simple version of temperature control technology. Several years after the release of the DNA40 and seeing an increase in demand for high-wattage devices, the DNA200 was released with a refined version of temperature control that could use additional wire types but that also included a revolutionary piece of software called eScribe.

eScribe Software

Available for free to anyone with a PC or Mac, eScribe provides not only the most comprehensive suite of features and customization options for vapers who use devices with a DNA board but also tools for researchers and scientists studying the health effects of vaping, allowing them to plot and record data with ease. The user features include custom screens, easy firmware updates, additional profiles and more. However, with more and more attention being brought upon vaping, particularly the health element, eScribe is the perfect tool for anyone to conduct their own studies and experiments. Everybody from the curious hobbyist vaper to large health institutions can access the features in eScribe and easily troubleshoot their device or go as far as to conduct large-scale studies.

Pod Systems and Nicotine Salt

Photo: Bantham

Sometimes, things come full circle. With vaping technology reaching a plateau due to an overall increase in quality across the board, becoming more affordable and accessible on beginner-focused devices and inevitably facing government regulations, it became easy to provide a small device that delivered on the promise that cig-a-likes made years before. Although pod systems generally still don’t resemble analog cigarettes in appearance, the vape experience has never been closer to feeling like smoking. Years of trial and error, innovation and refinement led to the widespread popularity of these inexpensive, simple devices. Additionally, while liquid nicotine had been the standard prior to the existence of pod systems, nicotine salts provide a level of nicotine comparable to smoking but without the overly harsh throat hit and pungent flavor of e-liquid that contains a large percentage of liquid nicotine solution. Together, pod systems and nicotine salt e-liquid provide a foolproof package that anybody can pick up at a local retailer, fill up and begin using immediately and with no prior knowledge of vaping or its underlying electrical concepts. Meanwhile, synthetic nicotine is presenting new opportunities given its lower levels of contaminants and its suitability for standardization of safety and quality.
Thanks to years of innovation, we are inundated with vaping products that not only provide a consistent, convenient and enjoyable alternative to smoking but that are also safer, more so than vaping used to be. As vapers looking back on the past decade, it’s clear that every technological innovation for the sake of a better vaping experience was also an innovation in harm reduction. The original cig-a-like was a proof-of-concept that demonstrated immense potential and got innovators excited for future prospects. The eGo addressed pressing needs of users but also directly led to a decrease in smoking, a net positive for public health. Moving from fixed voltage to variable voltage to variable wattage saw a directly linked connection to increased consistency and overall product quality while continuing to appeal to more and more people. Mechanical mods and sub-ohm vaping sparked a demand for safer and more efficient battery technology, which has huge implications for many other technological industries. With temperature control technology and eScribe, we see an answer to the health concerns, warranted or not, from health agencies and others. Pod systems bring everything full circle, utilizing all the advances in vapor technology while maintaining a simple, no-hassle design reminiscent of the original e-cigarette—where it all started.
Vaping technology has come a long way in a short 15 years. What started as a hobby of passionate vapers triggered a wave of innovations, first pursued by independent entrepreneurs and later turbocharged by the investments of well-resourced traditional tobacco companies. This has resulted in mass production of safer nicotine products, giving smokers a welcome alternative to deadly combustibles. While the majority of consumers are now embracing standardized products, the hobbyists will likely continue innovating, further pushing the boundaries of technology in what was once considered a staid business.

Mike Huml is a professional vapor hardware reviewer. An enthusiast vaper since 2009, he is always trying to get his hands on the newest, shiniest mod. Huml has evaluated countless vaping devices over the years, but you’ll usually find him with a mechanical mod and RDA in-hand, surrounded by an aura of fog. His personal motto: “Happiness is a warm coil.”

