Public Policy Report

Executive Summary

The use of e-cigarettes across the globe has been on the rise, and e-cigarettes have been marketed as an alternative to smokers willing to quit tobacco smoking. The use of electronic cigarettes and devices that provide nicotine-containing vapor has been on the rise across the United States and all over the globe. The use of e-cigarettes among U.S. middle and high school students was reported to have doubled between 2011 and 2012. According to statistics, 61.1% of the middle school students and 80.5% of the high school students’ e-cigarette smokers reported that they were engaged in the conventional cigarettes. The increased use of e-cigarette poses a risk where their use might renormalize and re-glamorize smoking. It is for these reasons that the paper proposes a policy development to deal with the issues. Strategies proposed in the policy plan include retailer licensing, taxation, and labeling and disclosure requirements. The need to develop a national strategic framework on e-cigarette encompassing laws and regulations is of utmost importance, to make sure initiatives on controlling tobacco use are successful. The policies should be compatible with policies on tobacco control developed by the World Health Organization. The policies should be formulated in such a way that a balance will be struck between probable benefits of e-cigarettes, and still, offer protection against harms e-cigarettes might cause to persons and the entire American population. 

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Public Policy Report

Introduction

The use of e-cigarettes across the globe has been on the rise, and e-cigarettes have been marketed as the alternative to smokers willing to quit tobacco smoking.  Nonetheless, evidence indicates that the marketing of e-cigarettes as a safer alternative to tobacco smoking has led to higher consumption by students in middle and high schools. Indeed, the number of high school students using e-cigarettes is higher than the number of adults consuming them. There are public health fears that experimenting with e-cigarettes may entice students to start conventional smoking eroding the gains achieved in controlling and reducing consumption of tobacco. The high usage of e-cigarettes among young people in the United States has been blamed on unregulated production, sale, and use of e-cigarettes. There is a need to enact rules and regulations to regulate the use of e-cigarettes in the U.S. (Tremblay et al., 2015). 

Problem Statement

The use of electronic cigarettes and devices that provide nicotine-containing vapor has been on the rise across the United States and all over the globe. This has been perceived and promoted as a healthier alternative compared to the conventional cigarettes. Smoking is among the risk factors for six out of eight top causes of death including ischemic heart disease, cerebrovascular disease, lower respiratory infections, chronic obstructive disease, tuberculosis, and lung cancer (Drummond & Upson, 2014). E-cigarette refers to an innovative nicotine delivery system.

The use of e-cigarettes among U.S. middle and high school students was reported to have doubled between 2011 and 2012. Among the high school students, the rates of students using e-cigarettes increased from 4.7% to 10%. The major concern in this trend is that it is regarded as a pathway to conventional cigarettes. A study in 2012 indicated that only 20.3% of middle school and 7.2% of high school students had not attempted to use the conventional cigarettes. Statistics also indicate, 61.1% of the middle school students and 80.5% of the high school e-cigarette smokers reported that they were engaged in the conventional cigarette (Drummond & Upson, 2014). Among the adult smokers, those trying to use e-cigarettes raised from 10% in 2010 to 21% in 2011 (Centers for Disease Control and Prevention, 2013). Other studies in the international level revealed that one in every eight smokers had attempted using e-cigarettes with a higher prevalence among the younger and non-minority population. 

The increased use of e-cigarette poses a risk where their use might renormalize and re-glamorize smoking. This is considered to be detrimental to decades of efforts that the public health and medical fraternity has put in controlling smoking. The growing popularity of the e-cigarette raises worries on implications to nicotine addiction and acts as a pathway to turning to conventional cigarettes among the youth. Nicotine is known to have a negative impact on the adolescent brain development. Lack of strict regulations on the usage of e-cigarettes is likely to cause increased nicotine dependence and reduce the incentives for cessations. Kralikova E, Novak J, West O, Kmetova A, Hajek (2013) in their report noted that about 28.3% of regular e-cigarettes users are allowed in areas where conventional smoking is banned. This highlights the need to develop a public policy to control the use of e-cigarettes. 

