Revisiting the Rise of Electronic Nicotine Delivery Systems Using Search Query Surveillance

Published:February 10, 2016DOI:


      Public perceptions of electronic nicotine delivery systems (ENDS) remain poorly understood because surveys are too costly to regularly implement and, when implemented, there are long delays between data collection and dissemination. Search query surveillance has bridged some of these gaps. Herein, ENDS’ popularity in the U.S. is reassessed using Google searches.


      ENDS searches originating in the U.S. from January 2009 through January 2015 were disaggregated by terms focused on e-cigarette (e.g., e-cig) versus vaping (e.g., vapers); their geolocation (e.g., state); the aggregate tobacco control measures corresponding to their geolocation (e.g., clean indoor air laws); and by terms that indicated the searcher’s potential interest (e.g., buy e-cigs likely indicates shopping)—all analyzed in 2015.


      ENDS searches are rapidly increasing in the U.S., with 8,498,000 searches during 2014 alone. Increasingly, searches are shifting from e-cigarette- to vaping-focused terms, especially in coastal states and states where anti-smoking norms are stronger. For example, nationally, e-cigarette searches declined 9% (95% CI=1%, 16%) during 2014 compared with 2013, whereas vaping searches increased 136% (95% CI=97%, 186%), even surpassing e-cigarette searches. Additionally, the percentage of ENDS searches related to shopping (e.g., vape shop) nearly doubled in 2014, whereas searches related to health concerns (e.g., vaping risks) or cessation (e.g., quit smoking with e-cigs) were rare and declined in 2014.


      ENDS popularity is rapidly growing and evolving. These findings could inform survey questionnaire development for follow-up investigation and immediately guide policy debates about how the public perceives the health risks or cessation benefits of ENDS.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Yamin C.K.
        • Bitton A.
        • Bates D.W.
        E-cigarettes: a rapidly growing Internet phenomenon.
        Ann Intern Med. 2010; 153: 607-609
        • Noel J.K.
        • Rees V.W.
        • Connolly G.N.
        Electronic cigarettes: a new “tobacco” industry?.
        Tob Control. 2011; 20: 81
        • Ayers J.W.
        • Ribisl K.M.
        • Brownstein J.S.
        Tracking the rise in popularity of electronic nicotine delivery systems (electronic cigarettes) using search query surveillance.
        Am J Prev Med. 2011; 40: 448-453
        • Adkison S.E.
        • O’Connor R.J.
        • Bansal-Travers M.
        • et al.
        Electronic nicotine delivery systems: International Tobacco Control Four-Country Survey.
        Am J Prev Med. 2013; 44: 207-215
        • Regan A.K.
        • Promoff G.
        • Dube S.R.
        • Arrazola R.
        Electronic nicotine delivery systems: adult use and awareness of the “e-cigarette” in the USA.
        Tob Control. 2013; 22: 19-23
        • Vickerman K.A.
        • Carpenter K.M.
        • Altman T.
        • Nash C.M.
        • Zbikowski S.M.
        Use of electronic cigarettes among state tobacco cessation quitline callers.
        Nicotine Tob Res. 2013; 15: 1787-1791
        • McMillen R.C.
        • Gottlieb M.A.
        • Shaefer R.M.
        • Winickoff J.P.
        • Klein J.D.
        Trends in electronic cigarette use among U.S. adults: use is increasing in both smokers and nonsmokers.
        Nicotine Tob Res. 2015; 17: 1195-1202
        • Tan A.S.
        • Bigman C.A.
        E-cigarette awareness and perceived harmfulness: prevalence and associations with smoking-cessation outcomes.
        Am J Prev Med. 2014; 47: 141-149
        • Giovenco D.P.
        • Lewis M.J.
        • Delnevo C.D.
        Factors associated with e-cigarette use: a national population survey of current and former smokers.
        Am J Prev Med. 2014; 47: 476-480
        • King B.A.
        • Patel R.
        • Nguyen K.H.
        • Dube S.R.
        Trends in awareness and use of electronic cigarettes among U.S. adults, 2010-2013.
        Nicotine Tob Res. 2015; 17: 219-227
        • Grana R.A.
        • Ling P.M.
        Smoking revolution: a content analysis of electronic cigarette retail websites.
        Am J Prev Med. 2014; 46: 395-403
        • Ayers J.W.
        • Althouse B.M.
        • Dredze M.
        Could behavioral medicine lead the web data revolution?.
        JAMA. 2014; 311: 1399-1400
        • Jo C.L.
        • Ayers J.W.
        • Althouse B.M.
        • Emery S.
        • Huang J.
        • Ribisl KM.U.S.
        consumer interest in non-cigarette tobacco products spikes around the 2009 federal tobacco tax increase.
        Tob Control. 2014; 24: 395-399
        • Ayers J.W.
        • Althouse B.M.
        • Johnson M.
        • Cohen J.E.
        Circaseptan (weekly) rhythms in smoking cessation considerations.
        JAMA Intern Med. 2014; 174: 146-148
        • Ayers J.W.
        • Althouse B.M.
        • Noar S.M.
        • Cohen J.E.
        Do celebrity cancer diagnoses promote primary cancer prevention?.
        Prev Med. 2014; 58: 81-84
        • Ayers J.W.
        • Althouse B.M.
        • Ribisl K.M.
        • Emery S.
        Digital detection for tobacco control: Online Reactions to the United States’ 2009 cigarette excise tax increase.
        Nicotine Tob Res. 2013; 16: 576-583
        • Nuti S.V.
        • Wayda B.
        • Ranasinghe I.
        • et al.
        The use of Google trends in health care research: a systematic review.
        PLoS One. 2014; 9: e109583
        • Santillana M.
        • Zhang D.W.
        • Althouse B.M.
        • Ayers J.W.
        What can digital disease detection learn from (an external revision to) Google flu trends?.
        Am J Prev Med. 2014; 47: 341-347
        • Ayers J.W.
        • Althouse B.M.
        • Johnson M.
        • Dredze M.
        • Cohen J.E.
        What’s the healthiest day? Circaseptan (weekly) rhythms in healthy considerations.
        Am J Prev Med. 2014; 47: 73-76
        • Ayers J.W.
        • Althouse B.M.
        • Emery S.
        Changes in Internet searches associated with the “tips from former smokers” campaign.
        Am J Prev Med. 2015; 48: e27-e29
      1. Hyndman RJ, Khandakar Y. Automatic time series forecasting: the forecast package for R 7, 2008. 2007.

