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E-cigarette Policymaking by Local and State Governments: 2009-2014: E-cigarette Policymaking: 2009-2014
Abstract
Policy Points
E‐cigarettes are new products that are generating policy issues, including youth access and smokefree laws, for local and state governments.
Unlike with analogous debates on conventional cigarettes, initial opposition came from e‐cigarette users and retailers independent of the multinational cigarette companies.
After the cigarette companies entered the e‐cigarette market, the opposition changed to resemble long‐standing industry resistance to tobacco control policies, including campaign contributions, lobbying, and working through third parties and front groups.
As with earlier efforts to restrict tobacco products, health advocates have had the most success at the local rather than the state level.
Context
E‐cigarettes entered the US market in 2007 without federal regulation. In 2009, local and state policymakers began identifying ways to regulate their sale, public usage, taxation, and marketing, often by integrating them into existing tobacco control laws.
Methods
We reviewed legislative hearings, newspaper articles, financial disclosure reports, NewsBank, Google, Twitter, and Facebook and conducted interviews to analyze e‐cigarette policy debates between 2009 and 2014 in 4 cities and the corresponding states.
Findings
Initial opposition to local and state legislation came from e‐cigarette users and retailers independent of the large multinational cigarette companies. After cigarette companies entered the e‐cigarette market, e‐cigarette policy debates increasingly resembled comparable tobacco control debates from the 1970s through the 1990s, including pushing pro‐industry legislation, working through third parties and front groups, mobilizing “grassroots” networks, lobbying and using campaign contributions, and claiming that policy was unnecessary due to “imminent” federal regulation. Similar to the 1980s, when the voluntary health organizations were slow to enter tobacco control debates, because they saw smoking restrictions as controversial, these organizations were reluctant to enter e‐cigarette debates. Strong legislation passed at the local level because of the committed efforts of local health departments and leadership from experienced politicians but failed at the state level due to intense cigarette company lobbying without countervailing pressure from the voluntary health organizations.
Conclusions
Passing e‐cigarette regulations at the state level has become more difficult since cigarette companies have entered the market. While state legislation is possible, as with earlier tobacco control policymaking, local governments remain a viable option for overcoming cigarette company interference in the policymaking process.
... The growing popularity of electronic nicotine-delivery systems (ENDS) has resulted in the expansion of the tobacco industry and new concerns about aggressive marketing, underage, and young adult uptake, and the growing presence of industry interference (i.e., various tactics used to defeat, weaken or delay public health measures meant to reduce tobacco use) in state and federal tobacco-control policies [1][2][3][4][5][6][7][8][9] The emergence of ENDS, including different types of e-cigarettes and other emerging and alternative products (e.g., Heated Tobacco Products (HTPs)) along with their differential pricing, represent new market entries with their own unique health risks, different channels of product marketing and sales, and the presence of new and old tobacco industry actors who promote their use and advocate for their protection from public policymaking [10][11][12][13]. However, there have been signs of a slowdown in ENDS sales, emphasizing the importance of continuing to strengthen state and federal tobacco-control efforts that have focused on instituting new tobacco/ENDS product taxes, raising the minimum age of sale, and sales bans on certain products (e.g., flavored ENDS products), all aimed at reducing uptake and appeal [8,14]. ...
... The growing popularity of electronic nicotine-delivery systems (ENDS) has resulted in the expansion of the tobacco industry and new concerns about aggressive marketing, underage, and young adult uptake, and the growing presence of industry interference (i.e., various tactics used to defeat, weaken or delay public health measures meant to reduce tobacco use) in state and federal tobacco-control policies [1][2][3][4][5][6][7][8][9] The emergence of ENDS, including different types of e-cigarettes and other emerging and alternative products (e.g., Heated Tobacco Products (HTPs)) along with their differential pricing, represent new market entries with their own unique health risks, different channels of product marketing and sales, and the presence of new and old tobacco industry actors who promote their use and advocate for their protection from public policymaking [10][11][12][13]. However, there have been signs of a slowdown in ENDS sales, emphasizing the importance of continuing to strengthen state and federal tobacco-control efforts that have focused on instituting new tobacco/ENDS product taxes, raising the minimum age of sale, and sales bans on certain products (e.g., flavored ENDS products), all aimed at reducing uptake and appeal [8,14]. ...
... Active in enacting tobacco-control policy efforts is the state of California, a focal point in efforts to regulate tobacco and nicotine products via enactment of progressive policies that now subject ENDS to existing anti-tobacco laws (SB X2-5, Senate Bill No.5 Electronic ciarattes), raised the minimum purchasing age to 21 (SB X2-7, Senate Bill No.7 Tobacco products: minimum legal age), and imposed additional taxes on cigarettes and ENDS (Proposition 56). In response, the tobacco and ENDS industry has become aggressive in mobilizing opposition to these policies, using its expansive and increasingly diverse network of manufacturers, trade associations, and tobacco and vaping user communities, including through traditional political advocacy activities (such as lobbying), coordination across industry stakeholders (efforts by trade associations), and grass-roots activities by organizing opposition to tobacco-control measures through live and online campaigns with vaping constituency groups [8,15]. ...
Growing popularity of electronic nicotine-delivery systems (ENDS) has coincided with a need to strengthen tobacco-control policy. In response, the ENDS industry has taken actions to mobilize against public health measures, including coordination on social media platforms. To explore this phenomenon, data mining was used to collect public posts on two Facebook public group pages: the California Consumer Advocates for Smoke Free Alternatives Association (CCASAA) and the community page of the Northern California Chapter of SFATA (NC-SFATA). Posts were manually annotated to characterize themes associated with industry political interference and user interaction. We collected 288 posts from the NC-SFATA and 411 posts from CCASAA. A total of 522 (74.7%) posts were categorized as a form of political interference, with 339 posts (64.9%) from CCASAA and 183 posts (35.1%) from NC-SFATA. We identified three different categories of policy interference-related posts: (1) providing updates on ENDS-related policy at the federal, state, and local levels; (2) sharing opinions about ENDS-related policies; (3) posts related to scientific information related to vaping; and (4) calls to action to mobilize against tobacco/ENDS policies. Our findings indicate that pro-tobacco social media communities on Facebook, driven by strategic activities of trade associations and their members, may act as focal points for anti-policy information dissemination, grass-roots mobilization, and industry coordination that needs further research.
... 22 In our study as in the literature, actors who were against the bans on e-cigarettes centred their arguments on the lower health risk associated with the use of e-cigarettes and HTPs, compared with cigarettes, and their potential use in smoking cessation. [17][18][19][20] As expected, this argument contrasts with the classic discourse by tobacco companies when selling cigarettes, which favoured claims of individual right to use and of economic importance of their products since there was extensive evidence of the dangers of their use. 23 These arguments of lower health risk and harm reduction were coupled with those of the supposed insufficient evidence of the harmful effects of e-cigarettes and HTPs. ...
... The need to protect youth was the most common claim among opponents of the regulation of e-cigarettes in the USA, and this was also present in the arguments used by the stakeholders who opposed sales and marketing in our study. 20 The differences in framing the existing evidence, obtaining different conclusions and supporting different political choices, have been previously discussed, 11 13 24 showing that this largely depends on the actors' belief of the most effective strategy to reduce smoking consequences in the population: harm reduction or abstinence. ...
... 27 28 The potential impact of a ban on e-cigarettes and HTPs on the economy due to the ban of e-cigarettes and HTPs has been brought up during discussions on e-cigarette regulation in the USA. 20 In Brazil, this argument was used in the discussions of the additive ban and the regulation of the display and health warning labels, 27 28 probably as those who have used this argument-unions of workers in companies related to tobacco production or sales, tobacconists, kiosks owners and politicians-may fear the consequences of these bans on their own or their populations' income. 29 Brazil has been one of the world leaders in tobacco leaf exports and holds 25% of global sales, 30 with about 520 000 people working in tobacco farming. ...
Objectives
To identify proponents and opponents of the commercialisation and marketing of e-cigarettes and heated tobacco products (HTPs), identify the arguments used on both sides and compare how the arguments have changed over time, we analysed three policy discussions occurring in 2009, 2018 and 2019.
Methods
We conducted a content analysis of one document and six videos from these discussions, provided on the Brazilian Health Regulatory Agency website, or upon request.
Results
The arguments most used by tobacco companies were related to claims that the use of e-cigarettes and HTPs is less harmful than conventional tobacco. Unions that support its commercialisation also argued that lifting the ban would prevent smuggling and guarantee their quality. On the other side, universities, medical and anti-tobacco institutions argued that such devices may have health risks, including the risk of inducing cigarette smoking. In 2009, most arguments belonged to the ‘health’ theme, while in 2018 and 2019 economic arguments and those related to morals and ethics were frequently used.
Conclusions
Those that supported the commercialisation and marketing of e-cigarettes and HTPs first focused on arguments of harm reduction, while 10 years later the right to access and potential economic consequences also became common. Public health agents and academics must gather evidence to effectively respond to these arguments and discuss these policies, and must prepare themselves to use and respond to arguments related to moral and economic themes.
... 39 Research conducted in the US suggests social media activity may also be effective in influencing public policy, with legislators opposing efforts to define e-cigarettes as tobacco products and preventing e-cigarette use from being included in smoke-free laws following Twitter campaigns by proponents of the devices. 40 Given claims made about e-cigarettes on social media platforms have the potential to influence the decisions of consumers and policymakers, an examination of the information being disseminated is warranted. Accordingly, the present study sought to explore the claims being made by Australian proponents of e-cigarettes via their Twitter feeds. ...
... Ongoing surveillance of the extent to which Australian proponents are calling for the legalisation of e-cigarettes, and the evidence being used to legitimise these calls, should be an important component of public health and policy agendas, 44,45 especially given social media activity has the potential to be an effective means of influencing public policy. 40 In light of evidence from the US suggesting the vaping industry is working with third-party allies to oppose policies prohibiting the use of e-cigarettes and create support for legalisation, 40,44 an examination of the extent to which this is occurring in Australia is warranted to determine the various mechanisms used by the vaping industry to push their agenda in this country. ...
... Ongoing surveillance of the extent to which Australian proponents are calling for the legalisation of e-cigarettes, and the evidence being used to legitimise these calls, should be an important component of public health and policy agendas, 44,45 especially given social media activity has the potential to be an effective means of influencing public policy. 40 In light of evidence from the US suggesting the vaping industry is working with third-party allies to oppose policies prohibiting the use of e-cigarettes and create support for legalisation, 40,44 an examination of the extent to which this is occurring in Australia is warranted to determine the various mechanisms used by the vaping industry to push their agenda in this country. ...
Issue addressed
Social media sites have become platforms for public discourse on e-cigarettes, providing proponents with an opportunity to disseminate favourable information about the devices. Research examining the information being presented by Australian proponents of e-cigarettes is limited. Accordingly, this study explored the Twitter feeds of Australian proponents of e-cigarettes to determine the nature of the e-cigarette-related content being disseminated.
Methods
All publicly available e-cigarette-related tweets and retweets (n=1397) disseminated over a 15-week period by five Australian e-cigarette proponents were captured and analysed.
Results
The main topics covered in the 1397 tweets analysed related to (i) criticism of the arguments made by public health agencies/advocates who oppose e-cigarettes (29%), (ii) Australian e-cigarette policy (19%), (iii) the health risks of e-cigarettes (16%), and (iv) the efficacy of e-cigarettes as cessation aids (13%). Proponents argued that the precautionary principle adopted by public health agencies/advocates lacks an appropriate evidence base and that legalising e-cigarettes would reduce smoking rates and smoking-related harm. Proponents minimised the risks associated with e-cigarette use and only presented evidence indicating that use facilitates smoking cessation.
Conclusions
The assessed tweets have the potential to reduce the public’s trust in the information being presented by authoritative public health agencies/advocates. The dissemination of information downplaying the health risks associated with e-cigarettes may distort perceptions of the devices.
So What?
To assist tobacco control efforts, results highlight the need for (i) ongoing surveillance of the tweets of e-cigarette proponents and (ii) provision of evidence-based counterarguments on social media.
... As the major tobacco companies have moved into, and increasingly dominated, the e-cigarette market, they are dominating the political and policy-making environments just as they have in conventional cigarette policy making (33,78). As they have done to influence tobacco control policies for conventional cigarettes (132), the large companies often try to stay out of sight and work through third parties that can obscure their links to the tobacco industry (33). ...