April 1, 2022
Preventative Measures

Photo: Metamorworks

Innovations in technology and regulation could help ease the concerns surrounding youth access to vaping products.
By Timothy S. Donahue
Most tobacco control experts agree that vaping is safer than smoking combustible cigarettes. The primary concern for anti-vaping groups, legislators and regulatory officials isn’t where e-cigarettes fall on the continuum of risk; it’s about preventing youth access to nicotine products, whether underage is defined as under age 21, as it is in the United States, or as under age 18, as it is in many other markets. The best way to prevent youth access is through innovative technology, according to vapor industry experts. Technology and regulatory policies will both be required for the vaping industry to satisfy its skeptics.
Technological innovations have been the vaping industry’s primary contribution to battling youth access. Several companies have developed devices that use biometrics, such as fingerprint and facial recognition. The OBS Cube FP Kit, for example, uses fingerprint recognition to prevent unauthorized use. However, a 2020 review by ecigclick.com found the fingerprinting function complicated to configure. “The instruction manual is total pants … it really is,” the reviewer wrote. “So far, I haven’t worked out how to use the fingerprint stuff; there are diagrams in the book which relate to bugger all on the actual device.”
Juul Labs launched its C1 in Canada in 2019. The device paired with an Android smartphone to limit who could use it and to provide monitoring of what and how often the user vaped. Juul says the C1 could only be used if people passed age verification and facial recognition checks. The C1 also had a system that could be set to automatically lock when it was not being used or was away from the phone to which it was linked.
Juul Labs then launched the Juul2, which had many of the same child safety features as the now discontinued C1. The Juul2 can also recognize and authenticate proprietary Juul2 pods when they’re attached, limiting the ability to use counterfeit pods or refill pods with other substances, such as THC.

The OBS Cube FP Kit, for example, uses fingerprint recognition to prevent unauthorized use. (Photo: OSB)

Steven Yang, senior director of FEELM R&D, says that FEELM has incorporated designs into its products that prevent misuse by children, for example, by requiring the user to follow a specific sequence of procedures to activate the device.
“With a number of [the] industry’s leading patents, FEELM is exploring ways to integrate Bluetooth, fingerprint, airflow switch, sensor and other electronic technologies to create a child lock on products,” Yang says, adding that many Chinese vaping industry leaders have already adopted ID verification and facial recognition technologies.
“FEELM’s strategic partner and China’s leading vape brand, RELX, has initiated Sunflower System in 2019. Based on AI and big data, the Sunflower System is integrated into different scenarios, such as RELX chain stores and the RELX app to prevent minors from purchasing vaping products,” explains Yang. “The Sunflower System has been extended to all RELX chain stores in China to ensure each purchase order is traceable. Moreover, through big data and GPS, the Sunflower System can automatically filter the addresses that do not meet the legal requirements of opening a vape store—for example, near schools.”
Project Sunflower consists of adopting ID and facial recognition technologies to ensure that only adults can purchase products in its Chinese stores, according to RELX. Minors are not allowed to enter RELX stores, and in-store face-scanning cameras send alerts to RELX store staff if a suspected minor enters the store. Any suspected minor that is not able to present legal, valid ID proving his or her age is asked to leave the RELX store.
Upon purchasing a product, RELX customers also need to verify their age through a facial recognition process that matches the customer’s face with the photo on the customer’s Resident Identity Card,” says a RELX representative. “This process is to ensure that the person in the store is using their own valid identification and not attempting to impersonate an adult.”
While facial recognition measures are widely used and accepted in China, they may encounter resistance elsewhere. Chris Howard, vice president, general counsel and chief compliance officer for E-Alternative Solutions, a U.S.-based e-cigarette manufacturer, says that consumers have generally accepted biometric controls in phones, tablets and other devices that use fingerprints or faces to unlock the screens.
Those who are tech savvy would likely welcome such an alternative in their vaping products, he says. However, traditional cigarettes don’t have any electronic controls to prevent unlawful use, so if vaping regulations follow tobacco rules, that would limit these types of innovations.

RLX Technologies has deployed facial recognition technologies to ensure that only adults can purchase its products in the company’s Chinese stores. (Photo: RLX Technolgies)

“The idea that such a requirement would be necessary for vapor products to receive marketing orders seems unlikely. It is important to remember that adult smokers may be unwilling to deal with an electronically locked tobacco product,” says Howard. “While some may enjoy the novelty, many may just use a tobacco product—likely higher risk—that is easier to use. Many questions surround the use of biometrics in products. There are legal privacy issues, which would increase the cost of such devices.”
Manufacturers must also remain aware of regulatory restrictions in the markets they operate within, according to Yang. FEELM has developed protocols to help retailers and distributors comply with local guidelines. Yang says the company attaches clear warning labels on its closed-system vaping devices and includes language in user manuals stating that the products are intended for use only by adults.
“We also focus to ensure that the retail stores in which our products are sold have mechanisms in place to verify the age of the consumers purchasing products manufactured by us so as to comply with local laws and regulations in relation to age restriction,” Yang says. “Moreover, our website and our major customers’ web stores require visitors to enter their age before entering the websites.”
While technology is an important component of a comprehensive strategy to prevent youth access, experts note that the industry and its regulators should also acknowledge technology’s limitations. Having grown up with smartphones, online social networks and e-commerce, today’s youngsters are the most digitally savvy generation to date. While the technical solutions to deter underage access may deter some, sufficiently motivated young buyers are likely to overcome such measures with relatively little effort.

