For e-cigarettes, public supports health warnings & ban on sales to minors

September 13, 2010 Volume 10 Issue 4
  • 68% of adults think e-cigarettes should have health warnings like cigarettes and nicotine products do.
  • 85% of adults support laws that would prohibit e-cigarette sales to minors.

Electronic cigarettes (“e-cigarettes”) are battery-operated devices that look like cigarettes but do not burn tobacco. Instead, e-cigarettes have replaceable cartridges of liquid containing nicotine, which is inhaled as a vapor along with flavors like tobacco and chocolate. e-Cigarettes are available in stores, mall kiosks and over the Internet.

Advocates of e-cigarettes see them as a healthier alternative to tobacco smoking—perhaps even as a way for smokers to quit. In addition, as smokeless devices e-cigarettes do not create secondhand smoke. Critics of e-cigarettes are concerned that they may have not-yet-determined health risks and may encourage people—including youth—to smoke tobacco. Currently, e-cigarettes are not regulated by the US Food and Drug Administration (FDA), and e-cigarettes may be sold without regard to the age of the purchaser.

The C.S. Mott Children’s Hospital National Poll on Children’s Health presented arguments for and against e-cigarettes, and then asked a national sample of adults for their opinions regarding e-cigarettes and possible regulations and laws.

Support for Health Warnings on e-Cigarettes

37% of adults have heard of e-cigarettes, while only 3% have ever tried one. Nearly half of adults (49%) are very concerned that e-cigarettes may increase nicotine and tobacco use among youth, and 42% are very concerned that it is easy for youth to buy e-cigarettes. 17% of parents are very concerned their children will try e-cigarettes.

Although there is little current evidence about the effects of e-cigarettes, 68% of adults think e-cigarettes should have health warnings like tobacco cigarettes and nicotine products.

Strong Support for Laws Regarding e-Cigarettes

Adults express widespread support for new laws regarding e-cigarettes (Figure 1): 91% think manufacturers should be required to test e-cigarettes for safety, and 85% favor prohibiting the sale of e-cigarettes to minors.

Strong majorities also support FDA regulation of e-cigarettes like that of other nicotine-containing products, marketing restrictions on social networking sites often frequented by youth, and prohibition of e-cigarette use indoors.

Implications

E-cigarettes are a relatively new product with little information about safety or long-term health effects. It is clear from this poll that US adults are not waiting for scientific evidence. Rather, they support restrictions on e-cigarettes based on potential risks—not just short-term health effects, but also the possibility that e-cigarettes may prompt youth to smoke tobacco. These findings add to the public dialogue about e-cigarettes, which has chiefly consisted of claims and counter-claims by advocates and opponents of these new devices.

Adults’ high level of concern—including easy availability of e-cigarettes for youth—explains their broad support for many potential new laws and regulations.  This poll indicates widespread support for e-cigarette initiatives being considered by state legislatures, including warning labels, bans on sales to minors and advertising restrictions in youth-targeted media. Public support is also strong for FDA regulatory action regarding e-cigarettes, similar to other nicotine-containing products.

Given these results, in order to gain more public support, advocates of e-cigarettes must provide more detailed evidence about safety and make clear their intentions about marketing to youth. Meanwhile, critics of e-cigarettes may want to move now with legislative action likely to gain strong public backing.

Data Source

This report presents findings from a nationally representative household survey conducted exclusively by Knowledge Networks, Inc, for C.S. Mott Children’s Hospital via a method used in many published studies. The survey was administered in May 2010 to a randomly selected, stratified group of adults aged 18 and older (n=2,064) with and without children from the Knowledge Networks standing panel that closely resembles the U.S. population. The sample was subsequently weighted to reflect population figures from the Census Bureau. The survey completion rate was 61% among panel members contacted to participate. The margin of sampling error is plus or minus 1 to 3 percentage points, depending on the question.

Director: Matthew M. Davis, MD, MAPP
Associate Director: Sarah J. Clark, MPH
Manager & Editor: Dianne C. Singer, MPH
Data Analyst: Amy T. Butchart, MPH

This Report includes research findings from the C.S. Mott Children's Hospital National Poll on Children's Health, which do not represent the opinions of the investigators or the opinions of the University of Michigan. The University of Michigan reserves all rights over this material.

This next set of questions is about a new product.

Q1. Have you ever heard of electronic cigarettes, or “e-cigarettes”?

  • Yes
  • No

[New screen]

Electronic cigarettes, or “e-cigarettes”, are battery-operated devices that look like cigarettes, but do not contain tobacco. E-cigarettes contain nicotine, which is inhaled as a mist. 

E-cigarettes come in flavors like tobacco, chocolate and vanilla. They are available in stores, mall kiosks and over the Internet.  Unlike tobacco cigarettes, sales of e-cigarettes are not restricted for people under 18.

Currently, e-cigarettes are not regulated by the US Food and Drug Administration (FDA).

[New screen]

Those against e-cigarettes say:

  • they have not been thoroughly tested for safety
  • they may lead to nicotine addiction and tobacco use among young people
  • they should be regulated by the FDA like other nicotine products (such as patches, lozenges and gum)
  • the FDA analyzed a small sample of e-cigarettes and found they may contain chemicals that could be harmful

Those in favor of e-cigarettes say:

  • they are a safe substitute for tobacco cigarettes
  • several lab reports have been published on the safety of e-cigarettes
  • contents in e-cigarettes are on the FDA’s ‘Generally Recognized As Safe’ list

Q2. How concerned are you with the following?

Please check one box in each row

  Very concerned Somewhat concerned Not at all concerned
It’s easy for people younger than 18 to buy e-cigarettes      
E-cigarettes may increase nicotine addiction and tobacco use by people younger than 18      
[Parents = 1 with child age 9-17] My child(ren) will try e-cigarettes      

Q3. Please indicate your opinion about the following statements:

Please check one box in each row

  Strongly disagree Disagree Neutral Agree Strongly agree
E-cigarettes are better for people to use than traditional cigarettes.          
E-cigarettes should have health warnings like cigarettes and nicotine products do          

Some states have recently proposed new laws related to e-cigarettes.

Q4. Please indicate whether or not you support the following:

Please check one box in each row

  Support Do not support
FDA regulation of e-cigarettes like other nicotine products (such as patches, gums and lozenges)    
Requiring manufacturers to test e-cigarettes for safety    
Prohibiting the sale of e-cigarettes to people younger than 18    
Restricting the marketing of e-cigarettes on social networking sites like Facebook or Twitter    
Prohibiting the use of e-cigarettes in indoor places and workplaces, like restrictions on tobacco smoking    

Q5. How often do you use the following tobacco products?

Please check one box in each row

  Every day Some days Rarely Not any more Never
Cigarettes          
Smokeless tobacco          

Q6. Have you ever tried an e-cigarette?

  • Yes
  • No

Participants were also asked demographic questions on race/ethnicity, annual household income, education level, insurance status. Parents were also asked questions regarding children in the household.

All information is the sole property of the University of Michigan CS Mott Children's Hospital National Poll on Children's Health.  It can only be used if there is an acknowledgment that "The information came from, is copyright by and is owned by and belongs to the Regents of the University of Michigan and their C.S. Mott Children's Hospital National Poll on Children's Health. It cannot be republished or used in any format without prior written permission from the University."

C.S. Mott Children’s Hospital National Poll on Children’s Health
Director: Matthew M. Davis, MD, MAPP
Associate Director: Sarah J. Clark, MPH
Manager & Editor: Dianne C. Singer, MPH
Data Analyst: Amy T. Butchart, MPH

 

Click on an image to download the full-size version

Public support for electronic cigarette laws