... As the major tobacco companies have moved into, and increasingly dominated, the e-cigarette market, they are dominating the political and policy-making environments just as they have in conventional cigarette policy making (33,78). As they have done to influence tobacco control policies for conventional cigarettes (132), the large companies often try to stay out of sight and work through third parties that can obscure their links to the tobacco industry (33). The one difference from the historical pattern of industry efforts to shape tobacco policy from behind the scenes is that there are also genuine independent sellers of e-cigarettes and associated users (so-called vape shops) who are not necessarily being directed by the cigarette companies. ...
... These smaller operators are, however, losing market share to the big tobacco companies (89), and the real political power is now being exercised by the cigarette companies. The cigarette companies try to take advantage of the existence of independent players while acting through the industry's traditional allies and front groups (33,42). ...
Since e-cigarettes appeared in the mid-2000s, some practitioners, researchers, and policy makers have embraced them as a safer alternative to conventional cigarettes and an effective way to stop smoking. While e-cigarettes deliver lower levels of carcinogens than do conventional cigarettes, they still expose users to high levels of ultrafine particles and other toxins that may substantially increase cardiovascular and noncancer lung disease risks, which account for more than half of all smoking-caused deaths, at rates similar to conventional cigarettes. Moreover, rather than stimulating smokers to switch from conventional cigarettes to less dangerous e-cigarettes or quitting altogether, e-cigarettes are reducing smoking cessation rates and expanding the nicotine market by attracting youth. Expected final online publication date for the Annual Review of Public Health Volume 39 is April 1, 2018. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
... Our findings highlight similar policy opposition identified by others, such as protests against a "nanny state" and suggestions that those who are willing to enlist in the military should be able to use tobacco products [30]. Such sentiment provides context to the political climate at the time the federal Tobacco 21 policy was passed, which was influenced by supportive "front groups" such as vape shop owners, employees, and advocacy organizations that were provided resources by the tobacco industry to appear as a "grassroots" network [45]. These findings are important for other countries that are considering policies to raise their tobacco sales age. ...
... While tobacco companies have made political position statements about tobacco control policies on Twitter [35], they may also promote their message via other less obvious approaches. Modern tobacco and e-cigarette companies have evolved from using their employees as the face of political movements to funding front groups to advance the industry's message [45]. However, promotion of industrywide political interests about recently enacted youth access policies has been insufficiently explored. ...
To combat the e-cigarette epidemic among young audiences, a federal law was passed in the US that raised the minimum legal sales age of tobacco to 21 years (commonly known as Tobacco 21). Little is known about sentiment toward this law. Thus, the purpose of our study was to systematically explore trends about Tobacco 21 discussions and comparisons to other age-restriction behaviors on Twitter. Twitter data (n = 4628) were collected from September to December of 2019 that were related to Tobacco 21. A random subsample of identified tweets was used to develop a codebook. Two trained coders independently coded all data, with strong inter-rater reliability (κ = 0.71 to 0.93) found for all content categories. Associations between sentiment and content categories were calculated using χ2 analyses. Among relevant tweets (n = 955), the most common theme—the disjunction between ages for military enlistment and tobacco use—was found in 17.8% of all tweets. Anti-policy sentiment was strongly associated with the age of military enlistment, alcohol, voting, and adulthood (p < 0.001 for all). Opposition to Tobacco 21 propagates on social media because the US federal law does not exempt military members. However, the e-cigarette epidemic may have fueled some support for this law.
... In 2008, the FDA attempted to regulate ENDS devices under the Federal Food, Drug, and Cosmetic Act as a drug delivery device. Under this classification ENDS devices would be required to have "pre-approval, registration, and listing with the FDA" (Cox, Barry, & Glantz, 2016;FDA, 2020a). This was challenged in court by Sottera, an ENDS product company (PHLC, 2009 (Congress, 2009;Cox, et al., 2016). ...
... Under this classification ENDS devices would be required to have "pre-approval, registration, and listing with the FDA" (Cox, Barry, & Glantz, 2016;FDA, 2020a). This was challenged in court by Sottera, an ENDS product company (PHLC, 2009 (Congress, 2009;Cox, et al., 2016). When it was enacted, the FSPTCA covered "cigarettes, cigarette tobacco, roll-your-own tobacco, and smokeless tobacco, and required that any tobacco product that appeared on the market after February 15, 2007… get approval from the FDA" (Congress, 2009). ...
Vaping is the process of inhaling and exhaling an aerosol produced by an e-cigarette, vape pen, or personal aerosolizer. When the device contains nicotine, the Food and Drug Administration (FDA) lists the product as an electronic nicotine delivery system or ENDS device. Similar electronic devices can be used to vape cannabis extracts. Over the past decade, the vaping market has increased exponentially, raising health concerns over the number of people exposed and a nationwide outbreak of cases of severe, sometimes fatal, lung dysfunction that arose suddenly in otherwise healthy individuals. In this review, we discuss the various vaping technologies, which are remarkably diverse, and summarize the use prevalence in the U.S. over time by youths and adults. We examine the complex chemistry of vape carrier solvents, flavoring chemicals, and transformation products. We review the health effects from epidemiological and laboratory studies and, finally, discuss the proposed mechanisms underlying some of these health effects. We conclude that since much of the research in this area is recent and vaping technologies are dynamic, our understanding of the health effects is insufficient. With the rapid growth of ENDS use, consumers and regulatory bodies need a better understanding of constituent-dependent toxicity to guide product use and regulatory decisions.
... State policymakers began identifying ways to regulate e-cigarettes since 2009. 1 In the absence of enacted federal regulation, varied state regulations on e-cigarettes have been developed and implemented in terms of sale bans, marketing/ advertising restrictions, access of minors, usage in public/indoor, packaging requirements, taxation and licensure restrictions. 2 Although the US Food and Drug Administration's (FDA) rule to assert regulatory authority over e-cigarettes as tobacco products became effective as of 8 August 2016, 3 the FDA jurisdiction has no effect on where e-cigarettes can be used or taxed, setting higher minimum age or licensing on retailers at the state level. 1 In the meantime, the vaping epidemic became a public health crisis. ...
... 2 Although the US Food and Drug Administration's (FDA) rule to assert regulatory authority over e-cigarettes as tobacco products became effective as of 8 August 2016, 3 the FDA jurisdiction has no effect on where e-cigarettes can be used or taxed, setting higher minimum age or licensing on retailers at the state level. 1 In the meantime, the vaping epidemic became a public health crisis. The US Center for Disease Control and Prevention (CDC) identified 60 deaths and 2172 cases of lung injuries associated with vaping as of January 2020 4 and announced special investigations on the association between e-cigarette usage or vaping and the outbreak of severe lung diseases and deaths throughout the country. ...
Background
We examine the association among five types of state regulations on electronic cigarettes (defining e-cigarettes, special tax, packaging, youth access and licensure) and initiation and current usage of e-cigarettes in 50 US states and the District of Columbia.
Methods
Data came from the 2017 Behavioral Risk Factor Surveillance System and the US e-cigarette regulations—50 state review by the Public Health Law Center. Logistic regressions were used to determine the odds of initiation and current use of e-cigarettes among individuals aged 18–24, 25–34 and the whole sample, adjusting for socio-demographic covariates.
Results
Despite the short history of state laws on e-cigarettes, each of the five state laws was associated with lower odds of initiation and use of e-cigarettes in the whole sample. In the 18–24 age group, only the licensure was associated with lower initiation. In the 25–34 age group, the licensure and taxation were related to lower initiation and current usage. There were significant differences of e-cigarette initiation and usage based on the number of state laws regulating e-cigarettes.
Conclusions
Our analysis indicates the potential of states’ policy efforts to regulate e-cigarettes comprehensively in leading significant changes to e-cigarette prevalence in their populations.
... For example, Park and Hassairi (2021) found that the bill text and topic of early childhood education bills affected bill outcomes, but more importantly, that past legislator effectiveness strongly predicted bill passage, "Highly effective legislators who previously passed five or more ECE bills had an extremely high probability of sponsoring their legislation to enactment regardless of topic" (p.28). Further, Cox, Barry, and Glantz (2016) found that anti-e-cigarette policymaking was more successful when introduced by local governments and championed by advocacy coalitions comprised interest groups such as voluntary health organizations and health departments. On the other hand, the authors also found that pro-e-cigarette interest groups, including cigarette companies and lobbyists, were able to weaken and/or defeat certain anti-cigarette policies, particularly at the state level. ...
Behavioral healthcare treatments are effective, yet access remains limited across the country. Policymakers are in a unique position to close coverage gaps, but most behavioral health-related legislation fails. Past research has examined ways to influence legislator voting, but knowledge is limited regarding factors influencing the behavioral health legislative process. Thus, a scoping review of peer-reviewed literature was conducted using 16 databases and Google Scholar. Results indicated that internal characteristics of the policymakers as well as external forces in their environments influenced the behavioral health-related legislative process. These results provide important implications for those who want to improve behavioral health policy.
... This is a potentially significant gap given that actions across diverse local venues have afforded important opportunities to circumvent industry opposition in advancing tobacco control. [10][11][12][13] Karnataka is located in India's southwest and, with a population of around 61 million, is its ninth largest state. 14 The rationale for Karnataka as a case study for Article 5.3 implementation also encompasses the state's significance to both tobacco control activism and to tobacco production in India. ...
Introduction
Accelerating progress on tobacco control will require Article 5.3 of the WHO Framework Convention on Tobacco Control to be systematically integrated into policies and practices of sectors beyond health at diverse government levels. However, no study has explored implementation challenges of Article 5.3 within multilevel systems such as India, where political decisions on tobacco control occur at diverse government levels, which may constrain action at local level.
Methods
Based on 33 semi-structured interviews with diverse government and civil society stakeholders across four districts in Karnataka, India (Mysore, Mangalore, Bengaluru (rural) and Udupi), this study examines challenges to implement Article 5.3 arising from competing agendas and policies of different actors at multiple levels.
Results
Our analysis reveals generally low levels of awareness of Article 5.3 and its guideline recommendations, even among those directly involved in tobacco control at district level. Efforts to implement Article 5.3 were also challenged by competing views on the appropriate terms of engagement with industry actors. Scope to reconcile tensions across competing health, agriculture and commercial agendas was further constrained by the policies and practices of the national Tobacco Board, thereby undermining local implementation of Article 5.3. The most challenging aspect of Article 5.3 implementation was the difficulties in restricting engagement by government officials and departments with tobacco industry corporate social responsibility initiatives given national requirements for such activities among major corporations.
Conclusions
Promoting effective implementation of Article 5.3 in Karnataka will require policymakers to work across policy silos and reconcile tensions across India’s national health and economic priorities.
... Researchers in the US applied this framework to evaluate the regulatory process for vapes (Cox, Barry, and Glantz 2016). By adopting this approach, they were able to understand the complex reality of regulating vapes and tobacco. ...
In the midst of rapid technological development and growing concerns around public health, vapes emerged as a device that has produced global polarization. Canada is home to world precedent setting legislation aimed at reducing tobacco consumption and nicotine addiction. Vapes are a product that, in theory, should complement that pursuit. However, there is more than one side to this story. In one perspective, vapes are the holy grail of tobacco reduction-the answer to smoking cessation. From another perspective, they are a product that, in the long run, will result in more tobacco initiation and nicotine addiction. This study examines the complex process of developing regulatory policy by exploring how vaping advocacy groups and public health advocacy groups interact with Health Canada. A qualitative approach is adopted to determine the factors that drive each respective side of this polarized issue, in pursuit of finding common ground and understanding. The project draws from historical institutionalism and the advocacy coalition framework to describe how path dependency, ideological bias, and advocacy groups influence regulatory decisions. This study offers policy recommendations to support cessation efforts and prevent youth initiation. The findings highlight the importance of transparent decision-making and the need to consider the potential unintended consequences of regulations.
