Regulation Of E-cigarettes Research Articles

전자담배 유해성 논란과 규제에 관한 비교 연구

최근 전자담배를 포함한 신종담배의 사용이 전 세계적으로 급속히 늘어나고 있다. 많은 신종 담배 중 전자담배에 대한 논란은 더 가중되고 있다. 전자담배의 유행이 확대 됨에 따라 이를 둘러싼 논쟁의 핵심은 첫째, 전자담배의 유해성 및 건강에 대한 위협 여부, 둘째, 세계보건기구의 담배규제기본협약과 국가마다 다르게 적용되는 규제법안, 셋째, 전자담배의 금연효과에 대한 상반된 시각 등이다. 많은 신종 담배 중 특히 전자담배는 인체에 미치는 유해성에 대한 논란이 양분화 되 어 있으며, 세계의 많은 나라들도 아직까지 이렇다 할 뚜렷한 연구결과를 기반으로 한 정책적 규제에 대한 결론을 도출하지 못하고 있는 상태이다. 이는 현재 전자담배에 대 한 명확한 정보가 매우 적다는데 기인한다. 따라서, 본 연구는 우리나라의 전자담배 규제법안을 고찰하는데에 앞서 국제법과 외 국 규제법의 현황을 살펴보고 비교해 보는데에 그 목적을 두고 있다고 볼 수 있다.

E-cigarettes and respiratory health: the latest evidence.

The E-cigarette market continues to expand at an alarming rate with thousands of flavours available for purchase and continuously evolving devices. Now that it is a multi-billion dollar industry and one without stringent regulation, there is rising concern over the safety of vaping products. Since June 2019, over 2800 cases of E-cigarette-associated acute lung toxicity have been reported in the USA, over 60 of which resulted in death. Many argue that E-cigarettes offer a safer alternative to smoking, but we are evidently far from fully understanding the potential hazards that they pose to respiratory health. Although the risk of an outbreak in the UK has been considered low due to tighter E-cigarette regulations, we cannot fully eliminate the possibility of similar events occurring in the future. With evidence frequently emerging of the harmful effects of E-cigarettes to pulmonary health, there is an urgent need to define the long-term implications of vaping. Studies show that E-cigarette exposure can disrupt pulmonary homeostasis, with reports of gas exchange disturbance, reduced lung function, increased airway inflammation and oxidative stress, downregulation of immunity, and increased risk of respiratory infection. In this review, the latest research on the effect of E-cigarette use on respiratory health will be presented.

Will E-Cigarette Regulation Evolve in Pace With New Products?

Will E-Cigarette Regulation Evolve in Pace With New Products?

Up in smoke: a content analysis of tweets during the vaping-related illness epidemic

ABSTRACT Background: This study examined public comments on Twitter about vaping in the days following national news stories of the ‘vaping-related illness epidemic.' What began in August 2019 with eight hospitalizations in Wisconsin spiraled into an ‘epidemic' linked to at least 12 deaths (Carlisle M. (2019, September 17). Seventh person to die from vaping-related illness in U.S. dies in California. Yahoo! Lifestyle. Available from: https://www.yahoo.com/lifestyle/seventh-person-die-vaping-related-145440400.html; Haglage A. (2019, September 26). CDC reports 52% increase in vaping-relating illnesses amid shake-up at Juul. Yahoo! Finance. Available from: https://finance.yahoo.com/news/cdc-reports-52-increase-in-vapingrelated-illnesses-amid-shakeup-at-juul-194131149; Kaplan, S. & Richtel, M. (2019, September 11). The mysterious vaping illness that’s ‘becoming an epidemic.’ New York Times. Available from: https://www.nytimes.com/2019/08/31/health/vaping-marijuana-ecigarettes-sickness.html). Method: A total of 500 tweets were assessed (N = 500) for sentiment, health claims, risks presented, and outrage. Specifically, four categories adapted from [1] were used to categorize risk and outrage. Results: It was found that the sampled tweets were very much against the regulation of vaping and e-cigarettes. More than 36 percent were negative toward regulations and only 2 percent were positive toward regulations. More than 55 percent of the tweets examined contained no risk mentioned at all. The primary area of concern or outrage was related to the potential for regulation, not about the health risk. Conclusions: These results were interesting in that little risk was noted by tweeters as compared to the risks being promoted in mass media . This study is an important contribution to a burgeoning area of research. It also serves a practical function, as the findings can be presented to government organizations as invaluable information regarding audience insights and the development of anti-vaping campaigns.

