Regulation profiles of e-cigarettes in the United States: a critical review with qualitative synthesis

Abstract

Background: Electronic cigarettes (e-cigarettes) have been steadily increasing in popularity since their introduction to US markets in 2007. Debates surrounding the proper regulatory mechanisms needed to mitigate potential harms associated with their use have focused on youth access, their potential for nicotine addiction, and the renormalization of a smoking culture. The objective of this study was to describe the enacted and planned regulations addressing this novel public health concern in the US.

Methods: We searched LexisNexis Academic under Federal Regulations and Registers, as well as State Administrative Codes and Registers. This same database was also used to find information about planned regulations in secondary sources. The search was restricted to US documents produced between January 1(st), 2004, and July 14(th), 2014.

Results: We found two planned regulations at the federal level, and 74 enacted and planned regulations in 44 states. We identified six state-based regulation types, including i) access, ii) usage, iii) marketing and advertisement, iv) packaging, v) taxation, and vi) licensure. These were further classified into 10 restriction subtypes: sales, sale to minors, use in indoor public places, use in limited venues, use by minors, licensure, marketing and advertising, packaging, and taxation. Most enacted restrictions aimed primarily to limit youth access, while few regulations enforced comprehensive restrictions on product use and availability.

Conclusions: Current regulations targeting e-cigarettes in the US are varied in nature and scope. There is greater consensus surrounding youth protection (access by minors and/or use by minors, and/or use in limited venues), with little consensus on multi-level regulations, including comprehensive use bans in public spaces.

Fig. 1

PRISMA flow diagram of systematic review literature search. * The 139 documents discussed 75 enacted or planned regulations, including two at the federal level and 73 at the state level (including the District of Columbia). US, United States

Fig. 2

State-by-state comparison of e-cigarette regulation profiles. Mix, Mixed regulations; SBM, Sale to minors ban; SBM-UPL, Sale to minors ban and prohibited use in limited venues; SBM-UPM, Sale to minors ban and prohibited use of e-cigarette by minors; SBM-UPL-UPM, Sale to minors ban, prohibited use by minors, and in limited venues; UPC, Use prohibited comprehensively in indoor public places. Map created with [24]