Les puffs : un risque d'épidémie pédiatrique

Oct 14, 2024

July 13, 2022

Par: National Committee Against Smoking

Dernière mise à jour: August 6, 2024

Temps de lecture: 12 minutes

Disposable electronic cigarettes (such as Puffs Bar, brands Wpuff, Ma petite vape, Flawoor or even VazeJet in France) are compact, ready-to-use and pre-filled vaping devices that can contain up to 20 mg/ ml (2%) of nicotine salts. Certain brands, produced outside the European Union but sold in France, can contain up to 50 mg/ml (5%). They deliver between 600 (or approximately two packs of cigarettes) and 2000 puffs per device and are thrown away once exhausted. These electronic cigarettes sell at an attractive price (between €6 and €10 depending on the brand) and are available in many points of sale and in several dozen fruity and sweet flavors.

History : Electronic cigarettes first appeared around 2007 and have evolved several times since then. Older versions were designed to look like regular cigarettes, or had tanks that were often heavy and bulky. The most recent generations are characterized by a system of pre-filled pods/pods (JUUL or Vuse type) containing nicotine salts and have quickly established themselves as flagship vaping products. These products with pre-filled pods arrived in France in 2015 and their markets are evolving rapidly.

More recently, disposable electronic cigarettes entered the market, first in the United States in 2019 under the “Puff bar” brand then in France during 2021 mainly under the “Wpuff” brand. Although pre-filled pods or cartridges remain the most popular type of device, the use of disposable electronic cigarettes is rapidly gaining popularity among younger people, propelled by social networks and very easily accessible outside the usual distribution channels.

In France, as vaping products, disposable devices such as “puffs” are required to fulfill the regulatory obligations associated with these products.[1] :

Any manufacturer of vaping products must submit, at least 6 months before placing on the market[2], a notification file for placing on the market by brand and by type of product to the French Agency for Food, Environmental and Occupational Health Safety (ANSES). As indicated on the website of the Ministry of Health, although some national and foreign manufacturers have fulfilled the obligation to notify their products intended for the French market, other products, not notified to the French authorities, are also accessible to the public, in particular via the Internet. Some of these products have nicotine levels higher than the level authorized for this type of product or have health messages that are not in French.

According to article 1 of the decree of May 19, 2016 relating to the terms of registration of health warnings on the packaging units of tobacco products, vaping products, plant-based smoking products other than tobacco and cigarette rolling paper: “Each packaging unit as well as any external packaging of tobacco products, vaping products, plant-based smoking products other than tobacco as well as cigarette rolling papers carry the health warnings provided for in this decree. These warnings are in French.

Figure 1 - Disposable electronic cigarette sold in a Parisian tobacco shop in non-compliant packaging

There European directive on tobacco products has put forward several regulatory requirements for vaping products, in particular concerning the nicotine level which must not exceed 20 mg/ml or 2% "Member States of the European Union shall ensure that nicotine liquid does not contain nicotine in excess of 20 mg/ml" - Article 20 DPT.

In France and Europe, vaping products containing more than 20 mg/ml of nicotine belong to the category of pharmaceutical products. Consequently, they are subject to an application for marketing authorization (AMM).

However, there are many accounts on social networks or websites that offer disposable electronic cigarettes containing a very high level of nicotine (around 50 mg/ml).

Figure 2 - screenshot of an account selling puffs containing 50 mg/ml of nicotine

Last May, in Ireland, The Health Service Executive's National Tobacco Control Office issued RAPEX alert notifications to Safety Gate (the European Union's rapid alert system for dangerous non-food products) after discovering that some disposable e-cigarettes contained up to at 50 mg/ml (5%) of nicotine. These electronic cigarettes were sold in packaging which nevertheless indicated a nicotine concentration of 20mg/ml (2%).

In March, the Swiss Association for the Prevention of Smoking (AT Suisse) had also alerted the Swiss federal authorities to the online sale of puffs containing nicotine concentrations well above the ceiling authorized by the regulations. The association had indicated that it had identified a website selling Puff Bars with a concentration of up to 60 milligrams, three times above the authorized ceiling, already corresponding to a very strong dosage.

In addition to the high levels of nicotine, the very way in which these products are consumed facilitates nicotine addiction, especially among young people. Ready to use, requiring no prior recharging and preparation, the product can be used straight away and the user does not realize its actual consumption.

However, nicotine dependence develops much more quickly in adolescents and the consequences of exposing the brain to nicotine are particularly harmful at a time when brain maturity has not been reached. For Professor Yves Martinet, pulmonologist and president of the National Committee against Smoking “ puffs are a new gateway to nicotine. The aromas help attract young people and the high nicotine level helps retain them. ". He is pointing out that " Nicotine is a hard drug and once you are addicted to it, it is difficult to give up.. Consuming these puffs means getting more quickly into nicotine addiction and moving on to consuming even more dangerous products. ".

