Electronic Nicotine Delivery Systems Policy: Public Health Analysis

This report provides a comprehensive analysis of Electronic Nicotine Delivery Systems (ENDS) policy, addressing the rising use of e-cigarettes and their impact on public health, particularly among youth. It examines the policy problem statement, emphasizing concerns about nicotine dependence, marketing strategies targeting young people, and the lack of sufficient evidence on the safety and efficacy of ENDS. The report presents specific objectives for the policy, including protecting youth from ENDS use through childproof packaging and flavor restrictions, restricting marketing and advertising, setting a minimum legal age of 21 for sales, and imposing a tax on nicotine liquid. It also outlines implementation strategies, such as health promotion through registered nurses and social media, and enforcement measures by government agencies. The report references several studies and reports, and provides valuable insights into the challenges and potential solutions related to ENDS policy.

Running Head: ELECTRONIC NICOTINE SYSTEMS POLICY
Electronic Nicotine Delivery Systems Policy
Students Name
University Name
Date

ELECTRONIC NICOTINE SYSTEMS POLICY 2
Electronic Nicotine Delivery Systems Policy
The policy problem statement
Electronic nicotine delivery system (ENDS) is known as handheld devices operating on
battery and have the aim of stimulating traditional cigarettes by creating a result typically
including nicotine, flavoring agents, glycerine and propylene glycol, that is combusted as well as
inhaled by the users as an aerosol (Pesko, Kenkel, Wang & Hughes, 2016). It should be noted
that the consumption of ENDS has significantly risen since it was introduced into the market in
the mid and late 2000s. On the other hand, there have been significant health discussions
concerning the pros and cons of the use of ENDS. ENDS has been promoted as an aid to cease or
minimize tobacco smoking is it has been endorsed by the Royal College of Physicians, the Royal
Society for Public Health as well as the Public health England. However, numerous other health
organizations like the World Health Organization, the Australian medical association and the
American Lung association have not supported the use of ENDS as a cessation aid in people
especially the youths. Such organizations have cited concerns about the safety of the product as
well as the potential that trial and error with ENDS might result in dependence on nicotine and
the consequent use of tobacco. Empirical evidence supports such claims and concerns have been
recorded in the United States Surgeon General report. Because the testing with cigarettes
happens with the young people and brain development is principally sensitive to the use of
nicotine, the use of ENDS by the youths has gotten great attention.
In numerous fields, products linked to ENDS are actively marketed using approaches
which appeal to the youths entailing the use of celebrity product promotion and endorsement of
flavored products such as candy flavor, as well as through social media. Even though numerous
jurisdictions in which ENDS can be lawfully acquired have placed prohibitions on sales to the

ELECTRONIC NICOTINE SYSTEMS POLICY 3
young people when the e-liquid has nicotine, ENDS are normally simply purchased via familiar
public areas like family members as well as friends (Loukas, Marti & Perry, 2019). Moreover,
few nations normally implement restrictions on age on the sale of ENDS products. Current meta-
analysis of the young population studies documented by the World Health Organization state that
the use of ENDS by non-smokers who are young is three times higher when compared to the use
of tobacco. Due to the promotion and availability of the ENDS in numerous nations as well as
their potential to determine the use of tobacco in young people, a comprehension of the incidence
of the ENDS use among the youth and among the non-smokers and smokers, is required to
evaluate their probable effect on public health (Tackett et al. 2015).
There is considerable empirical evidence showing a substantial rise in the use of ENDS
across geographical areas and population subgroups. For instance, in Australia, e-cigarettes have
been reported as the most usually used tobacco products by high school students (12%) and
middle school students (3%). In the United States of America between 2011 and 2014, 14% of
the middle school students and 38% of the high school students were reported to have used e-
cigarettes. The e-cigarette initiation is reported to have increased swiftly between 2013 and 2015,
and reaching its peak in 2015 in which one out of five students were reported to have used e-
cigarette (Yoong et al. 2018). There is increasing evidence that exposure to exhaled vape has
adverse health impacts on non-ENDS users, entailing children (Walley & Jenssen, 2015).
According to the World Health Organization and other government agencies in Australia, ENDS
safety as well as their efficacy in smoking cessation strategies is not enough. It should be noted
that empirical research studies on the psychological and physiological effect, biochemical
constituents, and the health benefits or risks of ENDS differ in relation to their methodological