        • King G.
        • Tomz M.
        • Wittenberg J.
        Making the most of statistical analyses: improving interpretation and presentation.
        Am J Polit Sci. 2000; 44: 341-355
        • American Lung Association
        American Lung Association State of Tobacco Control 2014.
        American Lung Association, Washington, DC2014
        • CDC
        Federal and state cigarette excise taxes—United States, 1995-2009.
        MMWR Morb Mortal Wkly Rep. 2009; 58: 524-527
        • Alamar B.
        • Glantz S.A.
        Effect of increased social unacceptability of cigarette smoking on reduction in cigarette consumption.
        Am J Public Health. 2006; 96: 1359-1363
        • Althouse B.M.
        • Allem J.-P.
        • Childers M.A.
        • Dredze M.
        • Ayers J.W.
        Population health concerns during the united states great recession.
        Am J Prev Med. 2014; 46: 166-170
        • Bhatnagar A.
        • Whitsel L.P.
        • Ribisl K.M.
        • et al.
        Electronic cigarettes: a policy statement from the American Heart Association.
        Circulation. 2014; 130: 1418-1436
        • Pepper J.K.
        • Brewer N.T.
        Electronic nicotine delivery system (electronic cigarette) awareness, use, reactions and beliefs: a systematic review.
        Tob Control. 2013; 23: 375-384
        • Contreary K.A.
        • Chattopadhyay S.K.
        • Hopkins D.P.
        • et al.
        Economic impact of tobacco price increases through taxation: a community guide systematic review.
        Am J Prev Med. 2015; 49: 800-808
        • Majeed B.A.
        • Dube S.R.
        • Sterling K.
        • Whitney C.
        • Eriksen M.P.
        Opinions about electronic cigarette use in smoke-free areas among U.S. adults, 2012.
        Nicotine Tob Res. 2015; 17: 675-681
        • Fairchild A.L.
        • Bayer R.
        • Colgrove J.
        The renormalization of smoking? E-cigarettes and the tobacco “endgame.”.
        N Engl J Med. 2014; 370: 293-295
        • Henriksen L.
        The retail environment for tobacco: a barometer of progress towards the endgame.
        Tob Control. 2015; 24: e1-e2
        • Williams R.S.
        • Derrick J.
        • Ribisl K.M.
        Electronic cigarette sales to minors via the Internet.
        JAMA Pediatr. 2015; 169: e1563
        • Siegel M.B.
        • Tanwar K.L.
        • Wood K.S.
        Electronic cigarettes as a smoking-cessation tool: results from an online survey.
        Am J Prev Med. 2011; 40: 472-475
        • Pearson J.L.
        • Richardson A.
        • Niaura R.S.
        • Vallone D.M.
        • Abrams D.B.
        E-cigarette awareness, use, and harm perceptions in U.S. adults.
        Am J Public Health. 2012; 102: 1758-1766
        • Etter J.F.
        • Bullen C.
        • Flouris A.D.
        • Laugesen M.
        • Eissenberg T.
        Electronic nicotine delivery systems: a research agenda.
        Tob Control. 2011; 20: 243-248
        • Goniewicz M.L.
        • Lingas E.O.
        • Hajek P.
        Patterns of electronic cigarette use and user beliefs about their safety and benefits: an Internet survey.
        Drug Alcohol Rev. 2013; 32: 133-140
        • Sussman S.
        • Garcia R.
        • Cruz T.B.
        • Baezconde-Garbanati L.
        • Pentz M.A.
        • Unger J.B.
        Consumers’ perceptions of vape shops in Southern California: an analysis of online Yelp reviews.
        Tob Induc Dis. 2014; 12: 22
        • Wills T.A.
        • Knight R.
        • Williams R.J.
        • Pagano I.
        • Sargent J.D.
        Risk factors for exclusive e-cigarette use and dual e-cigarette use and tobacco use in adolescents.
        Pediatrics. 2015; 135: e43-e51
        • Leventhal A.M.
        • Strong D.R.
        • Kirkpatrick M.G.
        • et al.
        Association of electronic cigarette use with initiation of combustible tobacco product smoking in early adolescence.
        JAMA. 2015; 314: 700-707
        • Hajek P.
        • Etter J.F.
        • Benowitz N.
        • Eissenberg T.
        • McRobbie H.
        Electronic cigarettes: review of use, content, safety, effects on smokers and potential for harm and benefit.
        Addiction. 2014; 109: 1801-1810
        • Maziak W.
        Harm reduction at the crossroads: the case of e-cigarettes.
        Am J Prev Med. 2014; 47: 505-507
        • Manzoli L.
        • Flacco M.E.
        • Fiore M.
        • et al.
        Electronic cigarettes efficacy and safety at 12 months: cohort study.
        PLoS One. 2015; 10: e0129443
        • Strauss M.E.
        • Smith G.T.
        Construct validity: advances in theory and methodology.
        Annu Rev Clin Psychol. 2009; 5: 1-25
        • Goel S.
        • Hofman J.M.
        • Lahaie S.
        • Pennock D.M.
        • Watts D.J.
        Predicting consumer behavior with Web search.
        Proc Natl Acad Sci U S A. 2010; 107: 17486-17490
        • Althouse B.M.
        • Ng Y.Y.
        • Cummings D.A.
        Prediction of dengue incidence using search query surveillance.
        PLoS Negl Trop Dis. 2011; 5: e1258
        • Internet & American Life Project
        Pew Research Center Internet Project Survey, January 2014.
        Pew Internet Research, Washington, DC2014
        • Ayers J.W.
        • Althouse B.M.
        “Tips from Former Smokers” can benefit from considering all available data: reply to McAfee et al.
        Am J Prev Med. 2015; 49: e133-e134
        • Cavazos-Rehg P.A.
        • Krauss M.J.
        • Spitznagel E.L.
        • et al.
        Monitoring of non-cigarette tobacco use using Google Trends.
        Tob Control. 2014; 24: 249-255
        • Chunara R.
        • Bouton L.
        • Ayers J.W.
        • Brownstein J.S.
        Assessing the online social environment for surveillance of obesity prevalence.
        PLoS One. 2013; 8: e61373
      2. Paul MJ, Dredze M. You are what you tweet: analyzing Twitter for public health. Paper presented at: Fifth International AAAI Conference on Weblogs and Social Media (ICWSM 2011); July 7–11, 2011; Barcelona, Spain.