Alternatives

The problem being addressed in the proposed policy plan is electronic cigarettes (e-cigarettes). It has been observed that the use of e-cigarettes among the middle and high school students in the U.S. doubled between 2011 and 2012 (Drummond & Upson, 2014). A major concern for the increased prevalence of consumption of e-cigarettes, especially among the youths is that it is considered a pathway for conventional cigarettes smoking. This is known to eventually lead to health-related issues. This has been noted to have a negative effect on the years of effort that has been put by the public health and medical departments in an effort to control smoking. Lack of strict regulations on the production, sale, and usage of e-cigarettes has been highlighted as having a possibility of causing an increase in levels of nicotine dependence and collude the incentives for cessations. The proposed strategies to deal with this policy problem include retailer licensing, taxation, and labeling and disclosure requirement.   

Strategies

  1. Retailer licensing

The laws on tobacco retailer licensing mandate that businesses involved in selling tobacco products to acquire a license from the government. This is considered as a means for the authority to identify the purveyors of tobacco and implement and follow up to ensure that the there is compliance with the rules and regulations on tobacco. The Center for Tobacco Policy and Organizing at the American Lung Association of California provides the characteristics of a strong licensing law. These include; should be renewed annually, should adequately fund using the fee collected tasks such as enforcement and administration of the program, appreciate and relate the full landscape of laws whether federal, state, or local, and set out fines for violations of a magnitude huge enough to act as a deterrent. A study has highlighted that the e-cigarette availability to be approximately 30% (Rose, Barker, D’Angelo, Khan, Huang, Chaloupka, & Rabisl, 2014). It was noted that most pharmacy, gas, and convenience stores were likely to sell e-cigarettes in comparison to beer, wine, or liquor stores.

  1. Taxation

Taxation is the most commonly used policy for curbing tobacco use. This is commonly referred to as the sin tax that aims to make the prices very high to discourage their use. Cigarette taxation has been described as the most effective means of reducing cigarette consumption. Studies have established an inverse relationship between taxation and tobacco use. It has been indicated that for every 10% increase in the actual price, this causes a reduction of cigarette consumption by about 3-5% (Atwater, Fradkin, Medeiros, Hamilton, Hagopian, & Halperin, 2015). The strategy proposed here is to increase the taxes for e-cigarettes, which will cause an increase in their prices, and thereby discourage their use due to the price sensitivity of the product. 

  1. Labeling and Disclosure Requirement

This strategy aims at sensitizing the consumers by providing them with the information through product warning labels on the associated risks with smoking e-cigarettes. The most effective way is to do this is to use graphic messages providing knowledge on health harms. This approach has been considered as an essential tool to promote prevention and cessation of tobacco use. Therefore, this will be an effective strategy for policy plan to deal with the issue of the e-cigarette (Atwater, Fradkin, Medeiros, Hamilton, Hagopian, & Halperin, 2015). 

Policy Recommendations

The need to develop a national strategic framework on e-cigarettes encompassing laws and regulations is of utmost importance, to make sure initiatives on controlling tobacco use are successful. This framework is principally essential for the United States due to its federal structure. There are notable differences in the regulation of e-cigarettes across the states and local governments. A policy that is nationally defined and coordinated centrally will permit shared goals and support consistency in policy measures. The federal government should be at the forefront in leading the formulation, passing, and enactment of national e-cigarette policies that are in line with the policies ratified to control tobacco use. The policies should be compatible with policies on tobacco control developed by the WHO. Their development should be evidence-based and easy to review in light of issues that may arise in the future (Tremblay et al, 2015).

The policies should be formulated in such a way that a balance will be struck between probable benefits of e-cigarettes, and still, offer protection against prospective harms e-cigarettes might cause to persons and the entire American population. Major tobacco companies in the world have developed and started producing e-cigarettes. The policy developers must be mindful of the tactics employed by players in the tobacco industry to defeat and sway policies put in place to control tobacco use. Tobacco industry players should not be allowed to make commercial gains at the expense of public health (Tremblay et al, 2015). 

In the absence of substantiation that would permit the correct assessment of harms versus benefits of e-cigarettes, this paper recommends strict laws to regulate the production, promotion, sale, and use of e-cigarettes focusing mainly on the protection of the young people. European Parliament passed a law to regulate strictly the sale and marketing of e-cigarettes. The law made it illegal to advertise e-cigarettes in all European countries as well as a demand for written health warnings in all e-cigarette packages highlighting the addictive and harmful nature of nicotine. E-cigarettes will be sold as a consumer product as opposed to the earlier version where they were regulated as medicine (Tremblay et al, 2015). 