ELECTRONIC NICOTINE SYSTEMS POLICY 4
rigor, recruitment techniques, sample sizes, and the control of possible confounding variables
(Bayly, Bernat, Porter & Choi, 2019).
Despite the uncertainties concerning the efficacy of ENDS in safety concerns and
smoking cessation, numerous manufacturers of ENDS promote their products as safe and
healthier alternatives to the traditional combustible tobacco as well as market them as means of
ceasing smoking traditional tobacco. Therefore, the orientation of harm reduction which
considers the net benefits and costs compared to the traditional tobacco smoking has been
accepted and promoted by the industry. In Australia, some scientists have started to adopt the
harm reduction model after recognizing the international burden of tobacco-linked mortality and
morbidity (estimated seven million deaths yearly). Nevertheless, to date, the proposed ENDS
value for public health has not been supported by evidence of their therapeutic advantages in
relation to smoking cessation (Selya, Dierker, Rose, Hedeker & Mermelstein, 2018). The
approach of harm reduction does not acknowledge the harmful impacts of nicotine, especially on
the at-risk population. Empirical evidence states that prenatal exposure to nicotine can lead to
cognitive abnormalities. Thus, more clinical and behavioral research is required to appropriately
understand as well as address the knowledge gaps in ENDS and to come up with a public health
policy framework that that defines the use of ENDS among the vulnerable population.
Specific objectives the policy and execution strategy
World Health Organization came up with proposals to address the proliferation of the use
of ENDS. The broad objective of this policy is to address the increased use of ENDS among the
youths. The specific objectives of the policy include;

ELECTRONIC NICOTINE SYSTEMS POLICY 5
Objective; Protect the youths and children from using ENDS; exposure to nicotine liquid
has been declared as a public health hazard as well as a major risk for young children since the
nicotine solution is sold in cartridges and bottles which can lead to accidental poisoning. In
Australia, more children and youths are normally exposed to liquid nicotine with the most
affected victims being children who are less than three years.
Execution/Implementation strategy; The policy will require industries in the country to
use childproof packaging as well as follow the regulations on the design standards which do not
appeal to the youths and children. Moreover, the policy stipulates that flavoring of the e-liquid
for the products of ENDS should be made illegal and any manufacturer is adding flavors to the
products of ENDS will be legally charged in the country’s judicial system.
Objective; Restrict marketing, promotion, advertising of ENDS; it is approximated that
the international ENDS market in 2015 was about $11 billion with Australia and the united states
of America accounting for about 60% (Pesko, Huang, Johnston & Chaloupka, 2018). It should be
noted that ENDS has a competitive advantage over traditional tobacco cigarettes in relation to
marketing and advertising. This is because numerous established policies are regulating the
advertising and marketing of traditional tobacco cigarettes on various print media, social media
and television with the high young people readership. Such policies also prohibited
manufacturers from sponsoring music festivals and sporting events in the country. Due to lack of
policy framework and regulations, promotion, advertising, and marketing of ENDS have been
rising in numerous venues. Historically, traditional tobacco cigarettes manufacturers used
marketing and advertising approaches of product differentiation like offering menthol flavors
and segmentation of the market like targeting women and youths (Weaver et al. 2018).
Numerous present ENDS marketing, and advertising approaches are similar to the ones which

