atomizer oil

Summary of U.S. e-cigarette policies and related reportsAs of September 18, 2019, the United States has reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaporized products, and 7 people have died. This has made the United States attach great importance to e-cigarettes and vaporized products. Congressional hearings, down to the states and e-cigarette manufacturers, are closely following relevant developments and successively issued attitudes and statements. In particular, flavored e-cigarettes have attracted attention due to their strong appeal to young people. The FDA in September It was announced on the 12th that it would issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention and even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . But from the market point of view, the reaction was strong. On the one hand, the health of e-cigarettes is being questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. The following is the important content of recent reports: On September 24, the United States held a congressional hearing on the issue of e-cigarettes. The preliminary results of the CDC investigation showed that about 80% of patients reported using tetrahydrocannabinol or THC e-liquid, and about 60% said they used e-cigarettes containing tetrahydrocannabinol or THC. Nicotine e-liquid, and about 10-20% of people claim that they only use nicotine-containing products. Although the source of the disease has not been determined, it can be clearly related to chemical exposure. The state of Illinois initially envisages banning the sale of flavored nicotine products. The American Lung Association report stated that 27.5% of young people now use e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The main reason for teenagers to use these products is the attraction of candies and fruit flavors. The American Lung Association will urge the FDA and Congress to ban all flavored tobacco products as soon as possible, including flavored cigars and menthol cigarettes. U.S. states have banned or are preparing to ban the sale of e-cigarettes. On June 25, the San Francisco City Supervisory Committee unanimously passed a ban on the sale of e-cigarettes. On September 15, New York State stated that it would ban the sale of flavored e-cigarettes, but retain the mint flavor. On September 18, Michigan announced a ban on the sale of flavored nicotine e-cigarettes, and the ban took effect immediately. On September 20, Wal-Mart announced that it would stop selling e-cigarettes after it sold out. On September 24, Massachusetts suspended the sale of all vaping products related to e-cigarettes for 4 months. The e-cigarette manufacturing company issued a statement that British Tobacco: 1) never added e-liquid containing THC and vitamin E acetate to its atomized products; 2) for 4 VUSE products planned to be launched in the United States, the company is confident in Submit PMTA before May 2020. Japan Tobacco International: In the Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. The market share and sales decline of cannabis-related atomized products compare the sales ratio of cannabis-related atomized products in the recreational cannabis product market on August 19 and September 16, and the ratio is showing a downward trend. Among them, California: decreased from 32.8% to 29%; Colorado: decreased from 19.2% to 14.5%; Nevada: decreased from 22.3% to 19.2%; Washington: decreased from 17.8% to 14.6%. Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, while the total sales of September 9-15 decreased to 689,924 U.S. dollars, a decrease of 25%. Risk warning: new tobacco policy changes risk, sales are not as expected; industrial hemp should be strictly distinguished from intermediate cannabis, recreational cannabis/drugs, and resolutely opposed to legalization of recreational cannabis. As of September 18, 2019, the United States has reported 530 confirmed cases Seven people died of lung diseases suspected to be related to the use of e-cigarettes or vaping products, making the United States attach great importance to e-cigarettes and vaping products, from congressional hearings to states and e-cigarette manufacturers. All are paying close attention to relevant developments and issuing attitudes and statements one after another, especially flavored e-cigarettes because of their strong appeal to young people. The FDA announced on September 12 that it will issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention to or even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . However, from the market point of view, the response was strong. On the one hand, the health of e-cigarettes has been questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. In order to give you a clearer understanding of recent reports on e-cigarettes in the United States, we have sorted out important content including relevant statements issued by congressional hearings, FDA, CDC, and states and e-cigarette manufacturers for reference. 1. Statement by relevant US agencies 1.1. Congressional hearing (2019/9/24) 1.1.1. Anne Schuchat, MD's speech (CDC, Chief Deputy Director of the Department of Health and Human Services) August 1, 2019, the first time in Wisconsin The Center for Disease Control and Prevention (CDC) was notified of a series of lung diseases that have appeared in young people since July 2019. As of September 18, 2019, 38 states and 1 region in the United States have reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaping products. There are already 6 states (California, Illinois, Indiana). States, Kansas, Minnesota and Oregon). These tragic deaths have exacerbated the urgency of the CDC and the FDA to jointly investigate the cause and provide states with the necessary resources to solve this emerging public health problem. CDC established a case investigation team in August and activated the Emergency Operations Center on September 16 to enable it to devote more resources to this investigation. 1) Case summary For many reasons, investigating the causes of lung injury related to the use of e-cigarettes or aerosol products is quite challenging. a. The investigation involves many states; b. The diversity of the e-cigarette or atomized product market, the wide variety of products, the wide range of ingredients, and the connection with potentially illegal substances such as marijuana all complicate the investigation. Consumers do not know what their e-cigarettes or atomized products contain, and many products and substances themselves can be modified by consumers. They can be obtained from physical stores, online retailers, on the street, or through social channels. Preliminary results: According to data collected in two states and recently published in the New England Journal of Medicine, most patients (about 80%) report using cigarettes containing tetrahydrocannabinol or THC (the psychoactive compound of cannabis) Oil, and half (about 60%) of people said they use nicotine-containing e-liquid, while about 10-20% said they only use nicotine-containing products. However, no e-cigarette or atomized product, a certain brand or a specific substance has a clear connection with the epidemic. CDC has received complete gender and age data for 373 of the 530 cases. Almost three-quarters of the cases are men. Two-thirds of the cases were between 18 and 34 years old, 16% were under 18 years old, and 17% were over 35 years old. The lung damage observed in this incident does not seem to be caused by infection. The pathological findings and the results of the non-infectious diagnosis indicate that the cause of the disease is related to exposure to chemical substances. Patients first showed signs of illness within a few days to a few weeks after using e-cigarettes or aerosol products, and gradually developed symptoms such as dyspnea, shortness of breath, or chest pain before hospitalization. Some patients developed mild to moderate gastrointestinal diseases. There are other symptoms including fatigue, fever and weight loss. So far, investigators have not found any specific products or compounds related to all cases. 2) Youth e-cigarette use data Preliminary data from the 2019 National Youth Tobacco Survey show that the use of youth e-cigarettes continues to rise. Data show that in 2019, more than a quarter of high school students currently (in the past 30 days) use e-cigarettes, a significant increase compared to 2017. From 2017 to 2018, the number of e-cigarettes used by high school students increased by 77.8%, and more than a quarter of high school students are currently using tobacco products. 3) Hazards associated with cannabis use CDC is committed to monitoring cannabis use, identifying related health effects, and improving the monitoring capabilities of CDC and state/local jurisdictions. In this outbreak, many patients used e-cigarettes or vaporized products containing THC, which indicates the need to understand the health effects of the increasing use of cannabis and the changing market in the United States, as states are working on the legalization of cannabis. For medical or recreational purposes. In 2018, it is estimated that 16% of the population 12 years and older uses marijuana. 4) CDC鈥檚 recommendations to manufacturers, states, and the public. CDC recommends that the public who are worried that e-cigarettes or vaping products may cause lung diseases should consider avoiding e-cigarettes or vaping products. Teenagers, pregnant women, or non-smokers do not Electronic cigarettes should be used. Anyone who uses electronic cigarettes or vaping products should not buy these products on the street, and should not modify or add ingredients on their own. 1.1.2. NgoziO. Ezike's speech (Director of the Illinois Department of Public Health) 69 people in Illinois suffered from serious respiratory diseases after using e-cigarettes or aerosol products, and 1 person died. The patients were between 15-42 years old, with a median of 22 years old, and most of them were men. Although the cause of the illness has not yet been determined, it is certain that smoking e-cigarettes is not a healthy behavior and is not conducive to the health of young people. Illinois began investigating after learning that some residents had respiratory diseases related to e-cigarettes on July 31, 2019, and issued an alert to the Department of Health on August 2 to conduct a cooperative investigation with the CDC and start investigating the effects of e-cigarettes. The prevalence and habit of smoking e-cigarettes among adolescents, and measures such as youth education, case studies, and related legal studies. Nevertheless, on the one hand, the number of patients per day is still increasing. More than 90% are admitted to the hospital for treatment, 72% of which are sent to the intensive care unit, and nearly 30% require medical devices to help breathe. On the other hand, the use of flavored e-cigarettes is increasing. The survey shows that 1) 68% of young people used flavored e-cigarettes in 2019, accounting for 61% in 2017; 2) The 2017 survey found that 63% of young people did not understand The JUUL products they use contain nicotine; 3) From 2011 to 2015, the number of e-cigarettes used by middle school students increased by 900%. 4) A 2018 study found that more than 3.6 million young people use e-cigarettes. The focus group found that the number of young people using e-cigarettes is increasing and there is a trend of addiction. From 2008 to 2018, the number of high school students in Illinois who smoked in the total tobacco market fell from 21% to 5%, but in 2016-2018 , The proportion of e-cigarette usage among high school students rose from 18.4% to 26.7%. The current preliminary idea is to ban flavored nicotine products and study the long- and short-term effects of atomized products on health. The governor of Illinois supported the enactment of legal provisions in the legislative session in October to ban the sale of flavored vaping products specifically targeted at young people. 1.1.3. Albert A. Rizzo's speech (Chief Medical Officer of the American Lung Association) There are two different e-cigarette crises in our country. One is the prevalence and increasing popularity of young people using e-cigarettes; the other is the recent outbreak of lung diseases caused by vaping products in adults and adolescents. According to the 2019 National Tobacco Youth Survey, 27.5% of young people are now using e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The survey asked students whether they had smoked for at least 20 days in the past 30 days? 12% of Grade 12 students, 7% of Grade 10 students, and 2% of Grade 8 students said they do this often. A 2018 CDC study showed that the main reason why teenagers use these products is that the taste of sweets and fruits attracts them, while their friends and family are using them, and they think that e-cigarettes are less harmful. The American Lung Association will urge the FDA and Congress to take action as soon as possible to ban the sale of all flavored tobacco products, including flavored cigars and menthol cigarettes. Regarding the health hazards of e-cigarettes, there are many misleadings, and some of the reasons lead to a high proportion of young people using e-cigarettes. In January 2018, the National Academies of Science, Engineering and Medicine released a research report that reviewed more than 800 different studies. The report clearly pointed out that the use of e-cigarettes is harmful to health, will increase the chance of children and young people starting to use e-cigarettes, and expose others to dangerous second-hand e-cigarette emissions. They concluded that there is "a large amount of evidence" that if young people use electronic cigarettes, the possibility of using traditional cigarettes will increase. A study in Pediatrics magazine also found that young people who use e-cigarettes are four times more likely to try traditional cigarettes than young people who do not use e-cigarettes. According to a study published in the Journal of the American Medical Association in 2015, 81% of young people have ever used tobacco products made from flavored products. Fruit, mint and menthol are the most popular flavors among middle school students who use e-cigarettes. Among them, 65.9% of children use fruit-flavored e-cigarettes, and 63.9% of children use mint or menthol e-cigarettes. The taste in e-cigarettes is produced by a combination of chemicals, which carry a serious risk of lung damage. A 2015 study at Harvard University tested 51 different flavors of e-cigarettes, including marshmallow, bubble gum, and cupcakes, and found that 47 of them were related to at least one chemical substance related to respiratory diseases. E-cigarettes are not smoking cessation products. Smokers who switch to e-cigarettes may also be using traditional cigarettes. "Annals of Internal MedicinA study on "e" found that the probability of wanting to use e-cigarettes to help quit smoking is lower. Only 10.1% of smokers who used e-cigarettes for six months quit smoking, while 26.6% of smokers who did not use e-cigarettes quit smoking . 1.2. FDA intends to ban the sale of flavored e-cigarettes (2019/9/12) On September 12, the FDA stated that in order to reduce the use of e-cigarettes among young people, it will issue a policy to ban the sale of flavored e-cigarettes (including mint flavored e-cigarettes) within a few weeks. ). 1.3. CDC released its views on the causes of death from e-cigarettes (2019/9/19) The latest report from the Centers for Disease Control and Prevention (CDC) of the United States stated that the number of people suffering from lung diseases due to e-cigarettes has soared to 530 in 38 states, as of At present, 7 people have died, causing the Governor of Indiana to pay attention to the ban on flavored e-cigarettes, and corresponding measures may be taken. The CDC is currently unable to determine the specific cause, but they believe that it is caused by chemical exposure. Most of the cases are related to illegal e-cigarette liquid, which contains THC ingredients. These products are from the black market and are not formal e-cigarette stores. But even so, e-cigarette retailers Will also be greatly affected. The American Lung Research Association believes that the country should take action as soon as possible, hoping to remove the flavored e-cigarettes before further research. 2. U.S. states have banned or are preparing to ban the sale of e-cigarettes 2.1. San Francisco became the first city to ban the sale of e-cigarettes (2019/6/25) On June 25, the San Francisco City Supervisory Committee unanimously approved a total ban on the sale of e-cigarettes The regulations stipulate that e-cigarettes will be banned unless they have been reviewed by the FDA鈥檚 PMTA. The regulations are planned to be fully implemented in six months. 2.2. New York State will ban the sale of flavored e-cigarettes, but retain the mint flavor (2019/9/15) Como signed an executive order on September 12 requiring e-cigarettes to be included in New York鈥檚 anti-smoking activities. According to the Cuomo office, 1) Dr. Howard Zucker, commissioner of the State Department of Health, will recommend this week to the State Public Health and Health Planning Commission to issue emergency regulations, which will take effect within two weeks at the earliest. 2) Como has instructed the New York police and the Department of Health to strengthen law enforcement, and retailers who sell e-cigarettes to minors may be subject to criminal penalties; in addition, Como plans to promote legislation to prohibit deceptive marketing of e-cigarettes to teenagers and children. However, the decree does not affect tobacco-based and menthol-flavored e-cigarettes. Trump said last week that an investigation by the Department of Health found hundreds of respiratory disease cases among consumers who use e-cigarettes, so the federal government plans to ban the sale of thousands of flavors in e-cigarettes. Although many cases involve smoking marijuana, problems with the devices, ingredients or additives have not yet been discovered. 2.3. Michigan bans the sale of flavored e-cigarettes (2019/9/18) On September 18, Michigan announced the ban on the sale of flavored nicotine e-cigarettes. The ban will take effect immediately, but there is still a 14-day buffer period for merchants, and the ban will be It lasts for 6 months, but the governor has the right to extend the period. 2.4. Wal-Mart stops selling e-cigarettes (2019/9/20) On September 20, Wal-Mart announced that it would stop selling e-cigarettes. After the current inventory is sold out, it will stop selling e-cigarettes in Wal-Mart stores and Sam’s Clubs. In July of this year, Wal-Mart raised the minimum age for purchasing tobacco products, including all e-cigarettes, to 21 years old, and has indicated that it is discontinuing the sale of fruit-flavored and dessert-flavored e-cigarettes. E-cigarettes are mainly sold through e-cigarette specialty stores, and there are approximately 115,000 specialty stores in the United States. The e-cigarette business only occupies a small part of Wal-Mart, so it has little impact on Wal-Mart. However, Wal-Mart Store + Sam’s Clubs has more than 5,000 stores in the United States. Wal-Mart鈥檚 suspension of sales will reduce the chance of direct contact between e-cigarettes and consumers. It is also difficult to find a replacement for this huge sales channel. 2.5. The state of Massachusetts suspends the sale of all vaping products related to e-cigarettes (2019/9/24) The state of Massachusetts has decided to suspend the sale of all vaping products related to e-cigarettes for 4 months (as of January 25 next year) No.), 1) This emergency suspension is mainly to cooperate with expert doctors to find out the cause of the disease; 2) Currently, the FDA laboratory is testing more than 150 suspicious product samples, but the cause of the patient鈥檚 lung disease has not yet been determined. 3. E-cigarette manufacturing company statement 3.1. British American Tobacco 3.1.1. Response to the US FDA's announcement of atomized products (2019/9/9) British American Tobacco Research Director Dr David O & rsquo; Reilly said that company toxicologists misted the company Each single ingredient in the chemical product has been carefully checked to see if they are suitable for atomization. And the company has never added e-liquid containing THC and vitamin E acetate to atomized products. The tragic incident was because these e-liquids were not purchased from well-known manufacturers and contained ingredients not used by the manufacturers (including THC and vitamin E acetate). The company supports the FDA鈥檚 view that users of vaping products should always buy smoking sets and e-liquids from reputable manufacturers, and should avoid modifying or adding substances to the products they buy, and should use these according to the manufacturer鈥檚 intentions. product. 3.1.2. Statement on supporting strong product quality standards, measures to prevent the use of young people in the United States, and preparing to apply for PMTA at any time (2019/9/12) 1) The company expressed its concern about the marketing of certain flavored products like the FDA Attract the attention of young people. At the same time, it is difficult to overestimate the role of flavored products in helping adult consumers switch from combustible products to alternative tobacco and nicotine products. The company has established corresponding procedures to ensure that its products are only sold to adult smokers and users of vaping products. 2) For the four VUSE products planned to be launched in the United States, the company is confident that it can submit Pre-Market Tobacco Applications (PMTA) before the deadline announced by the FDA (May 2020). If approved, our Reynolds Tobacco will be able to continue to sell its VUSE brand atomized products within the new regulatory framework in the United States. 3.1.3. Statement on the need for strong and effective atomization product supervision (2019/9/20) The company stated that no products developed or produced by British American Tobacco were involved in recent e-cigarette lung disease cases, and it supports investigations made by relevant agencies , And hopes to introduce strong and effective regulations to ensure high product standards, especially in testing and reporting the ingredients used in the e-liquid of atomized products. At the same time, the government also needs to ensure that relevant agencies force manufacturers to comply with these regulations, only through effective With supervision and law enforcement, consumers can maintain confidence in the harm reduction effects of atomized products compared to traditional tobacco. 3.2. Japan Tobacco International 3.2.1. Regarding the response to lung disease cases in the United States (2019/9/13) So far, the US Department of Health is investigating 450 cases of lung disease that may be related to the use of e-cigarettes. Currently, there is little information about the products involved and the underlying causes. We are not aware of any Logic products associated with these cases and are under investigation. We have learned from media reports that many patients have admitted to using e-cigarettes containing THC e-liquid. In addition, it is reported that vitamin E acetate, a chemical substance related to hemp oil, was found in many relevant samples analyzed by the authorities. In our Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. At JTI, we will know exactly the ingredients of Logic: all Logic e-liquids undergo a strict product management plan, including toxicological evaluation and quality control of all ingredients used. Logic e-liquid can only be sold after passing a comprehensive inspection. Nebulizer users should not use the e-liquid produced by manufacturers that have not undergone strict safety and quality inspections. After design and testing, smoking sets and cartridges that can be used together should always be paired with each other. 4. Market share and sales decline of marijuana-related vaping products Since the first death case related to e-cigarettes was reported on August 23, the sales proportion of marijuana-related vaping products in the recreational marijuana product market decline. Comparing the sales data on August 19 and September 16, California: 32.8% decreased to 29%; Colorado: 19.2% decreased to 14.5%; Nevada: 22.3% decreased to 19.2%; Washington: 17.8% decreased to 14.6 %. (Report time: 2019/9/12) Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, and September 9 Total sales from Japan to 15th fell to US$689,924, a decrease of 25%. (Reporting time: 2019/9/19)Summary of U.S. e-cigarette policies and related reportsAs of September 18, 2019, the United States has reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaporized products, and 7 people have died. This has made the United States attach great importance to e-cigarettes and vaporized products. Congressional hearings, down to the states and e-cigarette manufacturers, are closely following relevant developments and successively issued attitudes and statements. In particular, flavored e-cigarettes have attracted attention due to their strong appeal to young people. The FDA in September It was announced on the 12th that it would issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention and even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . But from the market point of view, the reaction was strong. On the one hand, the health of e-cigarettes is being questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. The following is the important content of recent reports: On September 24, the United States held a congressional hearing on the issue of e-cigarettes. The preliminary results of the CDC investigation showed that about 80% of patients reported using tetrahydrocannabinol or THC e-liquid, and about 60% said they used e-cigarettes containing tetrahydrocannabinol or THC. Nicotine e-liquid, and about 10-20% of people claim that they only use nicotine-containing products. Although the source of the disease has not been determined, it can be clearly related to chemical exposure. The state of Illinois initially envisages banning the sale of flavored nicotine products. The American Lung Association report stated that 27.5% of young people now use e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The main reason for teenagers to use these products is the attraction of candies and fruit flavors. The American Lung Association will urge the FDA and Congress to ban all flavored tobacco products as soon as possible, including flavored cigars and menthol cigarettes. U.S. states have banned or are preparing to ban the sale of e-cigarettes. On June 25, the San Francisco City Supervisory Committee unanimously passed a ban on the sale of e-cigarettes. On September 15, New York State stated that it would ban the sale of flavored e-cigarettes, but retain the mint flavor. On September 18, Michigan announced a ban on the sale of flavored nicotine e-cigarettes, and the ban took effect immediately. On September 20, Wal-Mart announced that it would stop selling e-cigarettes after it sold out. On September 24, Massachusetts suspended the sale of all vaping products related to e-cigarettes for 4 months. The e-cigarette manufacturing company issued a statement that British Tobacco: 1) never added e-liquid containing THC and vitamin E acetate to its atomized products; 2) for 4 VUSE products planned to be launched in the United States, the company is confident in Submit PMTA before May 2020. Japan Tobacco International: In the Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. The market share and sales decline of cannabis-related atomized products compare the sales ratio of cannabis-related atomized products in the recreational cannabis product market on August 19 and September 16, and the ratio is showing a downward trend. Among them, California: decreased from 32.8% to 29%; Colorado: decreased from 19.2% to 14.5%; Nevada: decreased from 22.3% to 19.2%; Washington: decreased from 17.8% to 14.6%. Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, while the total sales of September 9-15 decreased to 689,924 U.S. dollars, a decrease of 25%. Risk warning: new tobacco policy changes risk, sales are not as expected; industrial hemp should be strictly distinguished from intermediate cannabis, recreational cannabis/drugs, and resolutely opposed to legalization of recreational cannabis. As of September 18, 2019, the United States has reported 530 confirmed cases Seven people died of lung diseases suspected to be related to the use of e-cigarettes or vaping products, making the United States attach great importance to e-cigarettes and vaping products, from congressional hearings to states and e-cigarette manufacturers. All are paying close attention to relevant developments and issuing attitudes and statements one after another, especially flavored e-cigarettes because of their strong appeal to young people. The FDA announced on September 12 that it will issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention to or even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . However, from the market point of view, the response was strong. On the one hand, the health of e-cigarettes has been questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. In order to give you a clearer understanding of recent reports on e-cigarettes in the United States, we have sorted out important content including relevant statements issued by congressional hearings, FDA, CDC, and states and e-cigarette manufacturers for reference. 1. Statement by relevant US agencies 1.1. Congressional hearing (2019/9/24) 1.1.1. Anne Schuchat, MD's speech (CDC, Chief Deputy Director of the Department of Health and Human Services) August 1, 2019, the first time in Wisconsin The Center for Disease Control and Prevention (CDC) was notified of a series of lung diseases that have appeared in young people since July 2019. As of September 18, 2019, 38 states and 1 region in the United States have reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaping products. There are already 6 states (California, Illinois, Indiana). States, Kansas, Minnesota and Oregon). These tragic deaths have exacerbated the urgency of the CDC and the FDA to jointly investigate the cause and provide states with the necessary resources to solve this emerging public health problem. CDC established a case investigation team in August and activated the Emergency Operations Center on September 16 to enable it to devote more resources to this investigation. 1) Case summary For many reasons, investigating the causes of lung injury related to the use of e-cigarettes or aerosol products is quite challenging. a. The investigation involves many states; b. The diversity of the e-cigarette or atomized product market, the wide variety of products, the wide range of ingredients, and the connection with potentially illegal substances such as marijuana all complicate the investigation. Consumers do not know what their e-cigarettes or atomized products contain, and many products and substances themselves can be modified by consumers. They can be obtained from physical stores, online retailers, on the street, or through social channels. Preliminary results: According to data collected in two states and recently published in the New England Journal of Medicine, most patients (about 80%) report using cigarettes containing tetrahydrocannabinol or THC (the psychoactive compound of cannabis) Oil, and half (about 60%) of people said they use nicotine-containing e-liquid, while about 10-20% said they only use nicotine-containing products. However, no e-cigarette or atomized product, a certain brand or a specific substance has a clear connection with the epidemic. CDC has received complete gender and age data for 373 of the 530 cases. Almost three-quarters of the cases are men. Two-thirds of the cases were between 18 and 34 years old, 16% were under 18 years old, and 17% were over 35 years old. The lung damage observed in this incident does not seem to be caused by infection. The pathological findings and the results of the non-infectious diagnosis indicate that the cause of the disease is related to exposure to chemical substances. Patients first showed signs of illness within a few days to a few weeks after using e-cigarettes or aerosol products, and gradually developed symptoms such as dyspnea, shortness of breath, or chest pain before hospitalization. Some patients developed mild to moderate gastrointestinal diseases. There are other symptoms including fatigue, fever and weight loss. So far, investigators have not found any specific products or compounds related to all cases. 2) Youth e-cigarette use data Preliminary data from the 2019 National Youth Tobacco Survey show that the use of youth e-cigarettes continues to rise. Data show that in 2019, more than a quarter of high school students currently (in the past 30 days) use e-cigarettes, a significant increase compared to 2017. From 2017 to 2018, the number of e-cigarettes used by high school students increased by 77.8%, and more than a quarter of high school students are currently using tobacco products. 3) Hazards associated with cannabis use CDC is committed to monitoring cannabis use, identifying related health effects, and improving the monitoring capabilities of CDC and state/local jurisdictions. In this outbreak, many patients used e-cigarettes or vaporized products containing THC, which indicates the need to understand the health effects of the increasing use of cannabis and the changing market in the United States, as states are working on the legalization of cannabis. For medical or recreational purposes. In 2018, it is estimated that 16% of the population 12 years and older uses marijuana. 4) CDC鈥檚 recommendations to manufacturers, states, and the public. CDC recommends that the public who are worried that e-cigarettes or vaping products may cause lung diseases should consider avoiding e-cigarettes or vaping products. Teenagers, pregnant women, or non-smokers do not Electronic cigarettes should be used. Anyone who uses electronic cigarettes or vaping products should not buy these products on the street, and should not modify or add ingredients on their own. 1.1.2. NgoziO. Ezike's speech (Director of the Illinois Department of Public Health) 69 people in Illinois suffered from serious respiratory diseases after using e-cigarettes or aerosol products, and 1 person died. The patients were between 15-42 years old, with a median of 22 years old, and most of them were men. Although the cause of the illness has not yet been determined, it is certain that smoking e-cigarettes is not a healthy behavior and is not conducive to the health of young people. Illinois began investigating after learning that some residents had respiratory diseases related to e-cigarettes on July 31, 2019, and issued an alert to the Department of Health on August 2 to conduct a cooperative investigation with the CDC and start investigating the effects of e-cigarettes. The prevalence and habit of smoking e-cigarettes among adolescents, and measures such as youth education, case studies, and related legal studies. Nevertheless, on the one hand, the number of patients per day is still increasing. More than 90% are admitted to the hospital for treatment, 72% of which are sent to the intensive care unit, and nearly 30% require medical devices to help breathe. On the other hand, the use of flavored e-cigarettes is increasing. The survey shows that 1) 68% of young people used flavored e-cigarettes in 2019, accounting for 61% in 2017; 2) The 2017 survey found that 63% of young people did not understand The JUUL products they use contain nicotine; 3) From 2011 to 2015, the number of e-cigarettes used by middle school students increased by 900%. 4) A 2018 study found that more than 3.6 million young people use e-cigarettes. The focus group found that the number of young people using e-cigarettes is increasing and there is a trend of addiction. From 2008 to 2018, the number of high school students in Illinois who smoked in the total tobacco market fell from 21% to 5%, but in 2016-2018 , The proportion of e-cigarette usage among high school students rose from 18.4% to 26.7%. The current preliminary idea is to ban flavored nicotine products and study the long- and short-term effects of atomized products on health. The governor of Illinois supported the enactment of legal provisions in the legislative session in October to ban the sale of flavored vaping products specifically targeted at young people. 1.1.3. Albert A. Rizzo's speech (Chief Medical Officer of the American Lung Association) There are two different e-cigarette crises in our country. One is the prevalence and increasing popularity of young people using e-cigarettes; the other is the recent outbreak of lung diseases caused by vaping products in adults and adolescents. According to the 2019 National Tobacco Youth Survey, 27.5% of young people are now using e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The survey asked students whether they had smoked for at least 20 days in the past 30 days? 12% of Grade 12 students, 7% of Grade 10 students, and 2% of Grade 8 students said they do this often. A 2018 CDC study showed that the main reason why teenagers use these products is that the taste of sweets and fruits attracts them, while their friends and family are using them, and they think that e-cigarettes are less harmful. The American Lung Association will urge the FDA and Congress to take action as soon as possible to ban the sale of all flavored tobacco products, including flavored cigars and menthol cigarettes. Regarding the health hazards of e-cigarettes, there are many misleadings, and some of the reasons lead to a high proportion of young people using e-cigarettes. In January 2018, the National Academies of Science, Engineering and Medicine released a research report that reviewed more than 800 different studies. The report clearly pointed out that the use of e-cigarettes is harmful to health, will increase the chance of children and young people starting to use e-cigarettes, and expose others to dangerous second-hand e-cigarette emissions. They concluded that there is "a large amount of evidence" that if young people use electronic cigarettes, the possibility of using traditional cigarettes will increase. A study in Pediatrics magazine also found that young people who use e-cigarettes are four times more likely to try traditional cigarettes than young people who do not use e-cigarettes. According to a study published in the Journal of the American Medical Association in 2015, 81% of young people have ever used tobacco products made from flavored products. Fruit, mint and menthol are the most popular flavors among middle school students who use e-cigarettes. Among them, 65.9% of children use fruit-flavored e-cigarettes, and 63.9% of children use mint or menthol e-cigarettes. The taste in e-cigarettes is produced by a combination of chemicals, which carry a serious risk of lung damage. A 2015 study at Harvard University tested 51 different flavors of e-cigarettes, including marshmallow, bubble gum, and cupcakes, and found that 47 of them were related to at least one chemical substance related to respiratory diseases. E-cigarettes are not smoking cessation products. Smokers who switch to e-cigarettes may also be using traditional cigarettes. "Annals of Internal MedicinA study on "e" found that the probability of wanting to use e-cigarettes to help quit smoking is lower. Only 10.1% of smokers who used e-cigarettes for six months quit smoking, while 26.6% of smokers who did not use e-cigarettes quit smoking . 1.2. FDA intends to ban the sale of flavored e-cigarettes (2019/9/12) On September 12, the FDA stated that in order to reduce the use of e-cigarettes among young people, it will issue a policy to ban the sale of flavored e-cigarettes (including mint flavored e-cigarettes) within a few weeks. ). 1.3. CDC released its views on the causes of death from e-cigarettes (2019/9/19) The latest report from the Centers for Disease Control and Prevention (CDC) of the United States stated that the number of people suffering from lung diseases due to e-cigarettes has soared to 530 in 38 states, as of At present, 7 people have died, causing the Governor of Indiana to pay attention to the ban on flavored e-cigarettes, and corresponding measures may be taken. The CDC is currently unable to determine the specific cause, but they believe that it is caused by chemical exposure. Most of the cases are related to illegal e-cigarette liquid, which contains THC ingredients. These products are from the black market and are not formal e-cigarette stores. But even so, e-cigarette retailers Will also be greatly affected. The American Lung Research Association believes that the country should take action as soon as possible, hoping to remove the flavored e-cigarettes before further research. 2. U.S. states have banned or are preparing to ban the sale of e-cigarettes 2.1. San Francisco became the first city to ban the sale of e-cigarettes (2019/6/25) On June 25, the San Francisco City Supervisory Committee unanimously approved a total ban on the sale of e-cigarettes The regulations stipulate that e-cigarettes will be banned unless they have been reviewed by the FDA鈥檚 PMTA. The regulations are planned to be fully implemented in six months. 2.2. New York State will ban the sale of flavored e-cigarettes, but retain the mint flavor (2019/9/15) Como signed an executive order on September 12 requiring e-cigarettes to be included in New York鈥檚 anti-smoking activities. According to the Cuomo office, 1) Dr. Howard Zucker, commissioner of the State Department of Health, will recommend this week to the State Public Health and Health Planning Commission to issue emergency regulations, which will take effect within two weeks at the earliest. 2) Como has instructed the New York police and the Department of Health to strengthen law enforcement, and retailers who sell e-cigarettes to minors may be subject to criminal penalties; in addition, Como plans to promote legislation to prohibit deceptive marketing of e-cigarettes to teenagers and children. However, the decree does not affect tobacco-based and menthol-flavored e-cigarettes. Trump said last week that an investigation by the Department of Health found hundreds of respiratory disease cases among consumers who use e-cigarettes, so the federal government plans to ban the sale of thousands of flavors in e-cigarettes. Although many cases involve smoking marijuana, problems with the devices, ingredients or additives have not yet been discovered. 2.3. Michigan bans the sale of flavored e-cigarettes (2019/9/18) On September 18, Michigan announced the ban on the sale of flavored nicotine e-cigarettes. The ban will take effect immediately, but there is still a 14-day buffer period for merchants, and the ban will be It lasts for 6 months, but the governor has the right to extend the period. 2.4. Wal-Mart stops selling e-cigarettes (2019/9/20) On September 20, Wal-Mart announced that it would stop selling e-cigarettes. After the current inventory is sold out, it will stop selling e-cigarettes in Wal-Mart stores and Sam’s Clubs. In July of this year, Wal-Mart raised the minimum age for purchasing tobacco products, including all e-cigarettes, to 21 years old, and has indicated that it is discontinuing the sale of fruit-flavored and dessert-flavored e-cigarettes. E-cigarettes are mainly sold through e-cigarette specialty stores, and there are approximately 115,000 specialty stores in the United States. The e-cigarette business only occupies a small part of Wal-Mart, so it has little impact on Wal-Mart. However, Wal-Mart Store + Sam’s Clubs has more than 5,000 stores in the United States. Wal-Mart鈥檚 suspension of sales will reduce the chance of direct contact between e-cigarettes and consumers. It is also difficult to find a replacement for this huge sales channel. 2.5. The state of Massachusetts suspends the sale of all vaping products related to e-cigarettes (2019/9/24) The state of Massachusetts has decided to suspend the sale of all vaping products related to e-cigarettes for 4 months (as of January 25 next year) No.), 1) This emergency suspension is mainly to cooperate with expert doctors to find out the cause of the disease; 2) Currently, the FDA laboratory is testing more than 150 suspicious product samples, but the cause of the patient鈥檚 lung disease has not yet been determined. 3. E-cigarette manufacturing company statement 3.1. British American Tobacco 3.1.1. Response to the US FDA's announcement of atomized products (2019/9/9) British American Tobacco Research Director Dr David O & rsquo; Reilly said that company toxicologists misted the company Each single ingredient in the chemical product has been carefully checked to see if they are suitable for atomization. And the company has never added e-liquid containing THC and vitamin E acetate to atomized products. The tragic incident was because these e-liquids were not purchased from well-known manufacturers and contained ingredients not used by the manufacturers (including THC and vitamin E acetate). The company supports the FDA鈥檚 view that users of vaping products should always buy smoking sets and e-liquids from reputable manufacturers, and should avoid modifying or adding substances to the products they buy, and should use these according to the manufacturer鈥檚 intentions. product. 3.1.2. Statement on supporting strong product quality standards, measures to prevent the use of young people in the United States, and preparing to apply for PMTA at any time (2019/9/12) 1) The company expressed its concern about the marketing of certain flavored products like the FDA Attract the attention of young people. At the same time, it is difficult to overestimate the role of flavored products in helping adult consumers switch from combustible products to alternative tobacco and nicotine products. The company has established corresponding procedures to ensure that its products are only sold to adult smokers and users of vaping products. 2) For the four VUSE products planned to be launched in the United States, the company is confident that it can submit Pre-Market Tobacco Applications (PMTA) before the deadline announced by the FDA (May 2020). If approved, our Reynolds Tobacco will be able to continue to sell its VUSE brand atomized products within the new regulatory framework in the United States. 3.1.3. Statement on the need for strong and effective atomization product supervision (2019/9/20) The company stated that no products developed or produced by British American Tobacco were involved in recent e-cigarette lung disease cases, and it supports investigations made by relevant agencies , And hopes to introduce strong and effective regulations to ensure high product standards, especially in testing and reporting the ingredients used in the e-liquid of atomized products. At the same time, the government also needs to ensure that relevant agencies force manufacturers to comply with these regulations, only through effective With supervision and law enforcement, consumers can maintain confidence in the harm reduction effects of atomized products compared to traditional tobacco. 3.2. Japan Tobacco International 3.2.1. Regarding the response to lung disease cases in the United States (2019/9/13) So far, the US Department of Health is investigating 450 cases of lung disease that may be related to the use of e-cigarettes. Currently, there is little information about the products involved and the underlying causes. We are not aware of any Logic products associated with these cases and are under investigation. We have learned from media reports that many patients have admitted to using e-cigarettes containing THC e-liquid. In addition, it is reported that vitamin E acetate, a chemical substance related to hemp oil, was found in many relevant samples analyzed by the authorities. In our Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. At JTI, we will know exactly the ingredients of Logic: all Logic e-liquids undergo a strict product management plan, including toxicological evaluation and quality control of all ingredients used. Logic e-liquid can only be sold after passing a comprehensive inspection. Nebulizer users should not use the e-liquid produced by manufacturers that have not undergone strict safety and quality inspections. After design and testing, smoking sets and cartridges that can be used together should always be paired with each other. 4. Market share and sales decline of marijuana-related vaping products Since the first death case related to e-cigarettes was reported on August 23, the sales proportion of marijuana-related vaping products in the recreational marijuana product market decline. Comparing the sales data on August 19 and September 16, California: 32.8% decreased to 29%; Colorado: 19.2% decreased to 14.5%; Nevada: 22.3% decreased to 19.2%; Washington: 17.8% decreased to 14.6 %. (Report time: 2019/9/12) Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, and September 9 Total sales from Japan to 15th fell to US$689,924, a decrease of 25%. (Reporting time: 2019/9/19)As of September 18, 2019, the United States has reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaporized products, and 7 people have died. This has made the United States attach great importance to e-cigarettes and vaporized products. Congressional hearings, down to the states and e-cigarette manufacturers, are closely following relevant developments and successively issued attitudes and statements. In particular, flavored e-cigarettes have attracted attention due to their strong appeal to young people. The FDA in September It was announced on the 12th that it would issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention and even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . But from the market point of view, the reaction was strong. On the one hand, the health of e-cigarettes is being questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. The following is the important content of recent reports: On September 24, the United States held a congressional hearing on the issue of e-cigarettes. The preliminary results of the CDC investigation showed that about 80% of patients reported using tetrahydrocannabinol or THC e-liquid, and about 60% said they used e-cigarettes containing tetrahydrocannabinol or THC. Nicotine e-liquid, and about 10-20% of people claim that they only use nicotine-containing products. Although the source of the disease has not been determined, it can be clearly related to chemical exposure. The state of Illinois initially envisages banning the sale of flavored nicotine products. The American Lung Association report stated that 27.5% of young people now use e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The main reason for teenagers to use these products is the attraction of candies and fruit flavors. The American Lung Association will urge the FDA and Congress to ban all flavored tobacco products as soon as possible, including flavored cigars and menthol cigarettes. U.S. states have banned or are preparing to ban the sale of e-cigarettes. On June 25, the San Francisco City Supervisory Committee unanimously passed a ban on the sale of e-cigarettes. On September 15, New York State stated that it would ban the sale of flavored e-cigarettes, but retain the mint flavor. On September 18, Michigan announced a ban on the sale of flavored nicotine e-cigarettes, and the ban took effect immediately. On September 20, Wal-Mart announced that it would stop selling e-cigarettes after it sold out. On September 24, Massachusetts suspended the sale of all vaping products related to e-cigarettes for 4 months. The e-cigarette manufacturing company issued a statement that British Tobacco: 1) never added e-liquid containing THC and vitamin E acetate to its atomized products; 2) for 4 VUSE products planned to be launched in the United States, the company is confident in Submit PMTA before May 2020. Japan Tobacco International: In the Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. The market share and sales decline of cannabis-related atomized products compare the sales ratio of cannabis-related atomized products in the recreational cannabis product market on August 19 and September 16, and the ratio is showing a downward trend. Among them, California: decreased from 32.8% to 29%; Colorado: decreased from 19.2% to 14.5%; Nevada: decreased from 22.3% to 19.2%; Washington: decreased from 17.8% to 14.6%. Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, while the total sales of September 9-15 decreased to 689,924 U.S. dollars, a decrease of 25%. Risk warning: new tobacco policy changes risk, sales are not as expected; industrial hemp should be strictly distinguished from intermediate cannabis, recreational cannabis/drugs, and resolutely opposed to legalization of recreational cannabis. As of September 18, 2019, the United States has reported 530 confirmed cases Seven people died of lung diseases suspected to be related to the use of e-cigarettes or vaping products, making the United States attach great importance to e-cigarettes and vaping products, from congressional hearings to states and e-cigarette manufacturers. All are paying close attention to relevant developments and issuing attitudes and statements one after another, especially flavored e-cigarettes because of their strong appeal to young people. The FDA announced on September 12 that it will issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention to or even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . However, from the market point of view, the response was strong. On the one hand, the health of e-cigarettes has been questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. In order to give you a clearer understanding of recent reports on e-cigarettes in the United States, we have sorted out important content including relevant statements issued by congressional hearings, FDA, CDC, and states and e-cigarette manufacturers for reference. 1. Statement by relevant US agencies 1.1. Congressional hearing (2019/9/24) 1.1.1. Anne Schuchat, MD's speech (CDC, Chief Deputy Director of the Department of Health and Human Services) August 1, 2019, the first time in Wisconsin The Center for Disease Control and Prevention (CDC) was notified of a series of lung diseases that have appeared in young people since July 2019. As of September 18, 2019, 38 states and 1 region in the United States have reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaping products. There are already 6 states (California, Illinois, Indiana). States, Kansas, Minnesota and Oregon). These tragic deaths have exacerbated the urgency of the CDC and the FDA to jointly investigate the cause and provide states with the necessary resources to solve this emerging public health problem. CDC established a case investigation team in August and activated the Emergency Operations Center on September 16 to enable it to devote more resources to this investigation. 1) Case summary For many reasons, investigating the causes of lung injury related to the use of e-cigarettes or aerosol products is quite challenging. a. The investigation involves many states; b. The diversity of the e-cigarette or atomized product market, the wide variety of products, the wide range of ingredients, and the connection with potentially illegal substances such as marijuana all complicate the investigation. Consumers do not know what their e-cigarettes or atomized products contain, and many products and substances themselves can be modified by consumers. They can be obtained from physical stores, online retailers, on the street, or through social channels. Preliminary results: According to data collected in two states and recently published in the New England Journal of Medicine, most patients (about 80%) report using cigarettes containing tetrahydrocannabinol or THC (the psychoactive compound of cannabis) Oil, and half (about 60%) of people said they use nicotine-containing e-liquid, while about 10-20% said they only use nicotine-containing products. However, no e-cigarette or atomized product, a certain brand or a specific substance has a clear connection with the epidemic. CDC has received complete gender and age data for 373 of the 530 cases. Almost three-quarters of the cases are men. Two-thirds of the cases were between 18 and 34 years old, 16% were under 18 years old, and 17% were over 35 years old. The lung damage observed in this incident does not seem to be caused by infection. The pathological findings and the results of the non-infectious diagnosis indicate that the cause of the disease is related to exposure to chemical substances. Patients first showed signs of illness within a few days to a few weeks after using e-cigarettes or aerosol products, and gradually developed symptoms such as dyspnea, shortness of breath, or chest pain before hospitalization. Some patients developed mild to moderate gastrointestinal diseases. There are other symptoms including fatigue, fever and weight loss. So far, investigators have not found any specific products or compounds related to all cases. 2) Youth e-cigarette use data Preliminary data from the 2019 National Youth Tobacco Survey show that the use of youth e-cigarettes continues to rise. Data show that in 2019, more than a quarter of high school students currently (in the past 30 days) use e-cigarettes, a significant increase compared to 2017. From 2017 to 2018, the number of e-cigarettes used by high school students increased by 77.8%, and more than a quarter of high school students are currently using tobacco products. 3) Hazards associated with cannabis use CDC is committed to monitoring cannabis use, identifying related health effects, and improving the monitoring capabilities of CDC and state/local jurisdictions. In this outbreak, many patients used e-cigarettes or vaporized products containing THC, which indicates the need to understand the health effects of the increasing use of cannabis and the changing market in the United States, as states are working on the legalization of cannabis. For medical or recreational purposes. In 2018, it is estimated that 16% of the population 12 years and older uses marijuana. 