In addition, this type of device uses nicotine salts which facilitate the use of the products. According to a 2018 Surgeon General advisory on e-cigarette use among youth, nicotine salt technology allows users to inhale high levels of nicotine more easily and with less irritation than products that use free base nicotine.

These disposable electronic cigarettes come in around fifteen sweet or fruity flavors (marshmallow, iced grape, ice cream mango, chocolate hazelnut, etc.) in colorful and attractive packaging, reminiscent of confectionery packaging very popular with minors and young adults. These products often resemble the JUUL electronic cigarette aesthetically, comparable to a USB key, and a design reminiscent of new technologies. They quickly gained popularity among adolescents, propelled by social networks, notably TikTok, Snapchat and Instagram. Influencers, through videos, praise the ease of use of these cigarettes as well as the multitude of flavors available, creating a fashion effect in middle and high schools. These products are often presented in equally attractive packaging, which is reminiscent of certain famous confectioneries and which incorporates these flavors.

By using a specific graphic charter, a logo, visual symbols, a font and colors, the packaging makes it possible to quickly recognize the brand and build consumer loyalty. Some brands, like the tobacco industry, release limited editions of their products in order to encourage customers to collect products.

Figure 3 - Limited edition of the “wpuff” disposable electronic cigarette from the French manufacturer Liquidéo

This packaging is also designed to reduce the effectiveness of health warnings and mislead consumers. Thus, based on the colors and elements of the package which associates the electronic cigarette with candy, consumers believe that certain brands are less harmful than others.

These products are also available without nicotine. “0 nicotine” is a marketing argument from manufacturers who indicate that consuming these products not containing nicotine is not harmful and that there is no risk of addiction. Some manufacturers do not hesitate to “reassure” potential customers wondering if these products are dangerous, indicating “If you take those with 0% nicotine, there is no risk.”

Figure 4 - Screenshot of the official TikTok account of the wpuff manufacturer - Liquidéo

In reality, nicotine-free liquids lead young people to consider vaping normal. This trivialization of the act is likely to facilitate the next step which is experimentation with the product with nicotine, with the risk of becoming dependent. This product offering thus brings young people into a “consumption pattern”.

Numerous promotions are also in place for these products, both online and at points of sale. Manufacturers offer decreasing prices (One puff for €7.90, three for €20 for example), or free products from a certain quantity purchased (One puff free for three purchased). This type of illicit promotion is particularly aimed at a young audience receptive to promotions.

Figure 5 - Advertisements present in a Parisian tobacco shop

Some associations, including the National Committee Against Smoking (CNCT), denounce the aggressive marketing of puff manufacturers who do not respect the ban on advertising for vaping products at points of sale. The CNCT recalls that in matters of advertising, the prevailing principle is that of a general ban on all advertising and promotion in favor of vaping products. According to the public health code “ Only posters relating to electronic cigarettes and their refill bottles, which are not visible from the outside, are authorized inside places of sale. ".

According to the last “ Barometer of advertising at points of sale » of the CNCT, which monthly visits a panel of places of sale in France, these disposable electronic cigarettes have invaded numerous places of sale and raise the question of compliance with protective prohibitions such as the “strict supervision of advertising at the point of sale and the ban on sales to minors. According to the association, which visited more than 80 sales locations in the second quarter of 2022, the sale of one or more brands of puff was noted in 70% of the sales locations visited. Although they are mainly sold in tobacconists and specialized vaping product stores, the retail sale of these products is also growing rapidly. They can be found, for example, in Parisian kiosks and large retail chains (GIFI), and even decoration stores. The multiple methods of retail distribution of these products raise the question of compliance with the ban on sales to minors.

The online sale of these products also raises this issue. In addition to the official merchant sites of the brands which offer these products without any age verification, many accounts on social networks popular with adolescents sell them, often at attractive prices and even offer home delivery. Foreign sites also offer the possibility of having puffs delivered with nicotine levels well above the limit authorized in the European Union. Often, these sites do not offer any information on the ingredients contained in the products.

The rapid growth in the consumption of electronic cigarettes in general poses a new environmental problem. These are produced in large quantities and include batteries made up of heavy metals, electronic circuits, plastic and liquid and nicotine residue which become massive and dangerous sources of waste. When they are abandoned in nature, they decompose, releasing micro-plastics, polluting waterways, fauna and flora.

Disposable electronic cigarettes generate even higher environmental costs because they are used for a short time, do not recharge, either battery or liquid. Single use, they are thrown away after consumption. Finally, these types of products often do not provide any guidance on how to dispose of them after use and the possibilities for recycling materials.

Keywords: puff, disposable e-cigarettes, marketing, youth, vaping

AE

[1] The Ministry of Solidarity and Health attentive to “Puff” type vaping products and compliance with legal obligations concerning advertising and sales to minors, website of the Ministry of Health, published on March 17, 2022, consulted on July 5, 2022

[2] Notification of placing vaping products on the market (Online procedure)