        • Cohen J.E.
        • Sarabia V.
        • Ashley M.J.
        Tobacco commerce on the Internet: a threat to comprehensive tobacco control.
        Tob Control. 2001; 10: 364-367
        • Ribisl K.M.
        • Jo C.
        Tobacco control is losing ground in the Web 2.0 era: invited commentary.
        Tob Control. 2012; 21: 145-146
        • Ayers J.W.
        • Ribisl K.
        • Brownstein J.S.
        Using search query surveillance to monitor tax avoidance and smoking cessation following the United States’ 2009 “schip” cigarette tax increase.
        PLoS One. 2011; 6: e16777
      3. Allem JP, Ayers JW, Althouse BM, Williams R. When a ban really is not a ban: Internet loopholes and Djarum flavoured cigarettes in the USA. Tob Control. In press.

      4. Sussman S, Baezconde-Garbanati L, Garcia R, et al. Forces that drive the vape shop industry and implications for the health professions. Eval Health Prof. In press.

        • Barrington-Trimis J.L.
        • Samet J.M.
        • McConnell R.
        Flavorings in electronic cigarettes: an unrecognized respiratory health hazard?.
        JAMA. 2014; 312: 2493-2494
        • Cobb C.O.
        • Hendricks P.S.
        • Eissenberg T.
        Electronic cigarettes and nicotine dependence: evolving products, evolving problems.
        BMC Med. 2015; 13: 119
        • Etter J.F.
        E-cigarettes: methodological and ideological issues and research priorities.
        BMC Med. 2015; 13: 32