Abstract
Background
In April 2014, the Food and Drug Administration (FDA) proposed a rule to extend its tobacco regulatory authority to e-cigarettes, which have been unregulated and growing in use since their 2006–2007 US introduction. The FDA will issue a final rule based on comments and data received from researchers, tobacco companies and the public. We aimed to present data about current smokers’ awareness of and attitudes towards potential e-cigarette regulation and various policies in the United States.
Methods
We conducted a cross-sectional online e-cigarette focused survey of 519 adult current smokers in April 2014, before the FDA’s proposed rule was announced. Participants were recruited from a private research panel (GFK’s Knowledge Networks) designed to be representative of the U.S. population.
Results
The majority of respondents (62.5%) did not know that e-cigarettes are unregulated by the FDA but agreed that e-cigarettes should be regulated by the FDA for safety and quality (83.5%), carry warning labels about their potential risks (86.6%), and have the same legal age of sale as other tobacco (87.7%). Support was similarly high among current e-cigarette users. Support was substantial though lower overall for policies to restrict e-cigarette indoor use (41.2%), flavoring (44.3%) and advertising (55.5%), and was negatively associated with current e-cigarette use.
Conclusions
Support for many e-cigarette regulatory policies is strong among smokers, including for policies that the FDA has recently proposed and potential future regulations. States considering indoor e-cigarette restrictions should know that a substantial number of current smokers support such regulations.
Keywords: e-cigarettes, policy, public opinion, FDA regulation, tobacco control
INTRODUCTION
Electronic cigarettes (or “e-cigarettes) constitute a growing multibillion dollar market[1] and have the potential to positively impact public health if smokers use them to quit tobacco cigarettes,[2, 3] but may also have negative population-level consequences if, for example, they serve as a gateway back into smoking for former smokers or into smoking initiation for youth.[4]
Although previous research has tracked e-cigarette awareness, trial and use,[5–10] data about e-cigarette policy perceptions has been lacking. Such data could inform and support local and federal regulatory efforts. On April 25, 2014, the Food and Drug Administration (FDA) proposed to extend its tobacco regulatory authority to e-cigarettes, which would require e-cigarette companies to register their products with the FDA, apply to market new products, and use a nicotine addiction warning label.[11] It would also ban free samples, create a minimum age of sale, and act as a stepping stone to other potential regulations (e.g., on advertising, flavors) through future rulemaking. FDA will issue a final rule based on comments and data from researchers, tobacco companies and the public.[11] We aimed to contribute to the literature by presenting data about current smokers’ awareness of and attitudes towards potential e-cigarette policies in the United States. Smokers’ are a relevant stakeholder group given that they are the primary target audience of e-cigarettes and have historically been mobilized by tobacco companies and smokers’ rights groups to oppose tobacco control efforts. [12–14]
METHODS
We conducted an online survey of adult current smokers (i.e., have ever smoked 100 cigarettes and now smoke “some days” or “everyday”) from GFK’s Knowledge Networks (KN) nationally representative research panel. GFK sampled 1,042 participants and 609 (58.4%) completed the smoker eligibility questions. Of these 609 individuals, 519 qualified for and completed the survey. We compared weighted demographics of our sample (gender, race, age, education, census region) with current smokers from the 2013 National Health Interview Survey and judged that there were no concerning discrepancies. Data was collected between April 1–14, 2014, before the FDA’s proposed rule announcement.
Current e-cigarette users were defined as smokers who had used e-cigarettes in the past 30 days and former e-cigarette users/triers as those who had ever tried e-cigarettes but not used them in the past 30 days. All respondents were asked if they had ever heard of e-cigarettes prior to the survey and how harmful they believed e-cigarettes are compare to regular cigarettes. Additionally, participants were asked to what extent they agreed or disagreed (as 4-point Likert scale questions) with the following statements: “e-cigarette advertising should be banned in places where cigarette advertising is banned (e.g., television and radio)”; “e-cigarettes should carry warning labels about their potential risks, like other tobacco products do”; and “e-cigarettes should be regulated by the FDA for safety and quality standards”. Respondents were also asked about the sale of fruit or candy flavored e-cigarettes and the use of e-cigarettes indoors in places where smoking is banned (i.e., should/should not be allowed) and whether there should be a legal age to purchase e-cigarettes. Lastly, respondents were asked if they knew before the survey that e-cigarettes were not yet regulated by the FDA. Descriptive statistics and Wald Chi Square tests were conducted using Sudaan (Version 11), applying a post-stratification weight to adjust for non-coverage and non-response.
