E-cigarettes were invented in 2003 and entered the US market in 2007. Their use has grown rapidly, with sales exceeding $1 billion in 2013. While e-cigarettes may be less harmful than combustible cigarettes and have helped some smokers quit, their long-term health effects are unclear. Their rise has generated significant debate, as public health experts are concerned they could renormalize smoking or serve as a gateway for youth. The FDA proposed regulating e-cigarettes in 2014 to protect public health, but some argue this may not go far enough to restrict youth access and marketing. Going forward, further research and surveillance are needed to understand e-cigarettes' overall impact on public health.

1. E-cigarettesin America
THE STATE OF THE SCIENCE
InventedbyaChinesepharmacistin2003,thee-cigaretteisabattery-powereddevicethatsimulatessmoking byproducing avapor
thatresemblessmoke.Itgenerallyusesanatomizer,aheating elementthatvaporizesaliquidsolution.
June 2014
WhatisanE-cigarette?
Approximate date that the e-
cigarette is introduced into the
U.S. Market
Looks like
-but isn't-
a cigarette
2007
E-cigarettes contain nicotine,
flavoring and small amounts
of other ingredients. In
contrast, a cigarette can
create more than 4,000
chemicals when burned
In2013,somewereestimating thatsalesofe-cigaretteswillsurpassthatoftraditionalcigarettesby2047.However,withproposed
regulationsandachanging marketplace,futureprospectsfore-cigarettesareunclear.
Since its entry into the U.S.
market, sales have rapidly
risen, exceeding 1 Billion in
2013
The Rise of the E-Cigarette
$1+ Billion in
Sales
but.....
2006-2013 2013-2014
Sales and Volume Growth
Have Decelerated
Data on sales obtained from Wells Fargo and Nielsen/Citi Research.

2. Who is Using E-cigarettes?
All rates represent "ever use" of e-cigarettes. Youth rates obtained from the 2012 National Youth Tobacco Survey and Dutra and Glantz (2014).
Adult rates obtained from Giovenco et al.(2014) and Zhu et al.(2013). Reasons for use data obtained from Zhu et al.(2013), McQueen et
al.(2011), Li et al.(2011) and Etter(2010).
2.7%
of current and
former smokers
AdultsYouth
6X
of high
schoolers
of middle
schoolers 9.3%
Reduced Harm, Less Toxicity, Avoidance of Smoking Bans, and Cost
of young adults
8.1%
of adults
47%
Reasons Cited for Use:
BigTobacco'sEntrance Intothe Market
Whiletherearedozensofindependente-cigarettecompanies,including NJOY,Big Tobaccohasincreasinglyinvestedine-cigarettes
andcontinuetoexpand.Altria'sMarkTen,e.g.,isgoing nationalinthe2ndquarterof2014andthecompanyalsoboughtoutthee-
vaporbusinessGreenSmokefor$110MillioninFebruary2014.
Lorillard
acquires blu
April 2012 July 2013
Reynolds
launches Vuse
in Colorado
August 2013
Altria launches
MarkTen in
Indiana
Vuse/MarkTen
Going National
2014+

3. E-cigarettesarenotsubjecttothesamerestrictionsascigarettesand,asaresult,areadvertisedandpromotedthroughavarietyof
channelsincluding TV andradio.
TV
Tobacco can't be advertised on TV, but e-cigs can
spent in Summer 2012 alone
Cessation, Freedom, Sex,
Health, Cigarette Substitute
> $2.3 Million
AdvertisingandMarketing
common themes of e-cig ads
Advertising expenditures and theme data obtained from Richardson et al.(2013).
Celeb Endorsement
on talk shows, events and in magazines
Concernsof the PublicHealthCommunity
Could serve as a
gateway to tobacco use
among youth
Could re-normalize
smoking &
undermine gains in
tobacco control
Could cause
former smokers
to relapse
Could delay
cessation
Targets youth and
young adults with
flavored products
Althoughthereisgeneralagreementthate-cigarettesarelessharmfulthantraditionalcigarettesonaone-to-onebasis,thelong
termeffectsofe-cigaretteuseontobaccouseandhealtharestillunclear.

4. Whatthe DataSays...
PoisoningsQuit Success
Some studies suggest that e-cigs
may help some smokers quit
Calls to poison control centers rose to
41.7% of monthly e-cig and cig
exposure calls in 2014
The Good The Bad
Youth Exposure
Youth exposure to e-cigarette
advertising increased 256% from
2011 to 2013. Young adults
exposure up 321%
Data on quit success obtained from Brown et al.(2014), Bullen et al.(2013) and Caponnetto et al.(2013); data on toxicity obtained from a
review by Harrell et al.(2014), poisoning data from Chatham-Stephens et al.(2014), and youth ad exposure from Duke et al.(2014).
Less Toxic
E-cigarettes are less toxic and
have fewer carcinogens as
compared to cigarettes
The PublicResponse
Policy Action
Debates
Thee-cigarettedebatehasspilledoutfromthecoveroftobaccocontrolintothegeneralpublic,resulting inaneverincreasing number
ofnewspaperarticlesandpublicdebates,igniting passionsofconsumers,scientistsandpolicymakersalike.
Public
Interest
Google Search Results
Among top tobacco control scientists,
public health practioners, physicians,
policymakers and the public
>180,000
>3 Million
YouTube Videos
States restrict e-cig use in 100% smokefree venues
>300 News articles. including those from CNN, NYT, Fox News,
and the Washington Post
>100 E-cigarette forums, blogs and review sites
172
10
3
States restrict e-cig use in other venues
Localities restrict e-cig use in 100% smokefree
venues
Data on bans obtained from American Nonsmokers Rights Foundation and Legacy; reflects bans implemented through May 2014.
And let's not forgetimpending FDA regulation
States prohibit the sale of e-cigs to minors34

5. FDA Regulation
June 22,
2009
Date that the Family Smoking Prevention and Tobacco
Control Act (Tobacco Control Act) became law
The Tobacco Control Act does not
currently specify regulation of
e-cigs as a tobacco product
What's the Tobacco
Control Act?
Protection Against Deadly Cigarettes?
It gives the FDA the
authority to regulate
tobacco products to protect
public health
GREAT! But.....
*NO RESTRICTIONS proposed on flavored products, online sales or advertising
If enacted, this would extend several provisions of the Tobacco Control Act to e-cigarettes,
including banning sales to minors, requiring warning labels, and requiring manufacturers to
register with the FDA and seek the agency’s review of new products
However, on
April 24, 2014-FDA Releases its Proposed "Deeming Rule"
Public comment on the proposed rule will be accepted until July 9, 2014. The FDA will review and address comments and will publish a final
regulation in the Federal Register.
ChangeUp Research LLC, 2014
Significant resources are being invested in the surveillance of e-cigarettes and its effects on overall tobacco use,
cessation and health. This includes e-assessment as part of FDA's Population Assessment of Tobacco and Health (PATH)
survey, a nationally representative longitudinal cohort of approximately 59,000 people, which will run from 2013 to 2016.
With FDA's proposed regulation of e-cigarettes, both the public health community and e-cigarette companies stand to
win through a regulated product, which may optimally benefit health through a reduction in combustible tobacco use.
The Future
Evidence presented here current as of early June 2014. Further details on references can
be obtained by request.