Imposition of excise taxes has proven effective in controlling the use of tobacco products. Higher prices arising from increased taxes on cigarettes have discouraged people from smoking. Similarly, e-cigarettes should be subjected to taxes though at a relatively lower than or same rate as conventional tobacco to discourage users of e-cigarette from switching to tobacco cigarettes. Research carried out in six European Union countries showed that an increase in prices of e-cigarettes arising from imposed taxes led to an 8.2% decrease in sales. It was noted that e-cigarettes are more responsive to price changes as compared to the tobacco cigarette; thus, policymakers on taxing e-cigarettes must take this issue into consideration (Tremblay et al, 2015). 

Policy on packaging and labeling demand must be implemented. Manufacturers of e-cigarettes must disclose all the ingredients and level of concentrations in e-liquids. The package should be plain such that the packets are less appealing to the young people. Furthermore, labels on health warning must be clearly indicated on the packaging material. In addition, e-cigarettes flavors popular with the youth such as mint and menthol should be banned. To prevent children from poisoning and discourage use of e-cigarettes by children, the packaging should be childproof. The commission on consumer product safety would add nicotine to its list of regulated substances thereby facilitating application of the above recommendations (Tremblay et al, 2015).    

State and local government should pass and put into effect laws that restrict sales of cigarettes to young people, and outlaw the distribution of free samples and coupons for e-cigarettes. Moreover, the smoking of e-cigarettes in undesignated public places, as well as indoor smoking and smoking in places of employment, should be made illegal. These rules should be incorporated in the existing laws governing clean indoor air (Tremblay et al, 2015).    

The federal and state governments should fund research projects aimed at offering evidence on how e-cigarettes affect users, both in the short term and in the long term, as well as effects of exposure to e-cigarette vapor.  It will also provide evidence on the effectiveness of e-cigarettes in aiding smokers to quit smoking. In addition, the research will offer invaluable information on how inhaling flavoring chemicals contained in e-cigarettes affect the human body (Tremblay et al, 2015). 

Communication Plan

Public Policy Project Objectives

  1. Identify how e-cigarettes are considered a controversial issue requiring the development of public policy plan to control by discussing the positions held by different stakeholders. 
  2. Highlight the main effects of the increased prevalence of e-cigarettes consumption.
  3. Develop key strategies that could be used to deal with the issue of the increased prevalence rate of e-cigarette and the dangers they pose. 
  4. Propose recommendations on the most appropriate national strategic framework to control e-cigarettes.
  5. Propose short- and long-term for the implementation of the project to control e-cigarettes in the country

Strengths

An objective of the retailer license is to provide a means for restricting the density and location of retail outlets in a specific area. Introducing the retailer laws as a means of restricting the access points for the e-cigarette is noted to be beneficial in reducing the prevalence of up taking behavior. It has been noted that easy access to the retailers caused increased rates of teen smoking. The restriction on the number of retailers is an important counter-measure for the negative effect caused by living close to tobacco retail outlets and helps in the cessation of smoking. The trend in the distribution of tobacco retailers seems clustered in a low-income neighborhood, which is mainly inhabited by the African-Americans and causes disparities in tobacco use and related health outcomes. The retailer licensing provides an opportunity for the relevant authority to address these disparities in these marginalized societies.

A key strength of the use of taxation as a policy plan for dealing with the issue of e-cigarettes is pegged on the price elasticity of the tobacco. Studies have revealed a theoretical concept that cigarette addiction may cause price inelasticity. However, studies have proved that cigarette taxation is the most effective means of reducing cigarette consumption. Studies have shown a 10% hike in the overall price of cigarette causes a decrease in overall cigarette consumption by 3-5% overall, a reduction in young adult smokers by 3.5%, and 6-7% reduction the number of children engaging in smoking (Atwater, et al., 2015). 

A strength of using the labeling and disclosure requirement is on the use of visual and graphics for the required information. The visuals and graphics are an effective means of ensuring that the consumers understand the risks of use of the e-cigarettes. This provides detailed information that provides greater knowledge of health harms.