RESULTS
The study sample (n=519) was approximately equally distributed by gender (51% male, 49% female), about one-third were young adults (ages 18–34, 31.5%), two-thirds (66.1%) were white (14.7% black, 12.7% Hispanic, 6.4% other), 40.1% had at least some college education, and 54% were currently employed. Regarding smoking characteristics, 80.3% were daily smokers, 57.5% were lighter smokers (i.e., half a pack or less per day), and 52% had been smoking for at least 20 years. Approximately 39% of participants had tried to quit smoking at least once in the past year and 44.3% had plans to quit smoking within the next 30 days or six months. In terms of e-cigarette experience, the sample consisted of current (18.9%), former (37.8%) and never (43.3%) e-cigarette users/triers. The majority (59.9%) believed e-cigarettes are less harmful than tobacco cigarettes, while 40.1% indicated they were as or more harmful.
Although the vast majority of respondents were aware of e-cigarettes (90.7%), 62.5% did not know, prior to taking the survey, that e-cigarettes are unregulated. Lack of awareness was higher among never (68.4%) and former (62.3%) versus current e-cigarette users (45.8%)(p=.02). Awareness was also significantly associated with education and age (see Table 1). The vast majority of respondents (including current e-cigarette users) agreed that e-cigarettes should be regulated by the FDA for safety and quality (83.5%, all respondents, 77.9% current e-cigarette users), should carry warning labels about their potential risks (86.6%, all respondents, 77.5% current e-cigarette users), and should have the same legal age of sale as other tobacco products (87.7%, all respondents, 91.8% current e-cigarette users).
Table 1.
Current smokers’ regulation awareness and support of e-cigarette policies by user status and demographics (n=519)
|
|
||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Unaware Ecigs Unregulated | Support legal age of sale** | Support ecig warning labels | Agree FDA should regulate ecigs | Support Consistent ad policies | Support banning flavored ecigs | Support indoor ecig ban | ||||||||
|
| ||||||||||||||
| % | (95% CI) | % | (95% CI) | % | (95% CI) | % | (95% CI) | % | (95% CI) | % | (95% CI) | % | (95% CI) | |
|
|
||||||||||||||
| Gender | ||||||||||||||
| Male | 60.8 | (53.5–67.6) | 84.6 | (78.5–89.2) | 86.8 | (80.4–91.3) | 82.6 | (76.2–87.6) | 57.1 | (49.8–64.1) | 44.8 | (37.7–52.0) | 43.7 | (36.8–50.9) |
| Female | 64.2 | (56.0–71.7) | 90.9 | (85.1–94.6) | 86.4 | (79.3–91.4) | 84.3 | (77.0–89.6) | 53.8 | (45.5–61.9) | 43.9 | (35.9–52.2) | 38.6 | (30.9–46.9) |
| p-value* | 0.53 | 0.21 | 0.93 | 0.69 | 0.55 | 0.87 | 0.35 | |||||||
| Age | ||||||||||||||
| 18–29 | 69.2 | (54.0–81.2) | 88.1 | (75.4–94.7) | 85.5 | (70.4–93.6) | 82.9 | (66.9–92.0) | 49.1 | (35.1–63.3) | 41.0 | (27.8–55.7) | 36.3 | (23.7–51.1) |
| 30–44 | 55.1 | (44.5–65.2) | 87.4 | (78.8–92.9) | 83.9 | (73.3–90.9) | 82.5 | (72.9–89.1) | 52.6 | (42.0–62.9) | 36.7 | (27.5–46.9) | 40.7 | (31.1–51.0) |
| 45–59 | 70.5 | (62.5–77.5) | 86.1 | (79.1–91.1) | 89.9 | (83.8–93.9) | 85.2 | (78.2–90.3) | 59.2 | (50.7–67.1) | 44.0 | (35.8–52.6) | 41.6 | (33.5–50.2) |
| 60+ | 51.9 | (41.8–61.9) | 90.7 | (84.0–94.8) | 86.2 | (78.7–91.3) | 82.6 | (74.9–88.3) | 61.5 | (51.2–70.8) | 62.2 | (51.8–71.6) | 47.9 | (37.7–58.2) |
| p-value* | 0.01 | 0.04 | 0.60 | 0.93 | 0.42 | 0.01 | 0.60 | |||||||
| Education | ||||||||||||||