Regulatory Response
Taxation has long been the preferred deterrent to youth access by regulators. Studies suggest, however, that increasing taxes doesn’t always have the desired impact. Instead, these measures discourage combustible smokers from switching to a safer alternative, according to a study by Steve Pociask and Liam Sigaud for the American Consumer Institute Center for Citizen Research. The researchers state, “overzealous or poorly designed restrictions [like tax increases] on vaping, combined with misleading information about e-cigarettes’ actual health risks, are deterring smokers from pursuing a potentially life-saving alternative.”
Tim Andrews, director of Consumer Issues for Americans for Tax Reform, says that increasing taxes on reduced-risk tobacco alternatives will not reduce youth access but punish adult vaping consumers, leading many back to deadly combustible cigarettes.
“Paradoxically, by creating a booming black market, which, by definition, possesses none of the rigorous age verification processes required by legal retailers, vapor taxes may increase not decrease youth access,” he says. “Youth vaping has plummeted in recent years due to increased enforcement of existing law. [According to the U.S. Centers for Disease Control and Prevention, only 3.1 percent of high school students vape daily.] Adequate and appropriate enforcement of existing law—not increasing taxes—is what will continue to drive this number down.”
Tobacco harm reduction advocates also stress the importance of risk-proportionate pricing along with proper education about the products available to encourage smokers who cannot or will not quit nicotine to consider alternatives that are less harmful than cigarettes. By taxing the most harmful products—combustible cigarettes—at significantly higher levels than reduced-risk alternatives, regulators can nudge consumers to the least unhealthy options.

Chris Howard
Other innovative regulatory responses to youth vaping have had mixed results. Outside taxation and Tobacco 21 laws in the U.S., any effectiveness seems hard to prove. Research suggests that there are few studies available that show what impact differing regulatory actions have on youth vaping. A study published in BMC Public Health, “Policies that limit youth access and exposure to tobacco: a scientific neglect of the first stages of the policy process,” examined 200 international peer-reviewed articles. The researchers found that scientific evidence on the policy process for youth prevention initiatives were scarce.
“The processes influencing the adoption of youth access and exposure policies have been grossly understudied. A better understanding of the policy process is essential to understand country variations in tobacco control policy,” the researchers wrote. They then went on to suggest that “policymakers can adopt and implement various supply-side policies to limit youth access and exposure to tobacco, such as increasing the minimum age of sale, limiting the number or type of tobacco outlets or banning the display of tobacco products.”
Howard questions whether regulations limiting the number of tobacco outlets/vape shops or display bans would materially impact youth access. “Which companies should lose their business licenses? Should only major chains, with arguably more control over storefronts, be permitted to sell tobacco products?” Howard asks. “How will removal of businesses prevent youth from obtaining tobacco products? Yes, there will be [fewer] stores to find products [at], but that doesn’t mean youth vaping will decline. During the ‘youth vaping epidemic,’* Walmart, arguably the largest retail footprint in the U.S., removed vapor products from its stores—is there evidence of reduced youth vaping as a result? Finally, banning tobacco product displays may impact youth exposure to products but would also reduce adult smokers’ exposure to different, potentially less harmful products.”