4) CDC鈥檚 recommendations to manufacturers, states, and the public. CDC recommends that the public who are worried that e-cigarettes or vaping products may cause lung diseases should consider avoiding e-cigarettes or vaping products. Teenagers, pregnant women, or non-smokers do not Electronic cigarettes should be used. Anyone who uses electronic cigarettes or vaping products should not buy these products on the street, and should not modify or add ingredients on their own. 1.1.2. NgoziO. Ezike's speech (Director of the Illinois Department of Public Health) 69 people in Illinois suffered from serious respiratory diseases after using e-cigarettes or aerosol products, and 1 person died. The patients were between 15-42 years old, with a median of 22 years old, and most of them were men. Although the cause of the illness has not yet been determined, it is certain that smoking e-cigarettes is not a healthy behavior and is not conducive to the health of young people. Illinois began investigating after learning that some residents had respiratory diseases related to e-cigarettes on July 31, 2019, and issued an alert to the Department of Health on August 2 to conduct a cooperative investigation with the CDC and start investigating the effects of e-cigarettes. The prevalence and habit of smoking e-cigarettes among adolescents, and measures such as youth education, case studies, and related legal studies. Nevertheless, on the one hand, the number of patients per day is still increasing. More than 90% are admitted to the hospital for treatment, 72% of which are sent to the intensive care unit, and nearly 30% require medical devices to help breathe. On the other hand, the use of flavored e-cigarettes is increasing. The survey shows that 1) 68% of young people used flavored e-cigarettes in 2019, accounting for 61% in 2017; 2) The 2017 survey found that 63% of young people did not understand The JUUL products they use contain nicotine; 3) From 2011 to 2015, the number of e-cigarettes used by middle school students increased by 900%. 4) A 2018 study found that more than 3.6 million young people use e-cigarettes. The focus group found that the number of young people using e-cigarettes is increasing and there is a trend of addiction. From 2008 to 2018, the number of high school students in Illinois who smoked in the total tobacco market fell from 21% to 5%, but in 2016-2018 , The proportion of e-cigarette usage among high school students rose from 18.4% to 26.7%. The current preliminary idea is to ban flavored nicotine products and study the long- and short-term effects of atomized products on health. The governor of Illinois supported the enactment of legal provisions in the legislative session in October to ban the sale of flavored vaping products specifically targeted at young people. 1.1.3. Albert A. Rizzo's speech (Chief Medical Officer of the American Lung Association) There are two different e-cigarette crises in our country. One is the prevalence and increasing popularity of young people using e-cigarettes; the other is the recent outbreak of lung diseases caused by vaping products in adults and adolescents. According to the 2019 National Tobacco Youth Survey, 27.5% of young people are now using e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The survey asked students whether they had smoked for at least 20 days in the past 30 days? 12% of Grade 12 students, 7% of Grade 10 students, and 2% of Grade 8 students said they do this often. A 2018 CDC study showed that the main reason why teenagers use these products is that the taste of sweets and fruits attracts them, while their friends and family are using them, and they think that e-cigarettes are less harmful. The American Lung Association will urge the FDA and Congress to take action as soon as possible to ban the sale of all flavored tobacco products, including flavored cigars and menthol cigarettes. Regarding the health hazards of e-cigarettes, there are many misleadings, and some of the reasons lead to a high proportion of young people using e-cigarettes. In January 2018, the National Academies of Science, Engineering and Medicine released a research report that reviewed more than 800 different studies. The report clearly pointed out that the use of e-cigarettes is harmful to health, will increase the chance of children and young people starting to use e-cigarettes, and expose others to dangerous second-hand e-cigarette emissions. They concluded that there is "a large amount of evidence" that if young people use electronic cigarettes, the possibility of using traditional cigarettes will increase. A study in Pediatrics magazine also found that young people who use e-cigarettes are four times more likely to try traditional cigarettes than young people who do not use e-cigarettes. According to a study published in the Journal of the American Medical Association in 2015, 81% of young people have ever used tobacco products made from flavored products. Fruit, mint and menthol are the most popular flavors among middle school students who use e-cigarettes. Among them, 65.9% of children use fruit-flavored e-cigarettes, and 63.9% of children use mint or menthol e-cigarettes. The taste in e-cigarettes is produced by a combination of chemicals, which carry a serious risk of lung damage. A 2015 study at Harvard University tested 51 different flavors of e-cigarettes, including marshmallow, bubble gum, and cupcakes, and found that 47 of them were related to at least one chemical substance related to respiratory diseases. E-cigarettes are not smoking cessation products. Smokers who switch to e-cigarettes may also be using traditional cigarettes. "Annals of Internal MedicinA study on "e" found that the probability of wanting to use e-cigarettes to help quit smoking is lower. Only 10.1% of smokers who used e-cigarettes for six months quit smoking, while 26.6% of smokers who did not use e-cigarettes quit smoking . 1.2. FDA intends to ban the sale of flavored e-cigarettes (2019/9/12) On September 12, the FDA stated that in order to reduce the use of e-cigarettes among young people, it will issue a policy to ban the sale of flavored e-cigarettes (including mint flavored e-cigarettes) within a few weeks. ). 1.3. CDC released its views on the causes of death from e-cigarettes (2019/9/19) The latest report from the Centers for Disease Control and Prevention (CDC) of the United States stated that the number of people suffering from lung diseases due to e-cigarettes has soared to 530 in 38 states, as of At present, 7 people have died, causing the Governor of Indiana to pay attention to the ban on flavored e-cigarettes, and corresponding measures may be taken. The CDC is currently unable to determine the specific cause, but they believe that it is caused by chemical exposure. Most of the cases are related to illegal e-cigarette liquid, which contains THC ingredients. These products are from the black market and are not formal e-cigarette stores. But even so, e-cigarette retailers Will also be greatly affected. The American Lung Research Association believes that the country should take action as soon as possible, hoping to remove the flavored e-cigarettes before further research. 2. U.S. states have banned or are preparing to ban the sale of e-cigarettes 2.1. San Francisco became the first city to ban the sale of e-cigarettes (2019/6/25) On June 25, the San Francisco City Supervisory Committee unanimously approved a total ban on the sale of e-cigarettes The regulations stipulate that e-cigarettes will be banned unless they have been reviewed by the FDA鈥檚 PMTA. The regulations are planned to be fully implemented in six months. 2.2. New York State will ban the sale of flavored e-cigarettes, but retain the mint flavor (2019/9/15) Como signed an executive order on September 12 requiring e-cigarettes to be included in New York鈥檚 anti-smoking activities. According to the Cuomo office, 1) Dr. Howard Zucker, commissioner of the State Department of Health, will recommend this week to the State Public Health and Health Planning Commission to issue emergency regulations, which will take effect within two weeks at the earliest. 2) Como has instructed the New York police and the Department of Health to strengthen law enforcement, and retailers who sell e-cigarettes to minors may be subject to criminal penalties; in addition, Como plans to promote legislation to prohibit deceptive marketing of e-cigarettes to teenagers and children. However, the decree does not affect tobacco-based and menthol-flavored e-cigarettes. Trump said last week that an investigation by the Department of Health found hundreds of respiratory disease cases among consumers who use e-cigarettes, so the federal government plans to ban the sale of thousands of flavors in e-cigarettes. Although many cases involve smoking marijuana, problems with the devices, ingredients or additives have not yet been discovered. 2.3. Michigan bans the sale of flavored e-cigarettes (2019/9/18) On September 18, Michigan announced the ban on the sale of flavored nicotine e-cigarettes. The ban will take effect immediately, but there is still a 14-day buffer period for merchants, and the ban will be It lasts for 6 months, but the governor has the right to extend the period. 2.4. Wal-Mart stops selling e-cigarettes (2019/9/20) On September 20, Wal-Mart announced that it would stop selling e-cigarettes. After the current inventory is sold out, it will stop selling e-cigarettes in Wal-Mart stores and Sam’s Clubs. In July of this year, Wal-Mart raised the minimum age for purchasing tobacco products, including all e-cigarettes, to 21 years old, and has indicated that it is discontinuing the sale of fruit-flavored and dessert-flavored e-cigarettes. E-cigarettes are mainly sold through e-cigarette specialty stores, and there are approximately 115,000 specialty stores in the United States. The e-cigarette business only occupies a small part of Wal-Mart, so it has little impact on Wal-Mart. However, Wal-Mart Store + Sam’s Clubs has more than 5,000 stores in the United States. Wal-Mart鈥檚 suspension of sales will reduce the chance of direct contact between e-cigarettes and consumers. It is also difficult to find a replacement for this huge sales channel. 2.5. The state of Massachusetts suspends the sale of all vaping products related to e-cigarettes (2019/9/24) The state of Massachusetts has decided to suspend the sale of all vaping products related to e-cigarettes for 4 months (as of January 25 next year) No.), 1) This emergency suspension is mainly to cooperate with expert doctors to find out the cause of the disease; 2) Currently, the FDA laboratory is testing more than 150 suspicious product samples, but the cause of the patient鈥檚 lung disease has not yet been determined. 3. E-cigarette manufacturing company statement 3.1. British American Tobacco 3.1.1. Response to the US FDA's announcement of atomized products (2019/9/9) British American Tobacco Research Director Dr David O & rsquo; Reilly said that company toxicologists misted the company Each single ingredient in the chemical product has been carefully checked to see if they are suitable for atomization. And the company has never added e-liquid containing THC and vitamin E acetate to atomized products. The tragic incident was because these e-liquids were not purchased from well-known manufacturers and contained ingredients not used by the manufacturers (including THC and vitamin E acetate). The company supports the FDA鈥檚 view that users of vaping products should always buy smoking sets and e-liquids from reputable manufacturers, and should avoid modifying or adding substances to the products they buy, and should use these according to the manufacturer鈥檚 intentions. product. 3.1.2. Statement on supporting strong product quality standards, measures to prevent the use of young people in the United States, and preparing to apply for PMTA at any time (2019/9/12) 1) The company expressed its concern about the marketing of certain flavored products like the FDA Attract the attention of young people. At the same time, it is difficult to overestimate the role of flavored products in helping adult consumers switch from combustible products to alternative tobacco and nicotine products. The company has established corresponding procedures to ensure that its products are only sold to adult smokers and users of vaping products. 2) For the four VUSE products planned to be launched in the United States, the company is confident that it can submit Pre-Market Tobacco Applications (PMTA) before the deadline announced by the FDA (May 2020). If approved, our Reynolds Tobacco will be able to continue to sell its VUSE brand atomized products within the new regulatory framework in the United States. 3.1.3. Statement on the need for strong and effective atomization product supervision (2019/9/20) The company stated that no products developed or produced by British American Tobacco were involved in recent e-cigarette lung disease cases, and it supports investigations made by relevant agencies , And hopes to introduce strong and effective regulations to ensure high product standards, especially in testing and reporting the ingredients used in the e-liquid of atomized products. At the same time, the government also needs to ensure that relevant agencies force manufacturers to comply with these regulations, only through effective With supervision and law enforcement, consumers can maintain confidence in the harm reduction effects of atomized products compared to traditional tobacco. 3.2. Japan Tobacco International 3.2.1. Regarding the response to lung disease cases in the United States (2019/9/13) So far, the US Department of Health is investigating 450 cases of lung disease that may be related to the use of e-cigarettes. Currently, there is little information about the products involved and the underlying causes. We are not aware of any Logic products associated with these cases and are under investigation. We have learned from media reports that many patients have admitted to using e-cigarettes containing THC e-liquid. In addition, it is reported that vitamin E acetate, a chemical substance related to hemp oil, was found in many relevant samples analyzed by the authorities. In our Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. At JTI, we will know exactly the ingredients of Logic: all Logic e-liquids undergo a strict product management plan, including toxicological evaluation and quality control of all ingredients used. Logic e-liquid can only be sold after passing a comprehensive inspection. Nebulizer users should not use the e-liquid produced by manufacturers that have not undergone strict safety and quality inspections. After design and testing, smoking sets and cartridges that can be used together should always be paired with each other. 4. Market share and sales decline of marijuana-related vaping products Since the first death case related to e-cigarettes was reported on August 23, the sales proportion of marijuana-related vaping products in the recreational marijuana product market decline. Comparing the sales data on August 19 and September 16, California: 32.8% decreased to 29%; Colorado: 19.2% decreased to 14.5%; Nevada: 22.3% decreased to 19.2%; Washington: 17.8% decreased to 14.6 %. (Report time: 2019/9/12) Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, and September 9 Total sales from Japan to 15th fell to US$689,924, a decrease of 25%. (Reporting time: 2019/9/19)

As of September 18, 2019, the United States has reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaporized products, and 7 people have died. This has made the United States attach great importance to e-cigarettes and vaporized products. Congressional hearings, down to the states and e-cigarette manufacturers, are closely following relevant developments and successively issued attitudes and statements. In particular, flavored e-cigarettes have attracted attention due to their strong appeal to young people. The FDA in September It was announced on the 12th that it would issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention and even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . But from the market point of view, the reaction was strong. On the one hand, the health of e-cigarettes is being questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. The following is the important content of recent reports: On September 24, the United States held a congressional hearing on the issue of e-cigarettes. The preliminary results of the CDC investigation showed that about 80% of patients reported using tetrahydrocannabinol or THC e-liquid, and about 60% said they used e-cigarettes containing tetrahydrocannabinol or THC. Nicotine e-liquid, and about 10-20% of people claim that they only use nicotine-containing products. Although the source of the disease has not been determined, it can be clearly related to chemical exposure. The state of Illinois initially envisages banning the sale of flavored nicotine products. The American Lung Association report stated that 27.5% of young people now use e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The main reason for teenagers to use these products is the attraction of candies and fruit flavors. The American Lung Association will urge the FDA and Congress to ban all flavored tobacco products as soon as possible, including flavored cigars and menthol cigarettes. U.S. states have banned or are preparing to ban the sale of e-cigarettes. On June 25, the San Francisco City Supervisory Committee unanimously passed a ban on the sale of e-cigarettes. On September 15, New York State stated that it would ban the sale of flavored e-cigarettes, but retain the mint flavor. On September 18, Michigan announced a ban on the sale of flavored nicotine e-cigarettes, and the ban took effect immediately. On September 20, Wal-Mart announced that it would stop selling e-cigarettes after it sold out. On September 24, Massachusetts suspended the sale of all vaping products related to e-cigarettes for 4 months. The e-cigarette manufacturing company issued a statement that British Tobacco: 1) never added e-liquid containing THC and vitamin E acetate to its atomized products; 2) for 4 VUSE products planned to be launched in the United States, the company is confident in Submit PMTA before May 2020. Japan Tobacco International: In the Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. The market share and sales decline of cannabis-related atomized products compare the sales ratio of cannabis-related atomized products in the recreational cannabis product market on August 19 and September 16, and the ratio is showing a downward trend. Among them, California: decreased from 32.8% to 29%; Colorado: decreased from 19.2% to 14.5%; Nevada: decreased from 22.3% to 19.2%; Washington: decreased from 17.8% to 14.6%. Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, while the total sales of September 9-15 decreased to 689,924 U.S. dollars, a decrease of 25%. Risk warning: new tobacco policy changes risk, sales are not as expected; industrial hemp should be strictly distinguished from intermediate cannabis, recreational cannabis/drugs, and resolutely opposed to legalization of recreational cannabis. As of September 18, 2019, the United States has reported 530 confirmed cases Seven people died of lung diseases suspected to be related to the use of e-cigarettes or vaping products, making the United States attach great importance to e-cigarettes and vaping products, from congressional hearings to states and e-cigarette manufacturers. All are paying close attention to relevant developments and issuing attitudes and statements one after another, especially flavored e-cigarettes because of their strong appeal to young people. The FDA announced on September 12 that it will issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention to or even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . However, from the market point of view, the response was strong. On the one hand, the health of e-cigarettes has been questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. In order to give you a clearer understanding of recent reports on e-cigarettes in the United States, we have sorted out important content including relevant statements issued by congressional hearings, FDA, CDC, and states and e-cigarette manufacturers for reference. 1. Statement by relevant US agencies 1.1. Congressional hearing (2019/9/24) 1.1.1. Anne Schuchat, MD's speech (CDC, Chief Deputy Director of the Department of Health and Human Services) August 1, 2019, the first time in Wisconsin The Center for Disease Control and Prevention (CDC) was notified of a series of lung diseases that have appeared in young people since July 2019. As of September 18, 2019, 38 states and 1 region in the United States have reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaping products. There are already 6 states (California, Illinois, Indiana). States, Kansas, Minnesota and Oregon). These tragic deaths have exacerbated the urgency of the CDC and the FDA to jointly investigate the cause and provide states with the necessary resources to solve this emerging public health problem. CDC established a case investigation team in August and activated the Emergency Operations Center on September 16 to enable it to devote more resources to this investigation. 1) Case summary For many reasons, investigating the causes of lung injury related to the use of e-cigarettes or aerosol products is quite challenging. a. The investigation involves many states; b. The diversity of the e-cigarette or atomized product market, the wide variety of products, the wide range of ingredients, and the connection with potentially illegal substances such as marijuana all complicate the investigation. Consumers do not know what their e-cigarettes or atomized products contain, and many products and substances themselves can be modified by consumers. They can be obtained from physical stores, online retailers, on the street, or through social channels. Preliminary results: According to data collected in two states and recently published in the New England Journal of Medicine, most patients (about 80%) report using cigarettes containing tetrahydrocannabinol or THC (the psychoactive compound of cannabis) Oil, and half (about 60%) of people said they use nicotine-containing e-liquid, while about 10-20% said they only use nicotine-containing products. However, no e-cigarette or atomized product, a certain brand or a specific substance has a clear connection with the epidemic. CDC has received complete gender and age data for 373 of the 530 cases. Almost three-quarters of the cases are men. Two-thirds of the cases were between 18 and 34 years old, 16% were under 18 years old, and 17% were over 35 years old. The lung damage observed in this incident does not seem to be caused by infection. The pathological findings and the results of the non-infectious diagnosis indicate that the cause of the disease is related to exposure to chemical substances. Patients first showed signs of illness within a few days to a few weeks after using e-cigarettes or aerosol products, and gradually developed symptoms such as dyspnea, shortness of breath, or chest pain before hospitalization. Some patients developed mild to moderate gastrointestinal diseases. There are other symptoms including fatigue, fever and weight loss. So far, investigators have not found any specific products or compounds related to all cases. 2) Youth e-cigarette use data Preliminary data from the 2019 National Youth Tobacco Survey show that the use of youth e-cigarettes continues to rise. Data show that in 2019, more than a quarter of high school students currently (in the past 30 days) use e-cigarettes, a significant increase compared to 2017. From 2017 to 2018, the number of e-cigarettes used by high school students increased by 77.8%, and more than a quarter of high school students are currently using tobacco products. 3) Hazards associated with cannabis use CDC is committed to monitoring cannabis use, identifying related health effects, and improving the monitoring capabilities of CDC and state/local jurisdictions. In this outbreak, many patients used e-cigarettes or vaporized products containing THC, which indicates the need to understand the health effects of the increasing use of cannabis and the changing market in the United States, as states are working on the legalization of cannabis. For medical or recreational purposes. In 2018, it is estimated that 16% of the population 12 years and older uses marijuana. 4) CDC鈥檚 recommendations to manufacturers, states, and the public. CDC recommends that the public who are worried that e-cigarettes or vaping products may cause lung diseases should consider avoiding e-cigarettes or vaping products. Teenagers, pregnant women, or non-smokers do not Electronic cigarettes should be used. Anyone who uses electronic cigarettes or vaping products should not buy these products on the street, and should not modify or add ingredients on their own. 1.1.2. NgoziO. Ezike's speech (Director of the Illinois Department of Public Health) 69 people in Illinois suffered from serious respiratory diseases after using e-cigarettes or aerosol products, and 1 person died. The patients were between 15-42 years old, with a median of 22 years old, and most of them were men. Although the cause of the illness has not yet been determined, it is certain that smoking e-cigarettes is not a healthy behavior and is not conducive to the health of young people. Illinois began investigating after learning that some residents had respiratory diseases related to e-cigarettes on July 31, 2019, and issued an alert to the Department of Health on August 2 to conduct a cooperative investigation with the CDC and start investigating the effects of e-cigarettes. The prevalence and habit of smoking e-cigarettes among adolescents, and measures such as youth education, case studies, and related legal studies. Nevertheless, on the one hand, the number of patients per day is still increasing. More than 90% are admitted to the hospital for treatment, 72% of which are sent to the intensive care unit, and nearly 30% require medical devices to help breathe. On the other hand, the use of flavored e-cigarettes is increasing. The survey shows that 1) 68% of young people used flavored e-cigarettes in 2019, accounting for 61% in 2017; 2) The 2017 survey found that 63% of young people did not understand The JUUL products they use contain nicotine; 3) From 2011 to 2015, the number of e-cigarettes used by middle school students increased by 900%. 4) A 2018 study found that more than 3.6 million young people use e-cigarettes. The focus group found that the number of young people using e-cigarettes is increasing and there is a trend of addiction. From 2008 to 2018, the number of high school students in Illinois who smoked in the total tobacco market fell from 21% to 5%, but in 2016-2018 , The proportion of e-cigarette usage among high school students rose from 18.4% to 26.7%. The current preliminary idea is to ban flavored nicotine products and study the long- and short-term effects of atomized products on health. The governor of Illinois supported the enactment of legal provisions in the legislative session in October to ban the sale of flavored vaping products specifically targeted at young people. 1.1.3. Albert A. Rizzo's speech (Chief Medical Officer of the American Lung Association) There are two different e-cigarette crises in our country. One is the prevalence and increasing popularity of young people using e-cigarettes; the other is the recent outbreak of lung diseases caused by vaping products in adults and adolescents. According to the 2019 National Tobacco Youth Survey, 27.5% of young people are now using e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The survey asked students whether they had smoked for at least 20 days in the past 30 days? 12% of Grade 12 students, 7% of Grade 10 students, and 2% of Grade 8 students said they do this often. A 2018 CDC study showed that the main reason why teenagers use these products is that the taste of sweets and fruits attracts them, while their friends and family are using them, and they think that e-cigarettes are less harmful. The American Lung Association will urge the FDA and Congress to take action as soon as possible to ban the sale of all flavored tobacco products, including flavored cigars and menthol cigarettes. Regarding the health hazards of e-cigarettes, there are many misleadings, and some of the reasons lead to a high proportion of young people using e-cigarettes. In January 2018, the National Academies of Science, Engineering and Medicine released a research report that reviewed more than 800 different studies. The report clearly pointed out that the use of e-cigarettes is harmful to health, will increase the chance of children and young people starting to use e-cigarettes, and expose others to dangerous second-hand e-cigarette emissions. They concluded that there is "a large amount of evidence" that if young people use electronic cigarettes, the possibility of using traditional cigarettes will increase. A study in Pediatrics magazine also found that young people who use e-cigarettes are four times more likely to try traditional cigarettes than young people who do not use e-cigarettes. According to a study published in the Journal of the American Medical Association in 2015, 81% of young people have ever used tobacco products made from flavored products. Fruit, mint and menthol are the most popular flavors among middle school students who use e-cigarettes. Among them, 65.9% of children use fruit-flavored e-cigarettes, and 63.9% of children use mint or menthol e-cigarettes. The taste in e-cigarettes is produced by a combination of chemicals, which carry a serious risk of lung damage. A 2015 study at Harvard University tested 51 different flavors of e-cigarettes, including marshmallow, bubble gum, and cupcakes, and found that 47 of them were related to at least one chemical substance related to respiratory diseases. E-cigarettes are not smoking cessation products. Smokers who switch to e-cigarettes may also be using traditional cigarettes. "Annals of Internal MedicinA study on "e" found that the probability of wanting to use e-cigarettes to help quit smoking is lower. Only 10.1% of smokers who used e-cigarettes for six months quit smoking, while 26.6% of smokers who did not use e-cigarettes quit smoking . 1.2. FDA intends to ban the sale of flavored e-cigarettes (2019/9/12) On September 12, the FDA stated that in order to reduce the use of e-cigarettes among young people, it will issue a policy to ban the sale of flavored e-cigarettes (including mint flavored e-cigarettes) within a few weeks. ). 1.3. CDC released its views on the causes of death from e-cigarettes (2019/9/19) The latest report from the Centers for Disease Control and Prevention (CDC) of the United States stated that the number of people suffering from lung diseases due to e-cigarettes has soared to 530 in 38 states, as of At present, 7 people have died, causing the Governor of Indiana to pay attention to the ban on flavored e-cigarettes, and corresponding measures may be taken. The CDC is currently unable to determine the specific cause, but they believe that it is caused by chemical exposure. Most of the cases are related to illegal e-cigarette liquid, which contains THC ingredients. These products are from the black market and are not formal e-cigarette stores. But even so, e-cigarette retailers Will also be greatly affected. The American Lung Research Association believes that the country should take action as soon as possible, hoping to remove the flavored e-cigarettes before further research. 2. U.S. states have banned or are preparing to ban the sale of e-cigarettes 2.1. San Francisco became the first city to ban the sale of e-cigarettes (2019/6/25) On June 25, the San Francisco City Supervisory Committee unanimously approved a total ban on the sale of e-cigarettes The regulations stipulate that e-cigarettes will be banned unless they have been reviewed by the FDA鈥檚 PMTA. The regulations are planned to be fully implemented in six months. 2.2. New York State will ban the sale of flavored e-cigarettes, but retain the mint flavor (2019/9/15) Como signed an executive order on September 12 requiring e-cigarettes to be included in New York鈥檚 anti-smoking activities. According to the Cuomo office, 1) Dr. Howard Zucker, commissioner of the State Department of Health, will recommend this week to the State Public Health and Health Planning Commission to issue emergency regulations, which will take effect within two weeks at the earliest. 2) Como has instructed the New York police and the Department of Health to strengthen law enforcement, and retailers who sell e-cigarettes to minors may be subject to criminal penalties; in addition, Como plans to promote legislation to prohibit deceptive marketing of e-cigarettes to teenagers and children. However, the decree does not affect tobacco-based and menthol-flavored e-cigarettes. Trump said last week that an investigation by the Department of Health found hundreds of respiratory disease cases among consumers who use e-cigarettes, so the federal government plans to ban the sale of thousands of flavors in e-cigarettes. Although many cases involve smoking marijuana, problems with the devices, ingredients or additives have not yet been discovered. 2.3. Michigan bans the sale of flavored e-cigarettes (2019/9/18) On September 18, Michigan announced the ban on the sale of flavored nicotine e-cigarettes. The ban will take effect immediately, but there is still a 14-day buffer period for merchants, and the ban will be It lasts for 6 months, but the governor has the right to extend the period. 2.4. Wal-Mart stops selling e-cigarettes (2019/9/20) On September 20, Wal-Mart announced that it would stop selling e-cigarettes. After the current inventory is sold out, it will stop selling e-cigarettes in Wal-Mart stores and Sam’s Clubs. In July of this year, Wal-Mart raised the minimum age for purchasing tobacco products, including all e-cigarettes, to 21 years old, and has indicated that it is discontinuing the sale of fruit-flavored and dessert-flavored e-cigarettes. E-cigarettes are mainly sold through e-cigarette specialty stores, and there are approximately 115,000 specialty stores in the United States. The e-cigarette business only occupies a small part of Wal-Mart, so it has little impact on Wal-Mart. However, Wal-Mart Store + Sam’s Clubs has more than 5,000 stores in the United States. Wal-Mart鈥檚 suspension of sales will reduce the chance of direct contact between e-cigarettes and consumers. It is also difficult to find a replacement for this huge sales channel. 2.5. The state of Massachusetts suspends the sale of all vaping products related to e-cigarettes (2019/9/24) The state of Massachusetts has decided to suspend the sale of all vaping products related to e-cigarettes for 4 months (as of January 25 next year) No.), 1) This emergency suspension is mainly to cooperate with expert doctors to find out the cause of the disease; 2) Currently, the FDA laboratory is testing more than 150 suspicious product samples, but the cause of the patient鈥檚 lung disease has not yet been determined. 3. E-cigarette manufacturing company statement 3.1. British American Tobacco 3.1.1. Response to the US FDA's announcement of atomized products (2019/9/9) British American Tobacco Research Director Dr David O & rsquo; Reilly said that company toxicologists misted the company Each single ingredient in the chemical product has been carefully checked to see if they are suitable for atomization. And the company has never added e-liquid containing THC and vitamin E acetate to atomized products. The tragic incident was because these e-liquids were not purchased from well-known manufacturers and contained ingredients not used by the manufacturers (including THC and vitamin E acetate). The company supports the FDA鈥檚 view that users of vaping products should always buy smoking sets and e-liquids from reputable manufacturers, and should avoid modifying or adding substances to the products they buy, and should use these according to the manufacturer鈥檚 intentions. product. 3.1.2. Statement on supporting strong product quality standards, measures to prevent the use of young people in the United States, and preparing to apply for PMTA at any time (2019/9/12) 1) The company expressed its concern about the marketing of certain flavored products like the FDA Attract the attention of young people. At the same time, it is difficult to overestimate the role of flavored products in helping adult consumers switch from combustible products to alternative tobacco and nicotine products. The company has established corresponding procedures to ensure that its products are only sold to adult smokers and users of vaping products. 2) For the four VUSE products planned to be launched in the United States, the company is confident that it can submit Pre-Market Tobacco Applications (PMTA) before the deadline announced by the FDA (May 2020). If approved, our Reynolds Tobacco will be able to continue to sell its VUSE brand atomized products within the new regulatory framework in the United States. 3.1.3. Statement on the need for strong and effective atomization product supervision (2019/9/20) The company stated that no products developed or produced by British American Tobacco were involved in recent e-cigarette lung disease cases, and it supports investigations made by relevant agencies , And hopes to introduce strong and effective regulations to ensure high product standards, especially in testing and reporting the ingredients used in the e-liquid of atomized products. At the same time, the government also needs to ensure that relevant agencies force manufacturers to comply with these regulations, only through effective With supervision and law enforcement, consumers can maintain confidence in the harm reduction effects of atomized products compared to traditional tobacco. 3.2. Japan Tobacco International 3.2.1. Regarding the response to lung disease cases in the United States (2019/9/13) So far, the US Department of Health is investigating 450 cases of lung disease that may be related to the use of e-cigarettes. Currently, there is little information about the products involved and the underlying causes. We are not aware of any Logic products associated with these cases and are under investigation. We have learned from media reports that many patients have admitted to using e-cigarettes containing THC e-liquid. In addition, it is reported that vitamin E acetate, a chemical substance related to hemp oil, was found in many relevant samples analyzed by the authorities. In our Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. At JTI, we will know exactly the ingredients of Logic: all Logic e-liquids undergo a strict product management plan, including toxicological evaluation and quality control of all ingredients used. Logic e-liquid can only be sold after passing a comprehensive inspection. Nebulizer users should not use the e-liquid produced by manufacturers that have not undergone strict safety and quality inspections. After design and testing, smoking sets and cartridges that can be used together should always be paired with each other. 4. Market share and sales decline of marijuana-related vaping products Since the first death case related to e-cigarettes was reported on August 23, the sales proportion of marijuana-related vaping products in the recreational marijuana product market decline. Comparing the sales data on August 19 and September 16, California: 32.8% decreased to 29%; Colorado: 19.2% decreased to 14.5%; Nevada: 22.3% decreased to 19.2%; Washington: 17.8% decreased to 14.6 %. (Report time: 2019/9/12) Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, and September 9 Total sales from Japan to 15th fell to US$689,924, a decrease of 25%. (Reporting time: 2019/9/19)As of September 18, 2019, the United States has reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaporized products, and 7 people have died. This has made the United States attach great importance to e-cigarettes and vaporized products. Congressional hearings, down to the states and e-cigarette manufacturers, are closely following relevant developments and successively issued attitudes and statements. In particular, flavored e-cigarettes have attracted attention due to their strong appeal to young people. The FDA in September It was announced on the 12th that it would issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention and even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . But from the market point of view, the reaction was strong. On the one hand, the health of e-cigarettes is being questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. The following is the important content of recent reports: On September 24, the United States held a congressional hearing on the issue of e-cigarettes. The preliminary results of the CDC investigation showed that about 80% of patients reported using tetrahydrocannabinol or THC e-liquid, and about 60% said they used e-cigarettes containing tetrahydrocannabinol or THC. Nicotine e-liquid, and about 10-20% of people claim that they only use nicotine-containing products. Although the source of the disease has not been determined, it can be clearly related to chemical exposure. The state of Illinois initially envisages banning the sale of flavored nicotine products. The American Lung Association report stated that 27.5% of young people now use e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The main reason for teenagers to use these products is the attraction of candies and fruit flavors. The American Lung Association will urge the FDA and Congress to ban all flavored tobacco products as soon as possible, including flavored cigars and menthol cigarettes. U.S. states have banned or are preparing to ban the sale of e-cigarettes. On June 25, the San Francisco City Supervisory Committee unanimously passed a ban on the sale of e-cigarettes. On September 15, New York State stated that it would ban the sale of flavored e-cigarettes, but retain the mint flavor. On September 18, Michigan announced a ban on the sale of flavored nicotine e-cigarettes, and the ban took effect immediately. On September 20, Wal-Mart announced that it would stop selling e-cigarettes after it sold out. On September 24, Massachusetts suspended the sale of all vaping products related to e-cigarettes for 4 months. The e-cigarette manufacturing company issued a statement that British Tobacco: 1) never added e-liquid containing THC and vitamin E acetate to its atomized products; 2) for 4 VUSE products planned to be launched in the United States, the company is confident in Submit PMTA before May 2020. Japan Tobacco International: In the Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. The market share and sales decline of cannabis-related atomized products compare the sales ratio of cannabis-related atomized products in the recreational cannabis product market on August 19 and September 16, and the ratio is showing a downward trend. Among them, California: decreased from 32.8% to 29%; Colorado: decreased from 19.2% to 14.5%; Nevada: decreased from 22.3% to 19.2%; Washington: decreased from 17.8% to 14.6%. Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, while the total sales of September 9-15 decreased to 689,924 U.S. dollars, a decrease of 25%. Risk warning: new tobacco policy changes risk, sales are not as expected; industrial hemp should be strictly distinguished from intermediate cannabis, recreational cannabis/drugs, and resolutely opposed to legalization of recreational cannabis. As of September 18, 2019, the United States has reported 530 confirmed cases Seven people died of lung diseases suspected to be related to the use of e-cigarettes or vaping products, making the United States attach great importance to e-cigarettes and vaping products, from congressional hearings to states and e-cigarette manufacturers. All are paying close attention to relevant developments and issuing attitudes and statements one after another, especially flavored e-cigarettes because of their strong appeal to young people. The FDA announced on September 12 that it will issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention to or even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . However, from the market point of view, the response was strong. On the one hand, the health of e-cigarettes has been questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. In order to give you a clearer understanding of recent reports on e-cigarettes in the United States, we have sorted out important content including relevant statements issued by congressional hearings, FDA, CDC, and states and e-cigarette manufacturers for reference. 1. Statement by relevant US agencies 1.1. Congressional hearing (2019/9/24) 1.1.1. Anne Schuchat, MD's speech (CDC, Chief Deputy Director of the Department of Health and Human Services) August 1, 2019, the first time in Wisconsin The Center for Disease Control and Prevention (CDC) was notified of a series of lung diseases that have appeared in young people since July 2019. As of September 18, 2019, 38 states and 1 region in the United States have reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaping products. There are already 6 states (California, Illinois, Indiana). States, Kansas, Minnesota and Oregon). These tragic deaths have exacerbated the urgency of the CDC and the FDA to jointly investigate the cause and provide states with the necessary resources to solve this emerging public health problem. CDC established a case investigation team in August and activated the Emergency Operations Center on September 16 to enable it to devote more resources to this investigation. 1) Case summary For many reasons, investigating the causes of lung injury related to the use of e-cigarettes or aerosol products is quite challenging. a. The investigation involves many states; b. The diversity of the e-cigarette or atomized product market, the wide variety of products, the wide range of ingredients, and the connection with potentially illegal substances such as marijuana all complicate the investigation. Consumers do not know what their e-cigarettes or atomized products contain, and many products and substances themselves can be modified by consumers. They can be obtained from physical stores, online retailers, on the street, or through social channels. Preliminary results: According to data collected in two states and recently published in the New England Journal of Medicine, most patients (about 80%) report using cigarettes containing tetrahydrocannabinol or THC (the psychoactive compound of cannabis) Oil, and half (about 60%) of people said they use nicotine-containing e-liquid, while about 10-20% said they only use nicotine-containing products. However, no e-cigarette or atomized product, a certain brand or a specific substance has a clear connection with the epidemic. CDC has received complete gender and age data for 373 of the 530 cases. Almost three-quarters of the cases are men. Two-thirds of the cases were between 18 and 34 years old, 16% were under 18 years old, and 17% were over 35 years old. The lung damage observed in this incident does not seem to be caused by infection. The pathological findings and the results of the non-infectious diagnosis indicate that the cause of the disease is related to exposure to chemical substances. Patients first showed signs of illness within a few days to a few weeks after using e-cigarettes or aerosol products, and gradually developed symptoms such as dyspnea, shortness of breath, or chest pain before hospitalization. Some patients developed mild to moderate gastrointestinal diseases. There are other symptoms including fatigue, fever and weight loss. So far, investigators have not found any specific products or compounds related to all cases. 2) Youth e-cigarette use data Preliminary data from the 2019 National Youth Tobacco Survey show that the use of youth e-cigarettes continues to rise. Data show that in 2019, more than a quarter of high school students currently (in the past 30 days) use e-cigarettes, a significant increase compared to 2017. From 2017 to 2018, the number of e-cigarettes used by high school students increased by 77.8%, and more than a quarter of high school students are currently using tobacco products. 3) Hazards associated with cannabis use CDC is committed to monitoring cannabis use, identifying related health effects, and improving the monitoring capabilities of CDC and state/local jurisdictions. In this outbreak, many patients used e-cigarettes or vaporized products containing THC, which indicates the need to understand the health effects of the increasing use of cannabis and the changing market in the United States, as states are working on the legalization of cannabis. For medical or recreational purposes. In 2018, it is estimated that 16% of the population 12 years and older uses marijuana. 4) CDC鈥檚 recommendations to manufacturers, states, and the public. CDC recommends that the public who are worried that e-cigarettes or vaping products may cause lung diseases should consider avoiding e-cigarettes or vaping products. Teenagers, pregnant women, or non-smokers do not Electronic cigarettes should be used. Anyone who uses electronic cigarettes or vaping products should not buy these products on the street, and should not modify or add ingredients on their own. 1.1.2. NgoziO. Ezike's speech (Director of the Illinois Department of Public Health) 69 people in Illinois suffered from serious respiratory diseases after using e-cigarettes or aerosol products, and 1 person died. The patients were between 15-42 years old, with a median of 22 years old, and most of them were men. Although the cause of the illness has not yet been determined, it is certain that smoking e-cigarettes is not a healthy behavior and is not conducive to the health of young people. Illinois began investigating after learning that some residents had respiratory diseases related to e-cigarettes on July 31, 2019, and issued an alert to the Department of Health on August 2 to conduct a cooperative investigation with the CDC and start investigating the effects of e-cigarettes. The prevalence and habit of smoking e-cigarettes among adolescents, and measures such as youth education, case studies, and related legal studies. Nevertheless, on the one hand, the number of patients per day is still increasing. More than 90% are admitted to the hospital for treatment, 72% of which are sent to the intensive care unit, and nearly 30% require medical devices to help breathe. On the other hand, the use of flavored e-cigarettes is increasing. The survey shows that 1) 68% of young people used flavored e-cigarettes in 2019, accounting for 61% in 2017; 2) The 2017 survey found that 63% of young people did not understand The JUUL products they use contain nicotine; 3) From 2011 to 2015, the number of e-cigarettes used by middle school students increased by 900%. 4) A 2018 study found that more than 3.6 million young people use e-cigarettes. The focus group found that the number of young people using e-cigarettes is increasing and there is a trend of addiction. From 2008 to 2018, the number of high school students in Illinois who smoked in the total tobacco market fell from 21% to 5%, but in 2016-2018 , The proportion of e-cigarette usage among high school students rose from 18.4% to 26.7%. The current preliminary idea is to ban flavored nicotine products and study the long- and short-term effects of atomized products on health. The governor of Illinois supported the enactment of legal provisions in the legislative session in October to ban the sale of flavored vaping products specifically targeted at young people. 1.1.3. Albert A. Rizzo's speech (Chief Medical Officer of the American Lung Association) There are two different e-cigarette crises in our country. One is the prevalence and increasing popularity of young people using e-cigarettes; the other is the recent outbreak of lung diseases caused by vaping products in adults and adolescents. According to the 2019 National Tobacco Youth Survey, 27.5% of young people are now using e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The survey asked students whether they had smoked for at least 20 days in the past 30 days? 12% of Grade 12 students, 7% of Grade 10 students, and 2% of Grade 8 students said they do this often. A 2018 CDC study showed that the main reason why teenagers use these products is that the taste of sweets and fruits attracts them, while their friends and family are using them, and they think that e-cigarettes are less harmful. The American Lung Association will urge the FDA and Congress to take action as soon as possible to ban the sale of all flavored tobacco products, including flavored cigars and menthol cigarettes. Regarding the health hazards of e-cigarettes, there are many misleadings, and some of the reasons lead to a high proportion of young people using e-cigarettes. In January 2018, the National Academies of Science, Engineering and Medicine released a research report that reviewed more than 800 different studies. The report clearly pointed out that the use of e-cigarettes is harmful to health, will increase the chance of children and young people starting to use e-cigarettes, and expose others to dangerous second-hand e-cigarette emissions. They concluded that there is "a large amount of evidence" that if young people use electronic cigarettes, the possibility of using traditional cigarettes will increase. A study in Pediatrics magazine also found that young people who use e-cigarettes are four times more likely to try traditional cigarettes than young people who do not use e-cigarettes. According to a study published in the Journal of the American Medical Association in 2015, 81% of young people have ever used tobacco products made from flavored products. Fruit, mint and menthol are the most popular flavors among middle school students who use e-cigarettes. Among them, 65.9% of children use fruit-flavored e-cigarettes, and 63.9% of children use mint or menthol e-cigarettes. The taste in e-cigarettes is produced by a combination of chemicals, which carry a serious risk of lung damage. A 2015 study at Harvard University tested 51 different flavors of e-cigarettes, including marshmallow, bubble gum, and cupcakes, and found that 47 of them were related to at least one chemical substance related to respiratory diseases. E-cigarettes are not smoking cessation products. Smokers who switch to e-cigarettes may also be using traditional cigarettes. "Annals of Internal MedicinA study on "e" found that the probability of wanting to use e-cigarettes to help quit smoking is lower. Only 10.1% of smokers who used e-cigarettes for six months quit smoking, while 26.6% of smokers who did not use e-cigarettes quit smoking . 1.2. FDA intends to ban the sale of flavored e-cigarettes (2019/9/12) On September 12, the FDA stated that in order to reduce the use of e-cigarettes among young people, it will issue a policy to ban the sale of flavored e-cigarettes (including mint flavored e-cigarettes) within a few weeks. ). 1.3. CDC released its views on the causes of death from e-cigarettes (2019/9/19) The latest report from the Centers for Disease Control and Prevention (CDC) of the United States stated that the number of people suffering from lung diseases due to e-cigarettes has soared to 530 in 38 states, as of At present, 7 people have died, causing the Governor of Indiana to pay attention to the ban on flavored e-cigarettes, and corresponding measures may be taken. The CDC is currently unable to determine the specific cause, but they believe that it is caused by chemical exposure. Most of the cases are related to illegal e-cigarette liquid, which contains THC ingredients. These products are from the black market and are not formal e-cigarette stores. But even so, e-cigarette retailers Will also be greatly affected. The American Lung Research Association believes that the country should take action as soon as possible, hoping to remove the flavored e-cigarettes before further research. 2. U.S. states have banned or are preparing to ban the sale of e-cigarettes 2.1. San Francisco became the first city to ban the sale of e-cigarettes (2019/6/25) On June 25, the San Francisco City Supervisory Committee unanimously approved a total ban on the sale of e-cigarettes The regulations stipulate that e-cigarettes will be banned unless they have been reviewed by the FDA鈥檚 PMTA. The regulations are planned to be fully implemented in six months. 2.2. New York State will ban the sale of flavored e-cigarettes, but retain the mint flavor (2019/9/15) Como signed an executive order on September 12 requiring e-cigarettes to be included in New York鈥檚 anti-smoking activities. According to the Cuomo office, 1) Dr. Howard Zucker, commissioner of the State Department of Health, will recommend this week to the State Public Health and Health Planning Commission to issue emergency regulations, which will take effect within two weeks at the earliest. 2) Como has instructed the New York police and the Department of Health to strengthen law enforcement, and retailers who sell e-cigarettes to minors may be subject to criminal penalties; in addition, Como plans to promote legislation to prohibit deceptive marketing of e-cigarettes to teenagers and children. However, the decree does not affect tobacco-based and menthol-flavored e-cigarettes. Trump said last week that an investigation by the Department of Health found hundreds of respiratory disease cases among consumers who use e-cigarettes, so the federal government plans to ban the sale of thousands of flavors in e-cigarettes. Although many cases involve smoking marijuana, problems with the devices, ingredients or additives have not yet been discovered. 2.3. Michigan bans the sale of flavored e-cigarettes (2019/9/18) On September 18, Michigan announced the ban on the sale of flavored nicotine e-cigarettes. The ban will take effect immediately, but there is still a 14-day buffer period for merchants, and the ban will be It lasts for 6 months, but the governor has the right to extend the period. 