| High school or less | 71.6 | (64.6–77.6) | 87.4 | (82.1–91.4) | 86.6 | (81.0–90.8) | 82.6 | (76.2–87.5) | 57.1 | (49.8–64.1) | 48.6 | (41.3–56.0) | 43.5 | (36.4–50.8) |
| At least some college | 49.1 | (41.1–57.3) | 88.2 | (81.4–92.7) | 86.6 | (78.2–92.1) | 84.8 | (77.3–90.1) | 53.0 | (44.7–61.2) | 38.0 | (30.7–46.0) | 38.0 | (30.6–46.0) |
| p-value* | <0.01 | 0.90 | 0.99 | 0.61 | 0.47 | 0.06 | 0.31 | |||||||
| Race/ethnicity | ||||||||||||||
| White | 60.2 | (54.0–66.1) | 87.6 | (82.6–91.4) | 86.1 | (80.7–90.1) | 79.5 | (73.5–84.4) | 52.9 | (46.6–59.1) | 42.2 | (36.2–48.5) | 35.6 | (29.9–41.8) |
| Black | 79.1 | (64.7–88.7) | 89.8 | (79.0–95.3) | 93.6 | (83.1–97.8) | 96.3 | (85.4–99.1) | 59.8 | (43.9–73.8) | 63.6 | (47.7–77.1) | 56.9 | (41.1–71.4) |
| Hispanic | 57.9 | (37.7–75.8) | 85.1 | (68.0–93.9) | 80.0 | (56.7–92.4) | 86.8 | (65.2–95.8) | 66.3 | (45.3–82.3) | 36.3 | (20.3–56.1) | 56.4 | (35.7–75.1) |
| Other | 58.4 | (39.2–75.4) | 89.2 | (72.8–96.3) | 88.8 | (74.4–95.6) | 90.0 | (76.0–96.2) | 53.5 | (35.3–70.8) | 40.4 | (24.5–58.7) | 42.1 | (25.7–60.4) |
| p-value* | 0.08 | 0.87 | 0.28 | <0.01 | 0.56 | 0.09 | 0.04 | |||||||
| Census region | ||||||||||||||
| Northeast | 56.4 | (43.6–68.4) | 88.0 | (75.0–94.7) | 89.4 | (78.7–95.1) | 86.0 | (74.1–92.9) | 58.6 | (46.1–70.1) | 47.2 | (35.0–59.8) | 41.2 | (29.4–54.2) |
| Midwest | 66.8 | (55.9–76.2) | 85.1 | (74.6–91.8) | 83.3 | (71.9–90.7) | 75.0 | (62.7–84.3) | 48.1 | (37.3–59.1) | 39.4 | (29.3–50.4) | 27.0 | (18.9–37.1) |
| South | 62.7 | (53.9–70.8) | 89.0 | (83.1–93.0) | 87.6 | (79.4–92.8) | 87.1 | (79.9–91.9) | 54.2 | (45.5–62.7) | 47.0 | (38.5–55.7) | 46.5 | (38.1–55.0) |
| West | 62.2 | (49.0–73.8) | 88.2 | (78.7–93.8) | 86.0 | (76.4–92.1) | 84.1 | (74.4–90.6) | 64.5 | (51.6–75.6) | 42.0 | (29.4–55.6) | 49.2 | (36.4–62.2) |
| p-value* | 0.68 | 0.08 | 0.79 | 0.32 | 0.28 | 0.68 | 0.01 | |||||||
| E-cig experience | ||||||||||||||
| Never user | 68.4 | (60.3–75.5) | 84.5 | (77.2–89.7) | 85.6 | (77.3–91.1) | 83.4 | (75.3–89.2) | 63.8 | (55.2–71.6) | 55.9 | (47.4–64.1) | 57.3 | (48.8–65.5) |
| Former user | 62.4 | (53.3–70.6) | 88.6 | (81.4–93.2) | 92.0 | (86.1–95.6) | 85.7 | (78.6–90.7) | 53.2 | (44.4–61.8) | 40.6 | (32.3–49.5) | 34.9 | (27.0–43.8) |
| Current user | 45.8 | (33.7–58.4) | 91.8 | (84.4–95.9) | 77.5 | (65.0–86.5) | 77.9 | (65.3–86.9) | 38.5 | (27.1–51.2) | 24.9 | (15.5–37.4) | 15.1 | (8.1–26.4) |
| p-value* | 0.02 | 0.36 | 0.03 | 0.47 | 0.01 | <0.01 | <0.01 | |||||||
| Ecig risk belief | ||||||||||||||
| Less harmful than cigs | 58.1 | (50.8–65.1) | 91.4 | (86.6–94.6) | 85.4 | (79.1–90.0) | 82.7 | (76.3–87.7) | 42.2 | (35.3–49.4) | 32.3 | (30.6–44.5) | 29.9 | (23.7–37.0) |
| As or more harmful than cigs | 67.6 | (59.3–75.0) | 82.7 | (75.0–88.4) | 89.4 | (81.9–94.0) | 85.5 | (77.8–90.8) | 75.7 | (67.5–83.3) | 54.0 | (45.4–62.3) | 57.4 | (48.9–65.5) |
| p-value* | .08 | .03 | .32 | .53 | <0.01 | <0.01 | <0.01 | |||||||
| Total | 62.5 | (57.0–67.6) | 87.7 | (83.7–90.9) | 86.6 | (82.1–90.1) | 83.5 | (78.8–87.3) | 55.5 | (49.9–60.9) | 44.3 | (39.0–79.8) | 41.2 | (36.0–46.7) |
Wald F Chi Square;
ie, same age as other tobacco products
Support for FDA regulation was significantly associated with race (p=.005), with support highest among blacks (96.3%), and support for warning labels was significantly associated with e-cigarette experience (p=.03), with support highest among former e-cigarette users/triers (92%)(see Table 1).