Incentivizing Success
There may be more innovative options to consider in controlling youth access. Another potential avenue to curb youth access may be to require manufacturers to offer incentives to retailers to maintain good practices. B2B sales discounts or incentives for meeting certain standards is likely to go a long way toward limiting youth access, according to Howard.
“Manufacturers can incentivize limiting the number of products in a transaction to prevent straw sales, passing compliance checks, tobacco sales training and participating in the We Card program to encourage retailers to ‘up their game’ in preventing youth access,” he says.
States are slowly becoming more innovative in their regulatory approach to youth vaping. Hawaii, for example, is considering the passage of a law that would require its Department of Health (DOH) to coordinate with its Department of Education (DOE) to establish a “take back” program for students to “voluntarily dispose of electronic smoking devices, flavored tobacco or synthetic nicotine products, and tobacco products in their possession.” If passed, the rules would also require the DOH and DOE to coordinate quarterly meetings with students on addressing the youth vaping epidemic.
Many industry experts agree that the vaping industry, tobacco control community and regulators should be working together to solve the problem of youth uptake. However, that seems unlikely. It could be argued that the world’s most prominent regulator, the U.S. Food and Drug Administration’s Center for Tobacco Products (CTP), should be bringing stakeholders together to seek out common solutions to these problems. That hasn’t happened, according to Howard.
“It appears CTP felt compelled to use a club, as opposed to a scalpel, to excise youth vapor use. Banning flavored pods and blanket denials of millions of PMTAs [premarket tobacco product applications] for flavored products through sweeping MDOs [marketing denial orders] removed most industry stakeholders in just about a month,” says Howard. “While much of this was thrust upon CTP by outside forces, it is hard to imagine, when they can completely control the issue, why would CTP now resort to compromise solutions?
“CTP and the tobacco control lobby both detest those bad actors that market their products without regard to this important issue. Companies that actively follow the rules detest these bad actors too. CTP, tobacco control and the ethical side of the industry should join forces to root these bad actors out.”

*The surge in U.S. teen vaping was mainly a U.S. phenomenon. The most recent Centers for Disease Control and Prevention data suggest that episode is largely over, with both youth smoking and vaping at low levels. See https://www.cdc.gov/mmwr/volumes/71/ss/ss7105a1.htm?s_cid=ss7105a1_w.

Timothy Donahue is the assistant editor of Tobacco Reporter. Since joining our team in January 2013, he has become not only an expert on the traditional tobacco business but also a well-respected voice in the rapidly developing vapor industry. Tim spends much of his time on the road, attending conferences and interviewing industry representatives. His networking skills, work ethic and quick mind are valuable assets to our diverse audience.

April 1, 2022
All in the Mind

Photo: andriano_cz

A human-centric health ecosystem could unleash tobacco harm reduction’s full potential.
By Stefanie Rossel
In their efforts to end the era of combustible cigarettes, governments, public health authorities and other stakeholders today have a much larger toolkit at their disposal than they did at the turn of the millennium—at least in theory because only a fraction of available strategies are currently being employed.
Due to increasing connectivity, the Fourth Industrial Revolution has brought rapid changes to technology, industries and society. It is also transforming the healthcare system—insurance companies seeking to promote a healthy lifestyle by asking their customers to use wearable devices that record physical activity and calorie intake are just one example.
In order to better deal with today’s complex challenges, healthcare has in recent years become more human-centric, striving to understand human needs and how design—both the process of designing and the outcome of that process—can respond to these needs. “Design” in this context refers not only to products, services and procedures but also to strategies and policies.
A human-centric health ecosystem (HCHE) involves understanding people and their needs, engaging stakeholders throughout the design process and systematically addressing interactions between the micro-level, meso-level and macro-level of sociotechnical care systems as well as the transition of individual interests to collective interests.
This new approach to healthcare requires a holistic systemic approach, major organizational change and well-designed, dedicated interventions, such as products, services or procedures to be used by patients, caregivers and medical professionals to facilitate and implement the system.
The role of the patient in this system changes accordingly: Instead of being a passive recipient of medical directions, he or she becomes a well-informed, responsible patient, intrinsically motivated to actively contribute to the success of his or her treatment. In contrast to the traditional approach, he or she doesn’t simply passively comply with instructions and wait for professionals to solve their problems but makes use of a technology-enabled ecosystem with an embedded choice architecture that encourages the desirable behavior and seeks support from a variety of sources.
This healthcare model is shifting the focus from treatment toward prevention. Centralized, capital-intensive diagnostics facilities will be aided and perhaps even replaced by individual, on-demand or continuous inexpensive and readily available technologies, such as the mentioned wearables. Sensors in these devices generate data that enable disease prevention with the help of machine learning. Diagnostic and treatment data could be collected in a global database that practitioners can access but that is owned by the patients. Finally, instead of applying homogeneous therapies across groups of patients with similar health issues, treatments are likely to become more personalized.