2.4. Wal-Mart stops selling e-cigarettes (2019/9/20) On September 20, Wal-Mart announced that it would stop selling e-cigarettes. After the current inventory is sold out, it will stop selling e-cigarettes in Wal-Mart stores and Sam’s Clubs. In July of this year, Wal-Mart raised the minimum age for purchasing tobacco products, including all e-cigarettes, to 21 years old, and has indicated that it is discontinuing the sale of fruit-flavored and dessert-flavored e-cigarettes. E-cigarettes are mainly sold through e-cigarette specialty stores, and there are approximately 115,000 specialty stores in the United States. The e-cigarette business only occupies a small part of Wal-Mart, so it has little impact on Wal-Mart. However, Wal-Mart Store + Sam’s Clubs has more than 5,000 stores in the United States. Wal-Mart鈥檚 suspension of sales will reduce the chance of direct contact between e-cigarettes and consumers. It is also difficult to find a replacement for this huge sales channel. 2.5. The state of Massachusetts suspends the sale of all vaping products related to e-cigarettes (2019/9/24) The state of Massachusetts has decided to suspend the sale of all vaping products related to e-cigarettes for 4 months (as of January 25 next year) No.), 1) This emergency suspension is mainly to cooperate with expert doctors to find out the cause of the disease; 2) Currently, the FDA laboratory is testing more than 150 suspicious product samples, but the cause of the patient鈥檚 lung disease has not yet been determined. 3. E-cigarette manufacturing company statement 3.1. British American Tobacco 3.1.1. Response to the US FDA's announcement of atomized products (2019/9/9) British American Tobacco Research Director Dr David O & rsquo; Reilly said that company toxicologists misted the company Each single ingredient in the chemical product has been carefully checked to see if they are suitable for atomization. And the company has never added e-liquid containing THC and vitamin E acetate to atomized products. The tragic incident was because these e-liquids were not purchased from well-known manufacturers and contained ingredients not used by the manufacturers (including THC and vitamin E acetate). The company supports the FDA鈥檚 view that users of vaping products should always buy smoking sets and e-liquids from reputable manufacturers, and should avoid modifying or adding substances to the products they buy, and should use these according to the manufacturer鈥檚 intentions. product. 3.1.2. Statement on supporting strong product quality standards, measures to prevent the use of young people in the United States, and preparing to apply for PMTA at any time (2019/9/12) 1) The company expressed its concern about the marketing of certain flavored products like the FDA Attract the attention of young people. At the same time, it is difficult to overestimate the role of flavored products in helping adult consumers switch from combustible products to alternative tobacco and nicotine products. The company has established corresponding procedures to ensure that its products are only sold to adult smokers and users of vaping products. 2) For the four VUSE products planned to be launched in the United States, the company is confident that it can submit Pre-Market Tobacco Applications (PMTA) before the deadline announced by the FDA (May 2020). If approved, our Reynolds Tobacco will be able to continue to sell its VUSE brand atomized products within the new regulatory framework in the United States. 3.1.3. Statement on the need for strong and effective atomization product supervision (2019/9/20) The company stated that no products developed or produced by British American Tobacco were involved in recent e-cigarette lung disease cases, and it supports investigations made by relevant agencies , And hopes to introduce strong and effective regulations to ensure high product standards, especially in testing and reporting the ingredients used in the e-liquid of atomized products. At the same time, the government also needs to ensure that relevant agencies force manufacturers to comply with these regulations, only through effective With supervision and law enforcement, consumers can maintain confidence in the harm reduction effects of atomized products compared to traditional tobacco. 3.2. Japan Tobacco International 3.2.1. Regarding the response to lung disease cases in the United States (2019/9/13) So far, the US Department of Health is investigating 450 cases of lung disease that may be related to the use of e-cigarettes. Currently, there is little information about the products involved and the underlying causes. We are not aware of any Logic products associated with these cases and are under investigation. We have learned from media reports that many patients have admitted to using e-cigarettes containing THC e-liquid. In addition, it is reported that vitamin E acetate, a chemical substance related to hemp oil, was found in many relevant samples analyzed by the authorities. In our Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. At JTI, we will know exactly the ingredients of Logic: all Logic e-liquids undergo a strict product management plan, including toxicological evaluation and quality control of all ingredients used. Logic e-liquid can only be sold after passing a comprehensive inspection. Nebulizer users should not use the e-liquid produced by manufacturers that have not undergone strict safety and quality inspections. After design and testing, smoking sets and cartridges that can be used together should always be paired with each other. 4. Market share and sales decline of marijuana-related vaping products Since the first death case related to e-cigarettes was reported on August 23, the sales proportion of marijuana-related vaping products in the recreational marijuana product market decline. Comparing the sales data on August 19 and September 16, California: 32.8% decreased to 29%; Colorado: 19.2% decreased to 14.5%; Nevada: 22.3% decreased to 19.2%; Washington: 17.8% decreased to 14.6 %. (Report time: 2019/9/12) Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, and September 9 Total sales from Japan to 15th fell to US$689,924, a decrease of 25%. (Reporting time: 2019/9/19)As of September 18, 2019, the United States has reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaporized products, and 7 people have died. This has made the United States attach great importance to e-cigarettes and vaporized products. Congressional hearings, down to the states and e-cigarette manufacturers, are closely following relevant developments and successively issued attitudes and statements. In particular, flavored e-cigarettes have attracted attention due to their strong appeal to young people. The FDA in September It was announced on the 12th that it would issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention and even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . But from the market point of view, the reaction was strong. On the one hand, the health of e-cigarettes is being questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. The following is the important content of recent reports: On September 24, the United States held a congressional hearing on the issue of e-cigarettes. The preliminary results of the CDC investigation showed that about 80% of patients reported using tetrahydrocannabinol or THC e-liquid, and about 60% said they used e-cigarettes containing tetrahydrocannabinol or THC. Nicotine e-liquid, and about 10-20% of people claim that they only use nicotine-containing products. Although the source of the disease has not been determined, it can be clearly related to chemical exposure. The state of Illinois initially envisages banning the sale of flavored nicotine products. The American Lung Association report stated that 27.5% of young people now use e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The main reason for teenagers to use these products is the attraction of candies and fruit flavors. The American Lung Association will urge the FDA and Congress to ban all flavored tobacco products as soon as possible, including flavored cigars and menthol cigarettes. U.S. states have banned or are preparing to ban the sale of e-cigarettes. On June 25, the San Francisco City Supervisory Committee unanimously passed a ban on the sale of e-cigarettes. On September 15, New York State stated that it would ban the sale of flavored e-cigarettes, but retain the mint flavor. On September 18, Michigan announced a ban on the sale of flavored nicotine e-cigarettes, and the ban took effect immediately. On September 20, Wal-Mart announced that it would stop selling e-cigarettes after it sold out. On September 24, Massachusetts suspended the sale of all vaping products related to e-cigarettes for 4 months. The e-cigarette manufacturing company issued a statement that British Tobacco: 1) never added e-liquid containing THC and vitamin E acetate to its atomized products; 2) for 4 VUSE products planned to be launched in the United States, the company is confident in Submit PMTA before May 2020. Japan Tobacco International: In the Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. The market share and sales decline of cannabis-related atomized products compare the sales ratio of cannabis-related atomized products in the recreational cannabis product market on August 19 and September 16, and the ratio is showing a downward trend. Among them, California: decreased from 32.8% to 29%; Colorado: decreased from 19.2% to 14.5%; Nevada: decreased from 22.3% to 19.2%; Washington: decreased from 17.8% to 14.6%. Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, while the total sales of September 9-15 decreased to 689,924 U.S. dollars, a decrease of 25%. Risk warning: new tobacco policy changes risk, sales are not as expected; industrial hemp should be strictly distinguished from intermediate cannabis, recreational cannabis/drugs, and resolutely opposed to legalization of recreational cannabis. As of September 18, 2019, the United States has reported 530 confirmed cases Seven people died of lung diseases suspected to be related to the use of e-cigarettes or vaping products, making the United States attach great importance to e-cigarettes and vaping products, from congressional hearings to states and e-cigarette manufacturers. All are paying close attention to relevant developments and issuing attitudes and statements one after another, especially flavored e-cigarettes because of their strong appeal to young people. The FDA announced on September 12 that it will issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention to or even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . However, from the market point of view, the response was strong. On the one hand, the health of e-cigarettes has been questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. In order to give you a clearer understanding of recent reports on e-cigarettes in the United States, we have sorted out important content including relevant statements issued by congressional hearings, FDA, CDC, and states and e-cigarette manufacturers for reference. 1. Statement by relevant US agencies 1.1. Congressional hearing (2019/9/24) 1.1.1. Anne Schuchat, MD's speech (CDC, Chief Deputy Director of the Department of Health and Human Services) August 1, 2019, the first time in Wisconsin The Center for Disease Control and Prevention (CDC) was notified of a series of lung diseases that have appeared in young people since July 2019. As of September 18, 2019, 38 states and 1 region in the United States have reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaping products. There are already 6 states (California, Illinois, Indiana). States, Kansas, Minnesota and Oregon). These tragic deaths have exacerbated the urgency of the CDC and the FDA to jointly investigate the cause and provide states with the necessary resources to solve this emerging public health problem. CDC established a case investigation team in August and activated the Emergency Operations Center on September 16 to enable it to devote more resources to this investigation. 1) Case summary For many reasons, investigating the causes of lung injury related to the use of e-cigarettes or aerosol products is quite challenging. a. The investigation involves many states; b. The diversity of the e-cigarette or atomized product market, the wide variety of products, the wide range of ingredients, and the connection with potentially illegal substances such as marijuana all complicate the investigation. Consumers do not know what their e-cigarettes or atomized products contain, and many products and substances themselves can be modified by consumers. They can be obtained from physical stores, online retailers, on the street, or through social channels. Preliminary results: According to data collected in two states and recently published in the New England Journal of Medicine, most patients (about 80%) report using cigarettes containing tetrahydrocannabinol or THC (the psychoactive compound of cannabis) Oil, and half (about 60%) of people said they use nicotine-containing e-liquid, while about 10-20% said they only use nicotine-containing products. However, no e-cigarette or atomized product, a certain brand or a specific substance has a clear connection with the epidemic. CDC has received complete gender and age data for 373 of the 530 cases. Almost three-quarters of the cases are men. Two-thirds of the cases were between 18 and 34 years old, 16% were under 18 years old, and 17% were over 35 years old. The lung damage observed in this incident does not seem to be caused by infection. The pathological findings and the results of the non-infectious diagnosis indicate that the cause of the disease is related to exposure to chemical substances. Patients first showed signs of illness within a few days to a few weeks after using e-cigarettes or aerosol products, and gradually developed symptoms such as dyspnea, shortness of breath, or chest pain before hospitalization. Some patients developed mild to moderate gastrointestinal diseases. There are other symptoms including fatigue, fever and weight loss. So far, investigators have not found any specific products or compounds related to all cases. 2) Youth e-cigarette use data Preliminary data from the 2019 National Youth Tobacco Survey show that the use of youth e-cigarettes continues to rise. Data show that in 2019, more than a quarter of high school students currently (in the past 30 days) use e-cigarettes, a significant increase compared to 2017. From 2017 to 2018, the number of e-cigarettes used by high school students increased by 77.8%, and more than a quarter of high school students are currently using tobacco products. 3) Hazards associated with cannabis use CDC is committed to monitoring cannabis use, identifying related health effects, and improving the monitoring capabilities of CDC and state/local jurisdictions. In this outbreak, many patients used e-cigarettes or vaporized products containing THC, which indicates the need to understand the health effects of the increasing use of cannabis and the changing market in the United States, as states are working on the legalization of cannabis. For medical or recreational purposes. In 2018, it is estimated that 16% of the population 12 years and older uses marijuana. 4) CDC鈥檚 recommendations to manufacturers, states, and the public. CDC recommends that the public who are worried that e-cigarettes or vaping products may cause lung diseases should consider avoiding e-cigarettes or vaping products. Teenagers, pregnant women, or non-smokers do not Electronic cigarettes should be used. Anyone who uses electronic cigarettes or vaping products should not buy these products on the street, and should not modify or add ingredients on their own. 1.1.2. NgoziO. Ezike's speech (Director of the Illinois Department of Public Health) 69 people in Illinois suffered from serious respiratory diseases after using e-cigarettes or aerosol products, and 1 person died. The patients were between 15-42 years old, with a median of 22 years old, and most of them were men. Although the cause of the illness has not yet been determined, it is certain that smoking e-cigarettes is not a healthy behavior and is not conducive to the health of young people. Illinois began investigating after learning that some residents had respiratory diseases related to e-cigarettes on July 31, 2019, and issued an alert to the Department of Health on August 2 to conduct a cooperative investigation with the CDC and start investigating the effects of e-cigarettes. The prevalence and habit of smoking e-cigarettes among adolescents, and measures such as youth education, case studies, and related legal studies. Nevertheless, on the one hand, the number of patients per day is still increasing. More than 90% are admitted to the hospital for treatment, 72% of which are sent to the intensive care unit, and nearly 30% require medical devices to help breathe. On the other hand, the use of flavored e-cigarettes is increasing. The survey shows that 1) 68% of young people used flavored e-cigarettes in 2019, accounting for 61% in 2017; 2) The 2017 survey found that 63% of young people did not understand The JUUL products they use contain nicotine; 3) From 2011 to 2015, the number of e-cigarettes used by middle school students increased by 900%. 4) A 2018 study found that more than 3.6 million young people use e-cigarettes. The focus group found that the number of young people using e-cigarettes is increasing and there is a trend of addiction. From 2008 to 2018, the number of high school students in Illinois who smoked in the total tobacco market fell from 21% to 5%, but in 2016-2018 , The proportion of e-cigarette usage among high school students rose from 18.4% to 26.7%. The current preliminary idea is to ban flavored nicotine products and study the long- and short-term effects of atomized products on health. The governor of Illinois supported the enactment of legal provisions in the legislative session in October to ban the sale of flavored vaping products specifically targeted at young people. 1.1.3. Albert A. Rizzo's speech (Chief Medical Officer of the American Lung Association) There are two different e-cigarette crises in our country. One is the prevalence and increasing popularity of young people using e-cigarettes; the other is the recent outbreak of lung diseases caused by vaping products in adults and adolescents. According to the 2019 National Tobacco Youth Survey, 27.5% of young people are now using e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The survey asked students whether they had smoked for at least 20 days in the past 30 days? 12% of Grade 12 students, 7% of Grade 10 students, and 2% of Grade 8 students said they do this often. A 2018 CDC study showed that the main reason why teenagers use these products is that the taste of sweets and fruits attracts them, while their friends and family are using them, and they think that e-cigarettes are less harmful. The American Lung Association will urge the FDA and Congress to take action as soon as possible to ban the sale of all flavored tobacco products, including flavored cigars and menthol cigarettes. Regarding the health hazards of e-cigarettes, there are many misleadings, and some of the reasons lead to a high proportion of young people using e-cigarettes. In January 2018, the National Academies of Science, Engineering and Medicine released a research report that reviewed more than 800 different studies. The report clearly pointed out that the use of e-cigarettes is harmful to health, will increase the chance of children and young people starting to use e-cigarettes, and expose others to dangerous second-hand e-cigarette emissions. They concluded that there is "a large amount of evidence" that if young people use electronic cigarettes, the possibility of using traditional cigarettes will increase. A study in Pediatrics magazine also found that young people who use e-cigarettes are four times more likely to try traditional cigarettes than young people who do not use e-cigarettes. According to a study published in the Journal of the American Medical Association in 2015, 81% of young people have ever used tobacco products made from flavored products. Fruit, mint and menthol are the most popular flavors among middle school students who use e-cigarettes. Among them, 65.9% of children use fruit-flavored e-cigarettes, and 63.9% of children use mint or menthol e-cigarettes. The taste in e-cigarettes is produced by a combination of chemicals, which carry a serious risk of lung damage. A 2015 study at Harvard University tested 51 different flavors of e-cigarettes, including marshmallow, bubble gum, and cupcakes, and found that 47 of them were related to at least one chemical substance related to respiratory diseases. E-cigarettes are not smoking cessation products. Smokers who switch to e-cigarettes may also be using traditional cigarettes. "Annals of Internal MedicinA study on "e" found that the probability of wanting to use e-cigarettes to help quit smoking is lower. Only 10.1% of smokers who used e-cigarettes for six months quit smoking, while 26.6% of smokers who did not use e-cigarettes quit smoking . 1.2. FDA intends to ban the sale of flavored e-cigarettes (2019/9/12) On September 12, the FDA stated that in order to reduce the use of e-cigarettes among young people, it will issue a policy to ban the sale of flavored e-cigarettes (including mint flavored e-cigarettes) within a few weeks. ). 1.3. CDC released its views on the causes of death from e-cigarettes (2019/9/19) The latest report from the Centers for Disease Control and Prevention (CDC) of the United States stated that the number of people suffering from lung diseases due to e-cigarettes has soared to 530 in 38 states, as of At present, 7 people have died, causing the Governor of Indiana to pay attention to the ban on flavored e-cigarettes, and corresponding measures may be taken. The CDC is currently unable to determine the specific cause, but they believe that it is caused by chemical exposure. Most of the cases are related to illegal e-cigarette liquid, which contains THC ingredients. These products are from the black market and are not formal e-cigarette stores. But even so, e-cigarette retailers Will also be greatly affected. The American Lung Research Association believes that the country should take action as soon as possible, hoping to remove the flavored e-cigarettes before further research. 2. U.S. states have banned or are preparing to ban the sale of e-cigarettes 2.1. San Francisco became the first city to ban the sale of e-cigarettes (2019/6/25) On June 25, the San Francisco City Supervisory Committee unanimously approved a total ban on the sale of e-cigarettes The regulations stipulate that e-cigarettes will be banned unless they have been reviewed by the FDA鈥檚 PMTA. The regulations are planned to be fully implemented in six months. 2.2. New York State will ban the sale of flavored e-cigarettes, but retain the mint flavor (2019/9/15) Como signed an executive order on September 12 requiring e-cigarettes to be included in New York鈥檚 anti-smoking activities. According to the Cuomo office, 1) Dr. Howard Zucker, commissioner of the State Department of Health, will recommend this week to the State Public Health and Health Planning Commission to issue emergency regulations, which will take effect within two weeks at the earliest. 2) Como has instructed the New York police and the Department of Health to strengthen law enforcement, and retailers who sell e-cigarettes to minors may be subject to criminal penalties; in addition, Como plans to promote legislation to prohibit deceptive marketing of e-cigarettes to teenagers and children. However, the decree does not affect tobacco-based and menthol-flavored e-cigarettes. Trump said last week that an investigation by the Department of Health found hundreds of respiratory disease cases among consumers who use e-cigarettes, so the federal government plans to ban the sale of thousands of flavors in e-cigarettes. Although many cases involve smoking marijuana, problems with the devices, ingredients or additives have not yet been discovered. 2.3. Michigan bans the sale of flavored e-cigarettes (2019/9/18) On September 18, Michigan announced the ban on the sale of flavored nicotine e-cigarettes. The ban will take effect immediately, but there is still a 14-day buffer period for merchants, and the ban will be It lasts for 6 months, but the governor has the right to extend the period. 2.4. Wal-Mart stops selling e-cigarettes (2019/9/20) On September 20, Wal-Mart announced that it would stop selling e-cigarettes. After the current inventory is sold out, it will stop selling e-cigarettes in Wal-Mart stores and Sam’s Clubs. In July of this year, Wal-Mart raised the minimum age for purchasing tobacco products, including all e-cigarettes, to 21 years old, and has indicated that it is discontinuing the sale of fruit-flavored and dessert-flavored e-cigarettes. E-cigarettes are mainly sold through e-cigarette specialty stores, and there are approximately 115,000 specialty stores in the United States. The e-cigarette business only occupies a small part of Wal-Mart, so it has little impact on Wal-Mart. However, Wal-Mart Store + Sam’s Clubs has more than 5,000 stores in the United States. Wal-Mart鈥檚 suspension of sales will reduce the chance of direct contact between e-cigarettes and consumers. It is also difficult to find a replacement for this huge sales channel. 2.5. The state of Massachusetts suspends the sale of all vaping products related to e-cigarettes (2019/9/24) The state of Massachusetts has decided to suspend the sale of all vaping products related to e-cigarettes for 4 months (as of January 25 next year) No.), 1) This emergency suspension is mainly to cooperate with expert doctors to find out the cause of the disease; 2) Currently, the FDA laboratory is testing more than 150 suspicious product samples, but the cause of the patient鈥檚 lung disease has not yet been determined. 3. E-cigarette manufacturing company statement 3.1. British American Tobacco 3.1.1. Response to the US FDA's announcement of atomized products (2019/9/9) British American Tobacco Research Director Dr David O & rsquo; Reilly said that company toxicologists misted the company Each single ingredient in the chemical product has been carefully checked to see if they are suitable for atomization. And the company has never added e-liquid containing THC and vitamin E acetate to atomized products. The tragic incident was because these e-liquids were not purchased from well-known manufacturers and contained ingredients not used by the manufacturers (including THC and vitamin E acetate). The company supports the FDA鈥檚 view that users of vaping products should always buy smoking sets and e-liquids from reputable manufacturers, and should avoid modifying or adding substances to the products they buy, and should use these according to the manufacturer鈥檚 intentions. product. 3.1.2. Statement on supporting strong product quality standards, measures to prevent the use of young people in the United States, and preparing to apply for PMTA at any time (2019/9/12) 1) The company expressed its concern about the marketing of certain flavored products like the FDA Attract the attention of young people. At the same time, it is difficult to overestimate the role of flavored products in helping adult consumers switch from combustible products to alternative tobacco and nicotine products. The company has established corresponding procedures to ensure that its products are only sold to adult smokers and users of vaping products. 2) For the four VUSE products planned to be launched in the United States, the company is confident that it can submit Pre-Market Tobacco Applications (PMTA) before the deadline announced by the FDA (May 2020). If approved, our Reynolds Tobacco will be able to continue to sell its VUSE brand atomized products within the new regulatory framework in the United States. 3.1.3. Statement on the need for strong and effective atomization product supervision (2019/9/20) The company stated that no products developed or produced by British American Tobacco were involved in recent e-cigarette lung disease cases, and it supports investigations made by relevant agencies , And hopes to introduce strong and effective regulations to ensure high product standards, especially in testing and reporting the ingredients used in the e-liquid of atomized products. At the same time, the government also needs to ensure that relevant agencies force manufacturers to comply with these regulations, only through effective With supervision and law enforcement, consumers can maintain confidence in the harm reduction effects of atomized products compared to traditional tobacco. 3.2. Japan Tobacco International 3.2.1. Regarding the response to lung disease cases in the United States (2019/9/13) So far, the US Department of Health is investigating 450 cases of lung disease that may be related to the use of e-cigarettes. Currently, there is little information about the products involved and the underlying causes. We are not aware of any Logic products associated with these cases and are under investigation. We have learned from media reports that many patients have admitted to using e-cigarettes containing THC e-liquid. In addition, it is reported that vitamin E acetate, a chemical substance related to hemp oil, was found in many relevant samples analyzed by the authorities. In our Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. At JTI, we will know exactly the ingredients of Logic: all Logic e-liquids undergo a strict product management plan, including toxicological evaluation and quality control of all ingredients used. Logic e-liquid can only be sold after passing a comprehensive inspection. Nebulizer users should not use the e-liquid produced by manufacturers that have not undergone strict safety and quality inspections. After design and testing, smoking sets and cartridges that can be used together should always be paired with each other. 4. Market share and sales decline of marijuana-related vaping products Since the first death case related to e-cigarettes was reported on August 23, the sales proportion of marijuana-related vaping products in the recreational marijuana product market decline. Comparing the sales data on August 19 and September 16, California: 32.8% decreased to 29%; Colorado: 19.2% decreased to 14.5%; Nevada: 22.3% decreased to 19.2%; Washington: 17.8% decreased to 14.6 %. (Report time: 2019/9/12) Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, and September 9 Total sales from Japan to 15th fell to US$689,924, a decrease of 25%. (Reporting time: 2019/9/19)As of September 18, 2019, the United States has reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaporized products, and 7 people have died. This has made the United States attach great importance to e-cigarettes and vaporized products. Congressional hearings, down to the states and e-cigarette manufacturers, are closely following relevant developments and successively issued attitudes and statements. In particular, flavored e-cigarettes have attracted attention due to their strong appeal to young people. The FDA in September It was announced on the 12th that it would issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention and even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . But from the market point of view, the reaction was strong. On the one hand, the health of e-cigarettes is being questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. The following is the important content of recent reports: On September 24, the United States held a congressional hearing on the issue of e-cigarettes. The preliminary results of the CDC investigation showed that about 80% of patients reported using tetrahydrocannabinol or THC e-liquid, and about 60% said they used e-cigarettes containing tetrahydrocannabinol or THC. Nicotine e-liquid, and about 10-20% of people claim that they only use nicotine-containing products. Although the source of the disease has not been determined, it can be clearly related to chemical exposure. The state of Illinois initially envisages banning the sale of flavored nicotine products. The American Lung Association report stated that 27.5% of young people now use e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The main reason for teenagers to use these products is the attraction of candies and fruit flavors. The American Lung Association will urge the FDA and Congress to ban all flavored tobacco products as soon as possible, including flavored cigars and menthol cigarettes. U.S. states have banned or are preparing to ban the sale of e-cigarettes. On June 25, the San Francisco City Supervisory Committee unanimously passed a ban on the sale of e-cigarettes. On September 15, New York State stated that it would ban the sale of flavored e-cigarettes, but retain the mint flavor. On September 18, Michigan announced a ban on the sale of flavored nicotine e-cigarettes, and the ban took effect immediately. On September 20, Wal-Mart announced that it would stop selling e-cigarettes after it sold out. On September 24, Massachusetts suspended the sale of all vaping products related to e-cigarettes for 4 months. The e-cigarette manufacturing company issued a statement that British Tobacco: 1) never added e-liquid containing THC and vitamin E acetate to its atomized products; 2) for 4 VUSE products planned to be launched in the United States, the company is confident in Submit PMTA before May 2020. Japan Tobacco International: In the Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. The market share and sales decline of cannabis-related atomized products compare the sales ratio of cannabis-related atomized products in the recreational cannabis product market on August 19 and September 16, and the ratio is showing a downward trend. Among them, California: decreased from 32.8% to 29%; Colorado: decreased from 19.2% to 14.5%; Nevada: decreased from 22.3% to 19.2%; Washington: decreased from 17.8% to 14.6%. Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, while the total sales of September 9-15 decreased to 689,924 U.S. dollars, a decrease of 25%. Risk warning: new tobacco policy changes risk, sales are not as expected; industrial hemp should be strictly distinguished from intermediate cannabis, recreational cannabis/drugs, and resolutely opposed to legalization of recreational cannabis. As of September 18, 2019, the United States has reported 530 confirmed cases Seven people died of lung diseases suspected to be related to the use of e-cigarettes or vaping products, making the United States attach great importance to e-cigarettes and vaping products, from congressional hearings to states and e-cigarette manufacturers. All are paying close attention to relevant developments and issuing attitudes and statements one after another, especially flavored e-cigarettes because of their strong appeal to young people. The FDA announced on September 12 that it will issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention to or even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . However, from the market point of view, the response was strong. On the one hand, the health of e-cigarettes has been questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. In order to give you a clearer understanding of recent reports on e-cigarettes in the United States, we have sorted out important content including relevant statements issued by congressional hearings, FDA, CDC, and states and e-cigarette manufacturers for reference. 1. Statement by relevant US agencies 1.1. Congressional hearing (2019/9/24) 1.1.1. Anne Schuchat, MD's speech (CDC, Chief Deputy Director of the Department of Health and Human Services) August 1, 2019, the first time in Wisconsin The Center for Disease Control and Prevention (CDC) was notified of a series of lung diseases that have appeared in young people since July 2019. As of September 18, 2019, 38 states and 1 region in the United States have reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaping products. There are already 6 states (California, Illinois, Indiana). States, Kansas, Minnesota and Oregon). These tragic deaths have exacerbated the urgency of the CDC and the FDA to jointly investigate the cause and provide states with the necessary resources to solve this emerging public health problem. CDC established a case investigation team in August and activated the Emergency Operations Center on September 16 to enable it to devote more resources to this investigation. 1) Case summary For many reasons, investigating the causes of lung injury related to the use of e-cigarettes or aerosol products is quite challenging. a. The investigation involves many states; b. The diversity of the e-cigarette or atomized product market, the wide variety of products, the wide range of ingredients, and the connection with potentially illegal substances such as marijuana all complicate the investigation. Consumers do not know what their e-cigarettes or atomized products contain, and many products and substances themselves can be modified by consumers. They can be obtained from physical stores, online retailers, on the street, or through social channels. Preliminary results: According to data collected in two states and recently published in the New England Journal of Medicine, most patients (about 80%) report using cigarettes containing tetrahydrocannabinol or THC (the psychoactive compound of cannabis) Oil, and half (about 60%) of people said they use nicotine-containing e-liquid, while about 10-20% said they only use nicotine-containing products. However, no e-cigarette or atomized product, a certain brand or a specific substance has a clear connection with the epidemic. CDC has received complete gender and age data for 373 of the 530 cases. Almost three-quarters of the cases are men. Two-thirds of the cases were between 18 and 34 years old, 16% were under 18 years old, and 17% were over 35 years old. The lung damage observed in this incident does not seem to be caused by infection. The pathological findings and the results of the non-infectious diagnosis indicate that the cause of the disease is related to exposure to chemical substances. Patients first showed signs of illness within a few days to a few weeks after using e-cigarettes or aerosol products, and gradually developed symptoms such as dyspnea, shortness of breath, or chest pain before hospitalization. Some patients developed mild to moderate gastrointestinal diseases. There are other symptoms including fatigue, fever and weight loss. So far, investigators have not found any specific products or compounds related to all cases. 2) Youth e-cigarette use data Preliminary data from the 2019 National Youth Tobacco Survey show that the use of youth e-cigarettes continues to rise. Data show that in 2019, more than a quarter of high school students currently (in the past 30 days) use e-cigarettes, a significant increase compared to 2017. From 2017 to 2018, the number of e-cigarettes used by high school students increased by 77.8%, and more than a quarter of high school students are currently using tobacco products. 3) Hazards associated with cannabis use CDC is committed to monitoring cannabis use, identifying related health effects, and improving the monitoring capabilities of CDC and state/local jurisdictions. In this outbreak, many patients used e-cigarettes or vaporized products containing THC, which indicates the need to understand the health effects of the increasing use of cannabis and the changing market in the United States, as states are working on the legalization of cannabis. For medical or recreational purposes. In 2018, it is estimated that 16% of the population 12 years and older uses marijuana. 4) CDC鈥檚 recommendations to manufacturers, states, and the public. CDC recommends that the public who are worried that e-cigarettes or vaping products may cause lung diseases should consider avoiding e-cigarettes or vaping products. Teenagers, pregnant women, or non-smokers do not Electronic cigarettes should be used. Anyone who uses electronic cigarettes or vaping products should not buy these products on the street, and should not modify or add ingredients on their own. 1.1.2. NgoziO. Ezike's speech (Director of the Illinois Department of Public Health) 69 people in Illinois suffered from serious respiratory diseases after using e-cigarettes or aerosol products, and 1 person died. The patients were between 15-42 years old, with a median of 22 years old, and most of them were men. Although the cause of the illness has not yet been determined, it is certain that smoking e-cigarettes is not a healthy behavior and is not conducive to the health of young people. Illinois began investigating after learning that some residents had respiratory diseases related to e-cigarettes on July 31, 2019, and issued an alert to the Department of Health on August 2 to conduct a cooperative investigation with the CDC and start investigating the effects of e-cigarettes. The prevalence and habit of smoking e-cigarettes among adolescents, and measures such as youth education, case studies, and related legal studies. Nevertheless, on the one hand, the number of patients per day is still increasing. More than 90% are admitted to the hospital for treatment, 72% of which are sent to the intensive care unit, and nearly 30% require medical devices to help breathe. On the other hand, the use of flavored e-cigarettes is increasing. The survey shows that 1) 68% of young people used flavored e-cigarettes in 2019, accounting for 61% in 2017; 2) The 2017 survey found that 63% of young people did not understand The JUUL products they use contain nicotine; 3) From 2011 to 2015, the number of e-cigarettes used by middle school students increased by 900%. 4) A 2018 study found that more than 3.6 million young people use e-cigarettes. The focus group found that the number of young people using e-cigarettes is increasing and there is a trend of addiction. From 2008 to 2018, the number of high school students in Illinois who smoked in the total tobacco market fell from 21% to 5%, but in 2016-2018 , The proportion of e-cigarette usage among high school students rose from 18.4% to 26.7%. The current preliminary idea is to ban flavored nicotine products and study the long- and short-term effects of atomized products on health. The governor of Illinois supported the enactment of legal provisions in the legislative session in October to ban the sale of flavored vaping products specifically targeted at young people. 1.1.3. Albert A. Rizzo's speech (Chief Medical Officer of the American Lung Association) There are two different e-cigarette crises in our country. One is the prevalence and increasing popularity of young people using e-cigarettes; the other is the recent outbreak of lung diseases caused by vaping products in adults and adolescents. According to the 2019 National Tobacco Youth Survey, 27.5% of young people are now using e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The survey asked students whether they had smoked for at least 20 days in the past 30 days? 12% of Grade 12 students, 7% of Grade 10 students, and 2% of Grade 8 students said they do this often. A 2018 CDC study showed that the main reason why teenagers use these products is that the taste of sweets and fruits attracts them, while their friends and family are using them, and they think that e-cigarettes are less harmful. The American Lung Association will urge the FDA and Congress to take action as soon as possible to ban the sale of all flavored tobacco products, including flavored cigars and menthol cigarettes. Regarding the health hazards of e-cigarettes, there are many misleadings, and some of the reasons lead to a high proportion of young people using e-cigarettes. In January 2018, the National Academies of Science, Engineering and Medicine released a research report that reviewed more than 800 different studies. The report clearly pointed out that the use of e-cigarettes is harmful to health, will increase the chance of children and young people starting to use e-cigarettes, and expose others to dangerous second-hand e-cigarette emissions. They concluded that there is "a large amount of evidence" that if young people use electronic cigarettes, the possibility of using traditional cigarettes will increase. A study in Pediatrics magazine also found that young people who use e-cigarettes are four times more likely to try traditional cigarettes than young people who do not use e-cigarettes. According to a study published in the Journal of the American Medical Association in 2015, 81% of young people have ever used tobacco products made from flavored products. Fruit, mint and menthol are the most popular flavors among middle school students who use e-cigarettes. Among them, 65.9% of children use fruit-flavored e-cigarettes, and 63.9% of children use mint or menthol e-cigarettes. The taste in e-cigarettes is produced by a combination of chemicals, which carry a serious risk of lung damage. A 2015 study at Harvard University tested 51 different flavors of e-cigarettes, including marshmallow, bubble gum, and cupcakes, and found that 47 of them were related to at least one chemical substance related to respiratory diseases. E-cigarettes are not smoking cessation products. Smokers who switch to e-cigarettes may also be using traditional cigarettes. "Annals of Internal MedicinA study on "e" found that the probability of wanting to use e-cigarettes to help quit smoking is lower. Only 10.1% of smokers who used e-cigarettes for six months quit smoking, while 26.6% of smokers who did not use e-cigarettes quit smoking . 1.2. FDA intends to ban the sale of flavored e-cigarettes (2019/9/12) On September 12, the FDA stated that in order to reduce the use of e-cigarettes among young people, it will issue a policy to ban the sale of flavored e-cigarettes (including mint flavored e-cigarettes) within a few weeks. ). 1.3. CDC released its views on the causes of death from e-cigarettes (2019/9/19) The latest report from the Centers for Disease Control and Prevention (CDC) of the United States stated that the number of people suffering from lung diseases due to e-cigarettes has soared to 530 in 38 states, as of At present, 7 people have died, causing the Governor of Indiana to pay attention to the ban on flavored e-cigarettes, and corresponding measures may be taken. The CDC is currently unable to determine the specific cause, but they believe that it is caused by chemical exposure. Most of the cases are related to illegal e-cigarette liquid, which contains THC ingredients. These products are from the black market and are not formal e-cigarette stores. But even so, e-cigarette retailers Will also be greatly affected. The American Lung Research Association believes that the country should take action as soon as possible, hoping to remove the flavored e-cigarettes before further research. 2. U.S. states have banned or are preparing to ban the sale of e-cigarettes 2.1. San Francisco became the first city to ban the sale of e-cigarettes (2019/6/25) On June 25, the San Francisco City Supervisory Committee unanimously approved a total ban on the sale of e-cigarettes The regulations stipulate that e-cigarettes will be banned unless they have been reviewed by the FDA鈥檚 PMTA. The regulations are planned to be fully implemented in six months. 2.2. New York State will ban the sale of flavored e-cigarettes, but retain the mint flavor (2019/9/15) Como signed an executive order on September 12 requiring e-cigarettes to be included in New York鈥檚 anti-smoking activities. According to the Cuomo office, 1) Dr. Howard Zucker, commissioner of the State Department of Health, will recommend this week to the State Public Health and Health Planning Commission to issue emergency regulations, which will take effect within two weeks at the earliest. 2) Como has instructed the New York police and the Department of Health to strengthen law enforcement, and retailers who sell e-cigarettes to minors may be subject to criminal penalties; in addition, Como plans to promote legislation to prohibit deceptive marketing of e-cigarettes to teenagers and children. However, the decree does not affect tobacco-based and menthol-flavored e-cigarettes. Trump said last week that an investigation by the Department of Health found hundreds of respiratory disease cases among consumers who use e-cigarettes, so the federal government plans to ban the sale of thousands of flavors in e-cigarettes. Although many cases involve smoking marijuana, problems with the devices, ingredients or additives have not yet been discovered. 2.3. Michigan bans the sale of flavored e-cigarettes (2019/9/18) On September 18, Michigan announced the ban on the sale of flavored nicotine e-cigarettes. The ban will take effect immediately, but there is still a 14-day buffer period for merchants, and the ban will be It lasts for 6 months, but the governor has the right to extend the period. 2.4. Wal-Mart stops selling e-cigarettes (2019/9/20) On September 20, Wal-Mart announced that it would stop selling e-cigarettes. After the current inventory is sold out, it will stop selling e-cigarettes in Wal-Mart stores and Sam’s Clubs. In July of this year, Wal-Mart raised the minimum age for purchasing tobacco products, including all e-cigarettes, to 21 years old, and has indicated that it is discontinuing the sale of fruit-flavored and dessert-flavored e-cigarettes. E-cigarettes are mainly sold through e-cigarette specialty stores, and there are approximately 115,000 specialty stores in the United States. The e-cigarette business only occupies a small part of Wal-Mart, so it has little impact on Wal-Mart. However, Wal-Mart Store + Sam’s Clubs has more than 5,000 stores in the United States. Wal-Mart鈥檚 suspension of sales will reduce the chance of direct contact between e-cigarettes and consumers. It is also difficult to find a replacement for this huge sales channel. 2.5. The state of Massachusetts suspends the sale of all vaping products related to e-cigarettes (2019/9/24) The state of Massachusetts has decided to suspend the sale of all vaping products related to e-cigarettes for 4 months (as of January 25 next year) No.), 1) This emergency suspension is mainly to cooperate with expert doctors to find out the cause of the disease; 2) Currently, the FDA laboratory is testing more than 150 suspicious product samples, but the cause of the patient鈥檚 lung disease has not yet been determined. 3. E-cigarette manufacturing company statement 3.1. British American Tobacco 3.1.1. Response to the US FDA's announcement of atomized products (2019/9/9) British American Tobacco Research Director Dr David O & rsquo; Reilly said that company toxicologists misted the company Each single ingredient in the chemical product has been carefully checked to see if they are suitable for atomization. And the company has never added e-liquid containing THC and vitamin E acetate to atomized products. The tragic incident was because these e-liquids were not purchased from well-known manufacturers and contained ingredients not used by the manufacturers (including THC and vitamin E acetate). The company supports the FDA鈥檚 view that users of vaping products should always buy smoking sets and e-liquids from reputable manufacturers, and should avoid modifying or adding substances to the products they buy, and should use these according to the manufacturer鈥檚 intentions. product. 3.1.2. Statement on supporting strong product quality standards, measures to prevent the use of young people in the United States, and preparing to apply for PMTA at any time (2019/9/12) 1) The company expressed its concern about the marketing of certain flavored products like the FDA Attract the attention of young people. At the same time, it is difficult to overestimate the role of flavored products in helping adult consumers switch from combustible products to alternative tobacco and nicotine products. The company has established corresponding procedures to ensure that its products are only sold to adult smokers and users of vaping products. 2) For the four VUSE products planned to be launched in the United States, the company is confident that it can submit Pre-Market Tobacco Applications (PMTA) before the deadline announced by the FDA (May 2020). If approved, our Reynolds Tobacco will be able to continue to sell its VUSE brand atomized products within the new regulatory framework in the United States. 3.1.3. Statement on the need for strong and effective atomization product supervision (2019/9/20) The company stated that no products developed or produced by British American Tobacco were involved in recent e-cigarette lung disease cases, and it supports investigations made by relevant agencies , And hopes to introduce strong and effective regulations to ensure high product standards, especially in testing and reporting the ingredients used in the e-liquid of atomized products. At the same time, the government also needs to ensure that relevant agencies force manufacturers to comply with these regulations, only through effective With supervision and law enforcement, consumers can maintain confidence in the harm reduction effects of atomized products compared to traditional tobacco. 3.2. Japan Tobacco International 3.2.1. Regarding the response to lung disease cases in the United States (2019/9/13) So far, the US Department of Health is investigating 450 cases of lung disease that may be related to the use of e-cigarettes. Currently, there is little information about the products involved and the underlying causes. We are not aware of any Logic products associated with these cases and are under investigation. We have learned from media reports that many patients have admitted to using e-cigarettes containing THC e-liquid. In addition, it is reported that vitamin E acetate, a chemical substance related to hemp oil, was found in many relevant samples analyzed by the authorities. In our Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. At JTI, we will know exactly the ingredients of Logic: all Logic e-liquids undergo a strict product management plan, including toxicological evaluation and quality control of all ingredients used. Logic e-liquid can only be sold after passing a comprehensive inspection. Nebulizer users should not use the e-liquid produced by manufacturers that have not undergone strict safety and quality inspections. After design and testing, smoking sets and cartridges that can be used together should always be paired with each other. 4. Market share and sales decline of marijuana-related vaping products Since the first death case related to e-cigarettes was reported on August 23, the sales proportion of marijuana-related vaping products in the recreational marijuana product market decline. Comparing the sales data on August 19 and September 16, California: 32.8% decreased to 29%; Colorado: 19.2% decreased to 14.5%; Nevada: 22.3% decreased to 19.2%; Washington: 17.8% decreased to 14.6 %. (Report time: 2019/9/12) Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, and September 9 Total sales from Japan to 15th fell to US$689,924, a decrease of 25%. (Reporting time: 2019/9/19)As of September 18, 2019, the United States has reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaporized products, and 7 people have died. This has made the United States attach great importance to e-cigarettes and vaporized products. Congressional hearings, down to the states and e-cigarette manufacturers, are closely following relevant developments and successively issued attitudes and statements. In particular, flavored e-cigarettes have attracted attention due to their strong appeal to young people. The FDA in September It was announced on the 12th that it would issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention and even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . But from the market point of view, the reaction was strong. On the one hand, the health of e-cigarettes is being questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. The following is the important content of recent reports: On September 24, the United States held a congressional hearing on the issue of e-cigarettes. The preliminary results of the CDC investigation showed that about 80% of patients reported using tetrahydrocannabinol or THC e-liquid, and about 60% said they used e-cigarettes containing tetrahydrocannabinol or THC. Nicotine e-liquid, and about 10-20% of people claim that they only use nicotine-containing products. Although the source of the disease has not been determined, it can be clearly related to chemical exposure. The state of Illinois initially envisages banning the sale of flavored nicotine products. The American Lung Association report stated that 27.5% of young people now use e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The main reason for teenagers to use these products is the attraction of candies and fruit flavors. The American Lung Association will urge the FDA and Congress to ban all flavored tobacco products as soon as possible, including flavored cigars and menthol cigarettes. U.S. states have banned or are preparing to ban the sale of e-cigarettes. On June 25, the San Francisco City Supervisory Committee unanimously passed a ban on the sale of e-cigarettes. On September 15, New York State stated that it would ban the sale of flavored e-cigarettes, but retain the mint flavor. On September 18, Michigan announced a ban on the sale of flavored nicotine e-cigarettes, and the ban took effect immediately. On September 20, Wal-Mart announced that it would stop selling e-cigarettes after it sold out. On September 24, Massachusetts suspended the sale of all vaping products related to e-cigarettes for 4 months. The e-cigarette manufacturing company issued a statement that British Tobacco: 1) never added e-liquid containing THC and vitamin E acetate to its atomized products; 2) for 4 VUSE products planned to be launched in the United States, the company is confident in Submit PMTA before May 2020. Japan Tobacco International: In the Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. The market share and sales decline of cannabis-related atomized products compare the sales ratio of cannabis-related atomized products in the recreational cannabis product market on August 19 and September 16, and the ratio is showing a downward trend. Among them, California: decreased from 32.8% to 29%; Colorado: decreased from 19.2% to 14.5%; Nevada: decreased from 22.3% to 19.2%; Washington: decreased from 17.8% to 14.6%. Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, while the total sales of September 9-15 decreased to 689,924 U.S. dollars, a decrease of 25%. Risk warning: new tobacco policy changes risk, sales are not as expected; industrial hemp should be strictly distinguished from intermediate cannabis, recreational cannabis/drugs, and resolutely opposed to legalization of recreational cannabis. As of September 18, 2019, the United States has reported 530 confirmed cases Seven people died of lung diseases suspected to be related to the use of e-cigarettes or vaping products, making the United States attach great importance to e-cigarettes and vaping products, from congressional hearings to states and e-cigarette manufacturers. All are paying close attention to relevant developments and issuing attitudes and statements one after another, especially flavored e-cigarettes because of their strong appeal to young people. The FDA announced on September 12 that it will issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention to or even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . However, from the market point of view, the response was strong. On the one hand, the health of e-cigarettes has been questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. In order to give you a clearer understanding of recent reports on e-cigarettes in the United States, we have sorted out important content including relevant statements issued by congressional hearings, FDA, CDC, and states and e-cigarette manufacturers for reference. 1. Statement by relevant US agencies 1.1. Congressional hearing (2019/9/24) 1.1.1. Anne Schuchat, MD's speech (CDC, Chief Deputy Director of the Department of Health and Human Services) August 1, 2019, the first time in Wisconsin The Center for Disease Control and Prevention (CDC) was notified of a series of lung diseases that have appeared in young people since July 2019. As of September 18, 2019, 38 states and 1 region in the United States have reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaping products. There are already 6 states (California, Illinois, Indiana). States, Kansas, Minnesota and Oregon). These tragic deaths have exacerbated the urgency of the CDC and the FDA to jointly investigate the cause and provide states with the necessary resources to solve this emerging public health problem. CDC established a case investigation team in August and activated the Emergency Operations Center on September 16 to enable it to devote more resources to this investigation. 1) Case summary For many reasons, investigating the causes of lung injury related to the use of e-cigarettes or aerosol products is quite challenging. a. The investigation involves many states; b. The diversity of the e-cigarette or atomized product market, the wide variety of products, the wide range of ingredients, and the connection with potentially illegal substances such as marijuana all complicate the investigation. Consumers do not know what their e-cigarettes or atomized products contain, and many products and substances themselves can be modified by consumers. They can be obtained from physical stores, online retailers, on the street, or through social channels. Preliminary results: According to data collected in two states and recently published in the New England Journal of Medicine, most patients (about 80%) report using cigarettes containing tetrahydrocannabinol or THC (the psychoactive compound of cannabis) Oil, and half (about 60%) of people said they use nicotine-containing e-liquid, while about 10-20% said they only use nicotine-containing products. However, no e-cigarette or atomized product, a certain brand or a specific substance has a clear connection with the epidemic. CDC has received complete gender and age data for 373 of the 530 cases. Almost three-quarters of the cases are men. Two-thirds of the cases were between 18 and 34 years old, 16% were under 18 years old, and 17% were over 35 years old. The lung damage observed in this incident does not seem to be caused by infection. The pathological findings and the results of the non-infectious diagnosis indicate that the cause of the disease is related to exposure to chemical substances. Patients first showed signs of illness within a few days to a few weeks after using e-cigarettes or aerosol products, and gradually developed symptoms such as dyspnea, shortness of breath, or chest pain before hospitalization. Some patients developed mild to moderate gastrointestinal diseases. There are other symptoms including fatigue, fever and weight loss. So far, investigators have not found any specific products or compounds related to all cases. 2) Youth e-cigarette use data Preliminary data from the 2019 National Youth Tobacco Survey show that the use of youth e-cigarettes continues to rise. Data show that in 2019, more than a quarter of high school students currently (in the past 30 days) use e-cigarettes, a significant increase compared to 2017. From 2017 to 2018, the number of e-cigarettes used by high school students increased by 77.8%, and more than a quarter of high school students are currently using tobacco products. 3) Hazards associated with cannabis use CDC is committed to monitoring cannabis use, identifying related health effects, and improving the monitoring capabilities of CDC and state/local jurisdictions. In this outbreak, many patients used e-cigarettes or vaporized products containing THC, which indicates the need to understand the health effects of the increasing use of cannabis and the changing market in the United States, as states are working on the legalization of cannabis. For medical or recreational purposes. In 2018, it is estimated that 16% of the population 12 years and older uses marijuana. 4) CDC鈥檚 recommendations to manufacturers, states, and the public. CDC recommends that the public who are worried that e-cigarettes or vaping products may cause lung diseases should consider avoiding e-cigarettes or vaping products. Teenagers, pregnant women, or non-smokers do not Electronic cigarettes should be used. Anyone who uses electronic cigarettes or vaping products should not buy these products on the street, and should not modify or add ingredients on their own. 1.1.2. NgoziO. Ezike's speech (Director of the Illinois Department of Public Health) 69 people in Illinois suffered from serious respiratory diseases after using e-cigarettes or aerosol products, and 1 person died. The patients were between 15-42 years old, with a median of 22 years old, and most of them were men. Although the cause of the illness has not yet been determined, it is certain that smoking e-cigarettes is not a healthy behavior and is not conducive to the health of young people. Illinois began investigating after learning that some residents had respiratory diseases related to e-cigarettes on July 31, 2019, and issued an alert to the Department of Health on August 2 to conduct a cooperative investigation with the CDC and start investigating the effects of e-cigarettes. The prevalence and habit of smoking e-cigarettes among adolescents, and measures such as youth education, case studies, and related legal studies. Nevertheless, on the one hand, the number of patients per day is still increasing. More than 90% are admitted to the hospital for treatment, 72% of which are sent to the intensive care unit, and nearly 30% require medical devices to help breathe. On the other hand, the use of flavored e-cigarettes is increasing. The survey shows that 1) 68% of young people used flavored e-cigarettes in 2019, accounting for 61% in 2017; 2) The 2017 survey found that 63% of young people did not understand The JUUL products they use contain nicotine; 3) From 2011 to 2015, the number of e-cigarettes used by middle school students increased by 900%. 4) A 2018 study found that more than 3.6 million young people use e-cigarettes. The focus group found that the number of young people using e-cigarettes is increasing and there is a trend of addiction. From 2008 to 2018, the number of high school students in Illinois who smoked in the total tobacco market fell from 21% to 5%, but in 2016-2018 , The proportion of e-cigarette usage among high school students rose from 18.4% to 26.7%. The current preliminary idea is to ban flavored nicotine products and study the long- and short-term effects of atomized products on health. The governor of Illinois supported the enactment of legal provisions in the legislative session in October to ban the sale of flavored vaping products specifically targeted at young people. 1.1.3. Albert A. Rizzo's speech (Chief Medical Officer of the American Lung Association) There are two different e-cigarette crises in our country. One is the prevalence and increasing popularity of young people using e-cigarettes; the other is the recent outbreak of lung diseases caused by vaping products in adults and adolescents. According to the 2019 National Tobacco Youth Survey, 27.5% of young people are now using e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The survey asked students whether they had smoked for at least 20 days in the past 30 days? 12% of Grade 12 students, 7% of Grade 10 students, and 2% of Grade 8 students said they do this often. A 2018 CDC study showed that the main reason why teenagers use these products is that the taste of sweets and fruits attracts them, while their friends and family are using them, and they think that e-cigarettes are less harmful. The American Lung Association will urge the FDA and Congress to take action as soon as possible to ban the sale of all flavored tobacco products, including flavored cigars and menthol cigarettes. Regarding the health hazards of e-cigarettes, there are many misleadings, and some of the reasons lead to a high proportion of young people using e-cigarettes. In January 2018, the National Academies of Science, Engineering and Medicine released a research report that reviewed more than 800 different studies. The report clearly pointed out that the use of e-cigarettes is harmful to health, will increase the chance of children and young people starting to use e-cigarettes, and expose others to dangerous second-hand e-cigarette emissions. They concluded that there is "a large amount of evidence" that if young people use electronic cigarettes, the possibility of using traditional cigarettes will increase. A study in Pediatrics magazine also found that young people who use e-cigarettes are four times more likely to try traditional cigarettes than young people who do not use e-cigarettes. According to a study published in the Journal of the American Medical Association in 2015, 81% of young people have ever used tobacco products made from flavored products. Fruit, mint and menthol are the most popular flavors among middle school students who use e-cigarettes. Among them, 65.9% of children use fruit-flavored e-cigarettes, and 63.9% of children use mint or menthol e-cigarettes. The taste in e-cigarettes is produced by a combination of chemicals, which carry a serious risk of lung damage. A 2015 study at Harvard University tested 51 different flavors of e-cigarettes, including marshmallow, bubble gum, and cupcakes, and found that 47 of them were related to at least one chemical substance related to respiratory diseases. E-cigarettes are not smoking cessation products. Smokers who switch to e-cigarettes may also be using traditional cigarettes. "Annals of Internal MedicinA study on "e" found that the probability of wanting to use e-cigarettes to help quit smoking is lower. Only 10.1% of smokers who used e-cigarettes for six months quit smoking, while 26.6% of smokers who did not use e-cigarettes quit smoking . 1.2. FDA intends to ban the sale of flavored e-cigarettes (2019/9/12) On September 12, the FDA stated that in order to reduce the use of e-cigarettes among young people, it will issue a policy to ban the sale of flavored e-cigarettes (including mint flavored e-cigarettes) within a few weeks. ). 1.3. CDC released its views on the causes of death from e-cigarettes (2019/9/19) The latest report from the Centers for Disease Control and Prevention (CDC) of the United States stated that the number of people suffering from lung diseases due to e-cigarettes has soared to 530 in 38 states, as of At present, 7 people have died, causing the Governor of Indiana to pay attention to the ban on flavored e-cigarettes, and corresponding measures may be taken. The CDC is currently unable to determine the specific cause, but they believe that it is caused by chemical exposure. Most of the cases are related to illegal e-cigarette liquid, which contains THC ingredients. These products are from the black market and are not formal e-cigarette stores. But even so, e-cigarette retailers Will also be greatly affected. The American Lung Research Association believes that the country should take action as soon as possible, hoping to remove the flavored e-cigarettes before further research. 2. U.S. states have banned or are preparing to ban the sale of e-cigarettes 2.1. San Francisco became the first city to ban the sale of e-cigarettes (2019/6/25) On June 25, the San Francisco City Supervisory Committee unanimously approved a total ban on the sale of e-cigarettes The regulations stipulate that e-cigarettes will be banned unless they have been reviewed by the FDA鈥檚 PMTA. The regulations are planned to be fully implemented in six months. 2.2. New York State will ban the sale of flavored e-cigarettes, but retain the mint flavor (2019/9/15) Como signed an executive order on September 12 requiring e-cigarettes to be included in New York鈥檚 anti-smoking activities. According to the Cuomo office, 1) Dr. Howard Zucker, commissioner of the State Department of Health, will recommend this week to the State Public Health and Health Planning Commission to issue emergency regulations, which will take effect within two weeks at the earliest. 2) Como has instructed the New York police and the Department of Health to strengthen law enforcement, and retailers who sell e-cigarettes to minors may be subject to criminal penalties; in addition, Como plans to promote legislation to prohibit deceptive marketing of e-cigarettes to teenagers and children. However, the decree does not affect tobacco-based and menthol-flavored e-cigarettes. Trump said last week that an investigation by the Department of Health found hundreds of respiratory disease cases among consumers who use e-cigarettes, so the federal government plans to ban the sale of thousands of flavors in e-cigarettes. Although many cases involve smoking marijuana, problems with the devices, ingredients or additives have not yet been discovered. 2.3. Michigan bans the sale of flavored e-cigarettes (2019/9/18) On September 18, Michigan announced the ban on the sale of flavored nicotine e-cigarettes. The ban will take effect immediately, but there is still a 14-day buffer period for merchants, and the ban will be It lasts for 6 months, but the governor has the right to extend the period. 2.4. Wal-Mart stops selling e-cigarettes (2019/9/20) On September 20, Wal-Mart announced that it would stop selling e-cigarettes. After the current inventory is sold out, it will stop selling e-cigarettes in Wal-Mart stores and Sam’s Clubs. In July of this year, Wal-Mart raised the minimum age for purchasing tobacco products, including all e-cigarettes, to 21 years old, and has indicated that it is discontinuing the sale of fruit-flavored and dessert-flavored e-cigarettes. E-cigarettes are mainly sold through e-cigarette specialty stores, and there are approximately 115,000 specialty stores in the United States. The e-cigarette business only occupies a small part of Wal-Mart, so it has little impact on Wal-Mart. However, Wal-Mart Store + Sam’s Clubs has more than 5,000 stores in the United States. Wal-Mart鈥檚 suspension of sales will reduce the chance of direct contact between e-cigarettes and consumers. It is also difficult to find a replacement for this huge sales channel. 2.5. The state of Massachusetts suspends the sale of all vaping products related to e-cigarettes (2019/9/24) The state of Massachusetts has decided to suspend the sale of all vaping products related to e-cigarettes for 4 months (as of January 25 next year) No.), 1) This emergency suspension is mainly to cooperate with expert doctors to find out the cause of the disease; 2) Currently, the FDA laboratory is testing more than 150 suspicious product samples, but the cause of the patient鈥檚 lung disease has not yet been determined. 3. E-cigarette manufacturing company statement 3.1. British American Tobacco 3.1.1. Response to the US FDA's announcement of atomized products (2019/9/9) British American Tobacco Research Director Dr David O & rsquo; Reilly said that company toxicologists misted the company Each single ingredient in the chemical product has been carefully checked to see if they are suitable for atomization. And the company has never added e-liquid containing THC and vitamin E acetate to atomized products. The tragic incident was because these e-liquids were not purchased from well-known manufacturers and contained ingredients not used by the manufacturers (including THC and vitamin E acetate). The company supports the FDA鈥檚 view that users of vaping products should always buy smoking sets and e-liquids from reputable manufacturers, and should avoid modifying or adding substances to the products they buy, and should use these according to the manufacturer鈥檚 intentions. product. 3.1.2. Statement on supporting strong product quality standards, measures to prevent the use of young people in the United States, and preparing to apply for PMTA at any time (2019/9/12) 1) The company expressed its concern about the marketing of certain flavored products like the FDA Attract the attention of young people. At the same time, it is difficult to overestimate the role of flavored products in helping adult consumers switch from combustible products to alternative tobacco and nicotine products. The company has established corresponding procedures to ensure that its products are only sold to adult smokers and users of vaping products. 2) For the four VUSE products planned to be launched in the United States, the company is confident that it can submit Pre-Market Tobacco Applications (PMTA) before the deadline announced by the FDA (May 2020). If approved, our Reynolds Tobacco will be able to continue to sell its VUSE brand atomized products within the new regulatory framework in the United States. 3.1.3. Statement on the need for strong and effective atomization product supervision (2019/9/20) The company stated that no products developed or produced by British American Tobacco were involved in recent e-cigarette lung disease cases, and it supports investigations made by relevant agencies , And hopes to introduce strong and effective regulations to ensure high product standards, especially in testing and reporting the ingredients used in the e-liquid of atomized products. At the same time, the government also needs to ensure that relevant agencies force manufacturers to comply with these regulations, only through effective With supervision and law enforcement, consumers can maintain confidence in the harm reduction effects of atomized products compared to traditional tobacco. 3.2. Japan Tobacco International 3.2.1. Regarding the response to lung disease cases in the United States (2019/9/13) So far, the US Department of Health is investigating 450 cases of lung disease that may be related to the use of e-cigarettes. Currently, there is little information about the products involved and the underlying causes. We are not aware of any Logic products associated with these cases and are under investigation. We have learned from media reports that many patients have admitted to using e-cigarettes containing THC e-liquid. In addition, it is reported that vitamin E acetate, a chemical substance related to hemp oil, was found in many relevant samples analyzed by the authorities. In our Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. At JTI, we will know exactly the ingredients of Logic: all Logic e-liquids undergo a strict product management plan, including toxicological evaluation and quality control of all ingredients used. Logic e-liquid can only be sold after passing a comprehensive inspection. Nebulizer users should not use the e-liquid produced by manufacturers that have not undergone strict safety and quality inspections. After design and testing, smoking sets and cartridges that can be used together should always be paired with each other. 4. Market share and sales decline of marijuana-related vaping products Since the first death case related to e-cigarettes was reported on August 23, the sales proportion of marijuana-related vaping products in the recreational marijuana product market decline. Comparing the sales data on August 19 and September 16, California: 32.8% decreased to 29%; Colorado: 19.2% decreased to 14.5%; Nevada: 22.3% decreased to 19.2%; Washington: 17.8% decreased to 14.6 %. (Report time: 2019/9/12) Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, and September 9 Total sales from Japan to 15th fell to US$689,924, a decrease of 25%. (Reporting time: 2019/9/19)

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As of September 18, 2019, the United States has reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaporized products, and 7 people have died. This has made the United States attach great importance to e-cigarettes and vaporized products. Congressional hearings, down to the states and e-cigarette manufacturers, are closely following relevant developments and successively issued attitudes and statements. In particular, flavored e-cigarettes have attracted attention due to their strong appeal to young people. The FDA in September It was announced on the 12th that it would issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention and even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . But from the market point of view, the reaction was strong. On the one hand, the health of e-cigarettes is being questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. The following is the important content of recent reports: On September 24, the United States held a congressional hearing on the issue of e-cigarettes. The preliminary results of the CDC investigation showed that about 80% of patients reported using tetrahydrocannabinol or THC e-liquid, and about 60% said they used e-cigarettes containing tetrahydrocannabinol or THC. Nicotine e-liquid, and about 10-20% of people claim that they only use nicotine-containing products. Although the source of the disease has not been determined, it can be clearly related to chemical exposure. The state of Illinois initially envisages banning the sale of flavored nicotine products. The American Lung Association report stated that 27.5% of young people now use e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The main reason for teenagers to use these products is the attraction of candies and fruit flavors. The American Lung Association will urge the FDA and Congress to ban all flavored tobacco products as soon as possible, including flavored cigars and menthol cigarettes. U.S. states have banned or are preparing to ban the sale of e-cigarettes. On June 25, the San Francisco City Supervisory Committee unanimously passed a ban on the sale of e-cigarettes. On September 15, New York State stated that it would ban the sale of flavored e-cigarettes, but retain the mint flavor. On September 18, Michigan announced a ban on the sale of flavored nicotine e-cigarettes, and the ban took effect immediately. On September 20, Wal-Mart announced that it would stop selling e-cigarettes after it sold out. On September 24, Massachusetts suspended the sale of all vaping products related to e-cigarettes for 4 months. The e-cigarette manufacturing company issued a statement that British Tobacco: 1) never added e-liquid containing THC and vitamin E acetate to its atomized products; 2) for 4 VUSE products planned to be launched in the United States, the company is confident in Submit PMTA before May 2020. Japan Tobacco International: In the Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. The market share and sales decline of cannabis-related atomized products compare the sales ratio of cannabis-related atomized products in the recreational cannabis product market on August 19 and September 16, and the ratio is showing a downward trend. Among them, California: decreased from 32.8% to 29%; Colorado: decreased from 19.2% to 14.5%; Nevada: decreased from 22.3% to 19.2%; Washington: decreased from 17.8% to 14.6%. Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, while the total sales of September 9-15 decreased to 689,924 U.S. dollars, a decrease of 25%. Risk warning: new tobacco policy changes risk, sales are not as expected; industrial hemp should be strictly distinguished from intermediate cannabis, recreational cannabis/drugs, and resolutely opposed to legalization of recreational cannabis. As of September 18, 2019, the United States has reported 530 confirmed cases Seven people died of lung diseases suspected to be related to the use of e-cigarettes or vaping products, making the United States attach great importance to e-cigarettes and vaping products, from congressional hearings to states and e-cigarette manufacturers. All are paying close attention to relevant developments and issuing attitudes and statements one after another, especially flavored e-cigarettes because of their strong appeal to young people. The FDA announced on September 12 that it will issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention to or even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . However, from the market point of view, the response was strong. On the one hand, the health of e-cigarettes has been questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. In order to give you a clearer understanding of recent reports on e-cigarettes in the United States, we have sorted out important content including relevant statements issued by congressional hearings, FDA, CDC, and states and e-cigarette manufacturers for reference. 1. Statement by relevant US agencies 1.1. Congressional hearing (2019/9/24) 1.1.1. Anne Schuchat, MD's speech (CDC, Chief Deputy Director of the Department of Health and Human Services) August 1, 2019, the first time in Wisconsin The Center for Disease Control and Prevention (CDC) was notified of a series of lung diseases that have appeared in young people since July 2019. As of September 18, 2019, 38 states and 1 region in the United States have reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaping products. There are already 6 states (California, Illinois, Indiana). States, Kansas, Minnesota and Oregon). These tragic deaths have exacerbated the urgency of the CDC and the FDA to jointly investigate the cause and provide states with the necessary resources to solve this emerging public health problem. CDC established a case investigation team in August and activated the Emergency Operations Center on September 16 to enable it to devote more resources to this investigation. 1) Case summary For many reasons, investigating the causes of lung injury related to the use of e-cigarettes or aerosol products is quite challenging. a. The investigation involves many states; b. The diversity of the e-cigarette or atomized product market, the wide variety of products, the wide range of ingredients, and the connection with potentially illegal substances such as marijuana all complicate the investigation. Consumers do not know what their e-cigarettes or atomized products contain, and many products and substances themselves can be modified by consumers. They can be obtained from physical stores, online retailers, on the street, or through social channels. Preliminary results: According to data collected in two states and recently published in the New England Journal of Medicine, most patients (about 80%) report using cigarettes containing tetrahydrocannabinol or THC (the psychoactive compound of cannabis) Oil, and half (about 60%) of people said they use nicotine-containing e-liquid, while about 10-20% said they only use nicotine-containing products. However, no e-cigarette or atomized product, a certain brand or a specific substance has a clear connection with the epidemic. CDC has received complete gender and age data for 373 of the 530 cases. Almost three-quarters of the cases are men. Two-thirds of the cases were between 18 and 34 years old, 16% were under 18 years old, and 17% were over 35 years old. The lung damage observed in this incident does not seem to be caused by infection. The pathological findings and the results of the non-infectious diagnosis indicate that the cause of the disease is related to exposure to chemical substances. Patients first showed signs of illness within a few days to a few weeks after using e-cigarettes or aerosol products, and gradually developed symptoms such as dyspnea, shortness of breath, or chest pain before hospitalization. Some patients developed mild to moderate gastrointestinal diseases. There are other symptoms including fatigue, fever and weight loss. So far, investigators have not found any specific products or compounds related to all cases. 2) Youth e-cigarette use data Preliminary data from the 2019 National Youth Tobacco Survey show that the use of youth e-cigarettes continues to rise. Data show that in 2019, more than a quarter of high school students currently (in the past 30 days) use e-cigarettes, a significant increase compared to 2017. From 2017 to 2018, the number of e-cigarettes used by high school students increased by 77.8%, and more than a quarter of high school students are currently using tobacco products. 3) Hazards associated with cannabis use CDC is committed to monitoring cannabis use, identifying related health effects, and improving the monitoring capabilities of CDC and state/local jurisdictions. In this outbreak, many patients used e-cigarettes or vaporized products containing THC, which indicates the need to understand the health effects of the increasing use of cannabis and the changing market in the United States, as states are working on the legalization of cannabis. For medical or recreational purposes. In 2018, it is estimated that 16% of the population 12 years and older uses marijuana. 4) CDC鈥檚 recommendations to manufacturers, states, and the public. CDC recommends that the public who are worried that e-cigarettes or vaping products may cause lung diseases should consider avoiding e-cigarettes or vaping products. Teenagers, pregnant women, or non-smokers do not Electronic cigarettes should be used. Anyone who uses electronic cigarettes or vaping products should not buy these products on the street, and should not modify or add ingredients on their own. 1.1.2. NgoziO. Ezike's speech (Director of the Illinois Department of Public Health) 69 people in Illinois suffered from serious respiratory diseases after using e-cigarettes or aerosol products, and 1 person died. The patients were between 15-42 years old, with a median of 22 years old, and most of them were men. Although the cause of the illness has not yet been determined, it is certain that smoking e-cigarettes is not a healthy behavior and is not conducive to the health of young people. Illinois began investigating after learning that some residents had respiratory diseases related to e-cigarettes on July 31, 2019, and issued an alert to the Department of Health on August 2 to conduct a cooperative investigation with the CDC and start investigating the effects of e-cigarettes. The prevalence and habit of smoking e-cigarettes among adolescents, and measures such as youth education, case studies, and related legal studies. Nevertheless, on the one hand, the number of patients per day is still increasing. More than 90% are admitted to the hospital for treatment, 72% of which are sent to the intensive care unit, and nearly 30% require medical devices to help breathe. On the other hand, the use of flavored e-cigarettes is increasing. The survey shows that 1) 68% of young people used flavored e-cigarettes in 2019, accounting for 61% in 2017; 2) The 2017 survey found that 63% of young people did not understand The JUUL products they use contain nicotine; 3) From 2011 to 2015, the number of e-cigarettes used by middle school students increased by 900%. 4) A 2018 study found that more than 3.6 million young people use e-cigarettes. The focus group found that the number of young people using e-cigarettes is increasing and there is a trend of addiction. From 2008 to 2018, the number of high school students in Illinois who smoked in the total tobacco market fell from 21% to 5%, but in 2016-2018 , The proportion of e-cigarette usage among high school students rose from 18.4% to 26.7%. The current preliminary idea is to ban flavored nicotine products and study the long- and short-term effects of atomized products on health. The governor of Illinois supported the enactment of legal provisions in the legislative session in October to ban the sale of flavored vaping products specifically targeted at young people. 1.1.3. Albert A. Rizzo's speech (Chief Medical Officer of the American Lung Association) There are two different e-cigarette crises in our country. One is the prevalence and increasing popularity of young people using e-cigarettes; the other is the recent outbreak of lung diseases caused by vaping products in adults and adolescents. According to the 2019 National Tobacco Youth Survey, 27.5% of young people are now using e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The survey asked students whether they had smoked for at least 20 days in the past 30 days? 12% of Grade 12 students, 7% of Grade 10 students, and 2% of Grade 8 students said they do this often. A 2018 CDC study showed that the main reason why teenagers use these products is that the taste of sweets and fruits attracts them, while their friends and family are using them, and they think that e-cigarettes are less harmful. The American Lung Association will urge the FDA and Congress to take action as soon as possible to ban the sale of all flavored tobacco products, including flavored cigars and menthol cigarettes. Regarding the health hazards of e-cigarettes, there are many misleadings, and some of the reasons lead to a high proportion of young people using e-cigarettes. In January 2018, the National Academies of Science, Engineering and Medicine released a research report that reviewed more than 800 different studies. The report clearly pointed out that the use of e-cigarettes is harmful to health, will increase the chance of children and young people starting to use e-cigarettes, and expose others to dangerous second-hand e-cigarette emissions. They concluded that there is "a large amount of evidence" that if young people use electronic cigarettes, the possibility of using traditional cigarettes will increase. A study in Pediatrics magazine also found that young people who use e-cigarettes are four times more likely to try traditional cigarettes than young people who do not use e-cigarettes. According to a study published in the Journal of the American Medical Association in 2015, 81% of young people have ever used tobacco products made from flavored products. Fruit, mint and menthol are the most popular flavors among middle school students who use e-cigarettes. Among them, 65.9% of children use fruit-flavored e-cigarettes, and 63.9% of children use mint or menthol e-cigarettes. The taste in e-cigarettes is produced by a combination of chemicals, which carry a serious risk of lung damage. A 2015 study at Harvard University tested 51 different flavors of e-cigarettes, including marshmallow, bubble gum, and cupcakes, and found that 47 of them were related to at least one chemical substance related to respiratory diseases. E-cigarettes are not smoking cessation products. Smokers who switch to e-cigarettes may also be using traditional cigarettes. "Annals of Internal MedicinA study on "e" found that the probability of wanting to use e-cigarettes to help quit smoking is lower. Only 10.1% of smokers who used e-cigarettes for six months quit smoking, while 26.6% of smokers who did not use e-cigarettes quit smoking . 1.2. FDA intends to ban the sale of flavored e-cigarettes (2019/9/12) On September 12, the FDA stated that in order to reduce the use of e-cigarettes among young people, it will issue a policy to ban the sale of flavored e-cigarettes (including mint flavored e-cigarettes) within a few weeks. ). 1.3. CDC released its views on the causes of death from e-cigarettes (2019/9/19) The latest report from the Centers for Disease Control and Prevention (CDC) of the United States stated that the number of people suffering from lung diseases due to e-cigarettes has soared to 530 in 38 states, as of At present, 7 people have died, causing the Governor of Indiana to pay attention to the ban on flavored e-cigarettes, and corresponding measures may be taken. The CDC is currently unable to determine the specific cause, but they believe that it is caused by chemical exposure. Most of the cases are related to illegal e-cigarette liquid, which contains THC ingredients. These products are from the black market and are not formal e-cigarette stores. But even so, e-cigarette retailers Will also be greatly affected. The American Lung Research Association believes that the country should take action as soon as possible, hoping to remove the flavored e-cigarettes before further research. 2. U.S. states have banned or are preparing to ban the sale of e-cigarettes 2.1. San Francisco became the first city to ban the sale of e-cigarettes (2019/6/25) On June 25, the San Francisco City Supervisory Committee unanimously approved a total ban on the sale of e-cigarettes The regulations stipulate that e-cigarettes will be banned unless they have been reviewed by the FDA鈥檚 PMTA. The regulations are planned to be fully implemented in six months. 2.2. New York State will ban the sale of flavored e-cigarettes, but retain the mint flavor (2019/9/15) Como signed an executive order on September 12 requiring e-cigarettes to be included in New York鈥檚 anti-smoking activities. According to the Cuomo office, 1) Dr. Howard Zucker, commissioner of the State Department of Health, will recommend this week to the State Public Health and Health Planning Commission to issue emergency regulations, which will take effect within two weeks at the earliest. 2) Como has instructed the New York police and the Department of Health to strengthen law enforcement, and retailers who sell e-cigarettes to minors may be subject to criminal penalties; in addition, Como plans to promote legislation to prohibit deceptive marketing of e-cigarettes to teenagers and children. However, the decree does not affect tobacco-based and menthol-flavored e-cigarettes. Trump said last week that an investigation by the Department of Health found hundreds of respiratory disease cases among consumers who use e-cigarettes, so the federal government plans to ban the sale of thousands of flavors in e-cigarettes. Although many cases involve smoking marijuana, problems with the devices, ingredients or additives have not yet been discovered. 2.3. Michigan bans the sale of flavored e-cigarettes (2019/9/18) On September 18, Michigan announced the ban on the sale of flavored nicotine e-cigarettes. The ban will take effect immediately, but there is still a 14-day buffer period for merchants, and the ban will be It lasts for 6 months, but the governor has the right to extend the period. 2.4. Wal-Mart stops selling e-cigarettes (2019/9/20) On September 20, Wal-Mart announced that it would stop selling e-cigarettes. After the current inventory is sold out, it will stop selling e-cigarettes in Wal-Mart stores and Sam’s Clubs. In July of this year, Wal-Mart raised the minimum age for purchasing tobacco products, including all e-cigarettes, to 21 years old, and has indicated that it is discontinuing the sale of fruit-flavored and dessert-flavored e-cigarettes. E-cigarettes are mainly sold through e-cigarette specialty stores, and there are approximately 115,000 specialty stores in the United States. The e-cigarette business only occupies a small part of Wal-Mart, so it has little impact on Wal-Mart. However, Wal-Mart Store + Sam’s Clubs has more than 5,000 stores in the United States. Wal-Mart鈥檚 suspension of sales will reduce the chance of direct contact between e-cigarettes and consumers. It is also difficult to find a replacement for this huge sales channel. 2.5. The state of Massachusetts suspends the sale of all vaping products related to e-cigarettes (2019/9/24) The state of Massachusetts has decided to suspend the sale of all vaping products related to e-cigarettes for 4 months (as of January 25 next year) No.), 1) This emergency suspension is mainly to cooperate with expert doctors to find out the cause of the disease; 2) Currently, the FDA laboratory is testing more than 150 suspicious product samples, but the cause of the patient鈥檚 lung disease has not yet been determined. 3. E-cigarette manufacturing company statement 3.1. British American Tobacco 3.1.1. Response to the US FDA's announcement of atomized products (2019/9/9) British American Tobacco Research Director Dr David O & rsquo; Reilly said that company toxicologists misted the company Each single ingredient in the chemical product has been carefully checked to see if they are suitable for atomization. And the company has never added e-liquid containing THC and vitamin E acetate to atomized products. The tragic incident was because these e-liquids were not purchased from well-known manufacturers and contained ingredients not used by the manufacturers (including THC and vitamin E acetate). The company supports the FDA鈥檚 view that users of vaping products should always buy smoking sets and e-liquids from reputable manufacturers, and should avoid modifying or adding substances to the products they buy, and should use these according to the manufacturer鈥檚 intentions. product. 3.1.2. Statement on supporting strong product quality standards, measures to prevent the use of young people in the United States, and preparing to apply for PMTA at any time (2019/9/12) 1) The company expressed its concern about the marketing of certain flavored products like the FDA Attract the attention of young people. At the same time, it is difficult to overestimate the role of flavored products in helping adult consumers switch from combustible products to alternative tobacco and nicotine products. The company has established corresponding procedures to ensure that its products are only sold to adult smokers and users of vaping products. 2) For the four VUSE products planned to be launched in the United States, the company is confident that it can submit Pre-Market Tobacco Applications (PMTA) before the deadline announced by the FDA (May 2020). If approved, our Reynolds Tobacco will be able to continue to sell its VUSE brand atomized products within the new regulatory framework in the United States. 3.1.3. Statement on the need for strong and effective atomization product supervision (2019/9/20) The company stated that no products developed or produced by British American Tobacco were involved in recent e-cigarette lung disease cases, and it supports investigations made by relevant agencies , And hopes to introduce strong and effective regulations to ensure high product standards, especially in testing and reporting the ingredients used in the e-liquid of atomized products. At the same time, the government also needs to ensure that relevant agencies force manufacturers to comply with these regulations, only through effective With supervision and law enforcement, consumers can maintain confidence in the harm reduction effects of atomized products compared to traditional tobacco. 3.2. Japan Tobacco International 3.2.1. Regarding the response to lung disease cases in the United States (2019/9/13) So far, the US Department of Health is investigating 450 cases of lung disease that may be related to the use of e-cigarettes. Currently, there is little information about the products involved and the underlying causes. We are not aware of any Logic products associated with these cases and are under investigation. We have learned from media reports that many patients have admitted to using e-cigarettes containing THC e-liquid. In addition, it is reported that vitamin E acetate, a chemical substance related to hemp oil, was found in many relevant samples analyzed by the authorities. In our Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. At JTI, we will know exactly the ingredients of Logic: all Logic e-liquids undergo a strict product management plan, including toxicological evaluation and quality control of all ingredients used. Logic e-liquid can only be sold after passing a comprehensive inspection. Nebulizer users should not use the e-liquid produced by manufacturers that have not undergone strict safety and quality inspections. After design and testing, smoking sets and cartridges that can be used together should always be paired with each other. 4. Market share and sales decline of marijuana-related vaping products Since the first death case related to e-cigarettes was reported on August 23, the sales proportion of marijuana-related vaping products in the recreational marijuana product market decline. Comparing the sales data on August 19 and September 16, California: 32.8% decreased to 29%; Colorado: 19.2% decreased to 14.5%; Nevada: 22.3% decreased to 19.2%; Washington: 17.8% decreased to 14.6 %. (Report time: 2019/9/12) Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, and September 9 Total sales from Japan to 15th fell to US$689,924, a decrease of 25%. (Reporting time: 2019/9/19)Summary of U.S. e-cigarette policies and related reportsAs of September 18, 2019, the United States has reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaporized products, and 7 people have died. This has made the United States attach great importance to e-cigarettes and vaporized products. Congressional hearings, down to the states and e-cigarette manufacturers, are closely following relevant developments and successively issued attitudes and statements. In particular, flavored e-cigarettes have attracted attention due to their strong appeal to young people. The FDA in September It was announced on the 12th that it would issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention and even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . But from the market point of view, the reaction was strong. On the one hand, the health of e-cigarettes is being questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. The following is the important content of recent reports: On September 24, the United States held a congressional hearing on the issue of e-cigarettes. The preliminary results of the CDC investigation showed that about 80% of patients reported using tetrahydrocannabinol or THC e-liquid, and about 60% said they used e-cigarettes containing tetrahydrocannabinol or THC. Nicotine e-liquid, and about 10-20% of people claim that they only use nicotine-containing products. Although the source of the disease has not been determined, it can be clearly related to chemical exposure. The state of Illinois initially envisages banning the sale of flavored nicotine products. The American Lung Association report stated that 27.5% of young people now use e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The main reason for teenagers to use these products is the attraction of candies and fruit flavors. The American Lung Association will urge the FDA and Congress to ban all flavored tobacco products as soon as possible, including flavored cigars and menthol cigarettes. U.S. states have banned or are preparing to ban the sale of e-cigarettes. On June 25, the San Francisco City Supervisory Committee unanimously passed a ban on the sale of e-cigarettes. On September 15, New York State stated that it would ban the sale of flavored e-cigarettes, but retain the mint flavor. On September 18, Michigan announced a ban on the sale of flavored nicotine e-cigarettes, and the ban took effect immediately. On September 20, Wal-Mart announced that it would stop selling e-cigarettes after it sold out. On September 24, Massachusetts suspended the sale of all vaping products related to e-cigarettes for 4 months. The e-cigarette manufacturing company issued a statement that British Tobacco: 1) never added e-liquid containing THC and vitamin E acetate to its atomized products; 2) for 4 VUSE products planned to be launched in the United States, the company is confident in Submit PMTA before May 2020. Japan Tobacco International: In the Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. The market share and sales decline of cannabis-related atomized products compare the sales ratio of cannabis-related atomized products in the recreational cannabis product market on August 19 and September 16, and the ratio is showing a downward trend. Among them, California: decreased from 32.8% to 29%; Colorado: decreased from 19.2% to 14.5%; Nevada: decreased from 22.3% to 19.2%; Washington: decreased from 17.8% to 14.6%. Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, while the total sales of September 9-15 decreased to 689,924 U.S. dollars, a decrease of 25%. Risk warning: new tobacco policy changes risk, sales are not as expected; industrial hemp should be strictly distinguished from intermediate cannabis, recreational cannabis/drugs, and resolutely opposed to legalization of recreational cannabis. As of September 18, 2019, the United States has reported 530 confirmed cases Seven people died of lung diseases suspected to be related to the use of e-cigarettes or vaping products, making the United States attach great importance to e-cigarettes and vaping products, from congressional hearings to states and e-cigarette manufacturers. All are paying close attention to relevant developments and issuing attitudes and statements one after another, especially flavored e-cigarettes because of their strong appeal to young people. The FDA announced on September 12 that it will issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention to or even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . However, from the market point of view, the response was strong. On the one hand, the health of e-cigarettes has been questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. In order to give you a clearer understanding of recent reports on e-cigarettes in the United States, we have sorted out important content including relevant statements issued by congressional hearings, FDA, CDC, and states and e-cigarette manufacturers for reference. 1. Statement by relevant US agencies 1.1. Congressional hearing (2019/9/24) 1.1.1. Anne Schuchat, MD's speech (CDC, Chief Deputy Director of the Department of Health and Human Services) August 1, 2019, the first time in Wisconsin The Center for Disease Control and Prevention (CDC) was notified of a series of lung diseases that have appeared in young people since July 2019. As of September 18, 2019, 38 states and 1 region in the United States have reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaping products. There are already 6 states (California, Illinois, Indiana). States, Kansas, Minnesota and Oregon). These tragic deaths have exacerbated the urgency of the CDC and the FDA to jointly investigate the cause and provide states with the necessary resources to solve this emerging public health problem. CDC established a case investigation team in August and activated the Emergency Operations Center on September 16 to enable it to devote more resources to this investigation. 1) Case summary For many reasons, investigating the causes of lung injury related to the use of e-cigarettes or aerosol products is quite challenging. a. The investigation involves many states; b. The diversity of the e-cigarette or atomized product market, the wide variety of products, the wide range of ingredients, and the connection with potentially illegal substances such as marijuana all complicate the investigation. Consumers do not know what their e-cigarettes or atomized products contain, and many products and substances themselves can be modified by consumers. They can be obtained from physical stores, online retailers, on the street, or through social channels. Preliminary results: According to data collected in two states and recently published in the New England Journal of Medicine, most patients (about 80%) report using cigarettes containing tetrahydrocannabinol or THC (the psychoactive compound of cannabis) Oil, and half (about 60%) of people said they use nicotine-containing e-liquid, while about 10-20% said they only use nicotine-containing products. However, no e-cigarette or atomized product, a certain brand or a specific substance has a clear connection with the epidemic. CDC has received complete gender and age data for 373 of the 530 cases. Almost three-quarters of the cases are men. Two-thirds of the cases were between 18 and 34 years old, 16% were under 18 years old, and 17% were over 35 years old. The lung damage observed in this incident does not seem to be caused by infection. The pathological findings and the results of the non-infectious diagnosis indicate that the cause of the disease is related to exposure to chemical substances. Patients first showed signs of illness within a few days to a few weeks after using e-cigarettes or aerosol products, and gradually developed symptoms such as dyspnea, shortness of breath, or chest pain before hospitalization. Some patients developed mild to moderate gastrointestinal diseases. There are other symptoms including fatigue, fever and weight loss. So far, investigators have not found any specific products or compounds related to all cases. 2) Youth e-cigarette use data Preliminary data from the 2019 National Youth Tobacco Survey show that the use of youth e-cigarettes continues to rise. Data show that in 2019, more than a quarter of high school students currently (in the past 30 days) use e-cigarettes, a significant increase compared to 2017. From 2017 to 2018, the number of e-cigarettes used by high school students increased by 77.8%, and more than a quarter of high school students are currently using tobacco products. 3) Hazards associated with cannabis use CDC is committed to monitoring cannabis use, identifying related health effects, and improving the monitoring capabilities of CDC and state/local jurisdictions. In this outbreak, many patients used e-cigarettes or vaporized products containing THC, which indicates the need to understand the health effects of the increasing use of cannabis and the changing market in the United States, as states are working on the legalization of cannabis. For medical or recreational purposes. In 2018, it is estimated that 16% of the population 12 years and older uses marijuana. 4) CDC鈥檚 recommendations to manufacturers, states, and the public. CDC recommends that the public who are worried that e-cigarettes or vaping products may cause lung diseases should consider avoiding e-cigarettes or vaping products. Teenagers, pregnant women, or non-smokers do not Electronic cigarettes should be used. Anyone who uses electronic cigarettes or vaping products should not buy these products on the street, and should not modify or add ingredients on their own. 1.1.2. NgoziO. Ezike's speech (Director of the Illinois Department of Public Health) 69 people in Illinois suffered from serious respiratory diseases after using e-cigarettes or aerosol products, and 1 person died. The patients were between 15-42 years old, with a median of 22 years old, and most of them were men. Although the cause of the illness has not yet been determined, it is certain that smoking e-cigarettes is not a healthy behavior and is not conducive to the health of young people. Illinois began investigating after learning that some residents had respiratory diseases related to e-cigarettes on July 31, 2019, and issued an alert to the Department of Health on August 2 to conduct a cooperative investigation with the CDC and start investigating the effects of e-cigarettes. The prevalence and habit of smoking e-cigarettes among adolescents, and measures such as youth education, case studies, and related legal studies. Nevertheless, on the one hand, the number of patients per day is still increasing. More than 90% are admitted to the hospital for treatment, 72% of which are sent to the intensive care unit, and nearly 30% require medical devices to help breathe. On the other hand, the use of flavored e-cigarettes is increasing. The survey shows that 1) 68% of young people used flavored e-cigarettes in 2019, accounting for 61% in 2017; 2) The 2017 survey found that 63% of young people did not understand The JUUL products they use contain nicotine; 3) From 2011 to 2015, the number of e-cigarettes used by middle school students increased by 900%. 4) A 2018 study found that more than 3.6 million young people use e-cigarettes. The focus group found that the number of young people using e-cigarettes is increasing and there is a trend of addiction. From 2008 to 2018, the number of high school students in Illinois who smoked in the total tobacco market fell from 21% to 5%, but in 2016-2018 , The proportion of e-cigarette usage among high school students rose from 18.4% to 26.7%. The current preliminary idea is to ban flavored nicotine products and study the long- and short-term effects of atomized products on health. The governor of Illinois supported the enactment of legal provisions in the legislative session in October to ban the sale of flavored vaping products specifically targeted at young people. 