ELECTRONIC NICOTINE SYSTEMS POLICY 6
were used for traditional tobacco cigarette especially campaigns targeting the young people
(Hall, Gartner & Forlini, 2015).
Execution/Implementation strategy; the policy will require that the regulations and
guidelines which were placed for the traditional tobacco cigarette extend to ENDS. Moreover,
the policy requires that any manufacturer that breaches the advertising, promotion and marketing
regulations as spelled out in this policy will be held legally held liable and judicial actions will
be taken against them.
Objective; setting the minimum legal age for ENFDS sale at 21 years; in the country, it
has been empirically reported that approximately 90% of the smokers started smoking at the age
of 18 years while 99% at the age of 26 years (Hall, Gartner & Forlini, 2015). Therefore, the
present minimum age of sales regulation does not offer protection to the numerous of individuals
at risk of smoking initiation. The use of ENDS has been reported to have a positive effect on the
use of traditional tobacco products by the youths not covered by the current existing minimum
age of access and access laws (Wagoner et al. 2018).
Execution/Implementation strategy; the policy recommends raising the minimum age of
access and sales law to be 21 years. Current existing minimum age of sales and access laws on
the traditional tobacco products have had greater impacts on the population especially the young
adults. Moreover, there has been increasing public support for such regulations. The policy
supports the protection of children, and young adults from exposure to ENDS products just as
similarly as for traditional tobacco products.
Objective; imposing a tax on the nicotine liquid in e-cigarette

ELECTRONIC NICOTINE SYSTEMS POLICY 7
Execution/Implementation strategy; research evidence has shown that increased prices of
products are associated with a significant reduction in the consumption of that product.
Therefore, imposing a tax on the ENDS products has the potential to increase the prices of such
products. Consequently, there will be a reduced number of users of ENDs especially among the
youths and children who are not financially stable.
Promotion and compliance with the policy
Promotion of policies is one of the ways that ensure that the requirements of such policies
will enlighten every person in Australia. One of the approaches that this policy will use to create
awareness among the public is through the use of health promotion strategies (Loewen & Relich,
2019). Selected professional registered nurses will be used in educating the public concerning the
legal requirement of the policy. Nurses are the largest professionals in the healthcare system in
the country; thus, if they are recognized and identified to promote the policy, then it will reach a
wider geographical area and population. Use of social media using authorized sites will also be
used in disseminating information to the public. Most youths in the country are currently using
social media. Thus, the use of popular social media platforms like Facebook, Twitter, and even
Instagram will ensure that a larger proportion of the youths will be reached (Ayers et al. 2018).
Health organizations in the country will also be required to publish this policy on their
website to enhance the delivery of information regarding this policy. This policy will be
implemented by ensuring that the government agencies entrusted with the enforcing laws are
incorporated into the execution program (Tilburg, Hoke & Sager, 2017). Any retailer or
manufacturer who will be found selling ENDS products to the youths below the age of 21 will be
prosecuted, and their firms closed. Taxation regarding will be implemented by the government
agencies tasked with revenue collection.

ELECTRONIC NICOTINE SYSTEMS POLICY 8

ELECTRONIC NICOTINE SYSTEMS POLICY 9
References
Ayers, J. W., Dredze, M., Leas, E. C., Caputi, T. L., Allem, J.-P., & Cohen, J. E. (2018). Next
generation media monitoring: Global coverage of electronic nicotine delivery systems
(electronic cigarettes) on Bing, Google, and Twitter, 2013-2018. PLoS ONE, 13(11), 1–
14. Retrieved from https://doi.org/10.1371/journal.pone.0205822
Bayly, J. E., Bernat, D., Porter, L., & Choi, K. (2019). Secondhand Exposure to Aerosols from
Electronic Nicotine Delivery Systems and Asthma Exacerbations Among Youth with
Asthma. CHEST, 155(1), 88–93. Retrieved from
https://doi.org/10.1016/j.chest.2018.10.005
Hall, W., Gartner, C., & Forlini, C. (2015). Ethical issues raised by a ban on the sale of
electronic nicotine devices. Addiction, 110(7), 1061–1067. Retrieved from
https://doi.org/10.1111/add.12898
Hall, W., Gartner, C., & Forlini, C. (2015). Nuances in the ethical regulation of electronic
nicotine delivery systems. Addiction, 110(7), 1074–1075. Retrieved from
https://doi.org/10.1111/add.12984
Loewen, J. M., & Relich, E. E. (2019). Electronic Nicotine Delivery Systems: Current trends and
patient education opportunities for dental hygienists. Journal of Dental Hygiene, 93(1),
43–51. Retrieved from http://search.ebscohost.com/login.aspx?
direct=true&db=aph&AN=135622548&site=ehost-live
Loukas, A., Marti, C. N., & Perry, C. L. (2019). Trajectories of Tobacco and Nicotine Use
Across Young Adulthood, Texas, 2014–2017. American Journal of Public
Health, 109(3), 465–471. Retrieved from https://doi.org/10.2105/AJPH.2018.304850

