1. Anna Guymon, B.S., CHES aguymon@co.weber.ut.us (801)399-7182

2. 2010 2003 2006- 2007 2008 2009 2006

3. Typically consists of 3 parts: Battery – powers the e-cigarette Atomizer - heating element Cartridge – contains nicotine and flavor (including propylene glycol)

4. E-cigarettes are rapidly evolving and being marketed like cigarettes were in the 1950s and 1960s Marketing is back on television and radio All the major cigarette companies are now in the e-cigarette business The tobacco industry has a history of making false and misleading public statements regarding their control of the nicotine content and delivery of their products Sources: Tobacco Control Legal Consortium, The Verdict Is In: Findings From United States v. Phillip Morris, Nicotine Levels (2006). Full text of the Courts 1700pg Final Opinion is available at: http://www.tobaccolawcenter.org/dojlitigation.html ; Grana, R., Benowitz, N., & Glantz. S. 2013. Background paper on e- cigarettes (Electronic Nicotine Delivery Systems). Center for Tobacco Control Research and Education. University of California, San Francisco. WHO Collaborating Center on Tobacco Control.http://www.tobaccolawcenter.org/dojlitigation.html

5. Solutions come in a small bottle without a child safety cap, and are often fruit flavored.

6. Nicotine solutions come in varied strengths and concentration methods. Product labeling is inconsistent and ambiguous Creates risk for nicotine overdose/poisoning

7. Retailer labeled level of nicotine on e-juice sample Actual level of nicotine present in sample

8. Youth are rapidly adopting e-cigarettes High levels of dual use Youth who use e-cigarettes are heavier (not lighter) smokers Youth who use e-cigarettes are much less likely to have stopped smoking Sources: Lee, S., Grana, R. & Glantz, S. 2013. Electronic cigarette use among Korean adolescents: A cross-sectional study of market penetration, dual use and relationship to quit attempts and former smoking. Journal of Adolescent Health, in press. Camenga, D.R., Delmerico, J., Kong, G. Cavallo, D., Hyland, A., Cummings, K.M., & Krishnan-Sarin, S. 2013. Trends in use of electronic nicotine delivery systems by adolescents. Addictive Behaviors, http://dx.doi.org/10.1016/j.addbeh.2013.09.014, http://dx.doi.org/10.1016/j.addbeh.2013.09.014

9. National Data 2013

10. Prevention Needs Assessment (PNA) – Youth Data (Grades 8, 10, 12) Conducted in Utah schools in odd years with a sample of more than 50,000 students in grades 6, 8, 10, 12 Is considered a randomized, representative sample. Use rates doubled among youth who reported they had tried e-cigarettes Despite having no legal access to e-cigarettes, Utah youth are three times more likely to report current use than adults Nearly one-third of Utah youth who tried e-cigarettes report they never tried conventional cigarettes: 31.7%

11. Source: Tobacco Prevention and Control Program. Prevention Needs Assessment Tobacco Questions, 2013. Salt Lake City: Utah Department of Health. Tobacco Prevention and Control Program. Prevention Needs Assessment Tobacco Questions, 2011. Salt Lake City: Utah Department of Health.

12. Source: Tobacco Prevention and Control Program. Prevention Needs Assessment Tobacco Questions, 2013. Salt Lake City: Utah Department of Health. Tobacco Prevention and Control Program. Prevention Needs Assessment Tobacco Questions, 2011. Salt Lake City: Utah Department of Health.

13. Source: Tobacco Prevention and Control Program. Prevention Needs Assessment Tobacco Questions, 2013. Salt Lake City: Utah Department of Health. Tobacco Prevention and Control Program. Prevention Needs Assessment Tobacco Questions, 2011. Salt Lake City: Utah Department of Health.

14. 386 youth surveys collected between 7/1/2013 to 10/6/2013 from those who attended local pubic events and that were willing to take the survey Questions centered on e-cigarette use, as well as knowledge and attitudes toward policies, health risks and access to e- cigarettes Results cannot be generalized, instead it helps us to understand more of what may be happening in our community.

20. Has authority to regulate Product Whether to regulate as new products or modified risk products(for which health claims can be made). The latter process much harder for manufacturers to obtain approval, so likely that e- cigarettes will mostly be marketed as new tobacco products How the product is marketed NO authority over where e-cigarettes are used and how they are taxed and whether they are even sold

21. Utah Indoor Clean Air Act §26-38-2(1),(4)(c) Youth Access §76-10-104 and §76-10-105 Schools §53-A-11-902(5)(a)through(d) and §76- 10-101

22. Definition of tobacco products E-cigs are inconsistently defined as tobacco products in state code Youth access Online sales, free samples, paraphernalia Retail Local health departments do not have the authority to conduct compliance checks on e-cigarettes. Only law enforcement currently has the authority. No requirement for state tobacco retail license Schools Definition of paraphernalia

23. DR. GRO HARLEM BRUNTLAND, FORMER DIRECTOR-GENERAL of the World Health Organization: If we do not act decisively, a hundred years from now our grandchildren and their children will look back and seriously question how people claiming to be committed to public health and social justice allowed the tobacco epidemic to unfold unchecked. USDHHS. (2001). Women and Smoking: A Report of the Surgeon General. Washington, DC: PHS.