... Unlike e-cigarettes, which entered to the US market without federal/state regulations as well as scientific evidence on impacts on individual or public health, 24 there seems to be more research and learning from foreign markets for HTPs, and this information was being circulated as appeared in the results of text mining and statistical analysis. Optimistic findings are health professionals, tobacco control advocates, and educational institutions' active engagement in discussing potential risks of HTPs as well as news organizations' surveillance on IQOS marketing, advertising, and social media campaigns targeting young consumers. ...
Objectives: The U.S. Food and Drug Administration permitted sales of heated tobacco products (HTPs) on April 30, 2019. This paper provides a preliminary analysis of social media conversations regarding HTPs and the FDA authorization in the first 60 days.
Methods: 574 tweets regarding HTPs were examined in terms of the key events associated with tweet increases, valence, author characteristic, genre, risk/benefit, and comparison with cigarettes and e-cigarettes. Additionally, the semantic networks of HTPs and related keywords were identified through text mining analysis.
Results: Coded tweets were more likely to be neutral or anti-HTPs than pro-HTPs regardless of the author type (except for tobacco industry) or genre of the post. There was a small gap (6.4%) between the proportion of pro-HTPs and anti-HTPs among personal tweets. The proportion of pro-HTPs was larger in tweets posted by men (vs. women and no sex specified) and from rural areas (vs. urban). Nearly one third of the sample mentioned cigarettes or e-cigarettes, even though the size of posts making claims on inferiority/superiority of HTPs was small.
Conclusions: Unlike e-cigarettes which entered to the U.S. without regulations or scientific evidence on health impacts, there seems to be more conversations on risks of HTPs as well as surveillance on young consumer target marketing. However, tobacco companies’ launch of HTP sales in the U.S. and emerging tobacco issues can affect public perceptions on HTPs. Continuing surveillance of HTP marketing and public risk perceptions will guide tobacco regulations.
... For example, the United States Food and Drug Administration's new deeming rules for vaping products presents challenges for vaping product manufacturers and retailers to understand their obligations [28]. Substantial variation in vaping product regulations between jurisdictions has also been observed in the United States [29,30]. ...
Introduction and aims:
Vaping products have been growing in popularity in recent years, including in Australia. Australian laws covering vaping products are complex and vary significantly between jurisdictions. It has been acknowledged that there is public confusion about these laws. This study aims to explore publically-available information about vaping products-related laws disseminated via mainstream media and key stakeholder websites.
Design and methods:
A content analysis was conducted on 302 news articles identified in the Factiva database, and on 73 key stakeholder websites that provided information about vaping product regulations in Australia between January 2005 and January 2018. Items were coded for the type of regulations discussed, the source of information and the information provided about the legal status of vaping products.
Results:
Public advice covered regulations around sales, public use, nicotine importation, nicotine's classification as a poison and nicotine possession. In the majority of news articles, journalists did not cite the source of the information pertaining to vaping products laws, making it difficult for the public to judge its accuracy. We identified several inconsistencies in the information being disseminated through both channels.
Discussion and conclusions:
The inconsistent information provided to the public regarding vaping products likely reflects Australia's complex and varying laws governing the sale, use and possession of vaping products with and without nicotine. We recommend that relevant Australian federal, state and territory health agencies provide a clear and consistent message that covers all relevant information pertaining to vaping products and nicotine within respective jurisdictions.
... The industry continues to fund pro-vaping opinion, for example, 'moderate' doctors misreporting evidence (85,86), reaffirming their 'divide and conquer' strategy again in 2014 (58), lobbying groups, sham supportive campaigns and front groups coordinated by tobacco companies particularly in economically wealthy countries with falling cigarette consumption (63,87,88), whilst at the same time continuing to aggressively market cigarettes in Africa and Asia (89). ...
The smoking of tobacco cigarettes by millions of people over the past 100 or more years has had devastating public health consequences around the world. In some countries, this has been mitigated by the introduction of multiple regulatory strategies that have taken decades to implement. But even in the countries with most success at tobacco cigarette regulation, some smokers find it very hard to quit and need better treatment. Electronic cigarettes and other electronic nicotine delivery systems (ENDS) have emerged in the last decade or so. Initially designed to help smokers quit and produced by small independent entities, ENDS have become big business, with major transnational tobacco companies competing hard for market share where, for example, in the United States, a single device came to dominate the market within a couple of years and where soaring uptake by adolescents reached levels high enough to alarm the FDA. No doubts remain about the damaging health consequences of tobacco cigarettes. Controversies persist about e-cigarettes-their efficacy, health impacts, development of addiction and whether or not they provide a "gateway" to tobacco cigarette smoking. The regulation of tobacco cigarettes falls under a global WHO treaty, the Framework Convention on Tobacco Control (FCTC); over 180 countries are party to the FCTC. The regulation of ENDS has no such treaty, varies considerably around the world and in many countries remains completely untrammelled by specific directives. This paper will not discuss the evidence for or against the of e-cigarettes in smoking cessation (effectively discussed in this issue by Dr. Wallace) but aims to review the current state of tobacco regulation around the world, identify key differences in ENDS regulation, examine the impact of industry influence on public health policy and determine how the lessons of tobacco control should apply to ENDS.
... Additionally, social media users may interact with posts from tobacco companies or pro-e-cigarette advocacy groups that are known to mobilize opposition to e-cigarette regulation (e.g., Cox, Barry, & Glantz, 2016;Harris et al., 2014). Engagement with and exposure to tobacco marketing content, in particular, is largely unregulated by the FDA and is a likely risk factor for onset of tobacco use, increased frequency of use and poly-product use (Pokhrel et al., 2018;Soneji et al., 2018;Unger et al., 2018). ...
Introduction:
Given increasing efforts to regulate e-cigarettes, it is important to understand factors associated with support for tobacco regulatory policies. We investigate such factors found in social media and hypothesize that greater online engagement with tobacco content would be associated with less support for e-cigarette regulatory policies.
Methods:
We constructed social networks of Twitter users who tweet about tobacco and categorized them using a combination of social network and Twitter metrics. Twitter users were identified as representing leaders, followers or general users in online discussions of tobacco products, and invited to complete an online survey. Participants responded to questions about their engagement with tobacco-related content online, degree of support for e-cigarette regulations, exposure to tobacco marketing, e-cigarette use and other demographic information. We examined links between their reported engagement with tobacco-related content and support for e-cigarette regulatory policies using structural equation modelling.
Results:
The analytic sample consisted of 470 participants. The conceptualized structural equation model had a good fit (χ2 (32) = 24.85, p = 0.09, CFI = 0.99, RMSEA = 0.03). Findings support our hypothesis: engagement with online tobacco content was negatively associated with support for e-cigarette policies, while controlling for e-cigarette use, tobacco marketing exposure, social media use frequency and demographic factors.
Conclusions:
Findings suggest that our hypothesis was supported. Twitter users engaging with tobacco-related content and harboring negative attitudes toward e-cigarette regulatory policies could be an important audience segment to reach with tailored e-cigarette policy education messages.
... During this same period, most U.S. states set the age of purchase to 18 (although many laws were weak ones promoted by industry), 16 17 some states and localities prohibited ecigarette use where cigarette use was prohibited, and one state taxed e-cigarettes. 18 Although U.S. states began placing age requirements on e-cigarette purchases in 2010, 19 and the first state smokefree air law to include e-cigarettes took effect in 2010 in New Jersey, 20 there was M a n u s c r i p t 6 no federal regulation of e-cigarettes in the United States until May 2016, when the U.S. Food and Drug Administration issued its "deeming" rule asserting jurisdiction over e-cigarettes. 21 The rule, which went into effect August of 2016, set a national minimum age for purchase of 18 effective immediately and required warning labels on e-cigarettes effective August 2018. ...
Background:
In the context of different regulatory environments, different patterns of e-cigarette use have emerged among adolescents worldwide. One example is the United States and South Korea, the latter of which has maintained much more extensive regulation of e-cigarettes.
Methods:
This analysis compares the prevalence of e-cigarette and conventional cigarette use between 2011 and 2015 from the Korean Youth Risk Behavior Web-based Survey and the U.S. National Youth Tobacco Survey, both nationally representative samples of middle and high school students that use similar questions.
Results:
E-cigarette prevalence (past 30 day) among Korean adolescents decreased from 4.7% in 2011 (95% confidence interval [CI]: 4.4-5.0) to 4.0% in 2015; (3.7-4.3) but increased dramatically among U.S. adolescents from 0.9% (0.7-1.2) to 11.2% (9.9-12.7). Cigarette prevalence (past 30 day) decreased in Korea from 12.1% (11.6-12.7) to 7.8% (CI: 7.3-8.3) and in the United States from 11.1% (9.5-12.6) to 6.1% (5.1-7.3). Combined prevalence of cigarette and e-cigarette use (adjusting for dual users) decreased in Korea from 13.2% (12.7-13.8) to 8.5% (8.0-9.1) but increased in the United States from 11.3% (9.7-12.9) to 14.0% (12.4-15.7).
Conclusions:
In Korea, where e-cigarettes are extensively regulated, adolescent e-cigarette use remained stable at a low level, whereas in the United States, where e-cigarette regulation has been limited, e-cigarette use increased. Combined e-cigarette plus cigarette use declined in Korea whereas it increased in the US. The restrictive policies in Korea likely contributed to lower overall tobacco product use.
Introduction:
The state of California has enacted progressive anti-tobacco policies, including Proposition 56 in 2016. In response, the alternative and emerging tobacco product (ATP) industry has increased its political activity. This study explores the association between the proportion of people voting against Proposition 56 and tobacco/ATP retail density.
Methods:
We conducted a retrospective analysis using data on licensed California tobacco retailers, which were then cross-referenced for categorization using Yelp. Proportion voting against Proposition 56 was obtained from the Secretary of State's website. A series of linear regression tests were performed between population-normalized retailer density and voting proportion at the county level before and after adjusting for covariates such as age, gender, race/ethnicity and median household income.
Results:
The total number of licensed tobacco retailers increased by 29.31% from 2015 to 2019. Association between proportion voting against Proposition 56 and retail density was significant during voting and during periods of policy implementation and post-implementation (2016-2018) for non-specialized tobacco retailers. For specialized/ATP retailers, significance was only detected during the post-implementation period (2018-2019) after normalization. Proportion voting against Proposition 56 was also a significant predictor of increase in total number of non-specific (β=0.48, p=0.008) as well as specialized tobacco and/or ATP retail storefronts (β=0.21, p=0.001) from 2016 to 2018.
Conclusions:
This study provides initial evidence of the association between tobacco retail density and voting patterns for anti-tobacco policy. Future research should examine the role of tobacco retail density on variation in local support for state tobacco control initiatives, including tailoring outreach to specific voting census blocks in communities with heavy retail presence.
This paper presents the pharmaceutical supply chains in the larger context of health care supply chains. Pharmaceutical supply chains operate in a unique environment. This environment includes a two stage manufacturing process, multi-channel distribution and diverse storage and distribution requirements. The ability to respond in both normal and pandemic times adds an additional layer of complexity in pharmaceutical supply chains. Furthermore, the pharmaceutical supply chains need to operate under several regulatory requirements spanning across multiple nations in order to serve the global population. This paper explores these unique operational challenges, strategic issues as well as the emerging trends experienced by the pharmaceutical supply chains. Keywords: Supply Chain; Health care; Pharmaceutical; Operations; Distribution
Background
Existing research on media examining the news content related to Tobacco 21 (T21) pre-date the adoption of most T21 laws. This study examined the discussion of T21 laws in top-circulating print media sources in the U.S. between 2012 and 2020.
Methods
Systematic database searches using Access World News and Factiva identified T21 related news articles appearing in the top daily circulating newspapers in each state between January 2012 and December 2020 (n=586 articles). Content analyses documented prevalence, types of articles and context related to framing of arguments for or against T21 laws.
Results
Newspaper coverage of T21 was highest in 2019 (42.8% of articles). The majority were news/features (75.4%) followed by editorials/opinions (24.6%) which largely supported T21. Most articles focused on state or local T21 action. Coverage of federal T21 increased in 2019. The most common argument supporting T21 included reducing youth tobacco prevalence (64.8%) while the most frequent objection was freedom infringement (25.1%). Tobacco and vape industries began voicing support for T21 in 2019.
Conclusions
News coverage of state level T21 in the U.S. began to increase in 2015 and peaked in 2019 with enactment of federal T21, a newsworthy event. As states adopt and amend T21 laws to align with federal law, advocates can use media to help shape the narrative and encourage strong T21 policies.
