Online e-Cigarette Retailers’ Use of Price Incentives and Product Features to Attract Adolescent and Young Adult Purchases: Cross-Sectional Choice-Based Study

Abstract Background There are reports of several adolescents and young adults purchasing electronic cigarettes (e-cigarettes) from e-cigarette retailer websites. However, there is a lack of consumer research on how e-cigarette retailer websites’ content influences adolescent and young adult purchases. Objective This study aims to examine whether seeing specific characteristics on e-cigarette retailer websites encourages or discourages e-cigarette purchase by adolescents and young adults and to further assess whether such influences vary by age and e-cigarette use. Methods Using a web-based survey, we conducted a cross-sectional choice-based experiment in 5326 individuals (aged 13‐24 years). We examined associations between e-cigarette retailer websites’ content, reflected in 18 keywords, and the likelihood of e-cigarette purchase. Results Female and sexual minority (nonheterosexual) adolescents and young adults were more likely to purchase e-cigarettes if websites had a clearance or sale (female individuals: adjusted odds ratio aOR 1.19, 95% CI 1.04‐1.35; P= .02; sexual minority individuals: aOR 1.48, 95% CI 1.21‐1.82; P< .01), deals (sexual minority individuals: aOR 1.28, 95% CI 1.04‐1.57; P= .02), or direct discounts (female individuals: aOR 1.26, 95% CI 1.09‐1.45; P< .01; sexual minority individuals: aOR 1.29, 95% CI 1.03‐1.61; P= .03); if they could shop by flavor (female individuals: aOR 1.49, 95% CI 1.30‐1.71; P< .01); or if they saw new and trending products (female individuals: aOR 1.18, 95% CI 1.03‐1.34; P= .03). Female individuals were less likely to purchase e-cigarettes if required to register or sign-in (aOR 0.66, 95% CI 0.58‐0.76; P< .01) or upload an ID (aOR 0.84, 95% CI 0.74‐0.96; P= .02), and similarly, sexual minority individuals were less likely to purchase e-cigarettes if required to register or sign-in (aOR 0.77, 95% CI 0.63‐0.96; P =.02). Older participants were more likely to purchase from authorized dealers (aOR 1.06, 95% CI 1.03‐1.08; P <.01) if required to enter an email (aOR 1.03, 95% CI 1.01‐1.06; P =.01) or a photo ID (aOR 1.11, 95% CI 1.08‐1.13; P< .01) but less likely to purchase based on seeing new and trending products (aOR 0.94, 95% CI 0.92‐0.96; P< .01) or vape guides or blogs (aOR 0.97, 95% CI 0.95‐0.99; P= .04). Participants who had never used e-cigarettes were more susceptible to purchase if they saw a starter kit (aOR 1.27, 95% CI 1.07‐1.51; P= .01), if they saw new and trending products (aOR 1.28, 95% CI 1.08‐1.52; P< .01), or if they could shop by flavor (aOR 1.67, 95% CI 1.39‐2.00; P< .01). Conclusions The findings show that adolescents and young adults are attracted to several aspects of e-cigarette retailer website content. Providing tailored prevention education about price incentives, flavors, and starter kits to vulnerable groups at risk of purchase and ensuring effective age verification could discourage e-cigarette online purchases.