Objectives

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

Methods

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

Results

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

Conclusions

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