Support was lower for policies to restrict e-cigarette indoor use (41.2%), flavoring (44.3%) and advertising (55.5%)(see Table 1). Support for these three policies varied significantly by e-cigarette experience (p<.01) and risk perception beliefs (p<.01), and was consistently least prevalent among those who believed them to be less harmful than tobacco cigarettes, and was least prevalent among current e-cigarette users versus former and never users/triers.
DISCUSSION
To our knowledge, this is the first study about smokers’ attitudes on a range of e-cigarette policy issues in the United States. We found that support for many policies that would more strictly regulate e-cigarettes is strong among smokers, including ones that the FDA has recently proposed (e.g., age-of-sale restrictions) and potential future FDA policies (e.g., restrictions on e-cigarette advertising and flavoring).
We also found that most smokers were unaware that e-cigarettes are unregulated by the FDA. This is consistent with previous research finding smokers incorrectly believing that various unregulated tobacco products are evaluated for safety by the government, an issue that might impart some false sense of security.[15–16] However, we also found that when prompted the vast majority of smokers believed that they should be regulated by the FDA for safety and quality, a finding which directly supports the FDA’s proposed rule to do so. Although support was high among all groups, it was notably highest (96.3%) among black smokers. A recent study similarly found that support for banning menthol cigarettes, another timely policy issue, was highest among blacks even though they are the group most likely to use such products.[17]
Not surprisingly, support for some policies, such as banning e-cigarette use in indoor public places, was substantially lower among current e-cigarette users versus non-users. However, previous studies on indoor cigarette smoking have found that support for such laws increased among smokers after implementation.[18–19] As such, support for e-cigarette policies may also increase among e-cigarette users with time. Otherwise, while regulation of tobacco indoor air laws does not fall under the FDA’s jurisdiction, states or municipalities still considering policies about indoor e-cigarette use should know that even a substantial number of current smokers support such regulations. Although 27 states had local laws regulating e-cigarette use in public places as of October 1, 2014, only three had statewide laws explicitly restricting e-cigarette use in existing 100% smokefree venues.[20]
We also found that support for some policies was lower among those who believed e-cigarette are safer than regular cigarettes. This is reminiscent of research finding lower support for clean indoor air laws among those less likely to believe secondhand smoke is harmful.[21] Although our results were consistent with several studies in finding that a majority of smokers believe that e-cigarettes are less harmful than tobacco cigarettes,[5–6, 22–23] we found that almost 90% of smokers nevertheless agreed that e-cigarettes should carry warning labels about their potential risks like other tobacco products do. The FDA’s proposed rule would require e-cigarettes to carry a warning that they contain the addictive chemical of nicotine,[11] an important first step in formally warning the public about their potential risks, although some have called for additional and stronger warnings.[24] Future research should explore messages most effective for these new products.
Finally, our research may represent a conservative measure of support for e-cigarette policies since our sample was limited to current smokers. Given previous research on other tobacco policies, it would be reasonable to assume that support for e-cigarette restrictions might be even higher among non-smokers.[17,25–27] Additionally, the views of e-cigarette users in our sample, who all still smoked tobacco cigarettes, may be different than those of e-cigarette users who have completely quit smoking. Our study was limited in having a relatively small sample size, and future research should measure policy attitudes with larger samples, explore additional policy issues such as e-cigarette taxation and internet sales, further examine how policy perceptions correlate with e-cigarette knowledge and beliefs, and explore the public’s opinions about how changes to e-cigarette policies might change their e-cigarette attitudes and behaviors.