ELECTRONIC NICOTINE SYSTEMS POLICY 10
Pesko, M. F., Huang, J., Johnston, L. D., & Chaloupka, F. J. (2018). E‐cigarette price sensitivity
among middle‐ and high‐school students: evidence from monitoring the
future. Addiction, 113(5), 896–906. Retrieved from https://doi.org/10.1111/add.14119
Pesko, M. F., Kenkel, D. S., Wang, H., & Hughes, J. M. (2016). The effect of potential electronic
nicotine delivery system regulations on nicotine product selection. Addiction, 111(4),
734–744. Retrieved from https://doi.org/10.1111/add.13257
Selya, A. S., Dierker, L., Rose, J. S., Hedeker, D., & Mermelstein, R. J. (2018). The Role of
Nicotine Dependence in E-Cigarettes’ Potential for Smoking Reduction. Nicotine &
Tobacco Research, 20(10), 1272–1277. Retrieved from
https://doi.org/10.1093/ntr/ntx160
Tackett, A. P., Lechner, W. V., Meier, E., Grant, D. M., Driskill, L. M., Tahirkheli, N. N., &
Wagener, T. L. (2015). Biochemically verified smoking cessation and vaping beliefs
among vape store customers. Addiction, 110(5), 868–874. Retrieved from
https://doi.org/10.1111/add.12878
Tilburg, W., Hoke, K., & Sager, M. (2017). Fda Regulation of Electronic Nicotine Delivery
Systems and the “Deeming” Rule: What’s Left for States? Journal of Health Care Law &
Policy, 20(1), 27–72. Retrieved from http://search.ebscohost.com/login.aspx?
direct=true&db=aph&AN=129959066&site=ehost-live
Wagoner, K. G., Song, E. Y., King, J. L., Egan, K. L., Debinski, B., Wolfson, M., … Sutfin, E.
L. (2018). Availability and Placement of Electronic Nicotine Delivery Systems at the
Point-of-Sale. Nicotine & Tobacco Research, 20(8), 1020–1024. Retrieved from
https://doi.org/10.1093/ntr/ntx207

ELECTRONIC NICOTINE SYSTEMS POLICY 11
Walley, S. C., & Jenssen, B. P. (2015). Electronic Nicotine Delivery Systems. Pediatrics, 136(5),
1018–1026. Retrieved from https://doi.org/10.1542/peds.2015-3222
Weaver, S. R., Huang, J., Pechacek, T. F., Heath, J. W., Ashley, D. L., & Eriksen, M. P. (2018).
Are electronic nicotine delivery systems helping cigarette smokers quit? Evidence from a
prospective cohort study of U.S. adult smokers, 2015–2016. PLoS ONE, 13(7), 1–25.
Retrieved from https://doi.org/10.1371/journal.pone.0198047
Yoong, S. L., Stockings, E., Chai, L. K., Tzelepis, F., Wiggers, J., Oldmeadow, C., …
Wolfenden, L. (2018). Prevalence of electronic nicotine delivery systems (ENDS) uses
among youth globally: a systematic review and meta‐analysis of country-level
data. Australian & New Zealand Journal of Public Health, 42(3), 303–308. Retrieved
from https://doi.org/10.1111/1753-6405.12777