Behavioral Triggers
The novel concept also holds promise for the prevention of noncommunicable diseases (NCDs), for which tobacco use is one of the greatest risk factors. The U.K.’s progressive tobacco harm reduction (THR) strategy, for example, incorporates many HCHE components. It has established a comprehensive infrastructure that includes institutions and healthcare professionals to help smokers to switch to less hazardous products or quit nicotine altogether. In 2017, the U.K. launched a Tobacco Control Plan that stresses the importance of innovation and less harmful alternatives. According to studies, the U.K.’s approach has been able to reduce smoking prevalence from around 20 percent in 2011 to between 13.8 percent and 16 percent in 2021.
But the HCHE model offers further opportunities. Focusing on the individual and his or her perceptions, intentions and behaviors influencing personal health results, it is a demand-driven structure. Personal health outcomes, in turn, will ultimately influence population health. A fully developed HCHE environment uses a vast range of behavioral triggers that can encourage healthy decisions and eventually impact the incidence and prevalence of NCDs.
At the 2017 World Economic Forum (WEF) in Davos, Willis Towers Watson published a white paper assessing the progress in preventing NCDs with the help of behavioral economics as part of the Human-Centric Health project. According to the white paper, mortality rates due to NCDs are projected to increase from 38 million to 62 million by 2040. While NCDs presently impact mostly high-income countries, they are growing fastest in low-income and middle-income countries.
Participants in the Human-Centric Health project were tasked to develop and disseminate knowledge and tools for behavioral changes that would lead to long-term healthier lifestyles. The experts were also asked to identify public-private cooperation opportunities across nontraditional health and healthcare stakeholders, for which the WEF could provide a platform. The project touched upon smoking cessation but did not make use of the THR concept.

Making Healthy Choices
Human decision-making depends heavily on heuristics, mental shortcuts that can facilitate problem-solving in situations of limited knowledge and time. Heuristic processes are based on experience, thus enabling people to quickly make the thousands of decisions they must make every day. Not all precepts of behavioral economics, though, lead to choices that support good health. The WEF white paper reviews some of the more powerful principles in behavioral economics that may contribute to healthier behavior within the HCHE if being applied appropriately.
“Present bias,” for example, is a strong motivator: Humans tend to assign greater value to payoffs that are closer to the present time than those that occur further in the future—if people want something, they want it immediately. A strategy for health improvement should thus present choices that combine a current pleasure with a behavior that will lead to better health in the future and emphasize the near-term advantages of healthy behavior rather than the benefits that might be achieved later. A case study described by the white paper suggested glycemic control in diabetes patients reliant on food banks could be improved by providing clients with diabetes-appropriate food, blood sugar monitoring, primary care referral and self-management support.
Another behavioral trigger is loss aversion: People sense the pain of loss more deeply than the pleasure of gain. Recently, this insight has been used in initiatives to encourage smoking cessation: Smokers received a payment at the outset of the program, which they would be forced to pay back if they failed to keep their commitment to quit smoking.
Health choices can also be influenced by framing—by expressing the consequences of disease in survival rates rather than mortality rates, for example—even if the results are equal. The HCHE system may emphasize benefits that can be achieved through a specific action or the ease of healthy behavior compared with other activities people voluntarily decide on.
The HCHE system also takes advantage of the knowledge that humans respond better to narratives than logic or statistics. By telling compelling stories that people can relate to, health practitioners can drive healthier behaviors. Of course, facts must be given accurately, but data alone don’t necessarily drive change.
Humans are also subject to social norms—a person married to or friendly with smokers is more likely to smoke than a person without such relationships, according to the white paper. Findings like this, however, can also be used to achieve a positive effect—for example, by incorporating social media and influencers into information campaigns or asking people to make public commitments to future change.
Choice architecture and defaults can nudge people toward healthier decisions. In a realm of choices, humans tend to stay with a default as it takes less energy than making an active decision and allows them to focus on more important concerns. A prominent display of healthy food in shops, for example, can thus help people make healthier choices.
Humans’ tendency toward “irrational optimism” and “depletion” are additional behavioral triggers that can be taken advantage of to stimulate desirable behaviors. Including a lottery element in health incentives will generate attention at low cost. As people only have a limited span of attention, health improvement efforts should focus on measures with the most potential benefit while requiring the least cognitive effort of the targeted population.