WHAT THIS PAPER ADDS.
Previous research has tracked growth in e-cigarette awareness, trial and use, but data about e-cigarette policy perceptions has been lacking.
This study provides the first data about current smokers’ awareness of and attitudes towards potential e-cigarette FDA regulation and a variety of e-cigarette policies in the United States.
This study shows that support for many e-cigarette policies is strong among smokers, including for policies that the FDA has recently proposed and potential policies the FDA may be able to propose in the future.
Although support for bans on indoor e-cigarette use among e-cigarette users was low (15.1%), support among never users was substantial (57.3%) - states and municipalities should continue to pursue such legislation.
Acknowledgments
Thank you to Michelle T. Bover Manderski, MPH (Research Specialist, Rutgers School of Public Health) for assisting with data analysis and table construction.
Funding: This work was supported by a grant from the New Jersey Health Foundation and in part by grants from the National Cancer Institute (P30CA072720, K01CA189301). OAW was the study principal investigator. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Footnotes
Competing interests: None
Ethics Approval: The Institutional Review Board for the Rutgers Biomedical and Health Sciences School approved this study under exempt review.
Contributors: OAW conceived and obtained funding for the study, led data collection and analysis, and drafted the manuscript. CDD assisted in developing the survey instrument and critically reviewed the manuscript for important intellectual content. Both authors approved the final version.
The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding sources.
Contributor Information
Olivia A. Wackowski, Email: wackowol@sph.rutgers.edu, Assistant Professor, Center for Tobacco Studies, Department of Health Education & Behavioral Science, Rutgers School of Public Health, 335 George Street, Suite 2100, New Brunswick, NJ 08903, USA, 732-235-9731.
Cristine D. Delnevo, Professor, Director, Center for Tobacco Studies, Chair, Department of Health Education & Behavioral Science, Rutgers School of Public Health, 335 George Street, Suite 2100, New Brunswick, NJ 08903, USA.
References
- 1.Morrison M. CSP Daily News. Apr 10, 2014. Big three’s e-cig play: with cash at ready, Altria, Reynolds, Lorillard to increase investments, Herzog tells NATO. [Google Scholar]
- 2.Etter JF. Should electronic cigarettes be as freely available as tobacco? BMJ. 2013;346:f3418. doi: 10.1136/bmj.f3845. [DOI] [PubMed] [Google Scholar]
- 3.Benowitz NL, Goniewicz ML. The regulatory challenge of electronic cigarettes. JAMA. 2013;310:685–686. doi: 10.1001/jama.2013.109501. [DOI] [PubMed] [Google Scholar]
- 4.Grana R. Electronic cigarettes: a new nicotine gateway? J Adolesc Health. 2013;52:135–6. doi: 10.1016/j.jadohealth.2012.11.007. [DOI] [PubMed] [Google Scholar]
- 5.Adkison SE, O’Connor RJ, Bansal-Travers M, et al. Electronic nicotine delivery systems. International tobacco control four-country survey. Am J Prev Med. 2013;44:207–15. doi: 10.1016/j.amepre.2012.10.018. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Pearson JL, Richardson A, Niaura RS, et al. E-cigarettes awareness, use and harm perceptions in US adults. Am J Public Health. 2012;102:1758–66. doi: 10.2105/AJPH.2011.300526. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Regan AK, Promoff G, Dube SR, et al. Electronic nicotine delivery systems: adult use and awareness of the ‘e-cigarette’ in the USA. Tob Control. 2013;22:19–23. doi: 10.1136/tobaccocontrol-2011-050044. [DOI] [PubMed] [Google Scholar]