Implications
This study described the volume and content of Tobacco 21 print media coverage from 2012 to 2020, including common arguments used to support and oppose Tobacco 21. Arguments in support of Tobacco 21 included reducing youth tobacco use, particularly use of e-cigarettes, and related health effects while arguments against Tobacco 21 focused on individual rights. Support for Tobacco 21 reached a tipping point in 2019, including the tobacco industry’s reversal in opposing such laws. States can and should continue to improve existing T21 laws and policies and increase public awareness about critical policy components such as inspection procedures and penalties.
Electronic cigarettes (e-cigarettes) entered US markets around 2006. Since then, the e-cigarette industry has strategically circumvented the long-standing ordinances that regulate traditional cigarettes and has been distributing and selling electronic cigarettes in a largely unregulated market. Advocacy and regulatory efforts have been asserted at the federal, state, and local levels; however, the e-cigarette and tobacco industries have met these initiatives with well-funded challenges. Data indicates that federal and state e-cigarette regulations continue to lag behind those of traditional cigarettes. The numerous ongoing delays in regulating electronic cigarettes have contributed to the current youth vaping crisis and associated adverse health consequences. To reverse the e-cigarette epidemic, community leaders and constituents must coordinate with local, state, and national health and tobacco control organizations and advocate for stringent e-cigarette regulations. Previous and ongoing tobacco and e-cigarette control movements demonstrate that local-level campaigns can gain momentum, advance to the state and federal level, and result in effective changes to public health policy. In this chapter, we examine historical, policy-based tobacco control successes and identify the prime targets for ongoing advocacy in the e-cigarette regulatory landscape, including smoke-free zones, excise taxes, characterizing flavors bans, Tobacco 21 legislation, and retail licensure.
In 2019, San Francisco, California, prohibited the sale of electronic cigarettes lacking US Food and Drug Administration authorization. Juul then promoted a ballot initiative (Proposition C) to replace San Francisco’s e-cigarette legislation with legislation Juul wrote that required future legislation to be approved by the voters. Juul promoted Proposition C as a way to reduce youth e-cigarette use while allowing adult choice.
Health groups argued that Juul’s measure could nullify San Francisco’s prohibition on selling flavored tobacco products. Health groups benefitted from having an established campaign network that recently defended the flavor ban. They successfully framed Proposition C as a tobacco industry ploy to undo San Francisco’s e-cigarette regulations, particularly the prohibition on selling flavored tobacco products. Juul ended its campaign on September 30, 2019, and the measure failed on election day, with 82% voting against it.
Lessons learned from the campaign include the importance of framing an industry initiative as a threat to local public health lawmaking and the potential for the e-cigarette issue to attract parents as new leaders and engage a powerful constituency to support tobacco control measures. (Am J Public Health. Published online ahead of print January 21, 2021: e1–e8. https://doi.org/10.2105/AJPH.2020.305993 )
Background
After Thailand enacted laws to ban the import and sale of all types of electronic nicotine delivery systems (ENDS, including e-cigarettes and heated tobacco products (HTPs)) in 2015, pro-ENDS advocacy groups pressured the government to lift the ban, particularly after Philip Morris International (PMI) started promoting its HTP IQOS in 2017.
Methods
We reviewed information related to ENDS in Thailand between 2014 and 2019 from Thai newspaper articles, meeting minutes and letters submitted to government agencies, websites and social media platforms of pro-ENDS networks and Thai tobacco control organisations.
Results
The tobacco industry and the pro-ENDS groups used five tactics to try to reverse the Thai ban on ENDS: creating front groups, lobbying decision-makers, running public relations campaigns, seeking to discredit tobacco control advocates and funding pro-tobacco harm reduction research. ENDS Cigarette Smoking Thailand (ECST), a pro-ENDS group in Thailand, worked in parallel with Philip Morris Thailand Limited (PMTL) to oppose the ban. The group connected with international coalitions that promote harm reduction through the PMI-funded Foundation for a Smoke-Free World.
Conclusion
Although ECST and PMTL continuously worked to revoke the ban since 2017, the government still kept ENDS illegal as of October 2020. This decision resulted from the strong commitment and collaboration among Thai tobacco control organisations and their shared vision to protect the public’s health from harmful tobacco products. The linkages between the pro-ENDS movement in Thailand and the tobacco companies could inform health advocates and policy-makers in other low and middle income countries facing pressure to market ENDS.
Introduction
In response to rising rates of youth vaping and e-cigarette use, states and localities in the United States have adopted various tobacco control policies and have extended their utility to these emerging products. However, the extent to which these policies have been evaluated for their impact on youth use is unknown.
Method
Two databases (PubMed, Google Scholar) were searched for English language peer-reviewed articles pertaining to electronic cigarette policy evaluation between 2009 and 2020. Primary articles of interest were journal articles that evaluated an e-cigarette policy. Secondary articles of interest were journal articles that identified any e-cigarette policy action without a formal evaluation component, those that evaluated tobacco policy, or those that described e-cigarette behaviors and trends. Tertiary articles included gray literature that provided context for e-cigarette trends and additional policy identification.
Results
The final sample consisted of 12 relevant articles with an e-cigarette policy evaluation component and 62 relevant articles without such component, and 19 gray literature sources. Findings were synthesized based on policy type: product classification, age restrictions, smoke-free policies, flavor bans, sales restrictions, taxation, packaging, and advertising.
Conclusion
Policies that address access and use of e-cigarettes are common on the federal, state, and local level, are mostly reactionary, and mimic tobacco control efforts. Few policies have been formally evaluated for their effectiveness in reducing or preventing youth vaping. Strengthening the evidence base should be a priority for researchers going forward, given the potential of these policies to intervene on social and environmental conditions that affect youth initiation and uptake.
Objectives. To describe how US states and the District of Columbia regulate e-cigarette sales by examining e-cigarette–specific tobacco retail licensing (TRL) laws.
Methods. We coded 25 state-level e-cigarette TRL laws (effective as of January 1, 2020) for provisions we labeled as either “core” (e.g., presence of license terms, fees, and penalties) or “descriptive” (e.g., license fee amount and term length).
Results. Overall, 23 laws clearly defined a license term, 23 laws required a license fee, and 19 laws identified penalties for violations that included both license suspension and revocation. Fees widely ranged (5–1000 annually), and 8 laws did not explicitly direct fees toward TRL administration or enforcement. No law required that retailers comply with all local, state, and federal tobacco or e-cigarette laws.
Conclusions. Most laws contained core TRL provisions. Several laws, however, had minimal license fees and did not direct fees toward administration or enforcement. As youth e-cigarette use increases, more states should consider establishing e-cigarette TRL laws or incorporating provisions into existing TRL laws. (Am J Public Health. Published online ahead of print July 16, 2020: e1–e6. doi:10.2105/AJPH.2020.305771)
To gain attention and build support for new categories, market entrepreneurs often define a new category through its contrast with related, established offerings. Existing research has largely focused on the benefits of this oppositional categorical positioning. In this study, we explore how this strategy might be a double-edged sword. Through a longitudinal inductive study of the e-cigarette category in the U.S. (2007–2017), we develop theory on the risks of associating with an already established category. In our empirical case, we document how value-based distinctions between cigarettes and e-cigarettes became eroded and the e-cigarette category grew increasingly stigmatized. We then propose several mechanisms through which the symbolic and social boundaries between a new and an established category can weaken and the stigma associated with an existing category can become diffused, intensified, and generalized—both across organizational features and across organizations in the new category. This case allows us to investigate the processes by which strategies to legitimize categories may backfire and to consider the role that a diverse set of core and peripheral stakeholders—who enter the market with pre-existing knowledge and motivations—play in category stigmatization processes.
Background:
The rate of adoption of electronic medical record (EMR) systems has increased internationally, and new EMR adoption is currently a major topic in Japan. However, no study has performed a detailed analysis of longitudinal data to evaluate the changes in the EMR adoption status over time.
Objective:
This study aimed to evaluate the changes in the EMR adoption status over time in hospitals and clinics in Japan and to examine the facility and regional factors associated with these changes.
Methods:
Secondary longitudinal data were created by matching data in fiscal year (FY) 2011 and FY 2014 using reference numbers. EMR adoption status was defined as "EMR adoption," "specified adoption schedule," or "no adoption schedule." Data were obtained for hospitals (n=4410) and clinics (n=67,329) that had no adoption schedule in FY 2011 and for hospitals (n=1068) and clinics (n=3132) with a specified adoption schedule in FY 2011. The EMR adoption statuses of medical institutions in FY 2014 were also examined. A multinomial logistic model was used to investigate the associations between EMR adoption status in FY 2014 and facility and regional factors in FY 2011. Considering the regional variations of these models, multilevel analyses with second levels were conducted. These models were constructed separately for hospitals and clinics, resulting in four multinomial logistic models. The odds ratio (OR) and 95% Bayesian credible interval (CI) were estimated for each variable.
Results:
A total of 6.9% of hospitals and 14.82% of clinics with no EMR adoption schedules in FY 2011 had adopted EMR by FY 2014, while 10.49% of hospitals and 33.65% of clinics with specified adoption schedules in FY 2011 had cancelled the scheduled adoption by FY 2014. For hospitals with no adoption schedules in FY 2011, EMR adoption/scheduled adoption was associated with practice size characteristics, such as number of outpatients (from quantile 4 to quantile 1: OR 1.67, 95% CI 1.005-2.84 and OR 2.40, 95% CI 1.80-3.21, respectively), and number of doctors (from quantile 4 to quantile 1: OR 4.20, 95% CI 2.39-7.31 and OR 2.02, 95% CI 1.52-2.64, respectively). For clinics with specified EMR adoption schedules in FY 2011, the factors negatively associated with EMR adoption/cancellation of scheduled EMR adoption were the presence of beds (quantile 4 to quantile 1: OR 0.57, 95% CI 0.45-0.72 and OR 0.74, 95% CI 0.58-0.96, respectively) and having a private establisher (quantile 4 to quantile 1: OR 0.27, 95% CI 0.13-0.55 and OR 0.43, 95% CI 0.19-0.91, respectively). No regional factors were significantly associated with the EMR adoption status of hospitals with no EMR adoption schedules; population density was positively associated with EMR adoption in clinics with no EMR adoption schedule (quantile 4 to quantile 1: OR 1.49, 95% CI 1.32-1.69).
Conclusions:
Different approaches are needed to promote new adoption of EMR systems in hospitals as compared to clinics. It is important to induce decision making in small- and medium-sized hospitals, and regional postdecision technical support is important to avoid cancellation of scheduled EMR adoption in clinics.
Background:
E-cigarette use is rapidly increasing among adolescents in the United States, with some suggesting that e-cigarettes are the cause of declining youth cigarette smoking. We hypothesized that the decline in youth smoking changed after e-cigarettes arrived on the US market in 2007.
Methods:
Data were collected by using cross-sectional, nationally representative school-based samples of sixth- through 12th-graders from 2004-2014 National Youth Tobacco Surveys (samples ranged from 16 614 in 2013 to 25 324 in 2004). Analyses were conducted by using interrupted time series of ever (≥1 puff) and current (last 30 days) cigarette smoking. Logistic regression was used to identify psychosocial risk factors associated with cigarette smoking in the 2004-2009 samples; this model was then applied to estimate the probability of cigarette smoking among cigarette smokers and e-cigarette users in the 2011-2014 samples.
Results:
Youth cigarette smoking decreased linearly between 2004 and 2014 (P = .009 for ever smoking and P = .05 for current smoking), with no significant change in this trend after 2009 (P = .57 and .23). Based on the psychosocial model of smoking, including demographic characteristics, willingness to wear clothing with a tobacco logo, living with a smoker, likelihood of smoking in the next year, likelihood of smoking cigarettes from a friend, and use of tobacco products other than cigarettes or e-cigarettes, the model categorized <25% of current e-cigarette-only users (between 11.0% in 2012 and 23.1% in 2013) as current smokers.
Conclusions:
The introduction of e-cigarettes was not associated with a change in the linear decline in cigarette smoking among youth. E-cigarette-only users would be unlikely to have initiated tobacco product use with cigarettes.