1.1.3. Albert A. Rizzo's speech (Chief Medical Officer of the American Lung Association) There are two different e-cigarette crises in our country. One is the prevalence and increasing popularity of young people using e-cigarettes; the other is the recent outbreak of lung diseases caused by vaping products in adults and adolescents. According to the 2019 National Tobacco Youth Survey, 27.5% of young people are now using e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The survey asked students whether they had smoked for at least 20 days in the past 30 days? 12% of Grade 12 students, 7% of Grade 10 students, and 2% of Grade 8 students said they do this often. A 2018 CDC study showed that the main reason why teenagers use these products is that the taste of sweets and fruits attracts them, while their friends and family are using them, and they think that e-cigarettes are less harmful. The American Lung Association will urge the FDA and Congress to take action as soon as possible to ban the sale of all flavored tobacco products, including flavored cigars and menthol cigarettes. Regarding the health hazards of e-cigarettes, there are many misleadings, and some of the reasons lead to a high proportion of young people using e-cigarettes. In January 2018, the National Academies of Science, Engineering and Medicine released a research report that reviewed more than 800 different studies. The report clearly pointed out that the use of e-cigarettes is harmful to health, will increase the chance of children and young people starting to use e-cigarettes, and expose others to dangerous second-hand e-cigarette emissions. They concluded that there is "a large amount of evidence" that if young people use electronic cigarettes, the possibility of using traditional cigarettes will increase. A study in Pediatrics magazine also found that young people who use e-cigarettes are four times more likely to try traditional cigarettes than young people who do not use e-cigarettes. According to a study published in the Journal of the American Medical Association in 2015, 81% of young people have ever used tobacco products made from flavored products. Fruit, mint and menthol are the most popular flavors among middle school students who use e-cigarettes. Among them, 65.9% of children use fruit-flavored e-cigarettes, and 63.9% of children use mint or menthol e-cigarettes. The taste in e-cigarettes is produced by a combination of chemicals, which carry a serious risk of lung damage. A 2015 study at Harvard University tested 51 different flavors of e-cigarettes, including marshmallow, bubble gum, and cupcakes, and found that 47 of them were related to at least one chemical substance related to respiratory diseases. E-cigarettes are not smoking cessation products. Smokers who switch to e-cigarettes may also be using traditional cigarettes. "Annals of Internal MedicinA study on "e" found that the probability of wanting to use e-cigarettes to help quit smoking is lower. Only 10.1% of smokers who used e-cigarettes for six months quit smoking, while 26.6% of smokers who did not use e-cigarettes quit smoking . 1.2. FDA intends to ban the sale of flavored e-cigarettes (2019/9/12) On September 12, the FDA stated that in order to reduce the use of e-cigarettes among young people, it will issue a policy to ban the sale of flavored e-cigarettes (including mint flavored e-cigarettes) within a few weeks. ). 1.3. CDC released its views on the causes of death from e-cigarettes (2019/9/19) The latest report from the Centers for Disease Control and Prevention (CDC) of the United States stated that the number of people suffering from lung diseases due to e-cigarettes has soared to 530 in 38 states, as of At present, 7 people have died, causing the Governor of Indiana to pay attention to the ban on flavored e-cigarettes, and corresponding measures may be taken. The CDC is currently unable to determine the specific cause, but they believe that it is caused by chemical exposure. Most of the cases are related to illegal e-cigarette liquid, which contains THC ingredients. These products are from the black market and are not formal e-cigarette stores. But even so, e-cigarette retailers Will also be greatly affected. The American Lung Research Association believes that the country should take action as soon as possible, hoping to remove the flavored e-cigarettes before further research. 2. U.S. states have banned or are preparing to ban the sale of e-cigarettes 2.1. San Francisco became the first city to ban the sale of e-cigarettes (2019/6/25) On June 25, the San Francisco City Supervisory Committee unanimously approved a total ban on the sale of e-cigarettes The regulations stipulate that e-cigarettes will be banned unless they have been reviewed by the FDA鈥檚 PMTA. The regulations are planned to be fully implemented in six months. 2.2. New York State will ban the sale of flavored e-cigarettes, but retain the mint flavor (2019/9/15) Como signed an executive order on September 12 requiring e-cigarettes to be included in New York鈥檚 anti-smoking activities. According to the Cuomo office, 1) Dr. Howard Zucker, commissioner of the State Department of Health, will recommend this week to the State Public Health and Health Planning Commission to issue emergency regulations, which will take effect within two weeks at the earliest. 2) Como has instructed the New York police and the Department of Health to strengthen law enforcement, and retailers who sell e-cigarettes to minors may be subject to criminal penalties; in addition, Como plans to promote legislation to prohibit deceptive marketing of e-cigarettes to teenagers and children. However, the decree does not affect tobacco-based and menthol-flavored e-cigarettes. Trump said last week that an investigation by the Department of Health found hundreds of respiratory disease cases among consumers who use e-cigarettes, so the federal government plans to ban the sale of thousands of flavors in e-cigarettes. Although many cases involve smoking marijuana, problems with the devices, ingredients or additives have not yet been discovered. 2.3. Michigan bans the sale of flavored e-cigarettes (2019/9/18) On September 18, Michigan announced the ban on the sale of flavored nicotine e-cigarettes. The ban will take effect immediately, but there is still a 14-day buffer period for merchants, and the ban will be It lasts for 6 months, but the governor has the right to extend the period. 2.4. Wal-Mart stops selling e-cigarettes (2019/9/20) On September 20, Wal-Mart announced that it would stop selling e-cigarettes. After the current inventory is sold out, it will stop selling e-cigarettes in Wal-Mart stores and Sam’s Clubs. In July of this year, Wal-Mart raised the minimum age for purchasing tobacco products, including all e-cigarettes, to 21 years old, and has indicated that it is discontinuing the sale of fruit-flavored and dessert-flavored e-cigarettes. E-cigarettes are mainly sold through e-cigarette specialty stores, and there are approximately 115,000 specialty stores in the United States. The e-cigarette business only occupies a small part of Wal-Mart, so it has little impact on Wal-Mart. However, Wal-Mart Store + Sam’s Clubs has more than 5,000 stores in the United States. Wal-Mart鈥檚 suspension of sales will reduce the chance of direct contact between e-cigarettes and consumers. It is also difficult to find a replacement for this huge sales channel. 2.5. The state of Massachusetts suspends the sale of all vaping products related to e-cigarettes (2019/9/24) The state of Massachusetts has decided to suspend the sale of all vaping products related to e-cigarettes for 4 months (as of January 25 next year) No.), 1) This emergency suspension is mainly to cooperate with expert doctors to find out the cause of the disease; 2) Currently, the FDA laboratory is testing more than 150 suspicious product samples, but the cause of the patient鈥檚 lung disease has not yet been determined. 3. E-cigarette manufacturing company statement 3.1. British American Tobacco 3.1.1. Response to the US FDA's announcement of atomized products (2019/9/9) British American Tobacco Research Director Dr David O & rsquo; Reilly said that company toxicologists misted the company Each single ingredient in the chemical product has been carefully checked to see if they are suitable for atomization. And the company has never added e-liquid containing THC and vitamin E acetate to atomized products. The tragic incident was because these e-liquids were not purchased from well-known manufacturers and contained ingredients not used by the manufacturers (including THC and vitamin E acetate). The company supports the FDA鈥檚 view that users of vaping products should always buy smoking sets and e-liquids from reputable manufacturers, and should avoid modifying or adding substances to the products they buy, and should use these according to the manufacturer鈥檚 intentions. product. 3.1.2. Statement on supporting strong product quality standards, measures to prevent the use of young people in the United States, and preparing to apply for PMTA at any time (2019/9/12) 1) The company expressed its concern about the marketing of certain flavored products like the FDA Attract the attention of young people. At the same time, it is difficult to overestimate the role of flavored products in helping adult consumers switch from combustible products to alternative tobacco and nicotine products. The company has established corresponding procedures to ensure that its products are only sold to adult smokers and users of vaping products. 2) For the four VUSE products planned to be launched in the United States, the company is confident that it can submit Pre-Market Tobacco Applications (PMTA) before the deadline announced by the FDA (May 2020). If approved, our Reynolds Tobacco will be able to continue to sell its VUSE brand atomized products within the new regulatory framework in the United States. 3.1.3. Statement on the need for strong and effective atomization product supervision (2019/9/20) The company stated that no products developed or produced by British American Tobacco were involved in recent e-cigarette lung disease cases, and it supports investigations made by relevant agencies , And hopes to introduce strong and effective regulations to ensure high product standards, especially in testing and reporting the ingredients used in the e-liquid of atomized products. At the same time, the government also needs to ensure that relevant agencies force manufacturers to comply with these regulations, only through effective With supervision and law enforcement, consumers can maintain confidence in the harm reduction effects of atomized products compared to traditional tobacco. 3.2. Japan Tobacco International 3.2.1. Regarding the response to lung disease cases in the United States (2019/9/13) So far, the US Department of Health is investigating 450 cases of lung disease that may be related to the use of e-cigarettes. Currently, there is little information about the products involved and the underlying causes. We are not aware of any Logic products associated with these cases and are under investigation. We have learned from media reports that many patients have admitted to using e-cigarettes containing THC e-liquid. In addition, it is reported that vitamin E acetate, a chemical substance related to hemp oil, was found in many relevant samples analyzed by the authorities. In our Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. At JTI, we will know exactly the ingredients of Logic: all Logic e-liquids undergo a strict product management plan, including toxicological evaluation and quality control of all ingredients used. Logic e-liquid can only be sold after passing a comprehensive inspection. Nebulizer users should not use the e-liquid produced by manufacturers that have not undergone strict safety and quality inspections. After design and testing, smoking sets and cartridges that can be used together should always be paired with each other. 4. Market share and sales decline of marijuana-related vaping products Since the first death case related to e-cigarettes was reported on August 23, the sales proportion of marijuana-related vaping products in the recreational marijuana product market decline. Comparing the sales data on August 19 and September 16, California: 32.8% decreased to 29%; Colorado: 19.2% decreased to 14.5%; Nevada: 22.3% decreased to 19.2%; Washington: 17.8% decreased to 14.6 %. (Report time: 2019/9/12) Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, and September 9 Total sales from Japan to 15th fell to US$689,924, a decrease of 25%. (Reporting time: 2019/9/19)As of September 18, 2019, the United States has reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaporized products, and 7 people have died. This has made the United States attach great importance to e-cigarettes and vaporized products. Congressional hearings, down to the states and e-cigarette manufacturers, are closely following relevant developments and successively issued attitudes and statements. In particular, flavored e-cigarettes have attracted attention due to their strong appeal to young people. The FDA in September It was announced on the 12th that it would issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention and even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . But from the market point of view, the reaction was strong. On the one hand, the health of e-cigarettes is being questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. The following is the important content of recent reports: On September 24, the United States held a congressional hearing on the issue of e-cigarettes. The preliminary results of the CDC investigation showed that about 80% of patients reported using tetrahydrocannabinol or THC e-liquid, and about 60% said they used e-cigarettes containing tetrahydrocannabinol or THC. Nicotine e-liquid, and about 10-20% of people claim that they only use nicotine-containing products. Although the source of the disease has not been determined, it can be clearly related to chemical exposure. The state of Illinois initially envisages banning the sale of flavored nicotine products. The American Lung Association report stated that 27.5% of young people now use e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The main reason for teenagers to use these products is the attraction of candies and fruit flavors. The American Lung Association will urge the FDA and Congress to ban all flavored tobacco products as soon as possible, including flavored cigars and menthol cigarettes. U.S. states have banned or are preparing to ban the sale of e-cigarettes. On June 25, the San Francisco City Supervisory Committee unanimously passed a ban on the sale of e-cigarettes. On September 15, New York State stated that it would ban the sale of flavored e-cigarettes, but retain the mint flavor. On September 18, Michigan announced a ban on the sale of flavored nicotine e-cigarettes, and the ban took effect immediately. On September 20, Wal-Mart announced that it would stop selling e-cigarettes after it sold out. On September 24, Massachusetts suspended the sale of all vaping products related to e-cigarettes for 4 months. The e-cigarette manufacturing company issued a statement that British Tobacco: 1) never added e-liquid containing THC and vitamin E acetate to its atomized products; 2) for 4 VUSE products planned to be launched in the United States, the company is confident in Submit PMTA before May 2020. Japan Tobacco International: In the Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. The market share and sales decline of cannabis-related atomized products compare the sales ratio of cannabis-related atomized products in the recreational cannabis product market on August 19 and September 16, and the ratio is showing a downward trend. Among them, California: decreased from 32.8% to 29%; Colorado: decreased from 19.2% to 14.5%; Nevada: decreased from 22.3% to 19.2%; Washington: decreased from 17.8% to 14.6%. Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, while the total sales of September 9-15 decreased to 689,924 U.S. dollars, a decrease of 25%. Risk warning: new tobacco policy changes risk, sales are not as expected; industrial hemp should be strictly distinguished from intermediate cannabis, recreational cannabis/drugs, and resolutely opposed to legalization of recreational cannabis. As of September 18, 2019, the United States has reported 530 confirmed cases Seven people died of lung diseases suspected to be related to the use of e-cigarettes or vaping products, making the United States attach great importance to e-cigarettes and vaping products, from congressional hearings to states and e-cigarette manufacturers. All are paying close attention to relevant developments and issuing attitudes and statements one after another, especially flavored e-cigarettes because of their strong appeal to young people. The FDA announced on September 12 that it will issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention to or even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . However, from the market point of view, the response was strong. On the one hand, the health of e-cigarettes has been questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. In order to give you a clearer understanding of recent reports on e-cigarettes in the United States, we have sorted out important content including relevant statements issued by congressional hearings, FDA, CDC, and states and e-cigarette manufacturers for reference. 1. Statement by relevant US agencies 1.1. Congressional hearing (2019/9/24) 1.1.1. Anne Schuchat, MD's speech (CDC, Chief Deputy Director of the Department of Health and Human Services) August 1, 2019, the first time in Wisconsin The Center for Disease Control and Prevention (CDC) was notified of a series of lung diseases that have appeared in young people since July 2019. As of September 18, 2019, 38 states and 1 region in the United States have reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaping products. There are already 6 states (California, Illinois, Indiana). States, Kansas, Minnesota and Oregon). These tragic deaths have exacerbated the urgency of the CDC and the FDA to jointly investigate the cause and provide states with the necessary resources to solve this emerging public health problem. CDC established a case investigation team in August and activated the Emergency Operations Center on September 16 to enable it to devote more resources to this investigation. 1) Case summary For many reasons, investigating the causes of lung injury related to the use of e-cigarettes or aerosol products is quite challenging. a. The investigation involves many states; b. The diversity of the e-cigarette or atomized product market, the wide variety of products, the wide range of ingredients, and the connection with potentially illegal substances such as marijuana all complicate the investigation. Consumers do not know what their e-cigarettes or atomized products contain, and many products and substances themselves can be modified by consumers. They can be obtained from physical stores, online retailers, on the street, or through social channels. Preliminary results: According to data collected in two states and recently published in the New England Journal of Medicine, most patients (about 80%) report using cigarettes containing tetrahydrocannabinol or THC (the psychoactive compound of cannabis) Oil, and half (about 60%) of people said they use nicotine-containing e-liquid, while about 10-20% said they only use nicotine-containing products. However, no e-cigarette or atomized product, a certain brand or a specific substance has a clear connection with the epidemic. CDC has received complete gender and age data for 373 of the 530 cases. Almost three-quarters of the cases are men. Two-thirds of the cases were between 18 and 34 years old, 16% were under 18 years old, and 17% were over 35 years old. The lung damage observed in this incident does not seem to be caused by infection. The pathological findings and the results of the non-infectious diagnosis indicate that the cause of the disease is related to exposure to chemical substances. Patients first showed signs of illness within a few days to a few weeks after using e-cigarettes or aerosol products, and gradually developed symptoms such as dyspnea, shortness of breath, or chest pain before hospitalization. Some patients developed mild to moderate gastrointestinal diseases. There are other symptoms including fatigue, fever and weight loss. So far, investigators have not found any specific products or compounds related to all cases. 2) Youth e-cigarette use data Preliminary data from the 2019 National Youth Tobacco Survey show that the use of youth e-cigarettes continues to rise. Data show that in 2019, more than a quarter of high school students currently (in the past 30 days) use e-cigarettes, a significant increase compared to 2017. From 2017 to 2018, the number of e-cigarettes used by high school students increased by 77.8%, and more than a quarter of high school students are currently using tobacco products. 3) Hazards associated with cannabis use CDC is committed to monitoring cannabis use, identifying related health effects, and improving the monitoring capabilities of CDC and state/local jurisdictions. In this outbreak, many patients used e-cigarettes or vaporized products containing THC, which indicates the need to understand the health effects of the increasing use of cannabis and the changing market in the United States, as states are working on the legalization of cannabis. For medical or recreational purposes. In 2018, it is estimated that 16% of the population 12 years and older uses marijuana. 4) CDC鈥檚 recommendations to manufacturers, states, and the public. CDC recommends that the public who are worried that e-cigarettes or vaping products may cause lung diseases should consider avoiding e-cigarettes or vaping products. Teenagers, pregnant women, or non-smokers do not Electronic cigarettes should be used. Anyone who uses electronic cigarettes or vaping products should not buy these products on the street, and should not modify or add ingredients on their own. 1.1.2. NgoziO. Ezike's speech (Director of the Illinois Department of Public Health) 69 people in Illinois suffered from serious respiratory diseases after using e-cigarettes or aerosol products, and 1 person died. The patients were between 15-42 years old, with a median of 22 years old, and most of them were men. Although the cause of the illness has not yet been determined, it is certain that smoking e-cigarettes is not a healthy behavior and is not conducive to the health of young people. Illinois began investigating after learning that some residents had respiratory diseases related to e-cigarettes on July 31, 2019, and issued an alert to the Department of Health on August 2 to conduct a cooperative investigation with the CDC and start investigating the effects of e-cigarettes. The prevalence and habit of smoking e-cigarettes among adolescents, and measures such as youth education, case studies, and related legal studies. Nevertheless, on the one hand, the number of patients per day is still increasing. More than 90% are admitted to the hospital for treatment, 72% of which are sent to the intensive care unit, and nearly 30% require medical devices to help breathe. On the other hand, the use of flavored e-cigarettes is increasing. The survey shows that 1) 68% of young people used flavored e-cigarettes in 2019, accounting for 61% in 2017; 2) The 2017 survey found that 63% of young people did not understand The JUUL products they use contain nicotine; 3) From 2011 to 2015, the number of e-cigarettes used by middle school students increased by 900%. 4) A 2018 study found that more than 3.6 million young people use e-cigarettes. The focus group found that the number of young people using e-cigarettes is increasing and there is a trend of addiction. From 2008 to 2018, the number of high school students in Illinois who smoked in the total tobacco market fell from 21% to 5%, but in 2016-2018 , The proportion of e-cigarette usage among high school students rose from 18.4% to 26.7%. The current preliminary idea is to ban flavored nicotine products and study the long- and short-term effects of atomized products on health. The governor of Illinois supported the enactment of legal provisions in the legislative session in October to ban the sale of flavored vaping products specifically targeted at young people. 1.1.3. Albert A. Rizzo's speech (Chief Medical Officer of the American Lung Association) There are two different e-cigarette crises in our country. One is the prevalence and increasing popularity of young people using e-cigarettes; the other is the recent outbreak of lung diseases caused by vaping products in adults and adolescents. According to the 2019 National Tobacco Youth Survey, 27.5% of young people are now using e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The survey asked students whether they had smoked for at least 20 days in the past 30 days? 12% of Grade 12 students, 7% of Grade 10 students, and 2% of Grade 8 students said they do this often. A 2018 CDC study showed that the main reason why teenagers use these products is that the taste of sweets and fruits attracts them, while their friends and family are using them, and they think that e-cigarettes are less harmful. The American Lung Association will urge the FDA and Congress to take action as soon as possible to ban the sale of all flavored tobacco products, including flavored cigars and menthol cigarettes. Regarding the health hazards of e-cigarettes, there are many misleadings, and some of the reasons lead to a high proportion of young people using e-cigarettes. In January 2018, the National Academies of Science, Engineering and Medicine released a research report that reviewed more than 800 different studies. The report clearly pointed out that the use of e-cigarettes is harmful to health, will increase the chance of children and young people starting to use e-cigarettes, and expose others to dangerous second-hand e-cigarette emissions. They concluded that there is "a large amount of evidence" that if young people use electronic cigarettes, the possibility of using traditional cigarettes will increase. A study in Pediatrics magazine also found that young people who use e-cigarettes are four times more likely to try traditional cigarettes than young people who do not use e-cigarettes. According to a study published in the Journal of the American Medical Association in 2015, 81% of young people have ever used tobacco products made from flavored products. Fruit, mint and menthol are the most popular flavors among middle school students who use e-cigarettes. Among them, 65.9% of children use fruit-flavored e-cigarettes, and 63.9% of children use mint or menthol e-cigarettes. The taste in e-cigarettes is produced by a combination of chemicals, which carry a serious risk of lung damage. A 2015 study at Harvard University tested 51 different flavors of e-cigarettes, including marshmallow, bubble gum, and cupcakes, and found that 47 of them were related to at least one chemical substance related to respiratory diseases. E-cigarettes are not smoking cessation products. Smokers who switch to e-cigarettes may also be using traditional cigarettes. "Annals of Internal MedicinA study on "e" found that the probability of wanting to use e-cigarettes to help quit smoking is lower. Only 10.1% of smokers who used e-cigarettes for six months quit smoking, while 26.6% of smokers who did not use e-cigarettes quit smoking . 1.2. FDA intends to ban the sale of flavored e-cigarettes (2019/9/12) On September 12, the FDA stated that in order to reduce the use of e-cigarettes among young people, it will issue a policy to ban the sale of flavored e-cigarettes (including mint flavored e-cigarettes) within a few weeks. ). 1.3. CDC released its views on the causes of death from e-cigarettes (2019/9/19) The latest report from the Centers for Disease Control and Prevention (CDC) of the United States stated that the number of people suffering from lung diseases due to e-cigarettes has soared to 530 in 38 states, as of At present, 7 people have died, causing the Governor of Indiana to pay attention to the ban on flavored e-cigarettes, and corresponding measures may be taken. The CDC is currently unable to determine the specific cause, but they believe that it is caused by chemical exposure. Most of the cases are related to illegal e-cigarette liquid, which contains THC ingredients. These products are from the black market and are not formal e-cigarette stores. But even so, e-cigarette retailers Will also be greatly affected. The American Lung Research Association believes that the country should take action as soon as possible, hoping to remove the flavored e-cigarettes before further research. 2. U.S. states have banned or are preparing to ban the sale of e-cigarettes 2.1. San Francisco became the first city to ban the sale of e-cigarettes (2019/6/25) On June 25, the San Francisco City Supervisory Committee unanimously approved a total ban on the sale of e-cigarettes The regulations stipulate that e-cigarettes will be banned unless they have been reviewed by the FDA鈥檚 PMTA. The regulations are planned to be fully implemented in six months. 2.2. New York State will ban the sale of flavored e-cigarettes, but retain the mint flavor (2019/9/15) Como signed an executive order on September 12 requiring e-cigarettes to be included in New York鈥檚 anti-smoking activities. According to the Cuomo office, 1) Dr. Howard Zucker, commissioner of the State Department of Health, will recommend this week to the State Public Health and Health Planning Commission to issue emergency regulations, which will take effect within two weeks at the earliest. 2) Como has instructed the New York police and the Department of Health to strengthen law enforcement, and retailers who sell e-cigarettes to minors may be subject to criminal penalties; in addition, Como plans to promote legislation to prohibit deceptive marketing of e-cigarettes to teenagers and children. However, the decree does not affect tobacco-based and menthol-flavored e-cigarettes. Trump said last week that an investigation by the Department of Health found hundreds of respiratory disease cases among consumers who use e-cigarettes, so the federal government plans to ban the sale of thousands of flavors in e-cigarettes. Although many cases involve smoking marijuana, problems with the devices, ingredients or additives have not yet been discovered. 2.3. Michigan bans the sale of flavored e-cigarettes (2019/9/18) On September 18, Michigan announced the ban on the sale of flavored nicotine e-cigarettes. The ban will take effect immediately, but there is still a 14-day buffer period for merchants, and the ban will be It lasts for 6 months, but the governor has the right to extend the period. 2.4. Wal-Mart stops selling e-cigarettes (2019/9/20) On September 20, Wal-Mart announced that it would stop selling e-cigarettes. After the current inventory is sold out, it will stop selling e-cigarettes in Wal-Mart stores and Sam’s Clubs. In July of this year, Wal-Mart raised the minimum age for purchasing tobacco products, including all e-cigarettes, to 21 years old, and has indicated that it is discontinuing the sale of fruit-flavored and dessert-flavored e-cigarettes. E-cigarettes are mainly sold through e-cigarette specialty stores, and there are approximately 115,000 specialty stores in the United States. The e-cigarette business only occupies a small part of Wal-Mart, so it has little impact on Wal-Mart. However, Wal-Mart Store + Sam’s Clubs has more than 5,000 stores in the United States. Wal-Mart鈥檚 suspension of sales will reduce the chance of direct contact between e-cigarettes and consumers. It is also difficult to find a replacement for this huge sales channel. 2.5. The state of Massachusetts suspends the sale of all vaping products related to e-cigarettes (2019/9/24) The state of Massachusetts has decided to suspend the sale of all vaping products related to e-cigarettes for 4 months (as of January 25 next year) No.), 1) This emergency suspension is mainly to cooperate with expert doctors to find out the cause of the disease; 2) Currently, the FDA laboratory is testing more than 150 suspicious product samples, but the cause of the patient鈥檚 lung disease has not yet been determined. 3. E-cigarette manufacturing company statement 3.1. British American Tobacco 3.1.1. Response to the US FDA's announcement of atomized products (2019/9/9) British American Tobacco Research Director Dr David O & rsquo; Reilly said that company toxicologists misted the company Each single ingredient in the chemical product has been carefully checked to see if they are suitable for atomization. And the company has never added e-liquid containing THC and vitamin E acetate to atomized products. The tragic incident was because these e-liquids were not purchased from well-known manufacturers and contained ingredients not used by the manufacturers (including THC and vitamin E acetate). The company supports the FDA鈥檚 view that users of vaping products should always buy smoking sets and e-liquids from reputable manufacturers, and should avoid modifying or adding substances to the products they buy, and should use these according to the manufacturer鈥檚 intentions. product. 3.1.2. Statement on supporting strong product quality standards, measures to prevent the use of young people in the United States, and preparing to apply for PMTA at any time (2019/9/12) 1) The company expressed its concern about the marketing of certain flavored products like the FDA Attract the attention of young people. At the same time, it is difficult to overestimate the role of flavored products in helping adult consumers switch from combustible products to alternative tobacco and nicotine products. The company has established corresponding procedures to ensure that its products are only sold to adult smokers and users of vaping products. 2) For the four VUSE products planned to be launched in the United States, the company is confident that it can submit Pre-Market Tobacco Applications (PMTA) before the deadline announced by the FDA (May 2020). If approved, our Reynolds Tobacco will be able to continue to sell its VUSE brand atomized products within the new regulatory framework in the United States. 3.1.3. Statement on the need for strong and effective atomization product supervision (2019/9/20) The company stated that no products developed or produced by British American Tobacco were involved in recent e-cigarette lung disease cases, and it supports investigations made by relevant agencies , And hopes to introduce strong and effective regulations to ensure high product standards, especially in testing and reporting the ingredients used in the e-liquid of atomized products. At the same time, the government also needs to ensure that relevant agencies force manufacturers to comply with these regulations, only through effective With supervision and law enforcement, consumers can maintain confidence in the harm reduction effects of atomized products compared to traditional tobacco. 3.2. Japan Tobacco International 3.2.1. Regarding the response to lung disease cases in the United States (2019/9/13) So far, the US Department of Health is investigating 450 cases of lung disease that may be related to the use of e-cigarettes. Currently, there is little information about the products involved and the underlying causes. We are not aware of any Logic products associated with these cases and are under investigation. We have learned from media reports that many patients have admitted to using e-cigarettes containing THC e-liquid. In addition, it is reported that vitamin E acetate, a chemical substance related to hemp oil, was found in many relevant samples analyzed by the authorities. In our Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. At JTI, we will know exactly the ingredients of Logic: all Logic e-liquids undergo a strict product management plan, including toxicological evaluation and quality control of all ingredients used. Logic e-liquid can only be sold after passing a comprehensive inspection. Nebulizer users should not use the e-liquid produced by manufacturers that have not undergone strict safety and quality inspections. After design and testing, smoking sets and cartridges that can be used together should always be paired with each other. 4. Market share and sales decline of marijuana-related vaping products Since the first death case related to e-cigarettes was reported on August 23, the sales proportion of marijuana-related vaping products in the recreational marijuana product market decline. Comparing the sales data on August 19 and September 16, California: 32.8% decreased to 29%; Colorado: 19.2% decreased to 14.5%; Nevada: 22.3% decreased to 19.2%; Washington: 17.8% decreased to 14.6 %. (Report time: 2019/9/12) Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, and September 9 Total sales from Japan to 15th fell to US$689,924, a decrease of 25%. (Reporting time: 2019/9/19)As of September 18, 2019, the United States has reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaporized products, and 7 people have died. This has made the United States attach great importance to e-cigarettes and vaporized products. Congressional hearings, down to the states and e-cigarette manufacturers, are closely following relevant developments and successively issued attitudes and statements. In particular, flavored e-cigarettes have attracted attention due to their strong appeal to young people. The FDA in September It was announced on the 12th that it would issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention and even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . But from the market point of view, the reaction was strong. On the one hand, the health of e-cigarettes is being questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. The following is the important content of recent reports: On September 24, the United States held a congressional hearing on the issue of e-cigarettes. The preliminary results of the CDC investigation showed that about 80% of patients reported using tetrahydrocannabinol or THC e-liquid, and about 60% said they used e-cigarettes containing tetrahydrocannabinol or THC. Nicotine e-liquid, and about 10-20% of people claim that they only use nicotine-containing products. Although the source of the disease has not been determined, it can be clearly related to chemical exposure. The state of Illinois initially envisages banning the sale of flavored nicotine products. The American Lung Association report stated that 27.5% of young people now use e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The main reason for teenagers to use these products is the attraction of candies and fruit flavors. The American Lung Association will urge the FDA and Congress to ban all flavored tobacco products as soon as possible, including flavored cigars and menthol cigarettes. U.S. states have banned or are preparing to ban the sale of e-cigarettes. On June 25, the San Francisco City Supervisory Committee unanimously passed a ban on the sale of e-cigarettes. On September 15, New York State stated that it would ban the sale of flavored e-cigarettes, but retain the mint flavor. On September 18, Michigan announced a ban on the sale of flavored nicotine e-cigarettes, and the ban took effect immediately. On September 20, Wal-Mart announced that it would stop selling e-cigarettes after it sold out. On September 24, Massachusetts suspended the sale of all vaping products related to e-cigarettes for 4 months. The e-cigarette manufacturing company issued a statement that British Tobacco: 1) never added e-liquid containing THC and vitamin E acetate to its atomized products; 2) for 4 VUSE products planned to be launched in the United States, the company is confident in Submit PMTA before May 2020. Japan Tobacco International: In the Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. The market share and sales decline of cannabis-related atomized products compare the sales ratio of cannabis-related atomized products in the recreational cannabis product market on August 19 and September 16, and the ratio is showing a downward trend. Among them, California: decreased from 32.8% to 29%; Colorado: decreased from 19.2% to 14.5%; Nevada: decreased from 22.3% to 19.2%; Washington: decreased from 17.8% to 14.6%. Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, while the total sales of September 9-15 decreased to 689,924 U.S. dollars, a decrease of 25%. Risk warning: new tobacco policy changes risk, sales are not as expected; industrial hemp should be strictly distinguished from intermediate cannabis, recreational cannabis/drugs, and resolutely opposed to legalization of recreational cannabis. As of September 18, 2019, the United States has reported 530 confirmed cases Seven people died of lung diseases suspected to be related to the use of e-cigarettes or vaping products, making the United States attach great importance to e-cigarettes and vaping products, from congressional hearings to states and e-cigarette manufacturers. All are paying close attention to relevant developments and issuing attitudes and statements one after another, especially flavored e-cigarettes because of their strong appeal to young people. The FDA announced on September 12 that it will issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention to or even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . However, from the market point of view, the response was strong. On the one hand, the health of e-cigarettes has been questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. In order to give you a clearer understanding of recent reports on e-cigarettes in the United States, we have sorted out important content including relevant statements issued by congressional hearings, FDA, CDC, and states and e-cigarette manufacturers for reference. 1. Statement by relevant US agencies 1.1. Congressional hearing (2019/9/24) 1.1.1. Anne Schuchat, MD's speech (CDC, Chief Deputy Director of the Department of Health and Human Services) August 1, 2019, the first time in Wisconsin The Center for Disease Control and Prevention (CDC) was notified of a series of lung diseases that have appeared in young people since July 2019. As of September 18, 2019, 38 states and 1 region in the United States have reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaping products. There are already 6 states (California, Illinois, Indiana). States, Kansas, Minnesota and Oregon). These tragic deaths have exacerbated the urgency of the CDC and the FDA to jointly investigate the cause and provide states with the necessary resources to solve this emerging public health problem. CDC established a case investigation team in August and activated the Emergency Operations Center on September 16 to enable it to devote more resources to this investigation. 1) Case summary For many reasons, investigating the causes of lung injury related to the use of e-cigarettes or aerosol products is quite challenging. a. The investigation involves many states; b. The diversity of the e-cigarette or atomized product market, the wide variety of products, the wide range of ingredients, and the connection with potentially illegal substances such as marijuana all complicate the investigation. Consumers do not know what their e-cigarettes or atomized products contain, and many products and substances themselves can be modified by consumers. They can be obtained from physical stores, online retailers, on the street, or through social channels. Preliminary results: According to data collected in two states and recently published in the New England Journal of Medicine, most patients (about 80%) report using cigarettes containing tetrahydrocannabinol or THC (the psychoactive compound of cannabis) Oil, and half (about 60%) of people said they use nicotine-containing e-liquid, while about 10-20% said they only use nicotine-containing products. However, no e-cigarette or atomized product, a certain brand or a specific substance has a clear connection with the epidemic. CDC has received complete gender and age data for 373 of the 530 cases. Almost three-quarters of the cases are men. Two-thirds of the cases were between 18 and 34 years old, 16% were under 18 years old, and 17% were over 35 years old. The lung damage observed in this incident does not seem to be caused by infection. The pathological findings and the results of the non-infectious diagnosis indicate that the cause of the disease is related to exposure to chemical substances. Patients first showed signs of illness within a few days to a few weeks after using e-cigarettes or aerosol products, and gradually developed symptoms such as dyspnea, shortness of breath, or chest pain before hospitalization. Some patients developed mild to moderate gastrointestinal diseases. There are other symptoms including fatigue, fever and weight loss. So far, investigators have not found any specific products or compounds related to all cases. 2) Youth e-cigarette use data Preliminary data from the 2019 National Youth Tobacco Survey show that the use of youth e-cigarettes continues to rise. Data show that in 2019, more than a quarter of high school students currently (in the past 30 days) use e-cigarettes, a significant increase compared to 2017. From 2017 to 2018, the number of e-cigarettes used by high school students increased by 77.8%, and more than a quarter of high school students are currently using tobacco products. 3) Hazards associated with cannabis use CDC is committed to monitoring cannabis use, identifying related health effects, and improving the monitoring capabilities of CDC and state/local jurisdictions. In this outbreak, many patients used e-cigarettes or vaporized products containing THC, which indicates the need to understand the health effects of the increasing use of cannabis and the changing market in the United States, as states are working on the legalization of cannabis. For medical or recreational purposes. In 2018, it is estimated that 16% of the population 12 years and older uses marijuana. 4) CDC鈥檚 recommendations to manufacturers, states, and the public. CDC recommends that the public who are worried that e-cigarettes or vaping products may cause lung diseases should consider avoiding e-cigarettes or vaping products. Teenagers, pregnant women, or non-smokers do not Electronic cigarettes should be used. Anyone who uses electronic cigarettes or vaping products should not buy these products on the street, and should not modify or add ingredients on their own. 1.1.2. NgoziO. Ezike's speech (Director of the Illinois Department of Public Health) 69 people in Illinois suffered from serious respiratory diseases after using e-cigarettes or aerosol products, and 1 person died. The patients were between 15-42 years old, with a median of 22 years old, and most of them were men. Although the cause of the illness has not yet been determined, it is certain that smoking e-cigarettes is not a healthy behavior and is not conducive to the health of young people. Illinois began investigating after learning that some residents had respiratory diseases related to e-cigarettes on July 31, 2019, and issued an alert to the Department of Health on August 2 to conduct a cooperative investigation with the CDC and start investigating the effects of e-cigarettes. The prevalence and habit of smoking e-cigarettes among adolescents, and measures such as youth education, case studies, and related legal studies. Nevertheless, on the one hand, the number of patients per day is still increasing. More than 90% are admitted to the hospital for treatment, 72% of which are sent to the intensive care unit, and nearly 30% require medical devices to help breathe. On the other hand, the use of flavored e-cigarettes is increasing. The survey shows that 1) 68% of young people used flavored e-cigarettes in 2019, accounting for 61% in 2017; 2) The 2017 survey found that 63% of young people did not understand The JUUL products they use contain nicotine; 3) From 2011 to 2015, the number of e-cigarettes used by middle school students increased by 900%. 4) A 2018 study found that more than 3.6 million young people use e-cigarettes. The focus group found that the number of young people using e-cigarettes is increasing and there is a trend of addiction. From 2008 to 2018, the number of high school students in Illinois who smoked in the total tobacco market fell from 21% to 5%, but in 2016-2018 , The proportion of e-cigarette usage among high school students rose from 18.4% to 26.7%. The current preliminary idea is to ban flavored nicotine products and study the long- and short-term effects of atomized products on health. The governor of Illinois supported the enactment of legal provisions in the legislative session in October to ban the sale of flavored vaping products specifically targeted at young people. 1.1.3. Albert A. Rizzo's speech (Chief Medical Officer of the American Lung Association) There are two different e-cigarette crises in our country. One is the prevalence and increasing popularity of young people using e-cigarettes; the other is the recent outbreak of lung diseases caused by vaping products in adults and adolescents. According to the 2019 National Tobacco Youth Survey, 27.5% of young people are now using e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The survey asked students whether they had smoked for at least 20 days in the past 30 days? 12% of Grade 12 students, 7% of Grade 10 students, and 2% of Grade 8 students said they do this often. A 2018 CDC study showed that the main reason why teenagers use these products is that the taste of sweets and fruits attracts them, while their friends and family are using them, and they think that e-cigarettes are less harmful. The American Lung Association will urge the FDA and Congress to take action as soon as possible to ban the sale of all flavored tobacco products, including flavored cigars and menthol cigarettes. Regarding the health hazards of e-cigarettes, there are many misleadings, and some of the reasons lead to a high proportion of young people using e-cigarettes. In January 2018, the National Academies of Science, Engineering and Medicine released a research report that reviewed more than 800 different studies. The report clearly pointed out that the use of e-cigarettes is harmful to health, will increase the chance of children and young people starting to use e-cigarettes, and expose others to dangerous second-hand e-cigarette emissions. They concluded that there is "a large amount of evidence" that if young people use electronic cigarettes, the possibility of using traditional cigarettes will increase. A study in Pediatrics magazine also found that young people who use e-cigarettes are four times more likely to try traditional cigarettes than young people who do not use e-cigarettes. According to a study published in the Journal of the American Medical Association in 2015, 81% of young people have ever used tobacco products made from flavored products. Fruit, mint and menthol are the most popular flavors among middle school students who use e-cigarettes. Among them, 65.9% of children use fruit-flavored e-cigarettes, and 63.9% of children use mint or menthol e-cigarettes. The taste in e-cigarettes is produced by a combination of chemicals, which carry a serious risk of lung damage. A 2015 study at Harvard University tested 51 different flavors of e-cigarettes, including marshmallow, bubble gum, and cupcakes, and found that 47 of them were related to at least one chemical substance related to respiratory diseases. E-cigarettes are not smoking cessation products. Smokers who switch to e-cigarettes may also be using traditional cigarettes. "Annals of Internal MedicinA study on "e" found that the probability of wanting to use e-cigarettes to help quit smoking is lower. Only 10.1% of smokers who used e-cigarettes for six months quit smoking, while 26.6% of smokers who did not use e-cigarettes quit smoking . 1.2. FDA intends to ban the sale of flavored e-cigarettes (2019/9/12) On September 12, the FDA stated that in order to reduce the use of e-cigarettes among young people, it will issue a policy to ban the sale of flavored e-cigarettes (including mint flavored e-cigarettes) within a few weeks. ). 1.3. CDC released its views on the causes of death from e-cigarettes (2019/9/19) The latest report from the Centers for Disease Control and Prevention (CDC) of the United States stated that the number of people suffering from lung diseases due to e-cigarettes has soared to 530 in 38 states, as of At present, 7 people have died, causing the Governor of Indiana to pay attention to the ban on flavored e-cigarettes, and corresponding measures may be taken. The CDC is currently unable to determine the specific cause, but they believe that it is caused by chemical exposure. Most of the cases are related to illegal e-cigarette liquid, which contains THC ingredients. These products are from the black market and are not formal e-cigarette stores. But even so, e-cigarette retailers Will also be greatly affected. The American Lung Research Association believes that the country should take action as soon as possible, hoping to remove the flavored e-cigarettes before further research. 2. U.S. states have banned or are preparing to ban the sale of e-cigarettes 2.1. San Francisco became the first city to ban the sale of e-cigarettes (2019/6/25) On June 25, the San Francisco City Supervisory Committee unanimously approved a total ban on the sale of e-cigarettes The regulations stipulate that e-cigarettes will be banned unless they have been reviewed by the FDA鈥檚 PMTA. The regulations are planned to be fully implemented in six months. 2.2. New York State will ban the sale of flavored e-cigarettes, but retain the mint flavor (2019/9/15) Como signed an executive order on September 12 requiring e-cigarettes to be included in New York鈥檚 anti-smoking activities. According to the Cuomo office, 1) Dr. Howard Zucker, commissioner of the State Department of Health, will recommend this week to the State Public Health and Health Planning Commission to issue emergency regulations, which will take effect within two weeks at the earliest. 2) Como has instructed the New York police and the Department of Health to strengthen law enforcement, and retailers who sell e-cigarettes to minors may be subject to criminal penalties; in addition, Como plans to promote legislation to prohibit deceptive marketing of e-cigarettes to teenagers and children. However, the decree does not affect tobacco-based and menthol-flavored e-cigarettes. Trump said last week that an investigation by the Department of Health found hundreds of respiratory disease cases among consumers who use e-cigarettes, so the federal government plans to ban the sale of thousands of flavors in e-cigarettes. Although many cases involve smoking marijuana, problems with the devices, ingredients or additives have not yet been discovered. 2.3. Michigan bans the sale of flavored e-cigarettes (2019/9/18) On September 18, Michigan announced the ban on the sale of flavored nicotine e-cigarettes. The ban will take effect immediately, but there is still a 14-day buffer period for merchants, and the ban will be It lasts for 6 months, but the governor has the right to extend the period. 2.4. Wal-Mart stops selling e-cigarettes (2019/9/20) On September 20, Wal-Mart announced that it would stop selling e-cigarettes. After the current inventory is sold out, it will stop selling e-cigarettes in Wal-Mart stores and Sam’s Clubs. In July of this year, Wal-Mart raised the minimum age for purchasing tobacco products, including all e-cigarettes, to 21 years old, and has indicated that it is discontinuing the sale of fruit-flavored and dessert-flavored e-cigarettes. E-cigarettes are mainly sold through e-cigarette specialty stores, and there are approximately 115,000 specialty stores in the United States. The e-cigarette business only occupies a small part of Wal-Mart, so it has little impact on Wal-Mart. However, Wal-Mart Store + Sam’s Clubs has more than 5,000 stores in the United States. Wal-Mart鈥檚 suspension of sales will reduce the chance of direct contact between e-cigarettes and consumers. It is also difficult to find a replacement for this huge sales channel. 2.5. The state of Massachusetts suspends the sale of all vaping products related to e-cigarettes (2019/9/24) The state of Massachusetts has decided to suspend the sale of all vaping products related to e-cigarettes for 4 months (as of January 25 next year) No.), 1) This emergency suspension is mainly to cooperate with expert doctors to find out the cause of the disease; 2) Currently, the FDA laboratory is testing more than 150 suspicious product samples, but the cause of the patient鈥檚 lung disease has not yet been determined. 3. E-cigarette manufacturing company statement 3.1. British American Tobacco 3.1.1. Response to the US FDA's announcement of atomized products (2019/9/9) British American Tobacco Research Director Dr David O & rsquo; Reilly said that company toxicologists misted the company Each single ingredient in the chemical product has been carefully checked to see if they are suitable for atomization. And the company has never added e-liquid containing THC and vitamin E acetate to atomized products. The tragic incident was because these e-liquids were not purchased from well-known manufacturers and contained ingredients not used by the manufacturers (including THC and vitamin E acetate). The company supports the FDA鈥檚 view that users of vaping products should always buy smoking sets and e-liquids from reputable manufacturers, and should avoid modifying or adding substances to the products they buy, and should use these according to the manufacturer鈥檚 intentions. product. 3.1.2. Statement on supporting strong product quality standards, measures to prevent the use of young people in the United States, and preparing to apply for PMTA at any time (2019/9/12) 1) The company expressed its concern about the marketing of certain flavored products like the FDA Attract the attention of young people. At the same time, it is difficult to overestimate the role of flavored products in helping adult consumers switch from combustible products to alternative tobacco and nicotine products. The company has established corresponding procedures to ensure that its products are only sold to adult smokers and users of vaping products. 2) For the four VUSE products planned to be launched in the United States, the company is confident that it can submit Pre-Market Tobacco Applications (PMTA) before the deadline announced by the FDA (May 2020). If approved, our Reynolds Tobacco will be able to continue to sell its VUSE brand atomized products within the new regulatory framework in the United States. 3.1.3. Statement on the need for strong and effective atomization product supervision (2019/9/20) The company stated that no products developed or produced by British American Tobacco were involved in recent e-cigarette lung disease cases, and it supports investigations made by relevant agencies , And hopes to introduce strong and effective regulations to ensure high product standards, especially in testing and reporting the ingredients used in the e-liquid of atomized products. At the same time, the government also needs to ensure that relevant agencies force manufacturers to comply with these regulations, only through effective With supervision and law enforcement, consumers can maintain confidence in the harm reduction effects of atomized products compared to traditional tobacco. 3.2. Japan Tobacco International 3.2.1. Regarding the response to lung disease cases in the United States (2019/9/13) So far, the US Department of Health is investigating 450 cases of lung disease that may be related to the use of e-cigarettes. Currently, there is little information about the products involved and the underlying causes. We are not aware of any Logic products associated with these cases and are under investigation. We have learned from media reports that many patients have admitted to using e-cigarettes containing THC e-liquid. In addition, it is reported that vitamin E acetate, a chemical substance related to hemp oil, was found in many relevant samples analyzed by the authorities. In our Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. At JTI, we will know exactly the ingredients of Logic: all Logic e-liquids undergo a strict product management plan, including toxicological evaluation and quality control of all ingredients used. Logic e-liquid can only be sold after passing a comprehensive inspection. Nebulizer users should not use the e-liquid produced by manufacturers that have not undergone strict safety and quality inspections. After design and testing, smoking sets and cartridges that can be used together should always be paired with each other. 4. Market share and sales decline of marijuana-related vaping products Since the first death case related to e-cigarettes was reported on August 23, the sales proportion of marijuana-related vaping products in the recreational marijuana product market decline. Comparing the sales data on August 19 and September 16, California: 32.8% decreased to 29%; Colorado: 19.2% decreased to 14.5%; Nevada: 22.3% decreased to 19.2%; Washington: 17.8% decreased to 14.6 %. (Report time: 2019/9/12) Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, and September 9 Total sales from Japan to 15th fell to US$689,924, a decrease of 25%. (Reporting time: 2019/9/19)