Stakeholders
A successful HCHE, the white paper argues, resembles a consumer purchase model in which informed buyers express demands that support their well-being and stakeholders succeed by recognizing and meeting those demands. The paper identifies three actors that can greatly impact NCDs—insurers, retailers and technology.
Insurers can contribute to the HCHE by providing health assistance, for instance, through health coaching, paying healthcare claims and providing incentives, such as rewards to encourage smoking cessation. They can also provide information about achieving and maintaining health, including health risk assessments, biometric screening and education.
Next to increasing their inventories of healthy items, retailers, who act as a principal source of consumer products and therefore exercise particularly powerful influence over dietary quality, can provide access to selected health services, such as vaccinations on-site, and work with policymakers to develop pricing policies that encourage consumption of healthier foods and beverages. In the case of tobacco, the white paper recommends a reduced inventory, citing the example of CVS Caremark, a U.S. retailer that in 2014 stopped selling cigarettes.
While CVS Caremark’s sales declined during the following year, its decision reduced total cigarette sales by 1 percent across 13 U.S. states while nicotine patch purchases increased by 4 percent immediately after tobacco sales ended.
Health-related technology, the third component mentioned in the report, refers to the application of organized knowledge and skills in the form of devices, medicines, vaccines, procedures and systems developed to solve or prevent a health problem and improve the quality of lives.
For patients suffering from chronic obstructive pulmonary disease or asthma, for instance, tracking usage of inhalers that provide vital medication can be challenging. An estimated 70 percent to 90 percent of patients use their inhalers improperly, thus delivering insufficient levels of medication to their lungs. In late 2018, the U.S. Food and Drug Administration approved the first digital inhaler with built-in sensors that detect when the inhaler is used and measure breathing. The sensors connect to a smartphone app, recording data that can be shared with doctors who can evaluate a patient’s inhaler usage. There are many ways that these technologies could be adapted for e-cigarettes, heat-not-burn devices and related products.
The technology sector is also where reduced-risk tobacco products (RRPs) come into play as the gap between recreational and therapeutic inhalers is narrowing. Among recently published patents for nicotine vapor devices and heated-tobacco products, most cover therapeutic innovations, including vaping products that employ sensors (see “In the Pipeline,” page 20).
The combination of new technologies and behavioral economics allow for healthy choices to be the easier choices. Laws that regulate products proportionate to their risk compliment and support this.
Properly integrated into the HCHE, RRPs could drive tremendous progress in public health. The private sector has already realized the potential of RRPs as a smoking cessation tool. It is time for regulators to follow their example.

Stefanie Rossel is Tobacco Reporter’s editorial contributor. An experienced trade journalist, she combines sharp reporting skills with in-depth knowledge of the tobacco and vapor industries. Prior to joining Tobacco Reporter, Stefanie was editor-in-chief at Tobacco Journal International, where she worked for a decade. Fluent in English, German and French, Stefanie covers tobacco news around the world. She is based in Germany.

April 1, 2022
Gene Tree Recognized for Vaping Technology

Photo ICCPP

ICCPP’s Gene Tree nano-microcrystalline ceramic vaporizer core won China CE Magazine’s Pioneer Technology Award 2021.
Launched in September 2021, Gene Tree is the first “0 powder definition” ceramic core in the vapor industry. The manufacturing process is designed to eliminate dust and thus avoids the harm caused by powder falling of ordinary ceramic cores.
The high-void porous structure of the Gene Tree core, combined with the application of food-grade lipophilic rare earth oxide, gives it excellent e-juice “guiding and locking” ability. It not only enhances stability and prolongs the product’s lifespan, but also prevents leakage, dry burns and explosions while optimizing flavor.
According to ICCPP, the product’s self-developed heating slurry is more consistent with the thermodynamic properties of porous ceramics, greatly reducing the phenomenon of core slurry. Even after 4,000 tests of dry burning at 2.5 watts, the heating film and resistance value remained intact. The service life of dry burning at 6 watts is up to five times that of other products.
China CE Magazine is an influential publication in China’s electronic consumer goods industry.

March 31, 2022
Michele Mital to lead FDA CTP

Illustration: Skypixel | Dreamstime.com

The U.S. Food and Drug Administration’s Center for Tobacco Products (CTP) will name Michele Mital, the current deputy director of the CTP, as acting director when Mitch Zeller retires in April, reports Vaping360.
The news was first reported Wednesday afternoon in a tweet by FDA Tracker and confirmed by Filter reporter Alex Norcia after speaking with FDA sources. No formal announcement has been made.
Mital joined the FDA in 1996 and has held various positions in the agency, including in the Office of Legislation. Since the CTP was formed in 2009, Mital has worked there in various capacities. She was named deputy director in 2018.
The FDA is still looking for a permanent director.

March 31, 2022