Background
Use of electronic cigarettes (e-cigarettes) is increasing rapidly. Chinese pharmacist Hon Lik is frequently cited as inventing the modern e-cigarette in 2003. However, tobacco companies have developed electronic nicotine delivery systems since at least 1963.
Methods
We searched the University of California San Francisco Truth (formerly Legacy) Tobacco Industry Documents beginning with the terms ‘electric cigarette’ and ‘electronic cigarettes’, ‘e-cigarette’, ‘smokeless cigarettes’, ‘nicotine aerosol’, ‘tobacco aerosol’, and ‘vaping’ and then expanded the search using snowball sampling. We focused our analysis on Philip Morris (PM) documents discussing technology that aerosolised a nicotine solution because these devices resembled modern e-cigarettes. Over 1000 documents were reviewed; 40 were included in the final analysis.
Results
PM started developing a nicotine aerosol device in 1990 to address the health concerns and decreased social acceptability of smoking that were leading smokers to switch to nicotine replacement therapy. PM had developed a capillary aerosol generator that embodied basic e-cigarette technology in 1994, but in the mid-to-late 1990s focused on applying its aerosol technology to pharmaceutical applications because of uncertainty of how such products might affect potential Food and Drug Administration regulation of tobacco products. In 2001, PM resumed its work on a nicotine aerosol device, and in 2013, NuMark (a division of Altria, PM's parent company) released the MarkTen, a nicotine aerosol device.
Conclusions
Rather than a disruptive technology, PM developed e-cigarette technology to complement, not compete with, conventional cigarettes and evade tobacco control regulations.
California's position as a leader in tobacco control is under threat by the resurgence of the
tobacco industry, the emergence of new unregulated tobacco products, and the decreasing
spending power of the tobacco control program.
• Countering a resurging tobacco industry will require advocates to be much more visible and
assertive in challenging politicians who take tobacco money.
• Progress on tobacco control has been concentrated at the local level where policymakers are
relatively more sensitive to public support for public health and less susceptible to industry
campaign contributions and lobbyists.
Electronic cigarettes (e-cigarettes) have been steadily increasing in popularity since their introduction to US markets in 2007. Debates surrounding the proper regulatory mechanisms needed to mitigate potential harms associated with their use have focused on youth access, their potential for nicotine addiction, and the renormalization of a smoking culture. The objective of this study was to describe the enacted and planned regulations addressing this novel public health concern in the US.
We searched LexisNexis Academic under Federal Regulations and Registers, as well as State Administrative Codes and Registers. This same database was also used to find information about planned regulations in secondary sources. The search was restricted to US documents produced between January 1(st), 2004, and July 14(th), 2014.
We found two planned regulations at the federal level, and 74 enacted and planned regulations in 44 states. We identified six state-based regulation types, including i) access, ii) usage, iii) marketing and advertisement, iv) packaging, v) taxation, and vi) licensure. These were further classified into 10 restriction subtypes: sales, sale to minors, use in indoor public places, use in limited venues, use by minors, licensure, marketing and advertising, packaging, and taxation. Most enacted restrictions aimed primarily to limit youth access, while few regulations enforced comprehensive restrictions on product use and availability.
Current regulations targeting e-cigarettes in the US are varied in nature and scope. There is greater consensus surrounding youth protection (access by minors and/or use by minors, and/or use in limited venues), with little consensus on multi-level regulations, including comprehensive use bans in public spaces.
Tobacco use and addiction most often begin during youth and young adulthood. Youth use of tobacco in any form is unsafe. To determine the prevalence and trends of current (past 30-day) use of nine tobacco products (cigarettes, cigars, smokeless tobacco, e-cigarettes, hookahs, tobacco pipes, snus, dissolvable tobacco, and bidis) among U.S. middle (grades 6-8) and high school (grades 9-12) students, CDC and the Food and Drug Administration (FDA) analyzed data from the 2011-2014 National Youth Tobacco Surveys (NYTS). In 2014, e-cigarettes were the most commonly used tobacco product among middle (3.9%) and high (13.4%) school students. Between 2011 and 2014, statistically significant increases were observed among these students for current use of both e-cigarettes and hookahs (p<0.05), while decreases were observed for current use of more traditional products, such as cigarettes and cigars, resulting in no change in overall tobacco use. Consequently, 4.6 million middle and high school students continue to be exposed to harmful tobacco product constituents, including nicotine. Nicotine exposure during adolescence, a critical window for brain development, might have lasting adverse consequences for brain development, causes addiction, and might lead to sustained tobacco use. For this reason, comprehensive and sustained strategies are needed to prevent and reduce the use of all tobacco products among youths in the United States.
Electronic nicotine delivery systems (ENDS), including electronic cigarettes (e-cigarettes) and other devices such as electronic hookahs, electronic cigars, and vape pens, are battery-powered devices capable of delivering aerosolized nicotine and additives to the user. Experimentation with and current use of e-cigarettes has risen sharply among youths and adults in the United States. Youth access to and use of ENDS is of particular concern given the potential adverse effects of nicotine on adolescent brain development. Additionally, ENDS use in public indoor areas might passively expose bystanders (e.g., children, pregnant women, and other nontobacco users) to nicotine and other potentially harmful constituents. ENDS use could have the potential to renormalize tobacco use and complicate enforcement of smoke-free policies. State governments can regulate the sales of ENDS and their use in indoor areas where nonusers might be involuntarily exposed to secondhand aerosol. To learn the current status of state laws regulating the sales and use of ENDS, CDC assessed state laws that prohibit ENDS sales to minors and laws that include ENDS use in conventional smoking prohibitions in indoor areas of private worksites, restaurants, and bars. Findings indicate that as of November 30, 2014, 40 states prohibited ENDS sales to minors, but only three states prohibited ENDS use in private worksites, restaurants, and bars. Of the 40 states that prohibited ENDS sales to minors, 21 did not prohibit ENDS use or conventional smoking in private worksites, restaurants, and bars. Three states had no statewide laws prohibiting ENDS sales to minors and no statewide laws prohibiting ENDS use or conventional smoking in private worksites, restaurants, and bars. According to the Surgeon General, ENDS have the potential for public health harm or public health benefit. The possibility of public health benefit from ENDS could arise only if 1) current smokers use these devices to switch completely from combustible tobacco products and 2) the availability and use of combustible tobacco products are rapidly reduced. Therefore, when addressing potential public health harms associated with ENDS, it is important to simultaneously uphold and accelerate strategies found by the Surgeon General to prevent and reduce combustible tobacco use, including tobacco price increases, comprehensive smoke-free laws, high-impact media campaigns, barrier-free cessation treatment and services, and comprehensive statewide tobacco control programs.
Background:
In January 2014, the Chicago City Council scheduled a vote on local regulation of electronic cigarettes as tobacco products. One week prior to the vote, the Chicago Department of Public Health (CDPH) released a series of messages about electronic cigarettes (e-cigarettes) through its Twitter account. Shortly after the messages, or tweets, were released, the department's Twitter account became the target of a "Twitter bomb" by Twitter users sending more than 600 tweets in one week against the proposed regulation.
Objective:
The purpose of our study was to examine the messages and tweet patterns in the social media response to the CDPH e-cigarette campaign.
Methods:
We collected all tweets mentioning the CDPH in the week between the e-cigarette campaign and the vote on the new local e-cigarette policy. We conducted a content analysis of the tweets, used descriptive statistics to examine characteristics of involved Twitter users, and used network visualization and descriptive statistics to identify Twitter users prominent in the conversation.
Results:
Of the 683 tweets mentioning CDPH during the week, 609 (89.2%) were anti-policy. More than half of anti-policy tweets were about use of electronic cigarettes for cessation as a healthier alternative to combustible cigarettes (358/609, 58.8%). Just over one-third of anti-policy tweets asserted that the health department was lying or disseminating propaganda (224/609, 36.8%). Approximately 14% (96/683, 14.1%) of the tweets used an account or included elements consistent with "astroturfing"-a strategy employed to promote a false sense of consensus around an idea. Few Twitter users were from the Chicago area; Twitter users from Chicago were significantly more likely than expected to tweet in support of the policy.
Conclusions:
Our findings may assist public health organizations to anticipate, recognize, and respond to coordinated social media campaigns.
Introduction:
Electronic cigarette (e-cigarette) use is increasing rapidly, and the impact on youth is unknown. We assessed associations between e-cigarette use and smoking intentions among US youth who had never smoked conventional cigarettes.
Methods:
We analyzed data from the nationally representative 2011, 2012, and 2013 National Youth Tobacco Surveys of students in grades 6-12. Youth reporting they would definitely not smoke in the next year or if offered a cigarette by a friend were defined as not having an intention to smoke; all others were classified as having positive intention to smoke conventional cigarettes. Demographics, pro-tobacco advertisement exposure, ever use of e-cigarettes, and ever use of other combustibles (cigars, hookah, bidis, kreteks, and pipes) and noncombustibles (chewing tobacco, snuff, dip, snus, and dissolvables) were included in multivariate analyses that assessed associations with smoking intentions among never-cigarette-smoking youth.
Results:
Between 2011 and 2013, the number of never-smoking youth who used e-cigarettes increased 3-fold, from 79,000 to more than 263,000. Intention to smoke conventional cigarettes was 43.9% among ever e-cigarette users and 21.5% among never users. Ever e-cigarette users had higher adjusted odds for having smoking intentions than never users (adjusted odds ratio = 1.70, 95% confidence interval = 1.24-2.32). Those who ever used other combustibles, ever used noncombustibles, or reported pro-tobacco advertisement exposure also had increased odds for smoking intentions.
Conclusion:
In 2013, more than a quarter million never-smoking youth used e-cigarettes. E-cigarette use is associated with increased intentions to smoke cigarettes, and enhanced prevention efforts for youth are important for all forms of tobacco, including e-cigarettes.
Background
Electronic cigarettes (e-cigarettes) have been available for purchase in the USA since 2007, and have grown rapidly in popularity. Currently, there are no federal restrictions on e-cigarettes; therefore, any regulations are under the purview of state and/or local governments. This study examines state laws governing e-cigarettes through youth access restrictions, smoke-free air requirements and/or excise taxation.
Methods
Codified statutory and administrative laws, attorney general opinions, executive orders, and revenue notices and rulings effective as of 15 November 2013 for all 50 states and the District of Columbia, were compiled using Boolean searches in Lexis-Nexis and Westlaw. All laws were analysed by two study authors to determine the presence and components of relevant provisions. Two categories of laws were identified; (1) explicit e-cigarette laws and (2) laws focused on tobacco-derived and/or nicotine-containing products.
Results
Thirty-four states’ laws address e-cigarettes either explicitly or as part of language applying to tobacco-derived or nicotine-containing products. Laws explicitly addressing e-cigarettes primarily focus on youth access (22 states) or smoke-free air (12 states); only Minnesota imposes an excise tax on e-cigarettes. Similarly, tobacco-derived or nicotine-containing products are primarily regulated through youth access restrictions (6 states), smoke-free air laws (5 states), or excise taxation (2 states).
Conclusions
In the current absence of federal law governing e-cigarettes, more than one-half of the states have taken the initiative to regulate these products. The opportunity exists for the remaining states to incorporate e-cigarette-related restrictions into their pre-existing tobacco control laws.
Despite extraordinary success, progress has stalled in reducing premature deaths from tobacco (primarily caused by cigarettes or other combusting tobacco products and not by nicotine per se). The dominance of cigarettes over the past 100 years (the cigarette century) threatens to persist for another century. Two philosophies have dominated tobacco control: abstinence and harm reduction. Abstinence implies avoiding all tobacco use behavior because there is no safe tobacco or nicotine level. If avoidance is not practical or realistic, harm reduction sets a goal that minimizes the harm caused by the behavior. Tension between reduction and abstinence advocates can be divisive. The rapid rise in the use and popularity of e-cigarettes has substantially increased this tension because of their potential for harm reduction. Although still variable in quality, appeal, and efficient nicotine delivery, e-cigarettes represent an evolving frontier, filled with promise and peril for tobacco control practitioners, policy makers, and regulators.