Weakness 

A key weakness in the licensing of retailers is that it leads to the creation of specialized retailers focusing on e-cigarettes. Such shops are likely to feature more extensive product range and offer first-hand advice on e-cigarette thereby increasing their prevalence. These stores are likely to enjoy economies of scale and thereby reduce prices for customers. This is most likely to expand their market to even the non-smokers, and erode potential health gains. A key weakness in the use of labeling and disclosure requirement is based on the fact that the information provided in these labels is insufficient to discourage users from using the e-cigarettes. A study revealed that cigarette users get access to the warning labels messages for more than 7000 times annually. Despite this, the prevalence of smoking still continues to increase, which puts a question on how effective these messages are.

Project Audience

Stakeholders and their Interests

Federal government

The federal government is interested in making federal regulations for e-cigarettes. Among the most common law is the prohibition of the sale of conventional cigarettes to minors in the United States. The federal governments act through the Federal Drug Administration (FDA) especially on its Center for Tobacco Products. The FDA considers e-cigarette a tobacco product, which prompted them to initiate the rulemaking process in 2014. By recognizing e-cigarette as a tobacco product, the FDA can then enact rules to govern and control it including the sale of e-cigarettes to minors. 

The Federal government may also act through the Department of Health and Human Services (HHS). This abides by the laws provided by the FDA. For the HHS to recommend e-cigarette for therapeutic uses to facilitate smoking cessation, the FDA must first approve it. The HHS, however, continues to emphasize on the message that the e-cigarette contains nicotine that is still a highly addictive substance. It also issues the warning on the possible effect of the e-cigarette to the minors (Cavico, Mujtaba, & Samuel, 2014).

States and Local Governments

In the U.S., states have taken a proactive approach to the regulation of the e-cigarettes. As at July 2014, approximately 44 states had plans to or had already enacted regulations dealing with e-cigarettes and the electronic smoking devices. The states place laws and regulation related to the access, usage, marketing and advertisement, packaging, taxation, and licensure. These regulations may then be further broken down to cover sale ban, sale to minors ban, use prohibited in indoor public spaces, use prohibited in limited revenues, prohibition of use by minors, licensure restrictions, marketing and advertising laws, packaging rules, and taxation (Tremblay, Pluye, Gore, Granikov, Filion, Eisenberg, 2015).

Tobacco Manufacturers

The tobacco manufacturers including the transnational tobacco companies are key in the debate on the regulation of e-cigarettes. It was noted that the transnational tobacco companies between 2013 and 2014 maintained a low profile in the debate. One assumption into this might be to view this as an indication of the financial strength of these companies to adapt to regulations being proposed.

Tobacco Control Advocates 

Another important category of stakeholders in the debate on e-cigarette regulation discussion is tobacco control advocates. These have forwarded a unified front in supporting the regulatory measures on the manufacture, sale, and consumption of e-cigarette (Patterson, Hilton, & Weishar, 2015). These advocates propose mechanisms to regulate e-cigarettes through new, amended laws, or existing law. They make calls making restrictions or prohibition on product sale, manufacturing, importation, distribution, use, product design, advertising, trademarks, and taxations. Other issues that the advocates make include provision of health warning labels and adhering to child-safety standards (Kennedy, Awopegba, Leon, & Cohen, 2016).

Effects of e-cigarette

E-cigarettes have been described as tobacco leading disruptive technology due to its effect on displacing the established technology. The arguments for fewer regulations on the e-cigarette indicate that the use of e-cigarettes has the ability to deliver nicotine to the user in less effect than the conventional cigarettes, which have 7000 more chemicals. The e-cigarette has no effects of passive smoking, unlike the traditional cigarette. They have been indicated to have the potential in aiding cigarette smoker endeavoring to quit smoking (Glynn, 2014).

Among the health effects related to e-cigarette include aerosolization of e-cigarette liquid. Factors that contribute to inhalation effects of e-cigarette include climatic conditions, airflow, room size, number of users, types, and age of systems being used, battery voltage, puff length, the interval of puffs, and user characteristics. Glycol and glycerol vapor, which are mainly the components of the e-cigarette is known as upper airway irritants. The glycol mist is known to dry out mucous membranes and eyes. Nicotine is readily absorbed through the airways, skins, and mucous membranes and the gastrointestinal tract. Acute exposure of inhaled nicotine is indicated to cause dizziness, nausea, and vomiting. E-cigarettes have been found to pose an increased risk of nicotine toxicity due to the availability of high nicotine concentrations in the cartridges. Particulate matter (PM) emissions from e-cigarettes were found to be slightly higher than the WHO air quality guidelines (Callahan-Lyon, 2013).