- 8.King BA, Alam S, Promoff G, et al. Awareness and ever use of electronic cigarettes among US adults, 2010–2011. Nicotine Tob Res. 2013;15:1623–7. doi: 10.1093/ntr/ntt013. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Zhu SH, Gamst A, Lee M, et al. The use and perception of electronic cigarettes and snus among the US population. PLOS One. 2013;8:e79332. doi: 10.1371/journal.pone.0079332. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Pepper JK, Emery SL, Ribisl KM, et al. How US adults find out about electronic cigarettes: implications for public health messages. Nicotine Tob Res. 2014;16:1140–4. doi: 10.1093/ntr/ntu060. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Food and Drug Administration. Deeming Tobacco Products To Be Subject to the Federal Food, Drug, and Cosmetic Act, as Amended by the Family Smoking Prevention and Tobacco Control Act; Regulations on the Sale and Distribution of Tobacco Products and Required Warning Statements for Tobacco Products. [Accessed July 7, 2014];Proposed rule. 2014 Apr 25; https://www.federalregister.gov/articles/2014/04/25/2014-09491/deeming-tobacco-products-to-be-subject-to-the-federal-food-drug-and-cosmetic-act-as-amended-by-the. [PubMed]
- 12.Smith EA, Malone RE. ‘We will speak as the smoker’: the tobacco industry’s smokers’ rights groups. Eur J Public Health. 2007;17:306–13. doi: 10.1093/eurpub/ckl244. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Bruce S, Glantz SA. The Politics of Local Tobacco Control. JAMA. 1991;266:2110–2117. [PubMed] [Google Scholar]
- 14.McCarthy M. Smokers’ rights group challenges New York City’s ban on e-cigarettes. BMJ. 2014;348:g2422. doi: 10.1136/bmj.g2422. [DOI] [PubMed] [Google Scholar]
- 15.Kaufman AR, Waters EA, Parascandola M, et al. Food and Drug Administration evaluation and cigarette smoking risk perceptions. Am J Health Behav. 2011;35:766–776. doi: 10.5993/ajhb.35.6.12. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Latimer LA, Batanova M, Loukas A. Prevalence and harm perceptions of various tobacco products among college students. Nicotine Tob Res. 2014;16:519–26. doi: 10.1093/ntr/ntt174. [DOI] [PubMed] [Google Scholar]
- 17.Winickoff JP, McMillen RC, Vallone DM, et al. US attitudes about banning menthol in cigarettes: results from a nationally representative survey. Am J Public Health. 2011;101:1234–6. doi: 10.2105/AJPH.2011.300146. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Wakefield M, Roberts L, Owen N. Trends in prevalence and acceptance of workplace smoking bans among indoor workers in South Australia. Tob Control. 1996;5:205–8. doi: 10.1136/tc.5.3.205. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Tang H, Cowling DW, Lloyd JC, et al. Changes of attitudes and patronage behaviors in response to a smoke-free bar law. Am J Pub Health. 2003;93:611–7. doi: 10.2105/ajph.93.4.611. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.American Nonsmokers’ Rights Foundation. [Accessed October 10, 2014];US state and local laws regulating use of electronic cigarettes, as of October 1, 2014. http://www.no-smoke.org/pdf/ecigslaws.pdf.
- 21.Borland R, Yong HH, Siahpush M, et al. Support for and reported compliance with smoke-free restaurants and bars by smokers in four countries: findings from the International Tobacco Control (ITC) Four Country Survey. Tob Control. 2006;15(Suppl 3):iii34–41. doi: 10.1136/tc.2004.008748. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Dockrell M, Morison R, Bauld L, et al. E-cigarettes: prevalence and attitudes in Great Britain. Nicotine Tob Res. 2013;15:1737–44. doi: 10.1093/ntr/ntt057. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Tan A, Bigman AC. E-cigarette awareness and perceived harmfulness: prevalence and associations with smoking-cessation outcomes. Am J Prev Med. 2014;47:141–9. doi: 10.1016/j.amepre.2014.02.011. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Richtel M. Six Senators Urge Stronger Warnings on E-Cigarettes. NY Times. 2014 Oct 9; Available from: http://www.nytimes.com/2014/10/10/business/six-senators-urge-stronger-warnings-on-e-cigarettes.html?_r=0.
- 25.Connolly GN, Behm I, Healton CG, et al. Public attitudes regarding banning of cigarettes and regulation of nicotine. Am J Public Health. 2012;102:e1–2. doi: 10.2105/AJPH.2011.300583. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Pearson JL, Abrams DB, Niaura RS, et al. A ban on menthol cigarettes: impact on public opinion and smokers’ intention to quit. Am J Public Health. 2012;102:e107–14. doi: 10.2105/AJPH.2012.300804. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Thomson G, Wilson N, Edwards R. At the frontier of tobacco control: a brief review of public attitudes toward smoke-free outdoor places. Nicotine Tob Res. 2009;11:584–90. doi: 10.1093/ntr/ntp046. [DOI] [PubMed] [Google Scholar]