Students’ perceptions of socio-scientific issue-based learning and their appropriation of epistemic tools for systems thinking

ABSTRACT Learning science in the context of socio-scientific issues (SSI) is widely advocated for achieving the goal of scientific literacy that values using science in daily lives. While prior research suggests that SSI-based learning can promote students’ disciplinary knowledge and practices, less is known about students’ perceptions of SSI-based learning and how to support students in considering the epistemic aspects of SSI learning. In this study, we seek to address the research gap by examining students’ perceptions of their learning and how they appropriate the epistemic tools for systems thinking in an issue-based unit on the regulation of e-cigarettes. We used semi-structured interviews from 33 students in a midwestern U.S. high school as our primary data. The results suggest that students in general held positive attitudes towards SSI-based learning experiences and found SSI work to be 1) relevant, 2) interesting, 3) promoting agency, and 4) beneficial for their science learning. Also, we found that students differed in how they appropriated the epistemic tools for systems thinking ranging from lack of appropriation, to appropriating surface features, and to appropriating epistemic purposes. We conclude the paper by discussing how engaging students in meaningful learning activities may support students’ productive engagement in SSI learning.

E-cigarette Product Characteristics and Subsequent Frequency of Cigarette Smoking.

There is a dearth of evidence regarding the association of use of electronic cigarettes (e-cigarettes) with certain product characteristics and adolescent and young adult risk of unhealthy tobacco use patterns (eg, frequency of combustible cigarette smoking), which is needed to inform the regulation of e-cigarettes. Data were collected via an online survey of participants in the Southern California Children's Health Study from 2015 to 2016 (baseline) and 2016 to 2017 (follow-up) (N = 1312). We evaluated the association of binary categories of 3 nonmutually exclusive characteristics of the e-cigarette used most frequently with the number of cigarettes smoked in the past 30 days at 1-year follow-up. Product characteristics included device (vape pen and/or modifiable electronic cigarette [mod]), use of nicotine in electronic liquid (e-liquid; yes or no), and use for dripping (directly dripping e-liquid onto the device; yes or no). Relative to never e-cigarette users, past-30-day e-cigarette use was associated with greater frequency of past-30-day cigarette smoking at follow-up. Among baseline past-30-day e-cigarette users, participants who used mods (versus vape pens) smoked >6 times as many cigarettes at follow-up (mean: 20.8 vs 1.3 cigarettes; rate ratio = 6.33; 95% confidence interval: 1.64-24.5) after adjustment for sociodemographic characteristics, baseline frequency of cigarette smoking, and number of days of e-cigarette use. After adjustment for device, neither nicotine e-liquid nor dripping were associated with frequency of cigarette smoking. Baseline mod users (versus vape pen users) smoked more cigarettes in the past 30 days at follow-up. Regulation of e-cigarette device type warrants consideration as a strategy to reduce cigarette smoking among adolescents and young adults who vape.

Review of Health Consequences of Electronic Cigarettes and the Outbreak of Electronic Cigarette, or Vaping, Product Use-Associated Lung Injury.

