Online sales and promotion of E-cigarettes in India: A Cross-sectional study

Abstract Introduction: India is one of the countries to have banned the production, manufacture, import, export, transport, sale, distribution, storage and advertisement of electronic cigarettes (e-cigarettes). With the advent of technology, e-cigarettes are being marketed extensively on the internet despite the ban Objective: To assess online sales and promotion of e-cigarettes on the internet, and social networking sites (SNS) to identify violations of the current restrictive policies by the e-cigarette industry, SNS platforms and influencers. Methodology: A survey with youth (18-24 years), along with a desk review was conducted to identify influencers promoting and e-stores selling e-cigarettes in India. Further, a content analysis of the identified influencers and online stores was conducted, along with a analysis of the policies banning online e-cigarette sales and advertisements. Results: 370 youth with a mean age of 21.1±1.7 years ,participated in the survey. 66.6% of participants reported being aware of e-cigarettes through social media. Instagram (46%) was identified as the most popular social networking platform for promoting e-cigarettes. A total of 189 influencers promoting e-cigarettes on Instagram were identified and their posts positively portrayed e-cigarettes (trendy/cool, flavours, hedonic value, features cessation aid and cost-effective). In addition, 83 e-stores (49 Indian and 34 international) were identified selling e-cigarettes in India. Findings from content analysis of both influencers and e-stores also highlighted the issue of cross-border marketing. Collected data showed a violation of the restrictive policies by the influencers and e-stores. Conclusion: To safeguard the youth and move towards Tobacco Endgame; there is a dire need for empowering youth and the community via sensitization programs on the detrimental effects and existing policies related to e-cigarettes in India. Furthermore, strengthening the enforcement of PECA 2019 is the need of the hour to address cross-border advertisements and sales of e-cigarettes, as well as establish strong reporting violation mechanisms.