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Summary of U.S. e-cigarette policies and related reportsAs of September 18, 2019, the United States has reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaporized products, and 7 people have died. This has made the United States attach great importance to e-cigarettes and vaporized products. Congressional hearings, down to the states and e-cigarette manufacturers, are closely following relevant developments and successively issued attitudes and statements. In particular, flavored e-cigarettes have attracted attention due to their strong appeal to young people. The FDA in September It was announced on the 12th that it would issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention and even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . But from the market point of view, the reaction was strong. On the one hand, the health of e-cigarettes is being questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. The following is the important content of recent reports: On September 24, the United States held a congressional hearing on the issue of e-cigarettes. The preliminary results of the CDC investigation showed that about 80% of patients reported using tetrahydrocannabinol or THC e-liquid, and about 60% said they used e-cigarettes containing tetrahydrocannabinol or THC. Nicotine e-liquid, and about 10-20% of people claim that they only use nicotine-containing products. Although the source of the disease has not been determined, it can be clearly related to chemical exposure. The state of Illinois initially envisages banning the sale of flavored nicotine products. The American Lung Association report stated that 27.5% of young people now use e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The main reason for teenagers to use these products is the attraction of candies and fruit flavors. The American Lung Association will urge the FDA and Congress to ban all flavored tobacco products as soon as possible, including flavored cigars and menthol cigarettes. U.S. states have banned or are preparing to ban the sale of e-cigarettes. On June 25, the San Francisco City Supervisory Committee unanimously passed a ban on the sale of e-cigarettes. On September 15, New York State stated that it would ban the sale of flavored e-cigarettes, but retain the mint flavor. On September 18, Michigan announced a ban on the sale of flavored nicotine e-cigarettes, and the ban took effect immediately. On September 20, Wal-Mart announced that it would stop selling e-cigarettes after it sold out. On September 24, Massachusetts suspended the sale of all vaping products related to e-cigarettes for 4 months. The e-cigarette manufacturing company issued a statement that British Tobacco: 1) never added e-liquid containing THC and vitamin E acetate to its atomized products; 2) for 4 VUSE products planned to be launched in the United States, the company is confident in Submit PMTA before May 2020. Japan Tobacco International: In the Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. The market share and sales decline of cannabis-related atomized products compare the sales ratio of cannabis-related atomized products in the recreational cannabis product market on August 19 and September 16, and the ratio is showing a downward trend. Among them, California: decreased from 32.8% to 29%; Colorado: decreased from 19.2% to 14.5%; Nevada: decreased from 22.3% to 19.2%; Washington: decreased from 17.8% to 14.6%. Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, while the total sales of September 9-15 decreased to 689,924 U.S. dollars, a decrease of 25%. Risk warning: new tobacco policy changes risk, sales are not as expected; industrial hemp should be strictly distinguished from intermediate cannabis, recreational cannabis/drugs, and resolutely opposed to legalization of recreational cannabis. As of September 18, 2019, the United States has reported 530 confirmed cases Seven people died of lung diseases suspected to be related to the use of e-cigarettes or vaping products, making the United States attach great importance to e-cigarettes and vaping products, from congressional hearings to states and e-cigarette manufacturers. All are paying close attention to relevant developments and issuing attitudes and statements one after another, especially flavored e-cigarettes because of their strong appeal to young people. The FDA announced on September 12 that it will issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention to or even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . However, from the market point of view, the response was strong. On the one hand, the health of e-cigarettes has been questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. In order to give you a clearer understanding of recent reports on e-cigarettes in the United States, we have sorted out important content including relevant statements issued by congressional hearings, FDA, CDC, and states and e-cigarette manufacturers for reference. 1. Statement by relevant US agencies 1.1. Congressional hearing (2019/9/24) 1.1.1. Anne Schuchat, MD's speech (CDC, Chief Deputy Director of the Department of Health and Human Services) August 1, 2019, the first time in Wisconsin The Center for Disease Control and Prevention (CDC) was notified of a series of lung diseases that have appeared in young people since July 2019. As of September 18, 2019, 38 states and 1 region in the United States have reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaping products. There are already 6 states (California, Illinois, Indiana). States, Kansas, Minnesota and Oregon). These tragic deaths have exacerbated the urgency of the CDC and the FDA to jointly investigate the cause and provide states with the necessary resources to solve this emerging public health problem. CDC established a case investigation team in August and activated the Emergency Operations Center on September 16 to enable it to devote more resources to this investigation. 1) Case summary For many reasons, investigating the causes of lung injury related to the use of e-cigarettes or aerosol products is quite challenging. a. The investigation involves many states; b. The diversity of the e-cigarette or atomized product market, the wide variety of products, the wide range of ingredients, and the connection with potentially illegal substances such as marijuana all complicate the investigation. Consumers do not know what their e-cigarettes or atomized products contain, and many products and substances themselves can be modified by consumers. They can be obtained from physical stores, online retailers, on the street, or through social channels. Preliminary results: According to data collected in two states and recently published in the New England Journal of Medicine, most patients (about 80%) report using cigarettes containing tetrahydrocannabinol or THC (the psychoactive compound of cannabis) Oil, and half (about 60%) of people said they use nicotine-containing e-liquid, while about 10-20% said they only use nicotine-containing products. However, no e-cigarette or atomized product, a certain brand or a specific substance has a clear connection with the epidemic. CDC has received complete gender and age data for 373 of the 530 cases. Almost three-quarters of the cases are men. Two-thirds of the cases were between 18 and 34 years old, 16% were under 18 years old, and 17% were over 35 years old. The lung damage observed in this incident does not seem to be caused by infection. The pathological findings and the results of the non-infectious diagnosis indicate that the cause of the disease is related to exposure to chemical substances. Patients first showed signs of illness within a few days to a few weeks after using e-cigarettes or aerosol products, and gradually developed symptoms such as dyspnea, shortness of breath, or chest pain before hospitalization. Some patients developed mild to moderate gastrointestinal diseases. There are other symptoms including fatigue, fever and weight loss. So far, investigators have not found any specific products or compounds related to all cases. 2) Youth e-cigarette use data Preliminary data from the 2019 National Youth Tobacco Survey show that the use of youth e-cigarettes continues to rise. Data show that in 2019, more than a quarter of high school students currently (in the past 30 days) use e-cigarettes, a significant increase compared to 2017. From 2017 to 2018, the number of e-cigarettes used by high school students increased by 77.8%, and more than a quarter of high school students are currently using tobacco products. 3) Hazards associated with cannabis use CDC is committed to monitoring cannabis use, identifying related health effects, and improving the monitoring capabilities of CDC and state/local jurisdictions. In this outbreak, many patients used e-cigarettes or vaporized products containing THC, which indicates the need to understand the health effects of the increasing use of cannabis and the changing market in the United States, as states are working on the legalization of cannabis. For medical or recreational purposes. In 2018, it is estimated that 16% of the population 12 years and older uses marijuana. 4) CDC鈥檚 recommendations to manufacturers, states, and the public. CDC recommends that the public who are worried that e-cigarettes or vaping products may cause lung diseases should consider avoiding e-cigarettes or vaping products. Teenagers, pregnant women, or non-smokers do not Electronic cigarettes should be used. Anyone who uses electronic cigarettes or vaping products should not buy these products on the street, and should not modify or add ingredients on their own. 1.1.2. NgoziO. Ezike's speech (Director of the Illinois Department of Public Health) 69 people in Illinois suffered from serious respiratory diseases after using e-cigarettes or aerosol products, and 1 person died. The patients were between 15-42 years old, with a median of 22 years old, and most of them were men. Although the cause of the illness has not yet been determined, it is certain that smoking e-cigarettes is not a healthy behavior and is not conducive to the health of young people. Illinois began investigating after learning that some residents had respiratory diseases related to e-cigarettes on July 31, 2019, and issued an alert to the Department of Health on August 2 to conduct a cooperative investigation with the CDC and start investigating the effects of e-cigarettes. The prevalence and habit of smoking e-cigarettes among adolescents, and measures such as youth education, case studies, and related legal studies. Nevertheless, on the one hand, the number of patients per day is still increasing. More than 90% are admitted to the hospital for treatment, 72% of which are sent to the intensive care unit, and nearly 30% require medical devices to help breathe. On the other hand, the use of flavored e-cigarettes is increasing. The survey shows that 1) 68% of young people used flavored e-cigarettes in 2019, accounting for 61% in 2017; 2) The 2017 survey found that 63% of young people did not understand The JUUL products they use contain nicotine; 3) From 2011 to 2015, the number of e-cigarettes used by middle school students increased by 900%. 4) A 2018 study found that more than 3.6 million young people use e-cigarettes. The focus group found that the number of young people using e-cigarettes is increasing and there is a trend of addiction. From 2008 to 2018, the number of high school students in Illinois who smoked in the total tobacco market fell from 21% to 5%, but in 2016-2018 , The proportion of e-cigarette usage among high school students rose from 18.4% to 26.7%. The current preliminary idea is to ban flavored nicotine products and study the long- and short-term effects of atomized products on health. The governor of Illinois supported the enactment of legal provisions in the legislative session in October to ban the sale of flavored vaping products specifically targeted at young people. 1.1.3. Albert A. Rizzo's speech (Chief Medical Officer of the American Lung Association) There are two different e-cigarette crises in our country. One is the prevalence and increasing popularity of young people using e-cigarettes; the other is the recent outbreak of lung diseases caused by vaping products in adults and adolescents. According to the 2019 National Tobacco Youth Survey, 27.5% of young people are now using e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The survey asked students whether they had smoked for at least 20 days in the past 30 days? 12% of Grade 12 students, 7% of Grade 10 students, and 2% of Grade 8 students said they do this often. A 2018 CDC study showed that the main reason why teenagers use these products is that the taste of sweets and fruits attracts them, while their friends and family are using them, and they think that e-cigarettes are less harmful. The American Lung Association will urge the FDA and Congress to take action as soon as possible to ban the sale of all flavored tobacco products, including flavored cigars and menthol cigarettes. Regarding the health hazards of e-cigarettes, there are many misleadings, and some of the reasons lead to a high proportion of young people using e-cigarettes. In January 2018, the National Academies of Science, Engineering and Medicine released a research report that reviewed more than 800 different studies. The report clearly pointed out that the use of e-cigarettes is harmful to health, will increase the chance of children and young people starting to use e-cigarettes, and expose others to dangerous second-hand e-cigarette emissions. They concluded that there is "a large amount of evidence" that if young people use electronic cigarettes, the possibility of using traditional cigarettes will increase. A study in Pediatrics magazine also found that young people who use e-cigarettes are four times more likely to try traditional cigarettes than young people who do not use e-cigarettes. According to a study published in the Journal of the American Medical Association in 2015, 81% of young people have ever used tobacco products made from flavored products. Fruit, mint and menthol are the most popular flavors among middle school students who use e-cigarettes. Among them, 65.9% of children use fruit-flavored e-cigarettes, and 63.9% of children use mint or menthol e-cigarettes. The taste in e-cigarettes is produced by a combination of chemicals, which carry a serious risk of lung damage. A 2015 study at Harvard University tested 51 different flavors of e-cigarettes, including marshmallow, bubble gum, and cupcakes, and found that 47 of them were related to at least one chemical substance related to respiratory diseases. E-cigarettes are not smoking cessation products. Smokers who switch to e-cigarettes may also be using traditional cigarettes. "Annals of Internal MedicinA study on "e" found that the probability of wanting to use e-cigarettes to help quit smoking is lower. Only 10.1% of smokers who used e-cigarettes for six months quit smoking, while 26.6% of smokers who did not use e-cigarettes quit smoking . 1.2. FDA intends to ban the sale of flavored e-cigarettes (2019/9/12) On September 12, the FDA stated that in order to reduce the use of e-cigarettes among young people, it will issue a policy to ban the sale of flavored e-cigarettes (including mint flavored e-cigarettes) within a few weeks. ). 1.3. CDC released its views on the causes of death from e-cigarettes (2019/9/19) The latest report from the Centers for Disease Control and Prevention (CDC) of the United States stated that the number of people suffering from lung diseases due to e-cigarettes has soared to 530 in 38 states, as of At present, 7 people have died, causing the Governor of Indiana to pay attention to the ban on flavored e-cigarettes, and corresponding measures may be taken. The CDC is currently unable to determine the specific cause, but they believe that it is caused by chemical exposure. Most of the cases are related to illegal e-cigarette liquid, which contains THC ingredients. These products are from the black market and are not formal e-cigarette stores. But even so, e-cigarette retailers Will also be greatly affected. The American Lung Research Association believes that the country should take action as soon as possible, hoping to remove the flavored e-cigarettes before further research. 2. U.S. states have banned or are preparing to ban the sale of e-cigarettes 2.1. San Francisco became the first city to ban the sale of e-cigarettes (2019/6/25) On June 25, the San Francisco City Supervisory Committee unanimously approved a total ban on the sale of e-cigarettes The regulations stipulate that e-cigarettes will be banned unless they have been reviewed by the FDA鈥檚 PMTA. The regulations are planned to be fully implemented in six months. 2.2. New York State will ban the sale of flavored e-cigarettes, but retain the mint flavor (2019/9/15) Como signed an executive order on September 12 requiring e-cigarettes to be included in New York鈥檚 anti-smoking activities. According to the Cuomo office, 1) Dr. Howard Zucker, commissioner of the State Department of Health, will recommend this week to the State Public Health and Health Planning Commission to issue emergency regulations, which will take effect within two weeks at the earliest. 2) Como has instructed the New York police and the Department of Health to strengthen law enforcement, and retailers who sell e-cigarettes to minors may be subject to criminal penalties; in addition, Como plans to promote legislation to prohibit deceptive marketing of e-cigarettes to teenagers and children. However, the decree does not affect tobacco-based and menthol-flavored e-cigarettes. Trump said last week that an investigation by the Department of Health found hundreds of respiratory disease cases among consumers who use e-cigarettes, so the federal government plans to ban the sale of thousands of flavors in e-cigarettes. Although many cases involve smoking marijuana, problems with the devices, ingredients or additives have not yet been discovered. 2.3. Michigan bans the sale of flavored e-cigarettes (2019/9/18) On September 18, Michigan announced the ban on the sale of flavored nicotine e-cigarettes. The ban will take effect immediately, but there is still a 14-day buffer period for merchants, and the ban will be It lasts for 6 months, but the governor has the right to extend the period. 2.4. Wal-Mart stops selling e-cigarettes (2019/9/20) On September 20, Wal-Mart announced that it would stop selling e-cigarettes. After the current inventory is sold out, it will stop selling e-cigarettes in Wal-Mart stores and Sam’s Clubs. In July of this year, Wal-Mart raised the minimum age for purchasing tobacco products, including all e-cigarettes, to 21 years old, and has indicated that it is discontinuing the sale of fruit-flavored and dessert-flavored e-cigarettes. E-cigarettes are mainly sold through e-cigarette specialty stores, and there are approximately 115,000 specialty stores in the United States. The e-cigarette business only occupies a small part of Wal-Mart, so it has little impact on Wal-Mart. However, Wal-Mart Store + Sam’s Clubs has more than 5,000 stores in the United States. Wal-Mart鈥檚 suspension of sales will reduce the chance of direct contact between e-cigarettes and consumers. It is also difficult to find a replacement for this huge sales channel. 2.5. The state of Massachusetts suspends the sale of all vaping products related to e-cigarettes (2019/9/24) The state of Massachusetts has decided to suspend the sale of all vaping products related to e-cigarettes for 4 months (as of January 25 next year) No.), 1) This emergency suspension is mainly to cooperate with expert doctors to find out the cause of the disease; 2) Currently, the FDA laboratory is testing more than 150 suspicious product samples, but the cause of the patient鈥檚 lung disease has not yet been determined. 3. E-cigarette manufacturing company statement 3.1. British American Tobacco 3.1.1. Response to the US FDA's announcement of atomized products (2019/9/9) British American Tobacco Research Director Dr David O & rsquo; Reilly said that company toxicologists misted the company Each single ingredient in the chemical product has been carefully checked to see if they are suitable for atomization. And the company has never added e-liquid containing THC and vitamin E acetate to atomized products. The tragic incident was because these e-liquids were not purchased from well-known manufacturers and contained ingredients not used by the manufacturers (including THC and vitamin E acetate). The company supports the FDA鈥檚 view that users of vaping products should always buy smoking sets and e-liquids from reputable manufacturers, and should avoid modifying or adding substances to the products they buy, and should use these according to the manufacturer鈥檚 intentions. product. 3.1.2. Statement on supporting strong product quality standards, measures to prevent the use of young people in the United States, and preparing to apply for PMTA at any time (2019/9/12) 1) The company expressed its concern about the marketing of certain flavored products like the FDA Attract the attention of young people. At the same time, it is difficult to overestimate the role of flavored products in helping adult consumers switch from combustible products to alternative tobacco and nicotine products. The company has established corresponding procedures to ensure that its products are only sold to adult smokers and users of vaping products. 2) For the four VUSE products planned to be launched in the United States, the company is confident that it can submit Pre-Market Tobacco Applications (PMTA) before the deadline announced by the FDA (May 2020). If approved, our Reynolds Tobacco will be able to continue to sell its VUSE brand atomized products within the new regulatory framework in the United States. 3.1.3. Statement on the need for strong and effective atomization product supervision (2019/9/20) The company stated that no products developed or produced by British American Tobacco were involved in recent e-cigarette lung disease cases, and it supports investigations made by relevant agencies , And hopes to introduce strong and effective regulations to ensure high product standards, especially in testing and reporting the ingredients used in the e-liquid of atomized products. At the same time, the government also needs to ensure that relevant agencies force manufacturers to comply with these regulations, only through effective With supervision and law enforcement, consumers can maintain confidence in the harm reduction effects of atomized products compared to traditional tobacco. 3.2. Japan Tobacco International 3.2.1. Regarding the response to lung disease cases in the United States (2019/9/13) So far, the US Department of Health is investigating 450 cases of lung disease that may be related to the use of e-cigarettes. Currently, there is little information about the products involved and the underlying causes. We are not aware of any Logic products associated with these cases and are under investigation. We have learned from media reports that many patients have admitted to using e-cigarettes containing THC e-liquid. In addition, it is reported that vitamin E acetate, a chemical substance related to hemp oil, was found in many relevant samples analyzed by the authorities. In our Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. At JTI, we will know exactly the ingredients of Logic: all Logic e-liquids undergo a strict product management plan, including toxicological evaluation and quality control of all ingredients used. Logic e-liquid can only be sold after passing a comprehensive inspection. Nebulizer users should not use the e-liquid produced by manufacturers that have not undergone strict safety and quality inspections. After design and testing, smoking sets and cartridges that can be used together should always be paired with each other. 4. Market share and sales decline of marijuana-related vaping products Since the first death case related to e-cigarettes was reported on August 23, the sales proportion of marijuana-related vaping products in the recreational marijuana product market decline. Comparing the sales data on August 19 and September 16, California: 32.8% decreased to 29%; Colorado: 19.2% decreased to 14.5%; Nevada: 22.3% decreased to 19.2%; Washington: 17.8% decreased to 14.6 %. (Report time: 2019/9/12) Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, and September 9 Total sales from Japan to 15th fell to US$689,924, a decrease of 25%. (Reporting time: 2019/9/19)As of September 18, 2019, the United States has reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaporized products, and 7 people have died. This has made the United States attach great importance to e-cigarettes and vaporized products. Congressional hearings, down to the states and e-cigarette manufacturers, are closely following relevant developments and successively issued attitudes and statements. In particular, flavored e-cigarettes have attracted attention due to their strong appeal to young people. The FDA in September It was announced on the 12th that it would issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention and even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . But from the market point of view, the reaction was strong. On the one hand, the health of e-cigarettes is being questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. The following is the important content of recent reports: On September 24, the United States held a congressional hearing on the issue of e-cigarettes. The preliminary results of the CDC investigation showed that about 80% of patients reported using tetrahydrocannabinol or THC e-liquid, and about 60% said they used e-cigarettes containing tetrahydrocannabinol or THC. Nicotine e-liquid, and about 10-20% of people claim that they only use nicotine-containing products. Although the source of the disease has not been determined, it can be clearly related to chemical exposure. The state of Illinois initially envisages banning the sale of flavored nicotine products. The American Lung Association report stated that 27.5% of young people now use e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The main reason for teenagers to use these products is the attraction of candies and fruit flavors. The American Lung Association will urge the FDA and Congress to ban all flavored tobacco products as soon as possible, including flavored cigars and menthol cigarettes. U.S. states have banned or are preparing to ban the sale of e-cigarettes. On June 25, the San Francisco City Supervisory Committee unanimously passed a ban on the sale of e-cigarettes. On September 15, New York State stated that it would ban the sale of flavored e-cigarettes, but retain the mint flavor. On September 18, Michigan announced a ban on the sale of flavored nicotine e-cigarettes, and the ban took effect immediately. On September 20, Wal-Mart announced that it would stop selling e-cigarettes after it sold out. On September 24, Massachusetts suspended the sale of all vaping products related to e-cigarettes for 4 months. The e-cigarette manufacturing company issued a statement that British Tobacco: 1) never added e-liquid containing THC and vitamin E acetate to its atomized products; 2) for 4 VUSE products planned to be launched in the United States, the company is confident in Submit PMTA before May 2020. Japan Tobacco International: In the Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. The market share and sales decline of cannabis-related atomized products compare the sales ratio of cannabis-related atomized products in the recreational cannabis product market on August 19 and September 16, and the ratio is showing a downward trend. Among them, California: decreased from 32.8% to 29%; Colorado: decreased from 19.2% to 14.5%; Nevada: decreased from 22.3% to 19.2%; Washington: decreased from 17.8% to 14.6%. Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, while the total sales of September 9-15 decreased to 689,924 U.S. dollars, a decrease of 25%. Risk warning: new tobacco policy changes risk, sales are not as expected; industrial hemp should be strictly distinguished from intermediate cannabis, recreational cannabis/drugs, and resolutely opposed to legalization of recreational cannabis. As of September 18, 2019, the United States has reported 530 confirmed cases Seven people died of lung diseases suspected to be related to the use of e-cigarettes or vaping products, making the United States attach great importance to e-cigarettes and vaping products, from congressional hearings to states and e-cigarette manufacturers. All are paying close attention to relevant developments and issuing attitudes and statements one after another, especially flavored e-cigarettes because of their strong appeal to young people. The FDA announced on September 12 that it will issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention to or even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . However, from the market point of view, the response was strong. On the one hand, the health of e-cigarettes has been questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. In order to give you a clearer understanding of recent reports on e-cigarettes in the United States, we have sorted out important content including relevant statements issued by congressional hearings, FDA, CDC, and states and e-cigarette manufacturers for reference. 1. Statement by relevant US agencies 1.1. Congressional hearing (2019/9/24) 1.1.1. Anne Schuchat, MD's speech (CDC, Chief Deputy Director of the Department of Health and Human Services) August 1, 2019, the first time in Wisconsin The Center for Disease Control and Prevention (CDC) was notified of a series of lung diseases that have appeared in young people since July 2019. As of September 18, 2019, 38 states and 1 region in the United States have reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaping products. There are already 6 states (California, Illinois, Indiana). States, Kansas, Minnesota and Oregon). These tragic deaths have exacerbated the urgency of the CDC and the FDA to jointly investigate the cause and provide states with the necessary resources to solve this emerging public health problem. CDC established a case investigation team in August and activated the Emergency Operations Center on September 16 to enable it to devote more resources to this investigation. 1) Case summary For many reasons, investigating the causes of lung injury related to the use of e-cigarettes or aerosol products is quite challenging. a. The investigation involves many states; b. The diversity of the e-cigarette or atomized product market, the wide variety of products, the wide range of ingredients, and the connection with potentially illegal substances such as marijuana all complicate the investigation. Consumers do not know what their e-cigarettes or atomized products contain, and many products and substances themselves can be modified by consumers. They can be obtained from physical stores, online retailers, on the street, or through social channels. Preliminary results: According to data collected in two states and recently published in the New England Journal of Medicine, most patients (about 80%) report using cigarettes containing tetrahydrocannabinol or THC (the psychoactive compound of cannabis) Oil, and half (about 60%) of people said they use nicotine-containing e-liquid, while about 10-20% said they only use nicotine-containing products. However, no e-cigarette or atomized product, a certain brand or a specific substance has a clear connection with the epidemic. CDC has received complete gender and age data for 373 of the 530 cases. Almost three-quarters of the cases are men. Two-thirds of the cases were between 18 and 34 years old, 16% were under 18 years old, and 17% were over 35 years old. The lung damage observed in this incident does not seem to be caused by infection. The pathological findings and the results of the non-infectious diagnosis indicate that the cause of the disease is related to exposure to chemical substances. Patients first showed signs of illness within a few days to a few weeks after using e-cigarettes or aerosol products, and gradually developed symptoms such as dyspnea, shortness of breath, or chest pain before hospitalization. Some patients developed mild to moderate gastrointestinal diseases. There are other symptoms including fatigue, fever and weight loss. So far, investigators have not found any specific products or compounds related to all cases. 2) Youth e-cigarette use data Preliminary data from the 2019 National Youth Tobacco Survey show that the use of youth e-cigarettes continues to rise. Data show that in 2019, more than a quarter of high school students currently (in the past 30 days) use e-cigarettes, a significant increase compared to 2017. From 2017 to 2018, the number of e-cigarettes used by high school students increased by 77.8%, and more than a quarter of high school students are currently using tobacco products. 3) Hazards associated with cannabis use CDC is committed to monitoring cannabis use, identifying related health effects, and improving the monitoring capabilities of CDC and state/local jurisdictions. In this outbreak, many patients used e-cigarettes or vaporized products containing THC, which indicates the need to understand the health effects of the increasing use of cannabis and the changing market in the United States, as states are working on the legalization of cannabis. For medical or recreational purposes. In 2018, it is estimated that 16% of the population 12 years and older uses marijuana. 4) CDC鈥檚 recommendations to manufacturers, states, and the public. CDC recommends that the public who are worried that e-cigarettes or vaping products may cause lung diseases should consider avoiding e-cigarettes or vaping products. Teenagers, pregnant women, or non-smokers do not Electronic cigarettes should be used. Anyone who uses electronic cigarettes or vaping products should not buy these products on the street, and should not modify or add ingredients on their own. 1.1.2. NgoziO. Ezike's speech (Director of the Illinois Department of Public Health) 69 people in Illinois suffered from serious respiratory diseases after using e-cigarettes or aerosol products, and 1 person died. The patients were between 15-42 years old, with a median of 22 years old, and most of them were men. Although the cause of the illness has not yet been determined, it is certain that smoking e-cigarettes is not a healthy behavior and is not conducive to the health of young people. Illinois began investigating after learning that some residents had respiratory diseases related to e-cigarettes on July 31, 2019, and issued an alert to the Department of Health on August 2 to conduct a cooperative investigation with the CDC and start investigating the effects of e-cigarettes. The prevalence and habit of smoking e-cigarettes among adolescents, and measures such as youth education, case studies, and related legal studies. Nevertheless, on the one hand, the number of patients per day is still increasing. More than 90% are admitted to the hospital for treatment, 72% of which are sent to the intensive care unit, and nearly 30% require medical devices to help breathe. On the other hand, the use of flavored e-cigarettes is increasing. The survey shows that 1) 68% of young people used flavored e-cigarettes in 2019, accounting for 61% in 2017; 2) The 2017 survey found that 63% of young people did not understand The JUUL products they use contain nicotine; 3) From 2011 to 2015, the number of e-cigarettes used by middle school students increased by 900%. 4) A 2018 study found that more than 3.6 million young people use e-cigarettes. The focus group found that the number of young people using e-cigarettes is increasing and there is a trend of addiction. From 2008 to 2018, the number of high school students in Illinois who smoked in the total tobacco market fell from 21% to 5%, but in 2016-2018 , The proportion of e-cigarette usage among high school students rose from 18.4% to 26.7%. The current preliminary idea is to ban flavored nicotine products and study the long- and short-term effects of atomized products on health. The governor of Illinois supported the enactment of legal provisions in the legislative session in October to ban the sale of flavored vaping products specifically targeted at young people. 1.1.3. Albert A. Rizzo's speech (Chief Medical Officer of the American Lung Association) There are two different e-cigarette crises in our country. One is the prevalence and increasing popularity of young people using e-cigarettes; the other is the recent outbreak of lung diseases caused by vaping products in adults and adolescents. According to the 2019 National Tobacco Youth Survey, 27.5% of young people are now using e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The survey asked students whether they had smoked for at least 20 days in the past 30 days? 12% of Grade 12 students, 7% of Grade 10 students, and 2% of Grade 8 students said they do this often. A 2018 CDC study showed that the main reason why teenagers use these products is that the taste of sweets and fruits attracts them, while their friends and family are using them, and they think that e-cigarettes are less harmful. The American Lung Association will urge the FDA and Congress to take action as soon as possible to ban the sale of all flavored tobacco products, including flavored cigars and menthol cigarettes. Regarding the health hazards of e-cigarettes, there are many misleadings, and some of the reasons lead to a high proportion of young people using e-cigarettes. In January 2018, the National Academies of Science, Engineering and Medicine released a research report that reviewed more than 800 different studies. The report clearly pointed out that the use of e-cigarettes is harmful to health, will increase the chance of children and young people starting to use e-cigarettes, and expose others to dangerous second-hand e-cigarette emissions. They concluded that there is "a large amount of evidence" that if young people use electronic cigarettes, the possibility of using traditional cigarettes will increase. A study in Pediatrics magazine also found that young people who use e-cigarettes are four times more likely to try traditional cigarettes than young people who do not use e-cigarettes. According to a study published in the Journal of the American Medical Association in 2015, 81% of young people have ever used tobacco products made from flavored products. Fruit, mint and menthol are the most popular flavors among middle school students who use e-cigarettes. Among them, 65.9% of children use fruit-flavored e-cigarettes, and 63.9% of children use mint or menthol e-cigarettes. The taste in e-cigarettes is produced by a combination of chemicals, which carry a serious risk of lung damage. A 2015 study at Harvard University tested 51 different flavors of e-cigarettes, including marshmallow, bubble gum, and cupcakes, and found that 47 of them were related to at least one chemical substance related to respiratory diseases. E-cigarettes are not smoking cessation products. Smokers who switch to e-cigarettes may also be using traditional cigarettes. "Annals of Internal MedicinA study on "e" found that the probability of wanting to use e-cigarettes to help quit smoking is lower. Only 10.1% of smokers who used e-cigarettes for six months quit smoking, while 26.6% of smokers who did not use e-cigarettes quit smoking . 1.2. FDA intends to ban the sale of flavored e-cigarettes (2019/9/12) On September 12, the FDA stated that in order to reduce the use of e-cigarettes among young people, it will issue a policy to ban the sale of flavored e-cigarettes (including mint flavored e-cigarettes) within a few weeks. ). 1.3. CDC released its views on the causes of death from e-cigarettes (2019/9/19) The latest report from the Centers for Disease Control and Prevention (CDC) of the United States stated that the number of people suffering from lung diseases due to e-cigarettes has soared to 530 in 38 states, as of At present, 7 people have died, causing the Governor of Indiana to pay attention to the ban on flavored e-cigarettes, and corresponding measures may be taken. The CDC is currently unable to determine the specific cause, but they believe that it is caused by chemical exposure. Most of the cases are related to illegal e-cigarette liquid, which contains THC ingredients. These products are from the black market and are not formal e-cigarette stores. But even so, e-cigarette retailers Will also be greatly affected. The American Lung Research Association believes that the country should take action as soon as possible, hoping to remove the flavored e-cigarettes before further research. 2. U.S. states have banned or are preparing to ban the sale of e-cigarettes 2.1. San Francisco became the first city to ban the sale of e-cigarettes (2019/6/25) On June 25, the San Francisco City Supervisory Committee unanimously approved a total ban on the sale of e-cigarettes The regulations stipulate that e-cigarettes will be banned unless they have been reviewed by the FDA鈥檚 PMTA. The regulations are planned to be fully implemented in six months. 2.2. New York State will ban the sale of flavored e-cigarettes, but retain the mint flavor (2019/9/15) Como signed an executive order on September 12 requiring e-cigarettes to be included in New York鈥檚 anti-smoking activities. According to the Cuomo office, 1) Dr. Howard Zucker, commissioner of the State Department of Health, will recommend this week to the State Public Health and Health Planning Commission to issue emergency regulations, which will take effect within two weeks at the earliest. 2) Como has instructed the New York police and the Department of Health to strengthen law enforcement, and retailers who sell e-cigarettes to minors may be subject to criminal penalties; in addition, Como plans to promote legislation to prohibit deceptive marketing of e-cigarettes to teenagers and children. However, the decree does not affect tobacco-based and menthol-flavored e-cigarettes. Trump said last week that an investigation by the Department of Health found hundreds of respiratory disease cases among consumers who use e-cigarettes, so the federal government plans to ban the sale of thousands of flavors in e-cigarettes. Although many cases involve smoking marijuana, problems with the devices, ingredients or additives have not yet been discovered. 2.3. Michigan bans the sale of flavored e-cigarettes (2019/9/18) On September 18, Michigan announced the ban on the sale of flavored nicotine e-cigarettes. The ban will take effect immediately, but there is still a 14-day buffer period for merchants, and the ban will be It lasts for 6 months, but the governor has the right to extend the period. 2.4. Wal-Mart stops selling e-cigarettes (2019/9/20) On September 20, Wal-Mart announced that it would stop selling e-cigarettes. After the current inventory is sold out, it will stop selling e-cigarettes in Wal-Mart stores and Sam’s Clubs. In July of this year, Wal-Mart raised the minimum age for purchasing tobacco products, including all e-cigarettes, to 21 years old, and has indicated that it is discontinuing the sale of fruit-flavored and dessert-flavored e-cigarettes. E-cigarettes are mainly sold through e-cigarette specialty stores, and there are approximately 115,000 specialty stores in the United States. The e-cigarette business only occupies a small part of Wal-Mart, so it has little impact on Wal-Mart. However, Wal-Mart Store + Sam’s Clubs has more than 5,000 stores in the United States. Wal-Mart鈥檚 suspension of sales will reduce the chance of direct contact between e-cigarettes and consumers. It is also difficult to find a replacement for this huge sales channel. 2.5. The state of Massachusetts suspends the sale of all vaping products related to e-cigarettes (2019/9/24) The state of Massachusetts has decided to suspend the sale of all vaping products related to e-cigarettes for 4 months (as of January 25 next year) No.), 1) This emergency suspension is mainly to cooperate with expert doctors to find out the cause of the disease; 2) Currently, the FDA laboratory is testing more than 150 suspicious product samples, but the cause of the patient鈥檚 lung disease has not yet been determined. 3. E-cigarette manufacturing company statement 3.1. British American Tobacco 3.1.1. Response to the US FDA's announcement of atomized products (2019/9/9) British American Tobacco Research Director Dr David O & rsquo; Reilly said that company toxicologists misted the company Each single ingredient in the chemical product has been carefully checked to see if they are suitable for atomization. And the company has never added e-liquid containing THC and vitamin E acetate to atomized products. The tragic incident was because these e-liquids were not purchased from well-known manufacturers and contained ingredients not used by the manufacturers (including THC and vitamin E acetate). The company supports the FDA鈥檚 view that users of vaping products should always buy smoking sets and e-liquids from reputable manufacturers, and should avoid modifying or adding substances to the products they buy, and should use these according to the manufacturer鈥檚 intentions. product. 3.1.2. Statement on supporting strong product quality standards, measures to prevent the use of young people in the United States, and preparing to apply for PMTA at any time (2019/9/12) 1) The company expressed its concern about the marketing of certain flavored products like the FDA Attract the attention of young people. At the same time, it is difficult to overestimate the role of flavored products in helping adult consumers switch from combustible products to alternative tobacco and nicotine products. The company has established corresponding procedures to ensure that its products are only sold to adult smokers and users of vaping products. 2) For the four VUSE products planned to be launched in the United States, the company is confident that it can submit Pre-Market Tobacco Applications (PMTA) before the deadline announced by the FDA (May 2020). If approved, our Reynolds Tobacco will be able to continue to sell its VUSE brand atomized products within the new regulatory framework in the United States. 3.1.3. Statement on the need for strong and effective atomization product supervision (2019/9/20) The company stated that no products developed or produced by British American Tobacco were involved in recent e-cigarette lung disease cases, and it supports investigations made by relevant agencies , And hopes to introduce strong and effective regulations to ensure high product standards, especially in testing and reporting the ingredients used in the e-liquid of atomized products. At the same time, the government also needs to ensure that relevant agencies force manufacturers to comply with these regulations, only through effective With supervision and law enforcement, consumers can maintain confidence in the harm reduction effects of atomized products compared to traditional tobacco. 3.2. Japan Tobacco International 3.2.1. Regarding the response to lung disease cases in the United States (2019/9/13) So far, the US Department of Health is investigating 450 cases of lung disease that may be related to the use of e-cigarettes. Currently, there is little information about the products involved and the underlying causes. We are not aware of any Logic products associated with these cases and are under investigation. We have learned from media reports that many patients have admitted to using e-cigarettes containing THC e-liquid. In addition, it is reported that vitamin E acetate, a chemical substance related to hemp oil, was found in many relevant samples analyzed by the authorities. In our Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. At JTI, we will know exactly the ingredients of Logic: all Logic e-liquids undergo a strict product management plan, including toxicological evaluation and quality control of all ingredients used. Logic e-liquid can only be sold after passing a comprehensive inspection. Nebulizer users should not use the e-liquid produced by manufacturers that have not undergone strict safety and quality inspections. After design and testing, smoking sets and cartridges that can be used together should always be paired with each other. 4. Market share and sales decline of marijuana-related vaping products Since the first death case related to e-cigarettes was reported on August 23, the sales proportion of marijuana-related vaping products in the recreational marijuana product market decline. Comparing the sales data on August 19 and September 16, California: 32.8% decreased to 29%; Colorado: 19.2% decreased to 14.5%; Nevada: 22.3% decreased to 19.2%; Washington: 17.8% decreased to 14.6 %. (Report time: 2019/9/12) Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, and September 9 Total sales from Japan to 15th fell to US$689,924, a decrease of 25%. (Reporting time: 2019/9/19)As of September 18, 2019, the United States has reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaporized products, and 7 people have died. This has made the United States attach great importance to e-cigarettes and vaporized products. Congressional hearings, down to the states and e-cigarette manufacturers, are closely following relevant developments and successively issued attitudes and statements. In particular, flavored e-cigarettes have attracted attention due to their strong appeal to young people. The FDA in September It was announced on the 12th that it would issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention and even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . But from the market point of view, the reaction was strong. On the one hand, the health of e-cigarettes is being questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. The following is the important content of recent reports: On September 24, the United States held a congressional hearing on the issue of e-cigarettes. The preliminary results of the CDC investigation showed that about 80% of patients reported using tetrahydrocannabinol or THC e-liquid, and about 60% said they used e-cigarettes containing tetrahydrocannabinol or THC. Nicotine e-liquid, and about 10-20% of people claim that they only use nicotine-containing products. Although the source of the disease has not been determined, it can be clearly related to chemical exposure. The state of Illinois initially envisages banning the sale of flavored nicotine products. The American Lung Association report stated that 27.5% of young people now use e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The main reason for teenagers to use these products is the attraction of candies and fruit flavors. The American Lung Association will urge the FDA and Congress to ban all flavored tobacco products as soon as possible, including flavored cigars and menthol cigarettes. U.S. states have banned or are preparing to ban the sale of e-cigarettes. On June 25, the San Francisco City Supervisory Committee unanimously passed a ban on the sale of e-cigarettes. On September 15, New York State stated that it would ban the sale of flavored e-cigarettes, but retain the mint flavor. On September 18, Michigan announced a ban on the sale of flavored nicotine e-cigarettes, and the ban took effect immediately. On September 20, Wal-Mart announced that it would stop selling e-cigarettes after it sold out. On September 24, Massachusetts suspended the sale of all vaping products related to e-cigarettes for 4 months. The e-cigarette manufacturing company issued a statement that British Tobacco: 1) never added e-liquid containing THC and vitamin E acetate to its atomized products; 2) for 4 VUSE products planned to be launched in the United States, the company is confident in Submit PMTA before May 2020. Japan Tobacco International: In the Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. The market share and sales decline of cannabis-related atomized products compare the sales ratio of cannabis-related atomized products in the recreational cannabis product market on August 19 and September 16, and the ratio is showing a downward trend. Among them, California: decreased from 32.8% to 29%; Colorado: decreased from 19.2% to 14.5%; Nevada: decreased from 22.3% to 19.2%; Washington: decreased from 17.8% to 14.6%. Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, while the total sales of September 9-15 decreased to 689,924 U.S. dollars, a decrease of 25%. Risk warning: new tobacco policy changes risk, sales are not as expected; industrial hemp should be strictly distinguished from intermediate cannabis, recreational cannabis/drugs, and resolutely opposed to legalization of recreational cannabis. As of September 18, 2019, the United States has reported 530 confirmed cases Seven people died of lung diseases suspected to be related to the use of e-cigarettes or vaping products, making the United States attach great importance to e-cigarettes and vaping products, from congressional hearings to states and e-cigarette manufacturers. All are paying close attention to relevant developments and issuing attitudes and statements one after another, especially flavored e-cigarettes because of their strong appeal to young people. The FDA announced on September 12 that it will issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention to or even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . However, from the market point of view, the response was strong. On the one hand, the health of e-cigarettes has been questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. In order to give you a clearer understanding of recent reports on e-cigarettes in the United States, we have sorted out important content including relevant statements issued by congressional hearings, FDA, CDC, and states and e-cigarette manufacturers for reference. 1. Statement by relevant US agencies 1.1. Congressional hearing (2019/9/24) 1.1.1. Anne Schuchat, MD's speech (CDC, Chief Deputy Director of the Department of Health and Human Services) August 1, 2019, the first time in Wisconsin The Center for Disease Control and Prevention (CDC) was notified of a series of lung diseases that have appeared in young people since July 2019. As of September 18, 2019, 38 states and 1 region in the United States have reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaping products. There are already 6 states (California, Illinois, Indiana). States, Kansas, Minnesota and Oregon). These tragic deaths have exacerbated the urgency of the CDC and the FDA to jointly investigate the cause and provide states with the necessary resources to solve this emerging public health problem. CDC established a case investigation team in August and activated the Emergency Operations Center on September 16 to enable it to devote more resources to this investigation. 