As state and local governments increase restrictions on cigarette smoking, tobacco manufacturers have shifted to marketing alternative tobacco products. Tobacco control laws need to be updated to reflect this shifting marketplace. With the 2010 enactment of the Tobacco Modernization and Compliance Act, Minnesota addressed regulatory gaps and created a model law for other states. We have detailed the updated definitions of tobacco and tobacco products and identified ways that future laws could be strengthened. (Am J Public Health. Published online ahead of print December 12, 2013: e1-e3. doi:10.2105/AJPH.2013.301747).
The conservative movement and especially its think tanks play a critical role in denying the reality and significance of anthropogenic global warming (AGW), especially by manufacturing uncertainty over climate science. Books denying AGW are a crucial means of attacking climate science and scientists, and we examine the links between conservative think tanks (CTTs) and 108 climate change denial books published through 2010. We find a strong link, albeit noticeably weaker for the growing number of self-published denial books. We also examine the national origins of the books and the academic backgrounds of their authors or editors, finding that with the help of American CTTs climate change denial has spread to several other nations and that an increasing portion of denial books are produced by individuals with no scientific training. It appears that at least 90% of denial books do not undergo peer review, allowing authors or editors to recycle scientifically unfounded claims that are then amplified by the conservative movement, media, and political elites.
Introduction:
Electronic cigarettes (e-cigarettes) are a means of recreational nicotine use that can potentially eliminate the need to smoke tobacco. Little is known about the prevalence of use or smokers' attitudes toward e-cigarettes. This study describes use of and attitudes toward e-cigarettes in Britain.
Methods:
Respondents from three surveys were recruited from a panel of adults in Britain. Preliminary online and face-to-face qualitative research informed the development of a smokers' survey (486 smokers who had used e-cigarettes and 894 smokers who had not). Representative samples of adults in Britain were then constructed from the panel for population surveys in 2010 (12,597 adults, including 2,297 smokers) and 2012 (12,432 adults, including 2,093 smokers), generating estimates of the prevalence of e-cigarette use and trial in Great Britain.
Results:
Awareness, trial, and current use increased between 2010 and 2012; for example, current use more than doubled from 2.7% of smokers in 2010 to 6.7% in 2012. The proportion of ever-users currently using e-cigarettes was around one-third in both years. In 2012, 1.1% of ex-smokers reported current e-cigarette use, and a further 2.7% reported past use. Approximately 0.5% of never-smokers reported having tried e-cigarettes.
Conclusions:
While we found evidence supporting the view that e-cigarette use may be a bridge to quitting, we found very little evidence of e-cigarette use among adults who had never smoked. British smokers would benefit from information about the effective use, risks, and benefits of e-cigarettes, as this might enable the use of e-cigarettes to improve public health.
Background
The Tea Party, which gained prominence in the USA in 2009, advocates limited government and low taxes. Tea Party organisations, particularly Americans for Prosperity and FreedomWorks, oppose smoke-free laws and tobacco taxes.
Methods
We used the Legacy Tobacco Documents Library, the Wayback Machine, Google, LexisNexis, the Center for Media and Democracy and the Center for Responsive Politics (opensecrets.org) to examine the tobacco companies’ connections to the Tea Party.
Results
Starting in the 1980s, tobacco companies worked to create the appearance of broad opposition to tobacco control policies by attempting to create a grassroots smokers’ rights movement. Simultaneously, they funded and worked through third-party groups, such as Citizens for a Sound Economy, the predecessor of AFP and FreedomWorks, to accomplish their economic and political agenda. There has been continuity of some key players, strategies and messages from these groups to Tea Party organisations. As of 2012, the Tea Party was beginning to spread internationally.
Conclusions
Rather than being a purely grassroots movement that spontaneously developed in 2009, the Tea Party has developed over time, in part through decades of work by the tobacco industry and other corporate interests. It is important for tobacco control advocates in the USA and internationally, to anticipate and counter Tea Party opposition to tobacco control policies and ensure that policymakers, the media and the public understand the longstanding connection between the tobacco industry, the Tea Party and its associated organisations.
Discuss the efforts of the tobacco industry to prevent the passage of airline smoking restrictions. They find that interest groups and lobbyists do not necessarily feel obligated to provide accurate information and that competing interest groups may not be able to prevent this misrepresentation.
The Twitter Revolutions of 2009 reinvigorated the question of whether new social media have any real effect on contentious politics. In this article, the authors argue that evaluating the relation between transforming communication technologies and collective action demands recognizing how such technologies infuse specific protest ecologies. This includes looking beyond informational functions to the role of social media as organizing mechanisms and recognizing that traces of these media may reflect larger organizational schemes. Three points become salient in the case of Twitter against this background: (a) Twitter streams represent crosscutting networking mechanisms in a protest ecology, (b) they embed and are embedded in various kinds of gatekeeping processes, and (c) they reflect changing dynamics in the ecology over time. The authors illustrate their argument with reference to two hashtags used in the protests around the 2009 United Nations Climate Summit in Copenhagen.
Background: Cigarette smoking among youth has risen sharply during the 1990s. About 3,000 youths begin smoking each day and are becoming regular smokers earlier in adolescence. To counter this trend, policymakers have sought limits on youth access to tobacco through policies such as the Synar Amendment and FDA regulation. The purpose of this study is to evaluate the effectiveness of these limits in reducing youth cigarette smoking.
Preemption is a legislative or judicial arrangement in which a higher level of government precludes lower levels of government from exercising authority over a topic. In the area of smoke-free policy, preemption typically takes the form of a state law that prevents communities from adopting local smoking restrictions.
A broad consensus exists among tobacco control practitioners that preemption adversely impacts tobacco control efforts. This paper examines the effect of state provisions preempting local smoking restrictions in enclosed public places and workplaces.
Multiple data sources were used to assess the impact of state preemptive laws on the proportion of indoor workers covered by smoke-free workplace policies and public support for smoke-free policies. We controlled for potential confounding variables.
State preemptive laws were associated with fewer local ordinances restricting smoking, a reduced level of worker protection from secondhand smoke, and reduced support for smoke-free policies among current smokers.
State preemptive laws have several effects that could impede progress in secondhand smoke protections and broader tobacco control efforts. Conclusion. Practitioners and advocates working on other public health issues should familiarize themselves with the benefits of local policy making and the potential impact of preemption.
The “We Card” program is the most ubiquitous tobacco industry “youth smoking prevention” program in the United States, and its retailer materials have been copied in other countries. The program's effectiveness has been questioned, but no previous studies have examined its development, goals, and uses from the tobacco industry's perspective.
On the basis of our analysis of tobacco industry documents released under the 1998 Master Settlement Agreement, we concluded that the We Card program was undertaken for 2 primary purposes: to improve the tobacco industry's image and to reduce regulation and the enforcement of existing laws. Policymakers should be cautious about accepting industry self-regulation at face value, both because it redounds to the industry's benefit and because it is ineffective.
The tobacco industry often utilizes third parties to advance its policy agenda. One such utilization occurred when the industry identified organized labor and progressive groups as potential allies whose advocacy could undermine public support for excise tax increases. To attract such collaboration, the industry framed the issue as one of tax fairness, creating a labor management committee to provide distance from tobacco companies and furthering progressive allies' interests through financial and logistical support. Internal industry documents indicate that this strategic use of ideas, institutions, and interests facilitated the recruitment of leading progressive organizations as allies. By placing excise taxes within a strategic policy nexus that promotes mutual public interest goals, public health advocates may use a similar strategy in forging their own excise tax coalitions.
We examined the tobacco industry's new strategy to defeat and then repeal tobacco control ordinances in California and the efforts of health professionals to pass and defend these ordinances. Case studies were conducted in California communities in 1991 and 1992, using published reports, public documents, attendance at public meetings, and interviews. The tobacco industry is spending millions of dollars to intervene in California communities to oppose legislation protecting nonsmokers from secondhand smoke. The tobacco industry has moved beyond organizing smokers to use professional public affairs and political campaign firms to defeat or weaken local tobacco control ordinances. The industry used front groups to conceal its involvement because public knowledge of the industry's involvement increases support for legislation controlling smoking. Some firms closely monitor developing ordinances, while others actively organize and direct local opposition. If these efforts do not weaken or defeat an ordinance, the tobacco industry initiates a referendum petition drive to suspend it to pressure local elected officials to repeal or weaken it. If this tactic fails, the industry often finances an election campaign to repeal the ordinance by popular vote. Although the tobacco industry's new strategy has hindered the passage of some local tobacco control ordinances, when health professionals and elected officials remained active and committed, the industry's efforts have failed and the ordinances have been upheld.
In 1979 and 1980 in Dade County, Florida, a small grassroots advocacy group, Group Against Smoking Pollution (GASP), attempted to enact a clean indoor air ordinance through the initiative process. The tobacco industry's successful efforts to defeat the initiatives were expensive high-tech media-centered campaigns. Even though GASP's electoral resources were extremely limited for both initiatives, GASP utilized similar media-centered tactics. This approach attempted to defeat the tobacco industry in its own venue, in spite of the tobacco industry's vastly greater resources. Nevertheless, the industry defeated these ordinances by narrow margins because of broad voter support for the initiatives before the industry started its campaigns. Health advocates will never have the resources to match the tobacco industry in expensive high-tech media-centered initiative campaigns. Rather, their power lies in the general popularity of tobacco control legislation and their ability to mobilize broad grassroots efforts combined with an adequately funded media campaign.
This article examines the historical relationship between the tobacco industry and the Massachusetts Restaurant Association, a nonprofit trade association aligned with the food and beverage industry.
The study analyzed data from Web-based tobacco industry documents, public relations materials, news articles, testimony from public hearings, requests for injunctions, court decisions, economic impact studies, handbooks, and private correspondence.
Tobacco industry documents that became public after various state lawsuits reveal that a long history of collaboration exists between the Massachusetts Restaurant Association and the tobacco industry. For more than 20 years, their joint efforts have focused primarily on the battle to defeat state and local laws that would restrict smoking in public places, particularly in beverage and food service establishments. The resources of the tobacco industry, combined with the association's grassroots mobilization of its membership, have fueled their opposition to many state and local smoke-free restaurant, bar, and workplace laws in Massachusetts.
The universal opposition of the Massachusetts Restaurant Association to smoking bans in food and beverage establishments is a reflection of its historic relationship with the tobacco industry.
Throughout the 1990s the tobacco lobby was a potent political force in US state legislatures advancing its pro-tobacco agenda.
To describe the market and political motivations of the tobacco lobby and the strategies they use to achieve these goals in US state legislatures.
This study is a content analysis and summary overview of recently released historical tobacco industry documents; tobacco related government documents; and recent state tobacco control policy reports.
In the 1990s, the tobacco lobby engaged in a comprehensive and aggressive political effort in state legislatures to sell tobacco with the least hindrance using lobbying, the media, public relations, front groups, industry allies, and contributions to legislators. These efforts included campaigns to neutralise clean indoor air legislation, minimise tax increases, and preserve the industry's freedom to advertise and sell tobacco. The tobacco lobby succeeded in increasing the number of states that enacted state pre-emption of stricter local tobacco control laws and prevented the passage of many state tobacco control policies. Public health advocates were able to prevent pre-emption and other pro-tobacco policies from being enacted in several states.
The tobacco lobby is a powerful presence in state legislatures. Because of the poor public image of the tobacco lobby, it seeks to wield this power quietly and behind the scenes. State and local health advocates, who often have high public credibility, can use this fact against the tobacco lobby by focusing public attention on the tobacco lobby's political influence and policy goals and expose links between the tobacco lobby and its legislative supporters.
Youth access has benefited the tobacco industry.
To describe variation in Tobacco Institute (TI) lobbying expenditures across states and test whether these expenditures vary in relationship to measures of tobacco control activity at the state level. INDEPENDENT VARIABLE: Data for this study came from the TI's State Activities Division (SAD) annual budgets for the years 1991-97, excluding 1993. These data include budgetary information pertaining to state and local lobbying activity and special projects reported by state. DEPENDENT VARIABLES: The following measures of state tobacco control activity during the period 1991 to 1997 were considered: (1) American Stop Smoking Intervention Study (ASSIST) funding; (2) voter initiatives to raise cigarette taxes; (3) cigarette excise tax level; (4) workplace smoking restrictions; (5) the intensification of smoke-free air laws covering private worksites, government worksites, and restaurants; (6) the intensification of strength of sales to minors laws; (7) the intensification of strength of laws that punish minors for possessing, purchasing, and/or using cigarettes; (8) state status as a major grower of tobacco; (9) partisan control of state government, 1996; and (10) an overall composite index reflecting a state's strength of tobacco control, combining cigarette prices with workplace and home smoking bans.