Electronic cigarettes (e-cigarettes) are battery-operated devices to insufflate nicotine or other psychoactive e-liquid aerosols. Despite initial claims of e-cigarettes as a nicotine-cessation device, aggressive marketing of e-cigarettes has led to an explosion in adolescents' and young adults' use over the last few years. Coupled with a lack of adequate investigation and regulation of e-cigarettes, the USA is facing an outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) starting in mid-2019. While little long-term health hazard data are available, the components and constituents of e-cigarettes may adversely impact health. Propylene glycol and glycerin are humectants (water-retaining excipients) that generate pulmonary irritants and carcinogenic carbonyl compounds (e.g., formaldehyde, acetaldehyde, and acrolein) when heated in e-cigarettes. Metals contained in heating coils and cartridge casings may leach metals such as aluminum, chromium, iron, lead, manganese, nickel, and tin. Flavoring agents are considered safe for ingestion but lack safety data for inhalational exposures. Diacetyl, a common buttery flavoring agent, has known pulmonary toxicity with inhalational exposures leading to bronchiolitis obliterans. In 2019, clusters of lung injury associated with e-cigarette use were identified in Wisconsin and Illinois. Patients with EVALI present with a constellation of respiratory, gastrointestinal, and constitutional symptoms. Radiographically, patients have bilateral ground glass opacifications. As of February 18, 2020, the Centers for Disease Control has identified 2807 hospitalized patients diagnosed with either "confirmed" or "probable" EVALI in the US. Currently, vitamin E acetate (VEA) used as a diluent in tetrahydrocannabinol vape cartridges is implicated in EVALI. VEA cuts tetrahydrocannabinol oil without changing the appearance or viscosity. When inhaled, pulmonary tissue lacks the mechanism to metabolize and absorb VEA, which may lead to its accumulation. While most EVALI patients were hospitalized, treatment remains largely supportive, and use of corticosteroids has been associated with clinical improvement. The outbreak of EVALI highlights the need for regulation of e-cigarette devices and e-liquids. Clinicians need to be aware of the health hazards of e-cigarettes and be vigilant in asking about vaping.

Tobacco use and E-cigarette regulation: Perspectives of University Students in the Asia-Pacific

IntroductionThe Asia-Pacific is home to 30% of the world’s smokers. Additional efforts are needed to reduce negative health impacts of tobacco, including e-cigarettes. The study objectives were to 1. Investigate Asian-Pacific students’ knowledge, attitudes, and use of tobacco products; 2. Determine the level of student support for tobacco control policies; and 3. Examine differences in students’ attitudes by the strength of national tobacco control policies based on implementation of WHO’s MPOWER package, and e-cigarette regulation in their countries. MethodsA total of 1953 students from members of the Association of Pacific Rim Universities in 13 countries completed the online survey. We compared the results by the Fisher-Freeman-Halton test. ResultsWhile about 83% of students had heard of e-cigarettes; only 14.1% had tried them. Students in countries with e-cigarette bans were the least likely to report having experimented with e-cigarettes (8.1%). While the vast majority of students (87.9%) reported having seen health campaigns targeting combustible cigarettes, far fewer (42.5%) had seen any health campaigns targeting e-cigarettes. About 80% of students supported smoke-free campuses, with the most support coming from those in countries with the weakest adoption of MPOWER policies (88.7%) and no e-cigarette regulations (80.4%). Students in countries with the weakest MPOWER policies were also the most likely to support campus bans and government regulation of e-cigarettes. ConclusionsThe adoption of tobacco control polices by government may have an impact on e-cigarette smoking behavior among students, and student support for tobacco control, including noncombustible products, is high. Universities should take action by adopting comprehensive tobacco control measures that include e-cigarette regulations.

The perceived health effects of e-cigarette use among adult smokers

Background: Vaping and e-cigarettes have been an epidemic among youths in recent years. In addition, as of April 2020, there has been hundreds of vaping related illnesses causing fatalities. As such there has been increased coverage by media and the government in regard to reporting vaping-related dangers and implementing regulatory changes such as bans. These actions could deter the target population from engaging in vaping – tobacco users. Research has shown that e-cigarettes are significantly less toxic relative to tobacco and that it could be more effective as a cessation treatment relative to nicotine gums or patches. This study surveyed current perceptions of Canadians with regards to vaping in order to determine if certain groups (i.e. varying ages, smoking status) hold different opinions in terms of harm, health benefits, and support for stricter e-cigarette regulations. Methods: Self-administered online surveys created on Survey Monkey were distributed to Canadians via online platforms Reddit and Facebook. The survey assessed opinions and perceptions of Canadians through multiple choice questions and were collected over a three week period. Results: This study received 157 respondents the majority of which were under 35 (73.08%) and from British Columbia (65.38%). Thirteen chi-square tests were performed comparing group variables (age, smoking status, and awareness of vaping related news) to perception variables (perceived harm, health benefits, safety). There was no association found between age and the tested perception variables. Several associations were found where e-cigarette users viewed e-cigarettes more favourably relative to tobacco users and non-users based on chi-square results. Chi-square associations between media awareness and harm perceptions could not be established due to a small sample size (n< 30). Conclusion: The results indicated that there are associations with e-cigarette perceptions and a person’s smoking status. This may be an indication that there is possible misinformation between groups when it comes to evaluating objective health effects of e-cigarettes. Non-users and a percentage of tobacco users seem to overstate