1) Case summary For many reasons, investigating the causes of lung injury related to the use of e-cigarettes or aerosol products is quite challenging. a. The investigation involves many states; b. The diversity of the e-cigarette or atomized product market, the wide variety of products, the wide range of ingredients, and the connection with potentially illegal substances such as marijuana all complicate the investigation. Consumers do not know what their e-cigarettes or atomized products contain, and many products and substances themselves can be modified by consumers. They can be obtained from physical stores, online retailers, on the street, or through social channels. Preliminary results: According to data collected in two states and recently published in the New England Journal of Medicine, most patients (about 80%) report using cigarettes containing tetrahydrocannabinol or THC (the psychoactive compound of cannabis) Oil, and half (about 60%) of people said they use nicotine-containing e-liquid, while about 10-20% said they only use nicotine-containing products. However, no e-cigarette or atomized product, a certain brand or a specific substance has a clear connection with the epidemic. CDC has received complete gender and age data for 373 of the 530 cases. Almost three-quarters of the cases are men. Two-thirds of the cases were between 18 and 34 years old, 16% were under 18 years old, and 17% were over 35 years old. The lung damage observed in this incident does not seem to be caused by infection. The pathological findings and the results of the non-infectious diagnosis indicate that the cause of the disease is related to exposure to chemical substances. Patients first showed signs of illness within a few days to a few weeks after using e-cigarettes or aerosol products, and gradually developed symptoms such as dyspnea, shortness of breath, or chest pain before hospitalization. Some patients developed mild to moderate gastrointestinal diseases. There are other symptoms including fatigue, fever and weight loss. So far, investigators have not found any specific products or compounds related to all cases. 2) Youth e-cigarette use data Preliminary data from the 2019 National Youth Tobacco Survey show that the use of youth e-cigarettes continues to rise. Data show that in 2019, more than a quarter of high school students currently (in the past 30 days) use e-cigarettes, a significant increase compared to 2017. From 2017 to 2018, the number of e-cigarettes used by high school students increased by 77.8%, and more than a quarter of high school students are currently using tobacco products. 3) Hazards associated with cannabis use CDC is committed to monitoring cannabis use, identifying related health effects, and improving the monitoring capabilities of CDC and state/local jurisdictions. In this outbreak, many patients used e-cigarettes or vaporized products containing THC, which indicates the need to understand the health effects of the increasing use of cannabis and the changing market in the United States, as states are working on the legalization of cannabis. For medical or recreational purposes. In 2018, it is estimated that 16% of the population 12 years and older uses marijuana. 4) CDC鈥檚 recommendations to manufacturers, states, and the public. CDC recommends that the public who are worried that e-cigarettes or vaping products may cause lung diseases should consider avoiding e-cigarettes or vaping products. Teenagers, pregnant women, or non-smokers do not Electronic cigarettes should be used. Anyone who uses electronic cigarettes or vaping products should not buy these products on the street, and should not modify or add ingredients on their own. 1.1.2. NgoziO. Ezike's speech (Director of the Illinois Department of Public Health) 69 people in Illinois suffered from serious respiratory diseases after using e-cigarettes or aerosol products, and 1 person died. The patients were between 15-42 years old, with a median of 22 years old, and most of them were men. Although the cause of the illness has not yet been determined, it is certain that smoking e-cigarettes is not a healthy behavior and is not conducive to the health of young people. Illinois began investigating after learning that some residents had respiratory diseases related to e-cigarettes on July 31, 2019, and issued an alert to the Department of Health on August 2 to conduct a cooperative investigation with the CDC and start investigating the effects of e-cigarettes. The prevalence and habit of smoking e-cigarettes among adolescents, and measures such as youth education, case studies, and related legal studies. Nevertheless, on the one hand, the number of patients per day is still increasing. More than 90% are admitted to the hospital for treatment, 72% of which are sent to the intensive care unit, and nearly 30% require medical devices to help breathe. On the other hand, the use of flavored e-cigarettes is increasing. The survey shows that 1) 68% of young people used flavored e-cigarettes in 2019, accounting for 61% in 2017; 2) The 2017 survey found that 63% of young people did not understand The JUUL products they use contain nicotine; 3) From 2011 to 2015, the number of e-cigarettes used by middle school students increased by 900%. 4) A 2018 study found that more than 3.6 million young people use e-cigarettes. The focus group found that the number of young people using e-cigarettes is increasing and there is a trend of addiction. From 2008 to 2018, the number of high school students in Illinois who smoked in the total tobacco market fell from 21% to 5%, but in 2016-2018 , The proportion of e-cigarette usage among high school students rose from 18.4% to 26.7%. The current preliminary idea is to ban flavored nicotine products and study the long- and short-term effects of atomized products on health. The governor of Illinois supported the enactment of legal provisions in the legislative session in October to ban the sale of flavored vaping products specifically targeted at young people. 1.1.3. Albert A. Rizzo's speech (Chief Medical Officer of the American Lung Association) There are two different e-cigarette crises in our country. One is the prevalence and increasing popularity of young people using e-cigarettes; the other is the recent outbreak of lung diseases caused by vaping products in adults and adolescents. According to the 2019 National Tobacco Youth Survey, 27.5% of young people are now using e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The survey asked students whether they had smoked for at least 20 days in the past 30 days? 12% of Grade 12 students, 7% of Grade 10 students, and 2% of Grade 8 students said they do this often. A 2018 CDC study showed that the main reason why teenagers use these products is that the taste of sweets and fruits attracts them, while their friends and family are using them, and they think that e-cigarettes are less harmful. The American Lung Association will urge the FDA and Congress to take action as soon as possible to ban the sale of all flavored tobacco products, including flavored cigars and menthol cigarettes. Regarding the health hazards of e-cigarettes, there are many misleadings, and some of the reasons lead to a high proportion of young people using e-cigarettes. In January 2018, the National Academies of Science, Engineering and Medicine released a research report that reviewed more than 800 different studies. The report clearly pointed out that the use of e-cigarettes is harmful to health, will increase the chance of children and young people starting to use e-cigarettes, and expose others to dangerous second-hand e-cigarette emissions. They concluded that there is "a large amount of evidence" that if young people use electronic cigarettes, the possibility of using traditional cigarettes will increase. A study in Pediatrics magazine also found that young people who use e-cigarettes are four times more likely to try traditional cigarettes than young people who do not use e-cigarettes. According to a study published in the Journal of the American Medical Association in 2015, 81% of young people have ever used tobacco products made from flavored products. Fruit, mint and menthol are the most popular flavors among middle school students who use e-cigarettes. Among them, 65.9% of children use fruit-flavored e-cigarettes, and 63.9% of children use mint or menthol e-cigarettes. The taste in e-cigarettes is produced by a combination of chemicals, which carry a serious risk of lung damage. A 2015 study at Harvard University tested 51 different flavors of e-cigarettes, including marshmallow, bubble gum, and cupcakes, and found that 47 of them were related to at least one chemical substance related to respiratory diseases. E-cigarettes are not smoking cessation products. Smokers who switch to e-cigarettes may also be using traditional cigarettes. "Annals of Internal MedicinA study on "e" found that the probability of wanting to use e-cigarettes to help quit smoking is lower. Only 10.1% of smokers who used e-cigarettes for six months quit smoking, while 26.6% of smokers who did not use e-cigarettes quit smoking . 1.2. FDA intends to ban the sale of flavored e-cigarettes (2019/9/12) On September 12, the FDA stated that in order to reduce the use of e-cigarettes among young people, it will issue a policy to ban the sale of flavored e-cigarettes (including mint flavored e-cigarettes) within a few weeks. ). 1.3. CDC released its views on the causes of death from e-cigarettes (2019/9/19) The latest report from the Centers for Disease Control and Prevention (CDC) of the United States stated that the number of people suffering from lung diseases due to e-cigarettes has soared to 530 in 38 states, as of At present, 7 people have died, causing the Governor of Indiana to pay attention to the ban on flavored e-cigarettes, and corresponding measures may be taken. The CDC is currently unable to determine the specific cause, but they believe that it is caused by chemical exposure. Most of the cases are related to illegal e-cigarette liquid, which contains THC ingredients. These products are from the black market and are not formal e-cigarette stores. But even so, e-cigarette retailers Will also be greatly affected. The American Lung Research Association believes that the country should take action as soon as possible, hoping to remove the flavored e-cigarettes before further research. 2. U.S. states have banned or are preparing to ban the sale of e-cigarettes 2.1. San Francisco became the first city to ban the sale of e-cigarettes (2019/6/25) On June 25, the San Francisco City Supervisory Committee unanimously approved a total ban on the sale of e-cigarettes The regulations stipulate that e-cigarettes will be banned unless they have been reviewed by the FDA鈥檚 PMTA. The regulations are planned to be fully implemented in six months. 2.2. New York State will ban the sale of flavored e-cigarettes, but retain the mint flavor (2019/9/15) Como signed an executive order on September 12 requiring e-cigarettes to be included in New York鈥檚 anti-smoking activities. According to the Cuomo office, 1) Dr. Howard Zucker, commissioner of the State Department of Health, will recommend this week to the State Public Health and Health Planning Commission to issue emergency regulations, which will take effect within two weeks at the earliest. 2) Como has instructed the New York police and the Department of Health to strengthen law enforcement, and retailers who sell e-cigarettes to minors may be subject to criminal penalties; in addition, Como plans to promote legislation to prohibit deceptive marketing of e-cigarettes to teenagers and children. However, the decree does not affect tobacco-based and menthol-flavored e-cigarettes. Trump said last week that an investigation by the Department of Health found hundreds of respiratory disease cases among consumers who use e-cigarettes, so the federal government plans to ban the sale of thousands of flavors in e-cigarettes. Although many cases involve smoking marijuana, problems with the devices, ingredients or additives have not yet been discovered. 2.3. Michigan bans the sale of flavored e-cigarettes (2019/9/18) On September 18, Michigan announced the ban on the sale of flavored nicotine e-cigarettes. The ban will take effect immediately, but there is still a 14-day buffer period for merchants, and the ban will be It lasts for 6 months, but the governor has the right to extend the period. 2.4. Wal-Mart stops selling e-cigarettes (2019/9/20) On September 20, Wal-Mart announced that it would stop selling e-cigarettes. After the current inventory is sold out, it will stop selling e-cigarettes in Wal-Mart stores and Sam’s Clubs. In July of this year, Wal-Mart raised the minimum age for purchasing tobacco products, including all e-cigarettes, to 21 years old, and has indicated that it is discontinuing the sale of fruit-flavored and dessert-flavored e-cigarettes. E-cigarettes are mainly sold through e-cigarette specialty stores, and there are approximately 115,000 specialty stores in the United States. The e-cigarette business only occupies a small part of Wal-Mart, so it has little impact on Wal-Mart. However, Wal-Mart Store + Sam’s Clubs has more than 5,000 stores in the United States. Wal-Mart鈥檚 suspension of sales will reduce the chance of direct contact between e-cigarettes and consumers. It is also difficult to find a replacement for this huge sales channel. 2.5. The state of Massachusetts suspends the sale of all vaping products related to e-cigarettes (2019/9/24) The state of Massachusetts has decided to suspend the sale of all vaping products related to e-cigarettes for 4 months (as of January 25 next year) No.), 1) This emergency suspension is mainly to cooperate with expert doctors to find out the cause of the disease; 2) Currently, the FDA laboratory is testing more than 150 suspicious product samples, but the cause of the patient鈥檚 lung disease has not yet been determined. 3. E-cigarette manufacturing company statement 3.1. British American Tobacco 3.1.1. Response to the US FDA's announcement of atomized products (2019/9/9) British American Tobacco Research Director Dr David O & rsquo; Reilly said that company toxicologists misted the company Each single ingredient in the chemical product has been carefully checked to see if they are suitable for atomization. And the company has never added e-liquid containing THC and vitamin E acetate to atomized products. The tragic incident was because these e-liquids were not purchased from well-known manufacturers and contained ingredients not used by the manufacturers (including THC and vitamin E acetate). The company supports the FDA鈥檚 view that users of vaping products should always buy smoking sets and e-liquids from reputable manufacturers, and should avoid modifying or adding substances to the products they buy, and should use these according to the manufacturer鈥檚 intentions. product. 3.1.2. Statement on supporting strong product quality standards, measures to prevent the use of young people in the United States, and preparing to apply for PMTA at any time (2019/9/12) 1) The company expressed its concern about the marketing of certain flavored products like the FDA Attract the attention of young people. At the same time, it is difficult to overestimate the role of flavored products in helping adult consumers switch from combustible products to alternative tobacco and nicotine products. The company has established corresponding procedures to ensure that its products are only sold to adult smokers and users of vaping products. 2) For the four VUSE products planned to be launched in the United States, the company is confident that it can submit Pre-Market Tobacco Applications (PMTA) before the deadline announced by the FDA (May 2020). If approved, our Reynolds Tobacco will be able to continue to sell its VUSE brand atomized products within the new regulatory framework in the United States. 3.1.3. Statement on the need for strong and effective atomization product supervision (2019/9/20) The company stated that no products developed or produced by British American Tobacco were involved in recent e-cigarette lung disease cases, and it supports investigations made by relevant agencies , And hopes to introduce strong and effective regulations to ensure high product standards, especially in testing and reporting the ingredients used in the e-liquid of atomized products. At the same time, the government also needs to ensure that relevant agencies force manufacturers to comply with these regulations, only through effective With supervision and law enforcement, consumers can maintain confidence in the harm reduction effects of atomized products compared to traditional tobacco. 3.2. Japan Tobacco International 3.2.1. Regarding the response to lung disease cases in the United States (2019/9/13) So far, the US Department of Health is investigating 450 cases of lung disease that may be related to the use of e-cigarettes. Currently, there is little information about the products involved and the underlying causes. We are not aware of any Logic products associated with these cases and are under investigation. We have learned from media reports that many patients have admitted to using e-cigarettes containing THC e-liquid. In addition, it is reported that vitamin E acetate, a chemical substance related to hemp oil, was found in many relevant samples analyzed by the authorities. In our Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. At JTI, we will know exactly the ingredients of Logic: all Logic e-liquids undergo a strict product management plan, including toxicological evaluation and quality control of all ingredients used. Logic e-liquid can only be sold after passing a comprehensive inspection. Nebulizer users should not use the e-liquid produced by manufacturers that have not undergone strict safety and quality inspections. After design and testing, smoking sets and cartridges that can be used together should always be paired with each other. 4. Market share and sales decline of marijuana-related vaping products Since the first death case related to e-cigarettes was reported on August 23, the sales proportion of marijuana-related vaping products in the recreational marijuana product market decline. Comparing the sales data on August 19 and September 16, California: 32.8% decreased to 29%; Colorado: 19.2% decreased to 14.5%; Nevada: 22.3% decreased to 19.2%; Washington: 17.8% decreased to 14.6 %. (Report time: 2019/9/12) Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, and September 9 Total sales from Japan to 15th fell to US$689,924, a decrease of 25%. (Reporting time: 2019/9/19)As of September 18, 2019, the United States has reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaporized products, and 7 people have died. This has made the United States attach great importance to e-cigarettes and vaporized products. Congressional hearings, down to the states and e-cigarette manufacturers, are closely following relevant developments and successively issued attitudes and statements. In particular, flavored e-cigarettes have attracted attention due to their strong appeal to young people. The FDA in September It was announced on the 12th that it would issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention and even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . But from the market point of view, the reaction was strong. On the one hand, the health of e-cigarettes is being questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. The following is the important content of recent reports: On September 24, the United States held a congressional hearing on the issue of e-cigarettes. The preliminary results of the CDC investigation showed that about 80% of patients reported using tetrahydrocannabinol or THC e-liquid, and about 60% said they used e-cigarettes containing tetrahydrocannabinol or THC. Nicotine e-liquid, and about 10-20% of people claim that they only use nicotine-containing products. Although the source of the disease has not been determined, it can be clearly related to chemical exposure. The state of Illinois initially envisages banning the sale of flavored nicotine products. The American Lung Association report stated that 27.5% of young people now use e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The main reason for teenagers to use these products is the attraction of candies and fruit flavors. The American Lung Association will urge the FDA and Congress to ban all flavored tobacco products as soon as possible, including flavored cigars and menthol cigarettes. U.S. states have banned or are preparing to ban the sale of e-cigarettes. On June 25, the San Francisco City Supervisory Committee unanimously passed a ban on the sale of e-cigarettes. On September 15, New York State stated that it would ban the sale of flavored e-cigarettes, but retain the mint flavor. On September 18, Michigan announced a ban on the sale of flavored nicotine e-cigarettes, and the ban took effect immediately. On September 20, Wal-Mart announced that it would stop selling e-cigarettes after it sold out. On September 24, Massachusetts suspended the sale of all vaping products related to e-cigarettes for 4 months. The e-cigarette manufacturing company issued a statement that British Tobacco: 1) never added e-liquid containing THC and vitamin E acetate to its atomized products; 2) for 4 VUSE products planned to be launched in the United States, the company is confident in Submit PMTA before May 2020. Japan Tobacco International: In the Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. The market share and sales decline of cannabis-related atomized products compare the sales ratio of cannabis-related atomized products in the recreational cannabis product market on August 19 and September 16, and the ratio is showing a downward trend. Among them, California: decreased from 32.8% to 29%; Colorado: decreased from 19.2% to 14.5%; Nevada: decreased from 22.3% to 19.2%; Washington: decreased from 17.8% to 14.6%. Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, while the total sales of September 9-15 decreased to 689,924 U.S. dollars, a decrease of 25%. Risk warning: new tobacco policy changes risk, sales are not as expected; industrial hemp should be strictly distinguished from intermediate cannabis, recreational cannabis/drugs, and resolutely opposed to legalization of recreational cannabis. As of September 18, 2019, the United States has reported 530 confirmed cases Seven people died of lung diseases suspected to be related to the use of e-cigarettes or vaping products, making the United States attach great importance to e-cigarettes and vaping products, from congressional hearings to states and e-cigarette manufacturers. All are paying close attention to relevant developments and issuing attitudes and statements one after another, especially flavored e-cigarettes because of their strong appeal to young people. The FDA announced on September 12 that it will issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention to or even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . However, from the market point of view, the response was strong. On the one hand, the health of e-cigarettes has been questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. In order to give you a clearer understanding of recent reports on e-cigarettes in the United States, we have sorted out important content including relevant statements issued by congressional hearings, FDA, CDC, and states and e-cigarette manufacturers for reference. 1. Statement by relevant US agencies 1.1. Congressional hearing (2019/9/24) 1.1.1. Anne Schuchat, MD's speech (CDC, Chief Deputy Director of the Department of Health and Human Services) August 1, 2019, the first time in Wisconsin The Center for Disease Control and Prevention (CDC) was notified of a series of lung diseases that have appeared in young people since July 2019. As of September 18, 2019, 38 states and 1 region in the United States have reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaping products. There are already 6 states (California, Illinois, Indiana). States, Kansas, Minnesota and Oregon). These tragic deaths have exacerbated the urgency of the CDC and the FDA to jointly investigate the cause and provide states with the necessary resources to solve this emerging public health problem. CDC established a case investigation team in August and activated the Emergency Operations Center on September 16 to enable it to devote more resources to this investigation. 1) Case summary For many reasons, investigating the causes of lung injury related to the use of e-cigarettes or aerosol products is quite challenging. a. The investigation involves many states; b. The diversity of the e-cigarette or atomized product market, the wide variety of products, the wide range of ingredients, and the connection with potentially illegal substances such as marijuana all complicate the investigation. Consumers do not know what their e-cigarettes or atomized products contain, and many products and substances themselves can be modified by consumers. They can be obtained from physical stores, online retailers, on the street, or through social channels. Preliminary results: According to data collected in two states and recently published in the New England Journal of Medicine, most patients (about 80%) report using cigarettes containing tetrahydrocannabinol or THC (the psychoactive compound of cannabis) Oil, and half (about 60%) of people said they use nicotine-containing e-liquid, while about 10-20% said they only use nicotine-containing products. However, no e-cigarette or atomized product, a certain brand or a specific substance has a clear connection with the epidemic. CDC has received complete gender and age data for 373 of the 530 cases. Almost three-quarters of the cases are men. Two-thirds of the cases were between 18 and 34 years old, 16% were under 18 years old, and 17% were over 35 years old. The lung damage observed in this incident does not seem to be caused by infection. The pathological findings and the results of the non-infectious diagnosis indicate that the cause of the disease is related to exposure to chemical substances. Patients first showed signs of illness within a few days to a few weeks after using e-cigarettes or aerosol products, and gradually developed symptoms such as dyspnea, shortness of breath, or chest pain before hospitalization. Some patients developed mild to moderate gastrointestinal diseases. There are other symptoms including fatigue, fever and weight loss. So far, investigators have not found any specific products or compounds related to all cases. 2) Youth e-cigarette use data Preliminary data from the 2019 National Youth Tobacco Survey show that the use of youth e-cigarettes continues to rise. Data show that in 2019, more than a quarter of high school students currently (in the past 30 days) use e-cigarettes, a significant increase compared to 2017. From 2017 to 2018, the number of e-cigarettes used by high school students increased by 77.8%, and more than a quarter of high school students are currently using tobacco products. 3) Hazards associated with cannabis use CDC is committed to monitoring cannabis use, identifying related health effects, and improving the monitoring capabilities of CDC and state/local jurisdictions. In this outbreak, many patients used e-cigarettes or vaporized products containing THC, which indicates the need to understand the health effects of the increasing use of cannabis and the changing market in the United States, as states are working on the legalization of cannabis. For medical or recreational purposes. In 2018, it is estimated that 16% of the population 12 years and older uses marijuana. 4) CDC鈥檚 recommendations to manufacturers, states, and the public. CDC recommends that the public who are worried that e-cigarettes or vaping products may cause lung diseases should consider avoiding e-cigarettes or vaping products. Teenagers, pregnant women, or non-smokers do not Electronic cigarettes should be used. Anyone who uses electronic cigarettes or vaping products should not buy these products on the street, and should not modify or add ingredients on their own. 1.1.2. NgoziO. Ezike's speech (Director of the Illinois Department of Public Health) 69 people in Illinois suffered from serious respiratory diseases after using e-cigarettes or aerosol products, and 1 person died. The patients were between 15-42 years old, with a median of 22 years old, and most of them were men. Although the cause of the illness has not yet been determined, it is certain that smoking e-cigarettes is not a healthy behavior and is not conducive to the health of young people. Illinois began investigating after learning that some residents had respiratory diseases related to e-cigarettes on July 31, 2019, and issued an alert to the Department of Health on August 2 to conduct a cooperative investigation with the CDC and start investigating the effects of e-cigarettes. The prevalence and habit of smoking e-cigarettes among adolescents, and measures such as youth education, case studies, and related legal studies. Nevertheless, on the one hand, the number of patients per day is still increasing. More than 90% are admitted to the hospital for treatment, 72% of which are sent to the intensive care unit, and nearly 30% require medical devices to help breathe. On the other hand, the use of flavored e-cigarettes is increasing. The survey shows that 1) 68% of young people used flavored e-cigarettes in 2019, accounting for 61% in 2017; 2) The 2017 survey found that 63% of young people did not understand The JUUL products they use contain nicotine; 3) From 2011 to 2015, the number of e-cigarettes used by middle school students increased by 900%. 4) A 2018 study found that more than 3.6 million young people use e-cigarettes. The focus group found that the number of young people using e-cigarettes is increasing and there is a trend of addiction. From 2008 to 2018, the number of high school students in Illinois who smoked in the total tobacco market fell from 21% to 5%, but in 2016-2018 , The proportion of e-cigarette usage among high school students rose from 18.4% to 26.7%. The current preliminary idea is to ban flavored nicotine products and study the long- and short-term effects of atomized products on health. The governor of Illinois supported the enactment of legal provisions in the legislative session in October to ban the sale of flavored vaping products specifically targeted at young people. 1.1.3. Albert A. Rizzo's speech (Chief Medical Officer of the American Lung Association) There are two different e-cigarette crises in our country. One is the prevalence and increasing popularity of young people using e-cigarettes; the other is the recent outbreak of lung diseases caused by vaping products in adults and adolescents. According to the 2019 National Tobacco Youth Survey, 27.5% of young people are now using e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The survey asked students whether they had smoked for at least 20 days in the past 30 days? 12% of Grade 12 students, 7% of Grade 10 students, and 2% of Grade 8 students said they do this often. A 2018 CDC study showed that the main reason why teenagers use these products is that the taste of sweets and fruits attracts them, while their friends and family are using them, and they think that e-cigarettes are less harmful. The American Lung Association will urge the FDA and Congress to take action as soon as possible to ban the sale of all flavored tobacco products, including flavored cigars and menthol cigarettes. Regarding the health hazards of e-cigarettes, there are many misleadings, and some of the reasons lead to a high proportion of young people using e-cigarettes. In January 2018, the National Academies of Science, Engineering and Medicine released a research report that reviewed more than 800 different studies. The report clearly pointed out that the use of e-cigarettes is harmful to health, will increase the chance of children and young people starting to use e-cigarettes, and expose others to dangerous second-hand e-cigarette emissions. They concluded that there is "a large amount of evidence" that if young people use electronic cigarettes, the possibility of using traditional cigarettes will increase. A study in Pediatrics magazine also found that young people who use e-cigarettes are four times more likely to try traditional cigarettes than young people who do not use e-cigarettes. According to a study published in the Journal of the American Medical Association in 2015, 81% of young people have ever used tobacco products made from flavored products. Fruit, mint and menthol are the most popular flavors among middle school students who use e-cigarettes. Among them, 65.9% of children use fruit-flavored e-cigarettes, and 63.9% of children use mint or menthol e-cigarettes. The taste in e-cigarettes is produced by a combination of chemicals, which carry a serious risk of lung damage. A 2015 study at Harvard University tested 51 different flavors of e-cigarettes, including marshmallow, bubble gum, and cupcakes, and found that 47 of them were related to at least one chemical substance related to respiratory diseases. E-cigarettes are not smoking cessation products. Smokers who switch to e-cigarettes may also be using traditional cigarettes. "Annals of Internal MedicinA study on "e" found that the probability of wanting to use e-cigarettes to help quit smoking is lower. Only 10.1% of smokers who used e-cigarettes for six months quit smoking, while 26.6% of smokers who did not use e-cigarettes quit smoking . 1.2. FDA intends to ban the sale of flavored e-cigarettes (2019/9/12) On September 12, the FDA stated that in order to reduce the use of e-cigarettes among young people, it will issue a policy to ban the sale of flavored e-cigarettes (including mint flavored e-cigarettes) within a few weeks. ). 1.3. CDC released its views on the causes of death from e-cigarettes (2019/9/19) The latest report from the Centers for Disease Control and Prevention (CDC) of the United States stated that the number of people suffering from lung diseases due to e-cigarettes has soared to 530 in 38 states, as of At present, 7 people have died, causing the Governor of Indiana to pay attention to the ban on flavored e-cigarettes, and corresponding measures may be taken. The CDC is currently unable to determine the specific cause, but they believe that it is caused by chemical exposure. Most of the cases are related to illegal e-cigarette liquid, which contains THC ingredients. These products are from the black market and are not formal e-cigarette stores. But even so, e-cigarette retailers Will also be greatly affected. The American Lung Research Association believes that the country should take action as soon as possible, hoping to remove the flavored e-cigarettes before further research. 2. U.S. states have banned or are preparing to ban the sale of e-cigarettes 2.1. San Francisco became the first city to ban the sale of e-cigarettes (2019/6/25) On June 25, the San Francisco City Supervisory Committee unanimously approved a total ban on the sale of e-cigarettes The regulations stipulate that e-cigarettes will be banned unless they have been reviewed by the FDA鈥檚 PMTA. The regulations are planned to be fully implemented in six months. 2.2. New York State will ban the sale of flavored e-cigarettes, but retain the mint flavor (2019/9/15) Como signed an executive order on September 12 requiring e-cigarettes to be included in New York鈥檚 anti-smoking activities. According to the Cuomo office, 1) Dr. Howard Zucker, commissioner of the State Department of Health, will recommend this week to the State Public Health and Health Planning Commission to issue emergency regulations, which will take effect within two weeks at the earliest. 2) Como has instructed the New York police and the Department of Health to strengthen law enforcement, and retailers who sell e-cigarettes to minors may be subject to criminal penalties; in addition, Como plans to promote legislation to prohibit deceptive marketing of e-cigarettes to teenagers and children. However, the decree does not affect tobacco-based and menthol-flavored e-cigarettes. Trump said last week that an investigation by the Department of Health found hundreds of respiratory disease cases among consumers who use e-cigarettes, so the federal government plans to ban the sale of thousands of flavors in e-cigarettes. Although many cases involve smoking marijuana, problems with the devices, ingredients or additives have not yet been discovered. 2.3. Michigan bans the sale of flavored e-cigarettes (2019/9/18) On September 18, Michigan announced the ban on the sale of flavored nicotine e-cigarettes. The ban will take effect immediately, but there is still a 14-day buffer period for merchants, and the ban will be It lasts for 6 months, but the governor has the right to extend the period. 2.4. Wal-Mart stops selling e-cigarettes (2019/9/20) On September 20, Wal-Mart announced that it would stop selling e-cigarettes. After the current inventory is sold out, it will stop selling e-cigarettes in Wal-Mart stores and Sam’s Clubs. In July of this year, Wal-Mart raised the minimum age for purchasing tobacco products, including all e-cigarettes, to 21 years old, and has indicated that it is discontinuing the sale of fruit-flavored and dessert-flavored e-cigarettes. E-cigarettes are mainly sold through e-cigarette specialty stores, and there are approximately 115,000 specialty stores in the United States. The e-cigarette business only occupies a small part of Wal-Mart, so it has little impact on Wal-Mart. However, Wal-Mart Store + Sam’s Clubs has more than 5,000 stores in the United States. Wal-Mart鈥檚 suspension of sales will reduce the chance of direct contact between e-cigarettes and consumers. It is also difficult to find a replacement for this huge sales channel. 2.5. The state of Massachusetts suspends the sale of all vaping products related to e-cigarettes (2019/9/24) The state of Massachusetts has decided to suspend the sale of all vaping products related to e-cigarettes for 4 months (as of January 25 next year) No.), 1) This emergency suspension is mainly to cooperate with expert doctors to find out the cause of the disease; 2) Currently, the FDA laboratory is testing more than 150 suspicious product samples, but the cause of the patient鈥檚 lung disease has not yet been determined. 3. E-cigarette manufacturing company statement 3.1. British American Tobacco 3.1.1. Response to the US FDA's announcement of atomized products (2019/9/9) British American Tobacco Research Director Dr David O & rsquo; Reilly said that company toxicologists misted the company Each single ingredient in the chemical product has been carefully checked to see if they are suitable for atomization. And the company has never added e-liquid containing THC and vitamin E acetate to atomized products. The tragic incident was because these e-liquids were not purchased from well-known manufacturers and contained ingredients not used by the manufacturers (including THC and vitamin E acetate). The company supports the FDA鈥檚 view that users of vaping products should always buy smoking sets and e-liquids from reputable manufacturers, and should avoid modifying or adding substances to the products they buy, and should use these according to the manufacturer鈥檚 intentions. product. 3.1.2. Statement on supporting strong product quality standards, measures to prevent the use of young people in the United States, and preparing to apply for PMTA at any time (2019/9/12) 1) The company expressed its concern about the marketing of certain flavored products like the FDA Attract the attention of young people. At the same time, it is difficult to overestimate the role of flavored products in helping adult consumers switch from combustible products to alternative tobacco and nicotine products. The company has established corresponding procedures to ensure that its products are only sold to adult smokers and users of vaping products. 2) For the four VUSE products planned to be launched in the United States, the company is confident that it can submit Pre-Market Tobacco Applications (PMTA) before the deadline announced by the FDA (May 2020). If approved, our Reynolds Tobacco will be able to continue to sell its VUSE brand atomized products within the new regulatory framework in the United States. 3.1.3. Statement on the need for strong and effective atomization product supervision (2019/9/20) The company stated that no products developed or produced by British American Tobacco were involved in recent e-cigarette lung disease cases, and it supports investigations made by relevant agencies , And hopes to introduce strong and effective regulations to ensure high product standards, especially in testing and reporting the ingredients used in the e-liquid of atomized products. At the same time, the government also needs to ensure that relevant agencies force manufacturers to comply with these regulations, only through effective With supervision and law enforcement, consumers can maintain confidence in the harm reduction effects of atomized products compared to traditional tobacco. 3.2. Japan Tobacco International 3.2.1. Regarding the response to lung disease cases in the United States (2019/9/13) So far, the US Department of Health is investigating 450 cases of lung disease that may be related to the use of e-cigarettes. Currently, there is little information about the products involved and the underlying causes. We are not aware of any Logic products associated with these cases and are under investigation. We have learned from media reports that many patients have admitted to using e-cigarettes containing THC e-liquid. In addition, it is reported that vitamin E acetate, a chemical substance related to hemp oil, was found in many relevant samples analyzed by the authorities. In our Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. At JTI, we will know exactly the ingredients of Logic: all Logic e-liquids undergo a strict product management plan, including toxicological evaluation and quality control of all ingredients used. Logic e-liquid can only be sold after passing a comprehensive inspection. Nebulizer users should not use the e-liquid produced by manufacturers that have not undergone strict safety and quality inspections. After design and testing, smoking sets and cartridges that can be used together should always be paired with each other. 4. Market share and sales decline of marijuana-related vaping products Since the first death case related to e-cigarettes was reported on August 23, the sales proportion of marijuana-related vaping products in the recreational marijuana product market decline. Comparing the sales data on August 19 and September 16, California: 32.8% decreased to 29%; Colorado: 19.2% decreased to 14.5%; Nevada: 22.3% decreased to 19.2%; Washington: 17.8% decreased to 14.6 %. (Report time: 2019/9/12) Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, and September 9 Total sales from Japan to 15th fell to US$689,924, a decrease of 25%. (Reporting time: 2019/9/19)

As of September 18, 2019, the United States has reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaporized products, and 7 people have died. This has made the United States attach great importance to e-cigarettes and vaporized products. Congressional hearings, down to the states and e-cigarette manufacturers, are closely following relevant developments and successively issued attitudes and statements. In particular, flavored e-cigarettes have attracted attention due to their strong appeal to young people. The FDA in September It was announced on the 12th that it would issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention and even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . But from the market point of view, the reaction was strong. On the one hand, the health of e-cigarettes is being questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. The following is the important content of recent reports: On September 24, the United States held a congressional hearing on the issue of e-cigarettes. The preliminary results of the CDC investigation showed that about 80% of patients reported using tetrahydrocannabinol or THC e-liquid, and about 60% said they used e-cigarettes containing tetrahydrocannabinol or THC. Nicotine e-liquid, and about 10-20% of people claim that they only use nicotine-containing products. Although the source of the disease has not been determined, it can be clearly related to chemical exposure. The state of Illinois initially envisages banning the sale of flavored nicotine products. The American Lung Association report stated that 27.5% of young people now use e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The main reason for teenagers to use these products is the attraction of candies and fruit flavors. The American Lung Association will urge the FDA and Congress to ban all flavored tobacco products as soon as possible, including flavored cigars and menthol cigarettes. U.S. states have banned or are preparing to ban the sale of e-cigarettes. On June 25, the San Francisco City Supervisory Committee unanimously passed a ban on the sale of e-cigarettes. On September 15, New York State stated that it would ban the sale of flavored e-cigarettes, but retain the mint flavor. On September 18, Michigan announced a ban on the sale of flavored nicotine e-cigarettes, and the ban took effect immediately. On September 20, Wal-Mart announced that it would stop selling e-cigarettes after it sold out. On September 24, Massachusetts suspended the sale of all vaping products related to e-cigarettes for 4 months. The e-cigarette manufacturing company issued a statement that British Tobacco: 1) never added e-liquid containing THC and vitamin E acetate to its atomized products; 2) for 4 VUSE products planned to be launched in the United States, the company is confident in Submit PMTA before May 2020. Japan Tobacco International: In the Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. The market share and sales decline of cannabis-related atomized products compare the sales ratio of cannabis-related atomized products in the recreational cannabis product market on August 19 and September 16, and the ratio is showing a downward trend. Among them, California: decreased from 32.8% to 29%; Colorado: decreased from 19.2% to 14.5%; Nevada: decreased from 22.3% to 19.2%; Washington: decreased from 17.8% to 14.6%. Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, while the total sales of September 9-15 decreased to 689,924 U.S. dollars, a decrease of 25%. Risk warning: new tobacco policy changes risk, sales are not as expected; industrial hemp should be strictly distinguished from intermediate cannabis, recreational cannabis/drugs, and resolutely opposed to legalization of recreational cannabis. As of September 18, 2019, the United States has reported 530 confirmed cases Seven people died of lung diseases suspected to be related to the use of e-cigarettes or vaping products, making the United States attach great importance to e-cigarettes and vaping products, from congressional hearings to states and e-cigarette manufacturers. All are paying close attention to relevant developments and issuing attitudes and statements one after another, especially flavored e-cigarettes because of their strong appeal to young people. The FDA announced on September 12 that it will issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention to or even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . However, from the market point of view, the response was strong. On the one hand, the health of e-cigarettes has been questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. In order to give you a clearer understanding of recent reports on e-cigarettes in the United States, we have sorted out important content including relevant statements issued by congressional hearings, FDA, CDC, and states and e-cigarette manufacturers for reference. 1. Statement by relevant US agencies 1.1. Congressional hearing (2019/9/24) 1.1.1. Anne Schuchat, MD's speech (CDC, Chief Deputy Director of the Department of Health and Human Services) August 1, 2019, the first time in Wisconsin The Center for Disease Control and Prevention (CDC) was notified of a series of lung diseases that have appeared in young people since July 2019. As of September 18, 2019, 38 states and 1 region in the United States have reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaping products. There are already 6 states (California, Illinois, Indiana). States, Kansas, Minnesota and Oregon). These tragic deaths have exacerbated the urgency of the CDC and the FDA to jointly investigate the cause and provide states with the necessary resources to solve this emerging public health problem. CDC established a case investigation team in August and activated the Emergency Operations Center on September 16 to enable it to devote more resources to this investigation. 1) Case summary For many reasons, investigating the causes of lung injury related to the use of e-cigarettes or aerosol products is quite challenging. a. The investigation involves many states; b. The diversity of the e-cigarette or atomized product market, the wide variety of products, the wide range of ingredients, and the connection with potentially illegal substances such as marijuana all complicate the investigation. Consumers do not know what their e-cigarettes or atomized products contain, and many products and substances themselves can be modified by consumers. They can be obtained from physical stores, online retailers, on the street, or through social channels. Preliminary results: According to data collected in two states and recently published in the New England Journal of Medicine, most patients (about 80%) report using cigarettes containing tetrahydrocannabinol or THC (the psychoactive compound of cannabis) Oil, and half (about 60%) of people said they use nicotine-containing e-liquid, while about 10-20% said they only use nicotine-containing products. However, no e-cigarette or atomized product, a certain brand or a specific substance has a clear connection with the epidemic. CDC has received complete gender and age data for 373 of the 530 cases. Almost three-quarters of the cases are men. Two-thirds of the cases were between 18 and 34 years old, 16% were under 18 years old, and 17% were over 35 years old. The lung damage observed in this incident does not seem to be caused by infection. The pathological findings and the results of the non-infectious diagnosis indicate that the cause of the disease is related to exposure to chemical substances. Patients first showed signs of illness within a few days to a few weeks after using e-cigarettes or aerosol products, and gradually developed symptoms such as dyspnea, shortness of breath, or chest pain before hospitalization. Some patients developed mild to moderate gastrointestinal diseases. There are other symptoms including fatigue, fever and weight loss. So far, investigators have not found any specific products or compounds related to all cases. 2) Youth e-cigarette use data Preliminary data from the 2019 National Youth Tobacco Survey show that the use of youth e-cigarettes continues to rise. Data show that in 2019, more than a quarter of high school students currently (in the past 30 days) use e-cigarettes, a significant increase compared to 2017. From 2017 to 2018, the number of e-cigarettes used by high school students increased by 77.8%, and more than a quarter of high school students are currently using tobacco products. 3) Hazards associated with cannabis use CDC is committed to monitoring cannabis use, identifying related health effects, and improving the monitoring capabilities of CDC and state/local jurisdictions. In this outbreak, many patients used e-cigarettes or vaporized products containing THC, which indicates the need to understand the health effects of the increasing use of cannabis and the changing market in the United States, as states are working on the legalization of cannabis. For medical or recreational purposes. In 2018, it is estimated that 16% of the population 12 years and older uses marijuana. 4) CDC鈥檚 recommendations to manufacturers, states, and the public. CDC recommends that the public who are worried that e-cigarettes or vaping products may cause lung diseases should consider avoiding e-cigarettes or vaping products. Teenagers, pregnant women, or non-smokers do not Electronic cigarettes should be used. Anyone who uses electronic cigarettes or vaping products should not buy these products on the street, and should not modify or add ingredients on their own. 1.1.2. NgoziO. Ezike's speech (Director of the Illinois Department of Public Health) 69 people in Illinois suffered from serious respiratory diseases after using e-cigarettes or aerosol products, and 1 person died. The patients were between 15-42 years old, with a median of 22 years old, and most of them were men. Although the cause of the illness has not yet been determined, it is certain that smoking e-cigarettes is not a healthy behavior and is not conducive to the health of young people. Illinois began investigating after learning that some residents had respiratory diseases related to e-cigarettes on July 31, 2019, and issued an alert to the Department of Health on August 2 to conduct a cooperative investigation with the CDC and start investigating the effects of e-cigarettes. The prevalence and habit of smoking e-cigarettes among adolescents, and measures such as youth education, case studies, and related legal studies. Nevertheless, on the one hand, the number of patients per day is still increasing. More than 90% are admitted to the hospital for treatment, 72% of which are sent to the intensive care unit, and nearly 30% require medical devices to help breathe. On the other hand, the use of flavored e-cigarettes is increasing. The survey shows that 1) 68% of young people used flavored e-cigarettes in 2019, accounting for 61% in 2017; 2) The 2017 survey found that 63% of young people did not understand The JUUL products they use contain nicotine; 3) From 2011 to 2015, the number of e-cigarettes used by middle school students increased by 900%. 4) A 2018 study found that more than 3.6 million young people use e-cigarettes. The focus group found that the number of young people using e-cigarettes is increasing and there is a trend of addiction. From 2008 to 2018, the number of high school students in Illinois who smoked in the total tobacco market fell from 21% to 5%, but in 2016-2018 , The proportion of e-cigarette usage among high school students rose from 18.4% to 26.7%. The current preliminary idea is to ban flavored nicotine products and study the long- and short-term effects of atomized products on health. The governor of Illinois supported the enactment of legal provisions in the legislative session in October to ban the sale of flavored vaping products specifically targeted at young people. 1.1.3. Albert A. Rizzo's speech (Chief Medical Officer of the American Lung Association) There are two different e-cigarette crises in our country. One is the prevalence and increasing popularity of young people using e-cigarettes; the other is the recent outbreak of lung diseases caused by vaping products in adults and adolescents. According to the 2019 National Tobacco Youth Survey, 27.5% of young people are now using e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The survey asked students whether they had smoked for at least 20 days in the past 30 days? 12% of Grade 12 students, 7% of Grade 10 students, and 2% of Grade 8 students said they do this often. A 2018 CDC study showed that the main reason why teenagers use these products is that the taste of sweets and fruits attracts them, while their friends and family are using them, and they think that e-cigarettes are less harmful. The American Lung Association will urge the FDA and Congress to take action as soon as possible to ban the sale of all flavored tobacco products, including flavored cigars and menthol cigarettes. Regarding the health hazards of e-cigarettes, there are many misleadings, and some of the reasons lead to a high proportion of young people using e-cigarettes. In January 2018, the National Academies of Science, Engineering and Medicine released a research report that reviewed more than 800 different studies. The report clearly pointed out that the use of e-cigarettes is harmful to health, will increase the chance of children and young people starting to use e-cigarettes, and expose others to dangerous second-hand e-cigarette emissions. They concluded that there is "a large amount of evidence" that if young people use electronic cigarettes, the possibility of using traditional cigarettes will increase. A study in Pediatrics magazine also found that young people who use e-cigarettes are four times more likely to try traditional cigarettes than young people who do not use e-cigarettes. According to a study published in the Journal of the American Medical Association in 2015, 81% of young people have ever used tobacco products made from flavored products. Fruit, mint and menthol are the most popular flavors among middle school students who use e-cigarettes. Among them, 65.9% of children use fruit-flavored e-cigarettes, and 63.9% of children use mint or menthol e-cigarettes. The taste in e-cigarettes is produced by a combination of chemicals, which carry a serious risk of lung damage. A 2015 study at Harvard University tested 51 different flavors of e-cigarettes, including marshmallow, bubble gum, and cupcakes, and found that 47 of them were related to at least one chemical substance related to respiratory diseases. E-cigarettes are not smoking cessation products. Smokers who switch to e-cigarettes may also be using traditional cigarettes. "Annals of Internal MedicinA study on "e" found that the probability of wanting to use e-cigarettes to help quit smoking is lower. Only 10.1% of smokers who used e-cigarettes for six months quit smoking, while 26.6% of smokers who did not use e-cigarettes quit smoking . 