The overall annual budget for the TI declined steadily during the 1990s, from 28.1 million by 1996. The proportion of the TI's budget allocated to the SAD remained relatively stable at about 30%. TI expenditures for lobbyists were highest in California where tobacco control activity has been strong for the past decade. We found significant associations between TI SAD expenditures and cigarette excise tax levels, the status of a state as a recipient of federal ASSIST funds, and changes in the strength of statewide laws that penalise minors for possessing, purchasing, and/or using cigarettes. We found little or no association between state and local lobbying budgets of the TI and changes in statewide smoke-free air laws, although we did find evidence of TI special project expenditures earmarked to specific states and localities to resist clean indoor air legislation/regulations (that is, Maryland and New York City). We found no significant correlation between TI lobbying expenditures and sales to minors' laws, status as a major producer of tobacco, or partisan control of state government.
The findings from this study support the hypothesis that in the 1990s tobacco control activities such as raising cigarette excise taxes and participation in ASSIST attracted TI resources to undermine these efforts.
To describe how the tobacco industry used the "accommodation" message to mount an aggressive and effective worldwide campaign to recruit hospitality associations, such as restaurant associations, to serve as the tobacco industry's surrogate in fighting against smoke-free environments.
We analysed tobacco industry documents publicly available on the internet as a result of litigation in the USA. Documents were accessed between January and November 2001.
The tobacco industry, led by Philip Morris, made financial contributions to existing hospitality associations or, when it did not find an association willing to work for tobacco interests, created its own "association" in order to prevent the growth of smoke-free environments. The industry also used hospitality associations as a vehicle for programmes promoting "accommodation" of smokers and non-smokers, which ignore the health risks of second hand smoke for employees and patrons of hospitality venues.
Through the myth of lost profits, the tobacco industry has fooled the hospitality industry into embracing expensive ventilation equipment, while in reality 100% smoke-free laws have been shown to have no effect on business revenues, or even to improve them. The tobacco industry has effectively turned the hospitality industry into its de facto lobbying arm on clean indoor air. Public health advocates need to understand that, with rare exceptions, when they talk to organised restaurant associations they are effectively talking to the tobacco industry and must act accordingly.
This report describes the history, true goals, and effects of tobacco industry-sponsored youth smoking prevention programs.
We analyzed previously-secret tobacco industry documents.
The industry started these programs in the 1980s to forestall legislation that would restrict industry activities. Industry programs portray smoking as an adult choice and fail to discuss how tobacco advertising promotes smoking or the health dangers of smoking. The industry has used these programs to fight taxes, clean-indoor-air laws, and marketing restrictions worldwide. There is no evidence that these programs decrease smoking among youths.
Tobacco industry youth programs do more harm than good for tobacco control. The tobacco industry should not be allowed to run or directly fund youth smoking prevention programs.
The Food and Drug Administration (FDA) is issuing this final rule to deem products meeting the statutory definition of "tobacco product,'' except accessories of the newly deemed tobacco products, to be subject to the Federal Food, Drug, and Cosmetic Act (the FD&C Act), as amended by the Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act). The Tobacco Control Act provides FDA authority to regulate cigarettes, cigarette tobacco, roll-your-own tobacco, smokeless tobacco, and any other tobacco products that the Agency by regulation deems to be subject to the law. With this final rule, FDA is extending the Agency's "tobacco product'' authorities in the FD&C Act to all other categories of products that meet the statutory definition of "tobacco product" in the FD&C Act, except accessories of such newly deemed tobacco products. This final rule also prohibits the sale of "covered tobacco products" to individuals under the age of 18 and requires the display of health warnings on cigarette tobacco, roll-your own tobacco, and covered tobacco product packages and in advertisements. FDA is taking this action to reduce the death and disease from tobacco products. In accordance with the Tobacco Control Act, we consider and intend the extension of our authorities over tobacco products and the various requirements and prohibitions established by this rule to be severable.
We examined the tobacco industry's new strategy to defeat and then repeal tobacco control ordinances in California and the efforts of health professionals to pass and defend these ordinances. Case studies were conducted in California communities in 1991 and 1992, using published reports, public documents, attendance at public meetings, and interviews. The tobacco industry is spending millions of dollars to intervene in California communities to oppose legislation protecting nonsmokers from secondhand smoke. The tobacco industry has moved beyond organizing smokers to use professional public affairs and political campaign firms to defeat or weaken local tobacco control ordinances. The industry used front groups to conceal its involvement because public knowledge of the industry's involvement increases support for legislation controlling smoking. Some firms closely monitor developing ordinances, while others actively organize and direct local opposition. If these efforts do not weaken or defeat an ordinance, the tobacco industry initiates a referendum petition drive to suspend it to pressure local elected officials to repeal or weaken it. If this tactic fails, the industry often finances an election campaign to repeal the ordinance by popular vote. Although the tobacco industry's new strategy has hindered the passage of some local tobacco control ordinances, when health professionals and elected officials remained active and committed, the industry's efforts have failed and the ordinances have been upheld.
(JAMA. 1993;270:479-486)
Until the nonsmokers' rights movement, tobacco control activity was at the federal or state levels, which is where the tobacco industry dominates. Since the appearance of the nonsmokers' rights movement, progress in tobacco control has occurred primarily at the local level. In response to the success of this movement, the tobacco industry has developed "smokers' rights" groups and other tactics to fight local legislation. Several recent local campaigns in California illustrate these tactics. Tobacco control forces follow many paths, from sitting on the sidelines to making a serious commitment to smoking control legislation. Despite the tobacco industry's superior financial resources, the outcome of proposed local tobacco control legislation appears to depend on how seriously the health advocates mobilize in support of the local legislation. When the health community makes a serious commitment of time and resources, it wins. When it fails to make such a commitment, the tobacco industry prevails, more by default than by its superior financial resources.
(JAMA. 1991;266:2110-2117)
This qualitative research explores the use of electronic cigarettes and other similar 'vapor' delivery devices among young adults in New York City.
We employed 17 focus groups followed by 12 semistructured interviews to understand the beliefs, opinions and practices related to the use of electronic cigarettes among young adult smokers (N=87).
Participants were mainly daily (52%) and non-daily (41%) smokers. While experimentation with electronic cigarette devices was frequently reported, participants related an overall lack of information about the devices and what they did know often reflected messages in e-cigarette marketing campaigns. Participants also used their own bodily sensations as a way to gauge potential risks and benefits of the products. Finally, young adults, steeped in a culture of personal technologies, perceived e-cigarettes as one more 'toy' among other technologies integrated into their everyday lives.
E-cigarettes were also frequently used with other tobacco products, including conventional cigarettes. Our research indicates that public health campaigns may be needed to counter current industry marketing and inform the public that electronic cigarettes are currently unregulated, understudied and contain toxicants and carcinogens.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Electronic cigarettes (E-cigarettes) are devices that can vaporize a nicotine solution combined with liquid flavors instead of burning tobacco leaves. Since their emergence in 2004, E-cigarettes have become widely available, and their use has increased exponentially worldwide. E-cigarettes are aggressively advertised as a smoking cessation aid; as healthier, cheaper, and more socially acceptable than conventional cigarettes. In recent years, these claims have been evaluated in numerous studies. This review explores the development of the current E-cigarette and its market, prevalence of awareness, and use. The review also explores the beneficial and adverse effects of E-cigarettes in various aspects in accordance with recent research. The discussed aspects include smoking cessation or reduction and the health risks, social impact, and environmental consequences of E-cigarettes.
How electronic cigarettes and similar products (e-cigarettes) are defined affects how they are regulated, particularly whether existing laws for cigarettes apply, including sales and marketing, youth access, smoke-free and taxation laws.
We examined the text of 46 bills that define e-cigarettes enacted in 40 states and characterised how e-cigarettes and similar products were defined.
States enact laws creating new product categories for e-cigarettes separate from the 'tobacco product' category (eg, 'alternative nicotine product,' 'vapour product,' 'electronic nicotine device'), with four states explicitly excluding e-cigarettes from 'tobacco products.' Twenty-eight states do not include e-cigarettes in their definitions of 'tobacco products' or 'smoking,' eight include e-cigarettes as 'tobacco products,' three include e-cigarettes in 'smoking.' Sixteen states' definitions of e-cigarettes require nicotine, and five states pre-empt more stringent local laws. Tobacco and e-cigarette industry representatives tried to shape laws that benefit their interests.
Definitions separating e-cigarettes from other tobacco products are common. Similar to past 'Trojan horse' policies, e-cigarette policies that initially appear to restrict sales (eg, limit youth access) may actually undermine regulation if they establish local pre-emption or create definitions that divide e-cigarettes from other tobacco products. Comparable issues are raised by the European Union Tobacco Products Directive and e-cigarette regulations in other countries. Policymakers should carefully draft legislation with definitions of e-cigarettes that broadly define the products, do not require nicotine or tobacco, do not pre-empt stronger regulations and explicitly include e-cigarettes in smoke-free and taxation laws.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
In May 1994, a box containing 4,000 pages of internal tobacco industry documents arrived at the office of Professor Stanton Glantz at the University of California, San Francisco. The anonymous source of these "cigarette papers" was identified in the return address only as "Mr. Butts" - presumably a reference to the Doonesbury cartoon character. These documents provide a shocking inside account of the activities of one tobacco company over more than thirty years. Cigarette Papers shows that the tobacco industry's conduct has been more cynical and devious than even its harshest critics have suspected. For more than three decades, the industry has internally acknowledged that smoking is addictive and that use of tobacco products causes disease and death. Despite this acknowledgment, based on the industry's own internal and contract research, the industry has engaged in a variety of tactics to deny its own findings and to convince the public that there is still doubt about the harmful effects of tobacco or that the effects have been exaggerated. These campaigns of disinformation have been designed to maintain company profits, to block government regulation, and to defeat lawsuits filed by individuals with tobacco-caused illnesses. The Cigarette Papers quotes extensively from the documents themselves while analyzing what they reveal. The book gives us a sense of what the tobacco industry says when it thinks no one is listening. Written by experts with the scientific and legal knowledge to understand the meaning of the documents and explain their importance, Cigarette Papers will forever alter our perspective of tobacco industry tactics. It will have an enormous impact on public health debates about tobacco and will greatly influence legislation regarding its use.
In this article, we present the results of a systematic review of state, county, and municipal restrictions on the use of electronic cigarettes (e-cigarettes) in public spaces within the United States, alongside an overview of the current legal landscape. The lack of federal guidance leaves lower-level jurisdictions to debate the merits of restrictions on use in public spaces without sufficient scientific research. As we show through a geographic assessment of restrictions, this has resulted in an inconsistent patchwork of e-cigarette use bans across the United States of varying degrees of coverage. Bans have emerged over time in a manner that suggests a “bottom up” diffusion of e-cigarette clean air policies. Ultimately, the lack of clinical and scientific knowledge on the risks and potential harm reduction benefits has led to precautionary policymaking, which often lacks grounding in empirical evidence and results in spatially uneven diffusion of policy.
There has been a great deal of research in recent years concerning the use of substantive policy analysis in public policy-making. This paper seeks to integrate those findings - e.g., the enlightenment function of policy research - into a more general model of policy-making over periods of a decade or more. The conceptual framework focuses on the belief systems of advocacy coalitions within policy subsystems as the critical vehicle for understanding the role of policy analysis in policy-oriented learning and the effect, in turn, of such learning on changes in governmental programs.
Electronic cigarettes (e-cigarettes) have been increasingly available and marketed in the U.S. since 2007. As patterns of product adoption are frequently driven and reinforced by marketing, it is important to understand the marketing claims encountered by consumers.
To describe the main advertising claims made on branded e-cigarette retail websites.
Websites were retrieved from two major search engines in 2011 using iterative searches with the following terms: electronic cigarette, e-cigarette, e-cig, and personal vaporizer. Fifty-nine websites met inclusion criteria, and 13 marketing claims were coded for main marketing messages in 2012.
