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ABSTRACT Growth in the market for electronic cigarettes (e-cigarettes) raises complex questions about the devices' public health implications and, hence, challenging policy issues. We propose a policy agenda addressing concerns about preventing youth uptake of e-cigarettes and the desire to realize the potential of e-cigarettes to increase adult cigarette smoking cessation. We organize interventions according to the "four Ps" of marketing: product, price, place, and promotion. Policies include decreasing the addictiveness of combusted tobacco products while ensuring the availability of consumer-acceptable reduced-risk nicotine products, imposing large taxes on combustible products and smaller taxes on e-cigarettes, limiting the sale of all tobacco and (nonmedicinal) nicotine products to adult-only retailers, and developing communications that accurately portray e-cigarettes' risks to youth and benefits for inveterate adult smokers. All members of the public health community should unite to pursue a shared commitment to the principle that both youth and adults deserve a future free of tobacco-related disease.
The use of nicotine-containing electronic cigarettes (e-cigarettes) in the United States has created a debate within the public health community. Concern about e-cigarettes centers on the risks that they pose for young people. Support for the devices emphasizes their potential to reduce cigarette smoking and its enormous burden of disease and death.1 Differences in focus notwithstanding, all concur that both young people and adults deserve a future free of tobacco-related disease.
Tobacco use remains prevalent across the US. In 2020 about one in five adults (an estimated 47.1 million people) used tobacco products, with 30.8 million (12.5 percent) smoking cigarettes and more than 9 million (3.7 percent) using e-cigarettes.2 Among high school students, in 2021 more than two million (13.4 percent) used some form of nicotine or tobacco within the thirty days before being surveyed. Of those students, I.9 percent (280,000) smoked cigarettes, and II.3 percent (1.72 million) used e-cigarettes.3
Although there is widespread agreement that adolescents should not use nicotine in any form, including e-cigarettes, there is less agreement about whether e-cigarettes help some adults quit smoking.4 However, a growing body of research supports that contention.1 Recent evidence finds e-cigarettes to be more effective for smoking cessation than government-approved nicotine replacement therapy products such as nicotine gum and patches.5 In addition, e-cigarettes are the product most favored by US adults...