Do state regulations on e-cigarettes have impacts on the e-cigarette prevalence?

BackgroundWe 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...

전자담배 규제와 담배위해 감축: 미국의 정책과 시사점을 중심으로

전자담배 규제와 담배위해 감축: 미국의 정책과 시사점을 중심으로

Historical Perspective of Proactive and Reactive Regulations of E-cigarettes to Combat Nicotine Addiction.

Cigarettes and electronic cigarettes (e-cigarettes) are major sources of exposure to nicotine, an addictive chemical. Although these products are being regulated by the Food and Drug Administration (FDA) under the Tobacco Control Act, specifications about the nicotine content in these products have not been established yet. In e-cigarettes, nicotine concentration ranges from 0 to > 50mg/mL, and the recent e-cigarette devices provide control to change nicotine flux for higher nicotine delivery. Due to the lack of robust regulations in manufacturing, distribution and marketing, e-cigarettes have already infiltrated the market with youth appealing flavors and devices. As a result, the country is facing a youth epidemic of e-cigarette use. The unregulated nicotine levels in both cigarettes and e-cigarettes can lead to repeated and overexposure of nicotine to youth which can lead to the addiction and detrimental effects on their cognitive functions. Over the past decade, the corrective measures being taken by the FDA for cigarette and e-cigarette regulations also should focus on nicotine exposure levels. Before it is too late to prevent youth from lifetime addiction to nicotine, it is important to address the issues of nicotine concentration, nicotine flux and the e-cigarette device regulations while offering adults with smoking disorder less harmful alternatives to cigarettes.

Have e-cigarettes renormalised or displaced youth smoking? Results of a segmented regression analysis of repeated cross sectional survey data in England, Scotland and Wales

ObjectivesTo examine whether during a period of limited e-cigarette regulation and rapid growth in their use, smoking began to become renormalised among young people.DesignInterrupted time-series analysis of repeated cross-sectional time-series...

Bottom-up meets top-down: exploring vapers’ accounts of risk in a context of e-cigarette controversies

Framed both as a solution to and as an additional part of the tobacco problem, e-cigarettes have been the subject of risk controversies since they were launched in 2006, followed by massive divergence in media, public health approaches and regulations across the world. This study explores vapers’ risk perceptions and accounts of the public risk communication and regulation of e-cigarettes in a Norwegian context were nicotine-containing e-liquids are prohibited from being sold by domestic retailers. Based on analyses of semi-structured qualitative interviews (n = 30, 17 males) with adult vapers, I find that the participants emphasised three important dimensions related to risk. First, they perceived vaping as harm reduction by substituting for smoking. Second, they devalued much of the risk communication about e-cigarettes from Norwegian health authorities and media. Interlinked with their harm-reduction approach, they perceived the present regulation of nicotine e-liquid and vaporisers as increasing risk by decreasing their availability to smokers. Third, in general they preferred the lay expertise available online to the health authorities’ information on e-cigarettes. The analysis displays a lack of trust among the participants in what can be labelled as top-down information. Based on these dimensions, I conclude that the dissonance between vapers risk perceptions and the regulation and mixed messages in risk communication of e-cigarettes has contributed to their preference for bottom-up expertise. From the vapers’ point of view, e-cigarettes represent harm reduction, and the vaper community symbolises a bottom-up health movement where peer assistance compensates for a perceived lack of assistance from health authorities.