Possible risks from Implementation of the Strategies

Internal Risks

Among the key risks associated with the use of taxation as a policy for dealing with the issue of e-cigarettes, is the risk of reversing progress in people who had ceased smoking conventional who might fall back into smoking. The risk is due to the absence of cost benefits and lack of suppliers for the e-cigarettes. Another risk from taxation is the message it might send to the users who might get the notion that by taxing the e-cigarettes almost on the same level as conventional cigarettes, that the e-cigarettes are as harmful as the traditional cigarettes thereby become indifferent to whether they smoke or vape (IVVA, 2017).

An internal risk associated with the use of labeling and disclosure requirement is on the use of a language and words that highlight less negative impact from the use of the product. Such a problem was identified by the FDA in its requirement for labeling of tobacco products. This prompted the use of a law that prohibits the use of words such as “light, mild, or low” in the label and adverts (FDA, 2018). A risk in the adoption of retailer licensing is shifting the trade to illegal dealings in an area where restrictions have been put.

External Risks

Political. In the development of these policy plans, politics comes into play as a factor that may hinder their success. The policies are meant to restrict access to and public use of e-cigarettes. These policies need to go through a debate in the different jurisdiction in the U.S., which might lead to different positions. The manufacturers and dealers are known to use massive resources for lobbying to influence such debates. This introduces a risk in their enactment and adoption. A key political factor affecting the strategy on taxation is the differences applied across the different states. While different states have placed taxes, the rates are varied across the state. In 2011, New York had a $4.35 tax rate, which was 25 times higher than that placed in Missouri of $0.17 (Golden, Ribisl, Perreira, 2014). This geographical variation may lead to cross-border smuggling or online tobacco sales thereby watering down the public health impacts. In the use of the strategy on the labeling and disclosure requirement, there is a need to ensure that the rules provided by the states are in line with the requirements by the FDA. In relation to retailer licensing, the FDA lacks legislative authority to regulate the areas where e-cigarettes may be used (Sanders-Jackson, Tan, Bigman, Mello, Niederdeppe, 2016).  

Economic. A key economic factor associated with taxation of the e-cigarettes is the price sensitivity of the e-cigarettes. Studies have revealed that sales of e-cigarette are responsive to price changes. This implies that use of excise taxes is effective in reducing the increased prevalence in e-cigarette consumption. The e-cigarettes and the conventional cigarettes are considered as substitutes where the increase in prices of one product leads to an increase in demand of the other. Economic static models reveal that for every 10% increase in the e-cigarette prices, there is a reduction in e-cigarettes sales of about 8.2%. a dynamic model shows a reduction of 2.7% in the short run and 11.5% in the long-run (Stoklosa, Drope, & Chaloupka, 2016). It is such benefits that the taxation of e-cigarettes aims to exploit. On the strategy of labeling and disclosure requirement, the main economic factor is how this requirement affects the cost of production and thereafter the price to the final consumers. The licensing of retailers dealing with e-cigarettes has led to the emergence of specialized vape shops geared towards setting up a unique retail environment. This has seen them promote skewed messages to consumers aimed at making their products more attractive, which might increase the prevalence of smoking (Counter Tobacco, 2018).

Social. The main consideration under this aspect is now each strategy of the proposed policy plan affects different socio-demographic groups. A study in South Korea indicated that the increase in cigarette prices cause a backlash from smokers. This was more prevalent among the low-income groups that indicated that the tax was inequality (Park, Nam, Lee, Hong, & Oh, 2018). Tobacco excise taxes has been considered to be regressive where low-income tobacco users pay a larger share of the income in taxes as compared to higher-income individuals. However, a study indicated that the main effects of tobacco taxation are progressive where the low-income user consumes disproportionately more tobacco as compared to the wealthier populations. This implies that the low-income users experience higher health hazards than their wealthier counterparts (Chaloupka, Yurkli, & Fong, 2012). In the labeling and disclosure requirement, a key issue of concern is whether the visual warning labels have a similar impact across diverse racial/ethnic and social economic populations (Cantrell et al., 2013). A key social issue on the strategy of retailer licensing is its use as a means of addressing the disparity on tobacco use and resulting health effects between the low-income neighborhood and high-income areas. This may lead to a situation of putting the focus on one area at the expense of other regions. 