Ninety-five percent of the websites made explicit or implicit health-related claims, 64% had a smoking cessation-related claim, 22% featured doctors, and 76% claimed that the product does not produce secondhand smoke. Comparisons to cigarettes included claims that e-cigarettes were cleaner (95%) and cheaper (93%). Eighty-eight percent stated that the product could be smoked anywhere and 71% mentioned using the product to circumvent clean air policies. Candy, fruit, and coffee flavors were offered on most sites. Youthful appeals included images or claims of modernity (73%); increased social status (44%); enhanced social activity (32%); romance (31%); and use by celebrities (22%).
Health claims and smoking-cessation messages that are unsupported by current scientific evidence are frequently used to sell e-cigarettes. Implied and overt health claims, the presence of doctors on websites, celebrity endorsements, and the use of characterizing flavors should be prohibited.
Importance
Electronic cigarette (e-cigarette) use is increasing rapidly among adolescents, and e-cigarettes are currently unregulated.Objective
To examine e-cigarette use and conventional cigarette smoking.Design, Setting, and Participants
Cross-sectional analyses of survey data from a representative sample of US middle and high school students in 2011 (n = 17 353) and 2012 (n = 22 529) who completed the 2011 and 2012 National Youth Tobacco Survey.Exposures
Ever and current e-cigarette use.Main Outcomes and Measures
Experimentation with, ever, and current smoking, and smoking abstinence.Results
Among cigarette experimenters (≥1 puff), ever e-cigarette use was associated with higher odds of ever smoking cigarettes (≥100 cigarettes; odds ratio [OR] = 6.31; 95% CI, 5.39-7.39) and current cigarette smoking (OR = 5.96; 95% CI, 5.67-6.27). Current e-cigarette use was positively associated with ever smoking cigarettes (OR = 7.42; 95% CI, 5.63-9.79) and current cigarette smoking (OR = 7.88; 95% CI, 6.01-10.32). In 2011, current cigarette smokers who had ever used e-cigarettes were more likely to intend to quit smoking within the next year (OR = 1.53; 95% CI, 1.03-2.28). Among experimenters with conventional cigarettes, ever use of e-cigarettes was associated with lower 30-day (OR = 0.24; 95% CI, 0.21-0.28), 6-month (OR = 0.24; 95% CI, 0.21-0.28), and 1-year (OR = 0.25; 95% CI, 0.21-0.30) abstinence from cigarettes. Current e-cigarette use was also associated with lower 30-day (OR = 0.11; 95% CI, 0.08-0.15), 6-month (OR = 0.11; 95% CI, 0.08-0.15), and 1-year (OR = 0.12; 95% CI, 0.07-0.18) abstinence. Among ever smokers of cigarettes (≥100 cigarettes), ever e-cigarette use was negatively associated with 30-day (OR = 0.61; 95% CI, 0.42-0.89), 6-month (OR = 0.53; 95% CI, 0.33-0.83), and 1-year (OR = 0.32; 95% CI, 0.18-0.56) abstinence from conventional cigarettes. Current e-cigarette use was also negatively associated with 30-day (OR = 0.35; 95% CI, 0.18-0.69), 6-month (OR = 0.30; 95% CI, 0.13-0.68), and 1-year (OR = 0.34; 95% CI, 0.13-0.87) abstinence.Conclusions and Relevance
Use of e-cigarettes was associated with higher odds of ever or current cigarette smoking, higher odds of established smoking, higher odds of planning to quit smoking among current smokers, and, among experimenters, lower odds of abstinence from conventional cigarettes. Use of e-cigarettes does not discourage, and may encourage, conventional cigarette use among US adolescents.
As elsewhere, in South Korea electronic cigarettes (e-cigarettes) are marketed, in part, as a smoking cessation aid. We assessed the prevalence of e-cigarette use among Korean adolescents and the relationship between e-cigarette use and current (past 30-day) smoking, cigarettes/day, attempts to quit conventional cigarettes, and ceasing to use cigarettes.
Data from the 2011 Korean Youth Risk Behavior Web-based Survey of 75,643 students aged 13-18 years were analyzed with logistic regression.
A total of 9.4% (8.0% ever-dual users who were concurrently using e-cigarettes and smoking conventional cigarettes and 1.4% ever-e-cigarette only users) of Korean adolescents have ever used e-cigarettes and 4.7% were current (past 30-day) e-cigarette users (3.6% dual users and 1.1% e-cigarettes only). After adjusting for demographics, current cigarette smokers were much more likely to use e-cigarettes than were nonsmokers. Among current cigarette smokers, those who smoked more frequently were more likely to be current e-cigarette users. The odds of being an e-cigarette user were 1.58 times (95% confidence interval, 1.39-1.79) higher among students who had made an attempt to quit than for those who had not. It was rare for students no longer using cigarettes to be among current e-cigarette users (odds ratio, .10; confidence interval, .09-.12).
Some Korean adolescents may be responding to advertising claims that e-cigarettes are a cessation aid: those who had made an attempt to quit were more likely to use e-cigarettes but less likely to no longer use cigarettes. E-cigarette use was strongly associated with current and heavier cigarette smoking.
Theories of the Policy Process provides a forum for the proponents of the most promising and widely used theories to present the basic propositions of their frameworks, to assess the empirical evidence that has developed over the past decade.
Objectives:
We examined the pattern of the passage of smoking laws across venues (government and private workplaces, restaurants, bars) and by strength (no law to 100% smoke-free).
Methods:
We conducted transition analyses of local and state smoking restrictions passed between 1970 and 2009, with data from the Americans for Nonsmokers' Rights Ordinance Database.
Results:
Each decade, more laws were enacted, from 18 passed in the 1970s to 3172 in the first decade of this century, when 91% of existing state laws were passed. Most laws passed took states and localities from no law to some level of smoking restriction, and most new local (77%; 5148/6648) and state (73%; 115/158) laws passed in the study period did not change strength.
Conclusions:
Because these laws are "sticky"-once a law has passed, strength of the law and venues covered do not change often-policymakers and advocates should focus on passing strong laws the first time, rather than settling for less comprehensive laws with the hope of improving them in the future.
Over the last two decades, Swiss drug policy has moved away from a prohibitionist to a "harm reduction" model. This article uses the advocacy coalition framework (ACF) to understand this process of policy change, drawing on social movement theory to overcome shortcomings of the ACF regarding collective action. We argue that recent history in the field of drug policy in Switzerland can plausibly be presented as a competition between coalitions advocating belief systems regarding problems and policy. The Aids epidemic is considered a crucial noncognitive event helping the harm reduction coalition to overthrow the hegemonic abstinence coalition. Public order issues linked to harm reduction facilities led neighbourhood quality of life advocates to impede the location of such facilities, which, in turn, stimulated policy-oriented learning with harm reduction advocates. The analysis supports the ACF"s hypotheses on policy change, but social movement theory provides insights into coalition formation, persistence and strategies.
Context:
Electronic cigarettes (e-cigarettes) have earned considerable attention recently as an alternative to smoking tobacco, but uncertainties about their impact on health and indoor air quality have resulted in proposals for bans on indoor e-cigarette use.
Objective:
To assess potential health impacts relating to the use of e-cigarettes, a series of studies were conducted using e-cigarettes and standard tobacco cigarettes.
Methods and materials:
Four different high nicotine e-liquids were vaporized in two sets of experiments by generic 2-piece e-cigarettes to collect emissions and assess indoor air concentrations of common tobacco smoke by products. Tobacco cigarette smoke tests were conducted for comparison.
Results:
Comparisons of pollutant concentrations were made between e-cigarette vapor and tobacco smoke samples. Pollutants included VOCs, carbonyls, PAHs, nicotine, TSNAs, and glycols. From these results, risk analyses were conducted based on dilution into a 40 m³ room and standard toxicological data. Non-cancer risk analysis revealed "No Significant Risk" of harm to human health for vapor samples from e-liquids (A-D). In contrast, for tobacco smoke most findings markedly exceeded risk limits indicating a condition of "Significant Risk" of harm to human health. With regard to cancer risk analysis, no vapor sample from e-liquids A-D exceeded the risk limit for either children or adults. The tobacco smoke sample approached the risk limits for adult exposure.
Conclusions:
For all byproducts measured, electronic cigarettes produce very small exposures relative to tobacco cigarettes. The study indicates no apparent risk to human health from e-cigarette emissions based on the compounds analyzed.
This study examined the process of smoking control policymaking in Japan, employing the Advocacy Coalition Framework (ACF) and the Policy Process Analysis (PPA). In the view of the ACF, changes in policies and policymaking are explained as resulting from the emergence of, and the competition among, two advocacy coalitions, either protobacco or antitobacco. On the other hand, the PPA conceives of the process of policy change as a set of processes and gives a closer look into the important aspects of policymaking that the ACF does not well examine.
Using the global tobacco advocacy networks as a case study, this article argues that the Advocacy Coalition Framework (Sabatier and Jenkins-Smith 1999), which theorises how advocacy coalitions affect policymaking domestically, and Keck and Sikkink's research into transnational advocacy networks (Keck and Sikkink 1998) can provide insights into the mechanisms of how transnational advocacy networks impact both local and intergovernmental policymaking. I argue that by combining aspects of each of these approaches, all sides of a policy situation can be analysed. I contrast these approaches with the epistemic communities approach (Haas 1992), suggesting that, for the tobacco policy system, the epistemic communities approach provides less insight than the other two.
Until the nonsmokers' rights movement, tobacco control activity was at the federal or state levels, which is where the tobacco industry dominates. Since the appearance of the nonsmokers' rights movement, progress in tobacco control has occurred primarily at the local level. In response to the success of this movement, the tobacco industry has developed "smokers' rights" groups and other tactics to fight local legislation. Several recent local campaigns in California illustrate these tactics. Tobacco control forces follow many paths, from sitting on the sidelines to making a serious commitment to smoking control legislation. Despite the tobacco industry's superior financial resources, the outcome of proposed local tobacco control legislation appears to depend on how seriously the health advocates mobilize in support of the local legislation. When the health community makes a serious commitment of time and resources, it wins. When it fails to make such a commitment, the tobacco industry prevails, more by default than by its superior financial resources.
This study was undertaken to identify the content of tobacco industry smokers' rights publications and to analyze their major themes.
Fifty-eight issues of smokers' rights publications from 1987 to 1992 were selected at random and analyzed. The number of publications per year, number of mentions (sentences) in different thematic categories per year, and number of mentions per category per publication were examined.
The number of smokers' rights publications increased rapidly from 1987 to 1992. The number of mentions across all thematic categories increased over time, with the largest numbers appearing in 1990, 1991, and 1992. The category of Political and Social Action comprised the highest average number of mentions across years.
These publications appear to be consistent with past and present tobacco industry strategies to counter tobacco control efforts and negative public perceptions by attempting to refute scientific evidence about the health impact of environmental tobacco smoke. Additionally, they serve the industry goals of encouraging smokers to take action to protect their rights, mobilizing public opinion, and delaying societal rejection of smoking and secondhand smoke and acceptance of smoking restrictions.
To describe the nature, extent, and public health significance of state legislation that preempts the local regulation of tobacco.
A computerized database of local tobacco control ordinances, state tobacco control laws, preemption bills introduced during the 1996 state legislative session, articles obtained through a MEDLINE search (1984-1996) using the key word "preemption" or identified from bibliographies of these articles, public opinion surveys, and newspaper articles.
All identified data sources were used.
Content analyses of preemption bills and state laws were conducted independently by multiple observers.
There has been a striking increase in the adoption of local tobacco control ordinances during the past decade; by the end of 1995, approximately 1006 communities had enacted a local tobacco control ordinance. In response, the tobacco industry has advanced legislation in 29 states that preempts local authority to regulate tobacco. During the 1996 state legislative session alone, 26 bills containing preemption were introduced, and 2 were enacted. Emerging trends in the tobacco industry's strategy to advance preemption laws include (1) amending legitimate tobacco control bills to preempt local tobacco regulation, (2) using the Synar amendment as a vehicle to advance preemption, and (3) promoting "superpreemption" bills that eliminate all local control of tobacco policy.
Preemption of local tobacco regulation is an important tobacco industry strategy that undermines the public's health. Preventing the enactment of new preemption laws and repealing existing ones should become a public health priority.