title: Forensic analysis of online marketing for electronic nicotine delivery systems.
abstract: BACKGROUND
  Electronic nicotine delivery systems (ENDS) are growing in awareness and use in the USA. They are currently unregulated as the Food and Drug Administration has yet to assert jurisdiction under its tobacco authority over these products, and a US Court of Appeals held they cannot be regulated as drugs/delivery devices if they are not marketed for a therapeutic purpose. Observation of the current online marketplace suggests ENDS, like some nutraceutical products, are being promoted using affiliate marketing techniques using claims concerning purported health benefits.
  
  
  OBJECTIVE
  This study performed a forensic analysis to characterise the relationships between online ENDS affiliate advertisements and ENDS sellers, and evaluated descriptive content on advertisements and websites to inform future policy and regulatory efforts.
  
  
  METHODS
  A purposive sampling strategy was used to identify three forms of ENDS advertising. Web proxy software recorded identifiable objects and their ties to each other. Network analysis of these ties followed, as well as analysis of descriptive content on advertisements and websites identified.
  
  
  RESULTS
  The forensic analysis included four ENDS advertisements, two linked affiliate websites, and two linked seller websites, and demonstrated a multilevel relationship between advertisements and sellers with multiple layers of redirection. Descriptive analysis indicated that advertisements and affiliates, but not linked sellers, included smoking cessation claims. Results suggest that ENDS sellers may be trying to distance marketing efforts containing unsubstantiated claims from sales. A separate descriptive analysis of 20 ENDS seller web pages indicated that the use of affiliate marketing by sellers may be widespread.
  
  
  CONCLUSIONS
  These findings support increased monitoring and regulation of ENDS marketing to prevent deceptive marketing tactics and ensure consumer safety.
authors.affiliation: Division of Pulmonary & Critical Care, Department of Medicine, Georgetown University Medical Center, Washington, DC, USA Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC, USA.
authors.forename: Nathan K
authors.initials: NK
authors.lastname: Cobb
authors.affiliation: Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC, USA.
authors.forename: Jody
authors.initials: J
authors.lastname: Brookover
authors.affiliation: Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC, USA.
authors.forename: Caroline O
authors.initials: CO
authors.lastname: Cobb
mesh_terms: D003132:Commerce; D066300:Electronic Nicotine Delivery Systems / Q000191:economics; D004581:Electronics; D033161:Government Regulation; D006801:Humans; D020407:Internet; D040541:Marketing; D009538:Nicotine / Q000008:administration & dosage*; D011356:Product Labeling; D012907:Smoking; D016540:Smoking Cessation; D019460:Tobacco Industry; D062789:Tobacco Products
chemical_list: D009538:Nicotine
keywords: Advertising and Promotion; Cessation; Electronic nicotine delivery devices; Harm Reduction; Tobacco industry