Legal. Taxation of e-cigarette has faced numerous legal battles and is still expected to continue facing the same. Among the noticeable legal battle is East Coast Vapor v. Pennsylvania Department of Revenue where a petition was filed arguing the definition of tobacco products. The ruling indicated that separately packaged components of e-cigarettes cannot be taxed under the Tobacco Products Tax Act. This is likely to affect the manner in which the taxation is implemented (Needles, 2018). The laws on labeling and disclosure requirement may face legal opposition. Such was the case when the FDA suggested the use of more substantive warning labels for tobacco products. These were indicated by the court as unconstitutional and in violation of the First Amendment (Almasy, 2013). This indicates that the labeling and disclosure requirement has a restriction in the amount of information that may be mandated. A key consideration in the use of retailer licensing is that it needs to be done in consistency with other relevant laws. This puts a limit on the extent of the issues, which this strategy may address. 

Benchmarks

An important source of the benchmark is the European’s law on the e-cigarette. The legislation regulates the sale of electronic cigarettes and was passed by the European Parliament. The European laws allowed the shops to continue making sales of e-cigarettes as a consumer product to the market in Europe. This was a shift from the previous draft where it was regulated as medicines. The laws in European placed strict conditions on how cigarettes are developed, advertised, and sold. The law banned the advertising of e-cigarettes in the nations and requires modest written health warnings highlighting that nicotine in addiction and could be harmful (Coghlan, 2014). 

Policy Plan

Short-Term Plans

  1. Control the supply of e-cigarettes to the public by limiting the number of retailers selling the products. This will enhance the level of compliance with the rules and regulations governing the tobacco.
  2. Increase the prices for the e-cigarette with an aim of discouraging their consumption. The consumption of tobacco has been noted to have an inverse relationship with the increase in taxation.  
  3. Provide product-warning labels with graphics image. 

Long-term Plan

  1. By controlling the number of retailers, it is possible to counteract the inequality within the social demographics where low-income neighborhoods are clustered with retailers. This will eventually lead to adjustments of the prevalence of related health outcomes.
  2. Reduce the overall number of individuals consuming the e-cigarettes by increasing the prices of the commodity through taxation thereby exploiting price inelasticity related with tobacco products. 
  3. Increase public awareness using visual and graphics that portray the harmful effects of e-cigarettes. This aims to appeal to the emotional part of the users and instill a sense of fear among the users or potential users. 

Budget Strategies

Budget Cost Justification

  1. Direct costs

A key direct cost that will be common for the three policy plan strategies is the costs for carrying out enforcement. The enforcement of the taxation will require the revenue authority to dedicate resources to support this program and ensure that the taxes are actually paid. On the strategy of retailer licensing, resources are required to be allocated to a different authority to carry out a physical inspection to ascertain that all retailers are operating with a license and that concentration of the retailers in a given area does not exceed the required limit. In terms of labeling disclosure requirement, resources are also required to make the assessment on the products in the market and ensure that the required disclosures are made. The three strategies require resources for running awareness campaigns to sensitize the public, users, producers, and retailers of the possible effects of e-cigarettes. 

  1. Indirect costs

A key indirect cost that is likely to be incurred from the adoption of the three policy plans will arise from new initiatives by users to overcome the unavailability of the e-cigarettes caused by high prices, strict retailer laws, and labeling laws. The users are likely to seek other alternatives that will provide them with a means of smoking thereby reducing the public health impact that the strategies are designed to achieve. It has been indicated that about 55.4% of the adult smokers engage in legal activities that reduce the price of cigarettes. It is clear that smokers would seek other means, legal or otherwise to secure the product (Xu, Pesko, Tynan, Gerzoff, Malarcher, & Pechacek, 2013).