Policy design, non-design, and anti-design: the regulation of e-cigarettes in Indonesia

ABSTRACT In this article, we propose a typology of policy design and non-design, with special attention to a category of policy making which we term, “anti-design”. We argue that contrary to the established literature, the opposite of design is not politics, but rather, a disconnect between problems, interventions, and outcomes. This disconnect can be caused by political forces but also by non-political factors such as incompetence, corruption, or global economic trends. We use an attempt by the government of Indonesia to regulate e-cigarettes to illustrate a scenario in which design activities are virtually absent. Making the distinction between design and the various forms of non-design is an important step in understanding the conditions that enable or impede rational mechanisms in the policy process.

Perceived Safety and Effectiveness of Electronic Cigarettes among Malaysian Adults and Public Support for Regulations.

ABSTRACTContext:Electronic cigarettes have been used as a harm reduction method toward tobacco cessation. Malaysian government has enforced a strict policy to regulate the sale of electronic cigarette products because its liquid contains nicotine.Aims:This study aimed to explore the general public’s perception toward electronic cigarette use. Public support toward electronic cigarette regulation was also examined.Settings and Design:This was a Malaysian population-based survey.Materials and Methods:Data were obtained from the National E-Cigarette Survey (NECS) 2016, which used a multistage stratified cluster sampling household survey representing all Malaysian adults aged 18 years old. A cross-sectional survey was conducted among a total of 4288 adults.Statistical Analysis Used:Descriptive and logistic regression analysis.Results:Majority were aged 25–44 years old (44%), completed at least secondary education (69%), of Malay ethnicity (73%), and married (68%). Majority (88.1%) have never used electronic cigarette. A quarter (25.5%) perceived electronic cigarette helps people quit cigarette smoking, whereas 20.3% perceived electronic cigarette helps people to maintain cigarette abstinence. Approximately 85% believed that electronic cigarette use does not help in improving breathing and coughing. Majority (91.8%) disagreed that electronic cigarettes should be allowed in places where tobacco smoking is banned. Thus, 63.4% agreed that electronic cigarette should be banned completely rather than regulated.Conclusion:Majority of general public had negative perception about electronic cigarette use.

A Qualitative Exploration of Consumers' Perceived Impacts, Behavioural Reactions, and Future Reflections of the EU Tobacco Products Directive (2017) as Applied to Electronic Cigarettes.

Background:Electronic cigarette regulations included in the Tobacco Products Directive (TPD), Article 20, implemented in Europe by May 2017, aimed to improve safety for e-cigarette consumers, and prevent uptake among non-smokers, particularly young people. Before implementation, there were significant concerns from consumers, industry, and some in the scientific community about the potential negative impact of the TPD on people using e-cigarettes to remain abstinent from smoking. To date, there is limited evidence on how the TPD has affected consumers. This study aimed to add insight into how consumers perceived and experienced the regulations.Methods:Qualitative data, collected between March 2018 and March 2019, relating to participant views of the TPD were extracted from 160 interviews/extended surveys of e-cigarette consumers as part of a wider study into e-cigarette use trajectories (ECtra study). Data were thematically analysed.Results:Awareness of the TPD among consumers was not universal. Participants’ smoking behaviour did not appear to be influenced by the legislation. Participants were reassured by manufacturing regulations and requirements for ingredients labels. Participants responded negatively to changes perceived to cause inconvenience and extra plastic waste. The product restrictions prompted some participants to purchase non-compliant products illegally, potentially putting their safety at risk.Conclusions:E-cigarette regulation should focus on ensuring product safety. Raising awareness of the TPD among consumers and smokers could be beneficial.

United States' federal regulation of e-Cigarettes

United States' federal regulation of e-Cigarettes

Optimal Regulation of E-Cigarettes: Theory and Evidence

Optimal Regulation of E-Cigarettes: Theory and Evidence

The Regulation of E-cigarettes – International, European and National Challenges Lukasz Gruszczynski (ed) Cheltenham/Northampton: Edward Elgar Publishing, 2019, 320 pp.

The Regulation of E-cigarettes – International, European and National Challenges Lukasz Gruszczynski (ed) Cheltenham/Northampton: Edward Elgar Publishing, 2019, 320 pp.