References

Almasy, S. (2013). FDA changes course on graphic warning labels for cigarettes. CNN. Com. Retrieved from: www.cnn.com/2013/03/19/health/fda-graphic-tobacco-warnings/

Atwater, P., Fradkin, N., Medeiros, E., Hamilton, J., Hagopian, A., & Halperin, A. (2015). E-Cigarettes and Public Health: Policy Option for Washington State. The Evans Scool Review.

Callahan-Lyon, P. (2014). Electronic cigarettes: human health effects. Tobacco control23(suppl 2), ii36-ii40.

Cavico, F. J., Mujtaba, B. G., & Samuel, M. (2014). E-Cigarettes: An Unfolding Legal, Ethical, and Practical Quandary. Journal of Psychology and Behavior Sciences2(2), 1.

Cantrell, J., Vallone, D. M., Thrasher, J. F., Nagler, R. H., Feirman, S. P., Muenz, L. R., … & Viswanath, K. (2013). Impact of tobacco-related health warning labels across socioeconomic, race and ethnic groups: results from a randomized web-based experiment. PLoS One8(1), e52206.

Centers for Disease Control and Prevention, US Department of Health and Human Services Press release (2013): About one in five U.S. adult cigarette smokers have tried electronic cigarette. Atlanta. Retrieved from http://www.cdc.gov/media/releases/2013/p0228_electronic_cigarettes.html

Coghlan, A. (2014). Europe’s Law on E-cigarettes Sets Global Benchmark. New Scientist. Retrieved from https://www.newscientist.com/article/dn25131-europes-law-on-e-cigarettes-sets-global-benchmark/

Chaloupka, F. J., Yurekli, A., & Fong, G. T. (2012). Tobacco taxes as a tobacco control strategy. Tobacco control21(2), 172-180.

Counter Tobacco. (2018). E-Cigarettes at the Point of Sale. Countertobacco.org. Retrieved from https://countertobacco.org/resources-tools/evidence-summaries/e-cigarettes-at-the-point-of-sale/

Drummond, M. B., & Upson, D. (2014). Electronic cigarettes. Potential harms and benefits. Annals of the American Thoracic Society11(2), 236-242.

FDA. (2018). Labeling and Warning Statements for Tobacco Products. Retrieved from https://www.fda.gov/tobaccoproducts/labeling/labeling/default.htm

Glynn, T. J. (2014). E-cigarettes and the future of tobacco control. CA: a cancer journal for clinicians64(3), 164-168.

Golden, S. D., Ribisl, K. M., & Perreira, K. M. (2014). Economic and political influence on tobacco tax rates: a nationwide analysis of 31 years of state data. American journal of public health104(2), 350-357.

Gouda, H. N., & Powles, J. W. (2014). The science of epidemiology and the methods needed for public health assessments: a review of epidemiology textbooks. BMC public health14(1), 139.

IVVA. (2017). Irish Comment on Budget 2018. Ivva.ie. Retrieved from http://www.ivva.ie/latest-news/ivva-comment-budget2018/

Kennedy, R. D., Awopegba, A., De León, E., & Cohen, J. E. (2016). Global approaches to regulating electronic cigarettes. Tobacco control, tobacco control-2016.

Needles, Z. (2018). Court: E-cigarettes-But Not Separate Components can be Taxed as Tobacco Products. The Legal Intelligencer. Retrieved from https://www.law.com/thelegalintelligencer/2018/06/27/court-e-cigarettes-but-not-separate-components-can-be-taxed-as-tobacco-products/?slreturn=20180806232149

Park, M. B., Nam, E. W., Lee, H. L., Hong, K. S., & Oh, Y. (2018). Social phenomena following the tobacco tax increase in South Korea: Lessons and policy implications. TOBACCO INDUCED DISEASES16.

Patterson, C., Hilton, S., & Weishaar, H. (2016). Who thinks what about e-cigarette regulation? A content analysis of UK newspapers. Addiction111(7), 1267-1274.

Tremblay, M. C., Pluye, P., Gore, G., Granikov, V., Filion, K. B., & Eisenberg, M. J. (2015). Regulation profiles of e-cigarettes in the United States: a critical review with qualitative synthesis. BMC Medicine13(1), 130.Xu, X., Pesko, M. F., Tynan, M. A., Gerzoff, R. B., Malarcher, A. M., & Pechacek, T. F. (2013). Cigarette price-minimization strategies by US smokers. American journal of preventive medicine44(5), 472-476.

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