1.2. FDA intends to ban the sale of flavored e-cigarettes (2019/9/12) On September 12, the FDA stated that in order to reduce the use of e-cigarettes among young people, it will issue a policy to ban the sale of flavored e-cigarettes (including mint flavored e-cigarettes) within a few weeks. ). 1.3. CDC released its views on the causes of death from e-cigarettes (2019/9/19) The latest report from the Centers for Disease Control and Prevention (CDC) of the United States stated that the number of people suffering from lung diseases due to e-cigarettes has soared to 530 in 38 states, as of At present, 7 people have died, causing the Governor of Indiana to pay attention to the ban on flavored e-cigarettes, and corresponding measures may be taken. The CDC is currently unable to determine the specific cause, but they believe that it is caused by chemical exposure. Most of the cases are related to illegal e-cigarette liquid, which contains THC ingredients. These products are from the black market and are not formal e-cigarette stores. But even so, e-cigarette retailers Will also be greatly affected. The American Lung Research Association believes that the country should take action as soon as possible, hoping to remove the flavored e-cigarettes before further research. 2. U.S. states have banned or are preparing to ban the sale of e-cigarettes 2.1. San Francisco became the first city to ban the sale of e-cigarettes (2019/6/25) On June 25, the San Francisco City Supervisory Committee unanimously approved a total ban on the sale of e-cigarettes The regulations stipulate that e-cigarettes will be banned unless they have been reviewed by the FDA鈥檚 PMTA. The regulations are planned to be fully implemented in six months. 2.2. New York State will ban the sale of flavored e-cigarettes, but retain the mint flavor (2019/9/15) Como signed an executive order on September 12 requiring e-cigarettes to be included in New York鈥檚 anti-smoking activities. According to the Cuomo office, 1) Dr. Howard Zucker, commissioner of the State Department of Health, will recommend this week to the State Public Health and Health Planning Commission to issue emergency regulations, which will take effect within two weeks at the earliest. 2) Como has instructed the New York police and the Department of Health to strengthen law enforcement, and retailers who sell e-cigarettes to minors may be subject to criminal penalties; in addition, Como plans to promote legislation to prohibit deceptive marketing of e-cigarettes to teenagers and children. However, the decree does not affect tobacco-based and menthol-flavored e-cigarettes. Trump said last week that an investigation by the Department of Health found hundreds of respiratory disease cases among consumers who use e-cigarettes, so the federal government plans to ban the sale of thousands of flavors in e-cigarettes. Although many cases involve smoking marijuana, problems with the devices, ingredients or additives have not yet been discovered. 2.3. Michigan bans the sale of flavored e-cigarettes (2019/9/18) On September 18, Michigan announced the ban on the sale of flavored nicotine e-cigarettes. The ban will take effect immediately, but there is still a 14-day buffer period for merchants, and the ban will be It lasts for 6 months, but the governor has the right to extend the period. 2.4. Wal-Mart stops selling e-cigarettes (2019/9/20) On September 20, Wal-Mart announced that it would stop selling e-cigarettes. After the current inventory is sold out, it will stop selling e-cigarettes in Wal-Mart stores and Sam’s Clubs. In July of this year, Wal-Mart raised the minimum age for purchasing tobacco products, including all e-cigarettes, to 21 years old, and has indicated that it is discontinuing the sale of fruit-flavored and dessert-flavored e-cigarettes. E-cigarettes are mainly sold through e-cigarette specialty stores, and there are approximately 115,000 specialty stores in the United States. The e-cigarette business only occupies a small part of Wal-Mart, so it has little impact on Wal-Mart. However, Wal-Mart Store + Sam’s Clubs has more than 5,000 stores in the United States. Wal-Mart鈥檚 suspension of sales will reduce the chance of direct contact between e-cigarettes and consumers. It is also difficult to find a replacement for this huge sales channel. 2.5. The state of Massachusetts suspends the sale of all vaping products related to e-cigarettes (2019/9/24) The state of Massachusetts has decided to suspend the sale of all vaping products related to e-cigarettes for 4 months (as of January 25 next year) No.), 1) This emergency suspension is mainly to cooperate with expert doctors to find out the cause of the disease; 2) Currently, the FDA laboratory is testing more than 150 suspicious product samples, but the cause of the patient鈥檚 lung disease has not yet been determined. 3. E-cigarette manufacturing company statement 3.1. British American Tobacco 3.1.1. Response to the US FDA's announcement of atomized products (2019/9/9) British American Tobacco Research Director Dr David O & rsquo; Reilly said that company toxicologists misted the company Each single ingredient in the chemical product has been carefully checked to see if they are suitable for atomization. And the company has never added e-liquid containing THC and vitamin E acetate to atomized products. The tragic incident was because these e-liquids were not purchased from well-known manufacturers and contained ingredients not used by the manufacturers (including THC and vitamin E acetate). The company supports the FDA鈥檚 view that users of vaping products should always buy smoking sets and e-liquids from reputable manufacturers, and should avoid modifying or adding substances to the products they buy, and should use these according to the manufacturer鈥檚 intentions. product. 3.1.2. Statement on supporting strong product quality standards, measures to prevent the use of young people in the United States, and preparing to apply for PMTA at any time (2019/9/12) 1) The company expressed its concern about the marketing of certain flavored products like the FDA Attract the attention of young people. At the same time, it is difficult to overestimate the role of flavored products in helping adult consumers switch from combustible products to alternative tobacco and nicotine products. The company has established corresponding procedures to ensure that its products are only sold to adult smokers and users of vaping products. 2) For the four VUSE products planned to be launched in the United States, the company is confident that it can submit Pre-Market Tobacco Applications (PMTA) before the deadline announced by the FDA (May 2020). If approved, our Reynolds Tobacco will be able to continue to sell its VUSE brand atomized products within the new regulatory framework in the United States. 3.1.3. Statement on the need for strong and effective atomization product supervision (2019/9/20) The company stated that no products developed or produced by British American Tobacco were involved in recent e-cigarette lung disease cases, and it supports investigations made by relevant agencies , And hopes to introduce strong and effective regulations to ensure high product standards, especially in testing and reporting the ingredients used in the e-liquid of atomized products. At the same time, the government also needs to ensure that relevant agencies force manufacturers to comply with these regulations, only through effective With supervision and law enforcement, consumers can maintain confidence in the harm reduction effects of atomized products compared to traditional tobacco. 3.2. Japan Tobacco International 3.2.1. Regarding the response to lung disease cases in the United States (2019/9/13) So far, the US Department of Health is investigating 450 cases of lung disease that may be related to the use of e-cigarettes. Currently, there is little information about the products involved and the underlying causes. We are not aware of any Logic products associated with these cases and are under investigation. We have learned from media reports that many patients have admitted to using e-cigarettes containing THC e-liquid. In addition, it is reported that vitamin E acetate, a chemical substance related to hemp oil, was found in many relevant samples analyzed by the authorities. In our Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. At JTI, we will know exactly the ingredients of Logic: all Logic e-liquids undergo a strict product management plan, including toxicological evaluation and quality control of all ingredients used. Logic e-liquid can only be sold after passing a comprehensive inspection. Nebulizer users should not use the e-liquid produced by manufacturers that have not undergone strict safety and quality inspections. After design and testing, smoking sets and cartridges that can be used together should always be paired with each other. 4. Market share and sales decline of marijuana-related vaping products Since the first death case related to e-cigarettes was reported on August 23, the sales proportion of marijuana-related vaping products in the recreational marijuana product market decline. Comparing the sales data on August 19 and September 16, California: 32.8% decreased to 29%; Colorado: 19.2% decreased to 14.5%; Nevada: 22.3% decreased to 19.2%; Washington: 17.8% decreased to 14.6 %. (Report time: 2019/9/12) Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, and September 9 Total sales from Japan to 15th fell to US$689,924, a decrease of 25%. (Reporting time: 2019/9/19)As of September 18, 2019, the United States has reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaporized products, and 7 people have died. This has made the United States attach great importance to e-cigarettes and vaporized products. Congressional hearings, down to the states and e-cigarette manufacturers, are closely following relevant developments and successively issued attitudes and statements. In particular, flavored e-cigarettes have attracted attention due to their strong appeal to young people. The FDA in September It was announced on the 12th that it would issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention and even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . But from the market point of view, the reaction was strong. On the one hand, the health of e-cigarettes is being questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. The following is the important content of recent reports: On September 24, the United States held a congressional hearing on the issue of e-cigarettes. The preliminary results of the CDC investigation showed that about 80% of patients reported using tetrahydrocannabinol or THC e-liquid, and about 60% said they used e-cigarettes containing tetrahydrocannabinol or THC. Nicotine e-liquid, and about 10-20% of people claim that they only use nicotine-containing products. Although the source of the disease has not been determined, it can be clearly related to chemical exposure. The state of Illinois initially envisages banning the sale of flavored nicotine products. The American Lung Association report stated that 27.5% of young people now use e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The main reason for teenagers to use these products is the attraction of candies and fruit flavors. The American Lung Association will urge the FDA and Congress to ban all flavored tobacco products as soon as possible, including flavored cigars and menthol cigarettes. U.S. states have banned or are preparing to ban the sale of e-cigarettes. On June 25, the San Francisco City Supervisory Committee unanimously passed a ban on the sale of e-cigarettes. On September 15, New York State stated that it would ban the sale of flavored e-cigarettes, but retain the mint flavor. On September 18, Michigan announced a ban on the sale of flavored nicotine e-cigarettes, and the ban took effect immediately. On September 20, Wal-Mart announced that it would stop selling e-cigarettes after it sold out. On September 24, Massachusetts suspended the sale of all vaping products related to e-cigarettes for 4 months. The e-cigarette manufacturing company issued a statement that British Tobacco: 1) never added e-liquid containing THC and vitamin E acetate to its atomized products; 2) for 4 VUSE products planned to be launched in the United States, the company is confident in Submit PMTA before May 2020. Japan Tobacco International: In the Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. The market share and sales decline of cannabis-related atomized products compare the sales ratio of cannabis-related atomized products in the recreational cannabis product market on August 19 and September 16, and the ratio is showing a downward trend. Among them, California: decreased from 32.8% to 29%; Colorado: decreased from 19.2% to 14.5%; Nevada: decreased from 22.3% to 19.2%; Washington: decreased from 17.8% to 14.6%. Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, while the total sales of September 9-15 decreased to 689,924 U.S. dollars, a decrease of 25%. Risk warning: new tobacco policy changes risk, sales are not as expected; industrial hemp should be strictly distinguished from intermediate cannabis, recreational cannabis/drugs, and resolutely opposed to legalization of recreational cannabis. As of September 18, 2019, the United States has reported 530 confirmed cases Seven people died of lung diseases suspected to be related to the use of e-cigarettes or vaping products, making the United States attach great importance to e-cigarettes and vaping products, from congressional hearings to states and e-cigarette manufacturers. All are paying close attention to relevant developments and issuing attitudes and statements one after another, especially flavored e-cigarettes because of their strong appeal to young people. The FDA announced on September 12 that it will issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention to or even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . However, from the market point of view, the response was strong. On the one hand, the health of e-cigarettes has been questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. In order to give you a clearer understanding of recent reports on e-cigarettes in the United States, we have sorted out important content including relevant statements issued by congressional hearings, FDA, CDC, and states and e-cigarette manufacturers for reference. 1. Statement by relevant US agencies 1.1. Congressional hearing (2019/9/24) 1.1.1. Anne Schuchat, MD's speech (CDC, Chief Deputy Director of the Department of Health and Human Services) August 1, 2019, the first time in Wisconsin The Center for Disease Control and Prevention (CDC) was notified of a series of lung diseases that have appeared in young people since July 2019. As of September 18, 2019, 38 states and 1 region in the United States have reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaping products. There are already 6 states (California, Illinois, Indiana). States, Kansas, Minnesota and Oregon). These tragic deaths have exacerbated the urgency of the CDC and the FDA to jointly investigate the cause and provide states with the necessary resources to solve this emerging public health problem. CDC established a case investigation team in August and activated the Emergency Operations Center on September 16 to enable it to devote more resources to this investigation. 1) Case summary For many reasons, investigating the causes of lung injury related to the use of e-cigarettes or aerosol products is quite challenging. a. The investigation involves many states; b. The diversity of the e-cigarette or atomized product market, the wide variety of products, the wide range of ingredients, and the connection with potentially illegal substances such as marijuana all complicate the investigation. Consumers do not know what their e-cigarettes or atomized products contain, and many products and substances themselves can be modified by consumers. They can be obtained from physical stores, online retailers, on the street, or through social channels. Preliminary results: According to data collected in two states and recently published in the New England Journal of Medicine, most patients (about 80%) report using cigarettes containing tetrahydrocannabinol or THC (the psychoactive compound of cannabis) Oil, and half (about 60%) of people said they use nicotine-containing e-liquid, while about 10-20% said they only use nicotine-containing products. However, no e-cigarette or atomized product, a certain brand or a specific substance has a clear connection with the epidemic. CDC has received complete gender and age data for 373 of the 530 cases. Almost three-quarters of the cases are men. Two-thirds of the cases were between 18 and 34 years old, 16% were under 18 years old, and 17% were over 35 years old. The lung damage observed in this incident does not seem to be caused by infection. The pathological findings and the results of the non-infectious diagnosis indicate that the cause of the disease is related to exposure to chemical substances. Patients first showed signs of illness within a few days to a few weeks after using e-cigarettes or aerosol products, and gradually developed symptoms such as dyspnea, shortness of breath, or chest pain before hospitalization. Some patients developed mild to moderate gastrointestinal diseases. There are other symptoms including fatigue, fever and weight loss. So far, investigators have not found any specific products or compounds related to all cases. 2) Youth e-cigarette use data Preliminary data from the 2019 National Youth Tobacco Survey show that the use of youth e-cigarettes continues to rise. Data show that in 2019, more than a quarter of high school students currently (in the past 30 days) use e-cigarettes, a significant increase compared to 2017. From 2017 to 2018, the number of e-cigarettes used by high school students increased by 77.8%, and more than a quarter of high school students are currently using tobacco products. 3) Hazards associated with cannabis use CDC is committed to monitoring cannabis use, identifying related health effects, and improving the monitoring capabilities of CDC and state/local jurisdictions. In this outbreak, many patients used e-cigarettes or vaporized products containing THC, which indicates the need to understand the health effects of the increasing use of cannabis and the changing market in the United States, as states are working on the legalization of cannabis. For medical or recreational purposes. In 2018, it is estimated that 16% of the population 12 years and older uses marijuana. 4) CDC鈥檚 recommendations to manufacturers, states, and the public. CDC recommends that the public who are worried that e-cigarettes or vaping products may cause lung diseases should consider avoiding e-cigarettes or vaping products. Teenagers, pregnant women, or non-smokers do not Electronic cigarettes should be used. Anyone who uses electronic cigarettes or vaping products should not buy these products on the street, and should not modify or add ingredients on their own. 1.1.2. NgoziO. Ezike's speech (Director of the Illinois Department of Public Health) 69 people in Illinois suffered from serious respiratory diseases after using e-cigarettes or aerosol products, and 1 person died. The patients were between 15-42 years old, with a median of 22 years old, and most of them were men. Although the cause of the illness has not yet been determined, it is certain that smoking e-cigarettes is not a healthy behavior and is not conducive to the health of young people. Illinois began investigating after learning that some residents had respiratory diseases related to e-cigarettes on July 31, 2019, and issued an alert to the Department of Health on August 2 to conduct a cooperative investigation with the CDC and start investigating the effects of e-cigarettes. The prevalence and habit of smoking e-cigarettes among adolescents, and measures such as youth education, case studies, and related legal studies. Nevertheless, on the one hand, the number of patients per day is still increasing. More than 90% are admitted to the hospital for treatment, 72% of which are sent to the intensive care unit, and nearly 30% require medical devices to help breathe. On the other hand, the use of flavored e-cigarettes is increasing. The survey shows that 1) 68% of young people used flavored e-cigarettes in 2019, accounting for 61% in 2017; 2) The 2017 survey found that 63% of young people did not understand The JUUL products they use contain nicotine; 3) From 2011 to 2015, the number of e-cigarettes used by middle school students increased by 900%. 4) A 2018 study found that more than 3.6 million young people use e-cigarettes. The focus group found that the number of young people using e-cigarettes is increasing and there is a trend of addiction. From 2008 to 2018, the number of high school students in Illinois who smoked in the total tobacco market fell from 21% to 5%, but in 2016-2018 , The proportion of e-cigarette usage among high school students rose from 18.4% to 26.7%. The current preliminary idea is to ban flavored nicotine products and study the long- and short-term effects of atomized products on health. The governor of Illinois supported the enactment of legal provisions in the legislative session in October to ban the sale of flavored vaping products specifically targeted at young people. 1.1.3. Albert A. Rizzo's speech (Chief Medical Officer of the American Lung Association) There are two different e-cigarette crises in our country. One is the prevalence and increasing popularity of young people using e-cigarettes; the other is the recent outbreak of lung diseases caused by vaping products in adults and adolescents. According to the 2019 National Tobacco Youth Survey, 27.5% of young people are now using e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The survey asked students whether they had smoked for at least 20 days in the past 30 days? 12% of Grade 12 students, 7% of Grade 10 students, and 2% of Grade 8 students said they do this often. A 2018 CDC study showed that the main reason why teenagers use these products is that the taste of sweets and fruits attracts them, while their friends and family are using them, and they think that e-cigarettes are less harmful. The American Lung Association will urge the FDA and Congress to take action as soon as possible to ban the sale of all flavored tobacco products, including flavored cigars and menthol cigarettes. Regarding the health hazards of e-cigarettes, there are many misleadings, and some of the reasons lead to a high proportion of young people using e-cigarettes. In January 2018, the National Academies of Science, Engineering and Medicine released a research report that reviewed more than 800 different studies. The report clearly pointed out that the use of e-cigarettes is harmful to health, will increase the chance of children and young people starting to use e-cigarettes, and expose others to dangerous second-hand e-cigarette emissions. They concluded that there is "a large amount of evidence" that if young people use electronic cigarettes, the possibility of using traditional cigarettes will increase. A study in Pediatrics magazine also found that young people who use e-cigarettes are four times more likely to try traditional cigarettes than young people who do not use e-cigarettes. According to a study published in the Journal of the American Medical Association in 2015, 81% of young people have ever used tobacco products made from flavored products. Fruit, mint and menthol are the most popular flavors among middle school students who use e-cigarettes. Among them, 65.9% of children use fruit-flavored e-cigarettes, and 63.9% of children use mint or menthol e-cigarettes. The taste in e-cigarettes is produced by a combination of chemicals, which carry a serious risk of lung damage. A 2015 study at Harvard University tested 51 different flavors of e-cigarettes, including marshmallow, bubble gum, and cupcakes, and found that 47 of them were related to at least one chemical substance related to respiratory diseases. E-cigarettes are not smoking cessation products. Smokers who switch to e-cigarettes may also be using traditional cigarettes. "Annals of Internal MedicinA study on "e" found that the probability of wanting to use e-cigarettes to help quit smoking is lower. Only 10.1% of smokers who used e-cigarettes for six months quit smoking, while 26.6% of smokers who did not use e-cigarettes quit smoking . 1.2. FDA intends to ban the sale of flavored e-cigarettes (2019/9/12) On September 12, the FDA stated that in order to reduce the use of e-cigarettes among young people, it will issue a policy to ban the sale of flavored e-cigarettes (including mint flavored e-cigarettes) within a few weeks. ). 1.3. CDC released its views on the causes of death from e-cigarettes (2019/9/19) The latest report from the Centers for Disease Control and Prevention (CDC) of the United States stated that the number of people suffering from lung diseases due to e-cigarettes has soared to 530 in 38 states, as of At present, 7 people have died, causing the Governor of Indiana to pay attention to the ban on flavored e-cigarettes, and corresponding measures may be taken. The CDC is currently unable to determine the specific cause, but they believe that it is caused by chemical exposure. Most of the cases are related to illegal e-cigarette liquid, which contains THC ingredients. These products are from the black market and are not formal e-cigarette stores. But even so, e-cigarette retailers Will also be greatly affected. The American Lung Research Association believes that the country should take action as soon as possible, hoping to remove the flavored e-cigarettes before further research. 2. U.S. states have banned or are preparing to ban the sale of e-cigarettes 2.1. San Francisco became the first city to ban the sale of e-cigarettes (2019/6/25) On June 25, the San Francisco City Supervisory Committee unanimously approved a total ban on the sale of e-cigarettes The regulations stipulate that e-cigarettes will be banned unless they have been reviewed by the FDA鈥檚 PMTA. The regulations are planned to be fully implemented in six months. 2.2. New York State will ban the sale of flavored e-cigarettes, but retain the mint flavor (2019/9/15) Como signed an executive order on September 12 requiring e-cigarettes to be included in New York鈥檚 anti-smoking activities. According to the Cuomo office, 1) Dr. Howard Zucker, commissioner of the State Department of Health, will recommend this week to the State Public Health and Health Planning Commission to issue emergency regulations, which will take effect within two weeks at the earliest. 2) Como has instructed the New York police and the Department of Health to strengthen law enforcement, and retailers who sell e-cigarettes to minors may be subject to criminal penalties; in addition, Como plans to promote legislation to prohibit deceptive marketing of e-cigarettes to teenagers and children. However, the decree does not affect tobacco-based and menthol-flavored e-cigarettes. Trump said last week that an investigation by the Department of Health found hundreds of respiratory disease cases among consumers who use e-cigarettes, so the federal government plans to ban the sale of thousands of flavors in e-cigarettes. Although many cases involve smoking marijuana, problems with the devices, ingredients or additives have not yet been discovered. 2.3. Michigan bans the sale of flavored e-cigarettes (2019/9/18) On September 18, Michigan announced the ban on the sale of flavored nicotine e-cigarettes. The ban will take effect immediately, but there is still a 14-day buffer period for merchants, and the ban will be It lasts for 6 months, but the governor has the right to extend the period. 2.4. Wal-Mart stops selling e-cigarettes (2019/9/20) On September 20, Wal-Mart announced that it would stop selling e-cigarettes. After the current inventory is sold out, it will stop selling e-cigarettes in Wal-Mart stores and Sam’s Clubs. In July of this year, Wal-Mart raised the minimum age for purchasing tobacco products, including all e-cigarettes, to 21 years old, and has indicated that it is discontinuing the sale of fruit-flavored and dessert-flavored e-cigarettes. E-cigarettes are mainly sold through e-cigarette specialty stores, and there are approximately 115,000 specialty stores in the United States. The e-cigarette business only occupies a small part of Wal-Mart, so it has little impact on Wal-Mart. However, Wal-Mart Store + Sam’s Clubs has more than 5,000 stores in the United States. Wal-Mart鈥檚 suspension of sales will reduce the chance of direct contact between e-cigarettes and consumers. It is also difficult to find a replacement for this huge sales channel. 2.5. The state of Massachusetts suspends the sale of all vaping products related to e-cigarettes (2019/9/24) The state of Massachusetts has decided to suspend the sale of all vaping products related to e-cigarettes for 4 months (as of January 25 next year) No.), 1) This emergency suspension is mainly to cooperate with expert doctors to find out the cause of the disease; 2) Currently, the FDA laboratory is testing more than 150 suspicious product samples, but the cause of the patient鈥檚 lung disease has not yet been determined. 3. E-cigarette manufacturing company statement 3.1. British American Tobacco 3.1.1. Response to the US FDA's announcement of atomized products (2019/9/9) British American Tobacco Research Director Dr David O & rsquo; Reilly said that company toxicologists misted the company Each single ingredient in the chemical product has been carefully checked to see if they are suitable for atomization. And the company has never added e-liquid containing THC and vitamin E acetate to atomized products. The tragic incident was because these e-liquids were not purchased from well-known manufacturers and contained ingredients not used by the manufacturers (including THC and vitamin E acetate). The company supports the FDA鈥檚 view that users of vaping products should always buy smoking sets and e-liquids from reputable manufacturers, and should avoid modifying or adding substances to the products they buy, and should use these according to the manufacturer鈥檚 intentions. product. 3.1.2. Statement on supporting strong product quality standards, measures to prevent the use of young people in the United States, and preparing to apply for PMTA at any time (2019/9/12) 1) The company expressed its concern about the marketing of certain flavored products like the FDA Attract the attention of young people. At the same time, it is difficult to overestimate the role of flavored products in helping adult consumers switch from combustible products to alternative tobacco and nicotine products. The company has established corresponding procedures to ensure that its products are only sold to adult smokers and users of vaping products. 2) For the four VUSE products planned to be launched in the United States, the company is confident that it can submit Pre-Market Tobacco Applications (PMTA) before the deadline announced by the FDA (May 2020). If approved, our Reynolds Tobacco will be able to continue to sell its VUSE brand atomized products within the new regulatory framework in the United States. 3.1.3. Statement on the need for strong and effective atomization product supervision (2019/9/20) The company stated that no products developed or produced by British American Tobacco were involved in recent e-cigarette lung disease cases, and it supports investigations made by relevant agencies , And hopes to introduce strong and effective regulations to ensure high product standards, especially in testing and reporting the ingredients used in the e-liquid of atomized products. At the same time, the government also needs to ensure that relevant agencies force manufacturers to comply with these regulations, only through effective With supervision and law enforcement, consumers can maintain confidence in the harm reduction effects of atomized products compared to traditional tobacco. 3.2. Japan Tobacco International 3.2.1. Regarding the response to lung disease cases in the United States (2019/9/13) So far, the US Department of Health is investigating 450 cases of lung disease that may be related to the use of e-cigarettes. Currently, there is little information about the products involved and the underlying causes. We are not aware of any Logic products associated with these cases and are under investigation. We have learned from media reports that many patients have admitted to using e-cigarettes containing THC e-liquid. In addition, it is reported that vitamin E acetate, a chemical substance related to hemp oil, was found in many relevant samples analyzed by the authorities. In our Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. At JTI, we will know exactly the ingredients of Logic: all Logic e-liquids undergo a strict product management plan, including toxicological evaluation and quality control of all ingredients used. Logic e-liquid can only be sold after passing a comprehensive inspection. Nebulizer users should not use the e-liquid produced by manufacturers that have not undergone strict safety and quality inspections. After design and testing, smoking sets and cartridges that can be used together should always be paired with each other. 4. Market share and sales decline of marijuana-related vaping products Since the first death case related to e-cigarettes was reported on August 23, the sales proportion of marijuana-related vaping products in the recreational marijuana product market decline. Comparing the sales data on August 19 and September 16, California: 32.8% decreased to 29%; Colorado: 19.2% decreased to 14.5%; Nevada: 22.3% decreased to 19.2%; Washington: 17.8% decreased to 14.6 %. (Report time: 2019/9/12) Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, and September 9 Total sales from Japan to 15th fell to US$689,924, a decrease of 25%. (Reporting time: 2019/9/19)As of September 18, 2019, the United States has reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaporized products, and 7 people have died. This has made the United States attach great importance to e-cigarettes and vaporized products. Congressional hearings, down to the states and e-cigarette manufacturers, are closely following relevant developments and successively issued attitudes and statements. In particular, flavored e-cigarettes have attracted attention due to their strong appeal to young people. The FDA in September It was announced on the 12th that it would issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention and even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . But from the market point of view, the reaction was strong. On the one hand, the health of e-cigarettes is being questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. The following is the important content of recent reports: On September 24, the United States held a congressional hearing on the issue of e-cigarettes. The preliminary results of the CDC investigation showed that about 80% of patients reported using tetrahydrocannabinol or THC e-liquid, and about 60% said they used e-cigarettes containing tetrahydrocannabinol or THC. Nicotine e-liquid, and about 10-20% of people claim that they only use nicotine-containing products. Although the source of the disease has not been determined, it can be clearly related to chemical exposure. The state of Illinois initially envisages banning the sale of flavored nicotine products. The American Lung Association report stated that 27.5% of young people now use e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The main reason for teenagers to use these products is the attraction of candies and fruit flavors. The American Lung Association will urge the FDA and Congress to ban all flavored tobacco products as soon as possible, including flavored cigars and menthol cigarettes. U.S. states have banned or are preparing to ban the sale of e-cigarettes. On June 25, the San Francisco City Supervisory Committee unanimously passed a ban on the sale of e-cigarettes. On September 15, New York State stated that it would ban the sale of flavored e-cigarettes, but retain the mint flavor. On September 18, Michigan announced a ban on the sale of flavored nicotine e-cigarettes, and the ban took effect immediately. On September 20, Wal-Mart announced that it would stop selling e-cigarettes after it sold out. On September 24, Massachusetts suspended the sale of all vaping products related to e-cigarettes for 4 months. The e-cigarette manufacturing company issued a statement that British Tobacco: 1) never added e-liquid containing THC and vitamin E acetate to its atomized products; 2) for 4 VUSE products planned to be launched in the United States, the company is confident in Submit PMTA before May 2020. Japan Tobacco International: In the Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. The market share and sales decline of cannabis-related atomized products compare the sales ratio of cannabis-related atomized products in the recreational cannabis product market on August 19 and September 16, and the ratio is showing a downward trend. Among them, California: decreased from 32.8% to 29%; Colorado: decreased from 19.2% to 14.5%; Nevada: decreased from 22.3% to 19.2%; Washington: decreased from 17.8% to 14.6%. Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, while the total sales of September 9-15 decreased to 689,924 U.S. dollars, a decrease of 25%. Risk warning: new tobacco policy changes risk, sales are not as expected; industrial hemp should be strictly distinguished from intermediate cannabis, recreational cannabis/drugs, and resolutely opposed to legalization of recreational cannabis. As of September 18, 2019, the United States has reported 530 confirmed cases Seven people died of lung diseases suspected to be related to the use of e-cigarettes or vaping products, making the United States attach great importance to e-cigarettes and vaping products, from congressional hearings to states and e-cigarette manufacturers. All are paying close attention to relevant developments and issuing attitudes and statements one after another, especially flavored e-cigarettes because of their strong appeal to young people. The FDA announced on September 12 that it will issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention to or even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . However, from the market point of view, the response was strong. On the one hand, the health of e-cigarettes has been questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. In order to give you a clearer understanding of recent reports on e-cigarettes in the United States, we have sorted out important content including relevant statements issued by congressional hearings, FDA, CDC, and states and e-cigarette manufacturers for reference. 1. Statement by relevant US agencies 1.1. Congressional hearing (2019/9/24) 1.1.1. Anne Schuchat, MD's speech (CDC, Chief Deputy Director of the Department of Health and Human Services) August 1, 2019, the first time in Wisconsin The Center for Disease Control and Prevention (CDC) was notified of a series of lung diseases that have appeared in young people since July 2019. As of September 18, 2019, 38 states and 1 region in the United States have reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaping products. There are already 6 states (California, Illinois, Indiana). States, Kansas, Minnesota and Oregon). These tragic deaths have exacerbated the urgency of the CDC and the FDA to jointly investigate the cause and provide states with the necessary resources to solve this emerging public health problem. CDC established a case investigation team in August and activated the Emergency Operations Center on September 16 to enable it to devote more resources to this investigation. 1) Case summary For many reasons, investigating the causes of lung injury related to the use of e-cigarettes or aerosol products is quite challenging. a. The investigation involves many states; b. The diversity of the e-cigarette or atomized product market, the wide variety of products, the wide range of ingredients, and the connection with potentially illegal substances such as marijuana all complicate the investigation. Consumers do not know what their e-cigarettes or atomized products contain, and many products and substances themselves can be modified by consumers. They can be obtained from physical stores, online retailers, on the street, or through social channels. Preliminary results: According to data collected in two states and recently published in the New England Journal of Medicine, most patients (about 80%) report using cigarettes containing tetrahydrocannabinol or THC (the psychoactive compound of cannabis) Oil, and half (about 60%) of people said they use nicotine-containing e-liquid, while about 10-20% said they only use nicotine-containing products. However, no e-cigarette or atomized product, a certain brand or a specific substance has a clear connection with the epidemic. CDC has received complete gender and age data for 373 of the 530 cases. Almost three-quarters of the cases are men. Two-thirds of the cases were between 18 and 34 years old, 16% were under 18 years old, and 17% were over 35 years old. The lung damage observed in this incident does not seem to be caused by infection. The pathological findings and the results of the non-infectious diagnosis indicate that the cause of the disease is related to exposure to chemical substances. Patients first showed signs of illness within a few days to a few weeks after using e-cigarettes or aerosol products, and gradually developed symptoms such as dyspnea, shortness of breath, or chest pain before hospitalization. Some patients developed mild to moderate gastrointestinal diseases. There are other symptoms including fatigue, fever and weight loss. So far, investigators have not found any specific products or compounds related to all cases. 2) Youth e-cigarette use data Preliminary data from the 2019 National Youth Tobacco Survey show that the use of youth e-cigarettes continues to rise. Data show that in 2019, more than a quarter of high school students currently (in the past 30 days) use e-cigarettes, a significant increase compared to 2017. From 2017 to 2018, the number of e-cigarettes used by high school students increased by 77.8%, and more than a quarter of high school students are currently using tobacco products. 3) Hazards associated with cannabis use CDC is committed to monitoring cannabis use, identifying related health effects, and improving the monitoring capabilities of CDC and state/local jurisdictions. In this outbreak, many patients used e-cigarettes or vaporized products containing THC, which indicates the need to understand the health effects of the increasing use of cannabis and the changing market in the United States, as states are working on the legalization of cannabis. For medical or recreational purposes. In 2018, it is estimated that 16% of the population 12 years and older uses marijuana. 4) CDC鈥檚 recommendations to manufacturers, states, and the public. CDC recommends that the public who are worried that e-cigarettes or vaping products may cause lung diseases should consider avoiding e-cigarettes or vaping products. Teenagers, pregnant women, or non-smokers do not Electronic cigarettes should be used. Anyone who uses electronic cigarettes or vaping products should not buy these products on the street, and should not modify or add ingredients on their own. 1.1.2. NgoziO. Ezike's speech (Director of the Illinois Department of Public Health) 69 people in Illinois suffered from serious respiratory diseases after using e-cigarettes or aerosol products, and 1 person died. The patients were between 15-42 years old, with a median of 22 years old, and most of them were men. Although the cause of the illness has not yet been determined, it is certain that smoking e-cigarettes is not a healthy behavior and is not conducive to the health of young people. Illinois began investigating after learning that some residents had respiratory diseases related to e-cigarettes on July 31, 2019, and issued an alert to the Department of Health on August 2 to conduct a cooperative investigation with the CDC and start investigating the effects of e-cigarettes. The prevalence and habit of smoking e-cigarettes among adolescents, and measures such as youth education, case studies, and related legal studies. Nevertheless, on the one hand, the number of patients per day is still increasing. More than 90% are admitted to the hospital for treatment, 72% of which are sent to the intensive care unit, and nearly 30% require medical devices to help breathe. On the other hand, the use of flavored e-cigarettes is increasing. The survey shows that 1) 68% of young people used flavored e-cigarettes in 2019, accounting for 61% in 2017; 2) The 2017 survey found that 63% of young people did not understand The JUUL products they use contain nicotine; 3) From 2011 to 2015, the number of e-cigarettes used by middle school students increased by 900%. 4) A 2018 study found that more than 3.6 million young people use e-cigarettes. The focus group found that the number of young people using e-cigarettes is increasing and there is a trend of addiction. From 2008 to 2018, the number of high school students in Illinois who smoked in the total tobacco market fell from 21% to 5%, but in 2016-2018 , The proportion of e-cigarette usage among high school students rose from 18.4% to 26.7%. The current preliminary idea is to ban flavored nicotine products and study the long- and short-term effects of atomized products on health. The governor of Illinois supported the enactment of legal provisions in the legislative session in October to ban the sale of flavored vaping products specifically targeted at young people. 1.1.3. Albert A. Rizzo's speech (Chief Medical Officer of the American Lung Association) There are two different e-cigarette crises in our country. One is the prevalence and increasing popularity of young people using e-cigarettes; the other is the recent outbreak of lung diseases caused by vaping products in adults and adolescents. According to the 2019 National Tobacco Youth Survey, 27.5% of young people are now using e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The survey asked students whether they had smoked for at least 20 days in the past 30 days? 12% of Grade 12 students, 7% of Grade 10 students, and 2% of Grade 8 students said they do this often. A 2018 CDC study showed that the main reason why teenagers use these products is that the taste of sweets and fruits attracts them, while their friends and family are using them, and they think that e-cigarettes are less harmful. The American Lung Association will urge the FDA and Congress to take action as soon as possible to ban the sale of all flavored tobacco products, including flavored cigars and menthol cigarettes. Regarding the health hazards of e-cigarettes, there are many misleadings, and some of the reasons lead to a high proportion of young people using e-cigarettes. In January 2018, the National Academies of Science, Engineering and Medicine released a research report that reviewed more than 800 different studies. The report clearly pointed out that the use of e-cigarettes is harmful to health, will increase the chance of children and young people starting to use e-cigarettes, and expose others to dangerous second-hand e-cigarette emissions. They concluded that there is "a large amount of evidence" that if young people use electronic cigarettes, the possibility of using traditional cigarettes will increase. A study in Pediatrics magazine also found that young people who use e-cigarettes are four times more likely to try traditional cigarettes than young people who do not use e-cigarettes. According to a study published in the Journal of the American Medical Association in 2015, 81% of young people have ever used tobacco products made from flavored products. Fruit, mint and menthol are the most popular flavors among middle school students who use e-cigarettes. Among them, 65.9% of children use fruit-flavored e-cigarettes, and 63.9% of children use mint or menthol e-cigarettes. The taste in e-cigarettes is produced by a combination of chemicals, which carry a serious risk of lung damage. A 2015 study at Harvard University tested 51 different flavors of e-cigarettes, including marshmallow, bubble gum, and cupcakes, and found that 47 of them were related to at least one chemical substance related to respiratory diseases. E-cigarettes are not smoking cessation products. Smokers who switch to e-cigarettes may also be using traditional cigarettes. "Annals of Internal MedicinA study on "e" found that the probability of wanting to use e-cigarettes to help quit smoking is lower. Only 10.1% of smokers who used e-cigarettes for six months quit smoking, while 26.6% of smokers who did not use e-cigarettes quit smoking . 1.2. FDA intends to ban the sale of flavored e-cigarettes (2019/9/12) On September 12, the FDA stated that in order to reduce the use of e-cigarettes among young people, it will issue a policy to ban the sale of flavored e-cigarettes (including mint flavored e-cigarettes) within a few weeks. ). 1.3. CDC released its views on the causes of death from e-cigarettes (2019/9/19) The latest report from the Centers for Disease Control and Prevention (CDC) of the United States stated that the number of people suffering from lung diseases due to e-cigarettes has soared to 530 in 38 states, as of At present, 7 people have died, causing the Governor of Indiana to pay attention to the ban on flavored e-cigarettes, and corresponding measures may be taken. The CDC is currently unable to determine the specific cause, but they believe that it is caused by chemical exposure. Most of the cases are related to illegal e-cigarette liquid, which contains THC ingredients. These products are from the black market and are not formal e-cigarette stores. But even so, e-cigarette retailers Will also be greatly affected. The American Lung Research Association believes that the country should take action as soon as possible, hoping to remove the flavored e-cigarettes before further research. 2. U.S. states have banned or are preparing to ban the sale of e-cigarettes 2.1. San Francisco became the first city to ban the sale of e-cigarettes (2019/6/25) On June 25, the San Francisco City Supervisory Committee unanimously approved a total ban on the sale of e-cigarettes The regulations stipulate that e-cigarettes will be banned unless they have been reviewed by the FDA鈥檚 PMTA. The regulations are planned to be fully implemented in six months. 2.2. New York State will ban the sale of flavored e-cigarettes, but retain the mint flavor (2019/9/15) Como signed an executive order on September 12 requiring e-cigarettes to be included in New York鈥檚 anti-smoking activities. According to the Cuomo office, 1) Dr. Howard Zucker, commissioner of the State Department of Health, will recommend this week to the State Public Health and Health Planning Commission to issue emergency regulations, which will take effect within two weeks at the earliest. 2) Como has instructed the New York police and the Department of Health to strengthen law enforcement, and retailers who sell e-cigarettes to minors may be subject to criminal penalties; in addition, Como plans to promote legislation to prohibit deceptive marketing of e-cigarettes to teenagers and children. However, the decree does not affect tobacco-based and menthol-flavored e-cigarettes. Trump said last week that an investigation by the Department of Health found hundreds of respiratory disease cases among consumers who use e-cigarettes, so the federal government plans to ban the sale of thousands of flavors in e-cigarettes. Although many cases involve smoking marijuana, problems with the devices, ingredients or additives have not yet been discovered. 2.3. Michigan bans the sale of flavored e-cigarettes (2019/9/18) On September 18, Michigan announced the ban on the sale of flavored nicotine e-cigarettes. The ban will take effect immediately, but there is still a 14-day buffer period for merchants, and the ban will be It lasts for 6 months, but the governor has the right to extend the period. 2.4. Wal-Mart stops selling e-cigarettes (2019/9/20) On September 20, Wal-Mart announced that it would stop selling e-cigarettes. After the current inventory is sold out, it will stop selling e-cigarettes in Wal-Mart stores and Sam’s Clubs. In July of this year, Wal-Mart raised the minimum age for purchasing tobacco products, including all e-cigarettes, to 21 years old, and has indicated that it is discontinuing the sale of fruit-flavored and dessert-flavored e-cigarettes. E-cigarettes are mainly sold through e-cigarette specialty stores, and there are approximately 115,000 specialty stores in the United States. The e-cigarette business only occupies a small part of Wal-Mart, so it has little impact on Wal-Mart. However, Wal-Mart Store + Sam’s Clubs has more than 5,000 stores in the United States. Wal-Mart鈥檚 suspension of sales will reduce the chance of direct contact between e-cigarettes and consumers. It is also difficult to find a replacement for this huge sales channel. 2.5. The state of Massachusetts suspends the sale of all vaping products related to e-cigarettes (2019/9/24) The state of Massachusetts has decided to suspend the sale of all vaping products related to e-cigarettes for 4 months (as of January 25 next year) No.), 1) This emergency suspension is mainly to cooperate with expert doctors to find out the cause of the disease; 2) Currently, the FDA laboratory is testing more than 150 suspicious product samples, but the cause of the patient鈥檚 lung disease has not yet been determined. 3. E-cigarette manufacturing company statement 3.1. British American Tobacco 3.1.1. Response to the US FDA's announcement of atomized products (2019/9/9) British American Tobacco Research Director Dr David O & rsquo; Reilly said that company toxicologists misted the company Each single ingredient in the chemical product has been carefully checked to see if they are suitable for atomization. And the company has never added e-liquid containing THC and vitamin E acetate to atomized products. The tragic incident was because these e-liquids were not purchased from well-known manufacturers and contained ingredients not used by the manufacturers (including THC and vitamin E acetate). The company supports the FDA鈥檚 view that users of vaping products should always buy smoking sets and e-liquids from reputable manufacturers, and should avoid modifying or adding substances to the products they buy, and should use these according to the manufacturer鈥檚 intentions. product. 3.1.2. Statement on supporting strong product quality standards, measures to prevent the use of young people in the United States, and preparing to apply for PMTA at any time (2019/9/12) 1) The company expressed its concern about the marketing of certain flavored products like the FDA Attract the attention of young people. At the same time, it is difficult to overestimate the role of flavored products in helping adult consumers switch from combustible products to alternative tobacco and nicotine products. The company has established corresponding procedures to ensure that its products are only sold to adult smokers and users of vaping products. 2) For the four VUSE products planned to be launched in the United States, the company is confident that it can submit Pre-Market Tobacco Applications (PMTA) before the deadline announced by the FDA (May 2020). If approved, our Reynolds Tobacco will be able to continue to sell its VUSE brand atomized products within the new regulatory framework in the United States. 3.1.3. Statement on the need for strong and effective atomization product supervision (2019/9/20) The company stated that no products developed or produced by British American Tobacco were involved in recent e-cigarette lung disease cases, and it supports investigations made by relevant agencies , And hopes to introduce strong and effective regulations to ensure high product standards, especially in testing and reporting the ingredients used in the e-liquid of atomized products. At the same time, the government also needs to ensure that relevant agencies force manufacturers to comply with these regulations, only through effective With supervision and law enforcement, consumers can maintain confidence in the harm reduction effects of atomized products compared to traditional tobacco. 3.2. Japan Tobacco International 3.2.1. Regarding the response to lung disease cases in the United States (2019/9/13) So far, the US Department of Health is investigating 450 cases of lung disease that may be related to the use of e-cigarettes. Currently, there is little information about the products involved and the underlying causes. We are not aware of any Logic products associated with these cases and are under investigation. We have learned from media reports that many patients have admitted to using e-cigarettes containing THC e-liquid. In addition, it is reported that vitamin E acetate, a chemical substance related to hemp oil, was found in many relevant samples analyzed by the authorities. In our Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. At JTI, we will know exactly the ingredients of Logic: all Logic e-liquids undergo a strict product management plan, including toxicological evaluation and quality control of all ingredients used. Logic e-liquid can only be sold after passing a comprehensive inspection. Nebulizer users should not use the e-liquid produced by manufacturers that have not undergone strict safety and quality inspections. After design and testing, smoking sets and cartridges that can be used together should always be paired with each other. 4. Market share and sales decline of marijuana-related vaping products Since the first death case related to e-cigarettes was reported on August 23, the sales proportion of marijuana-related vaping products in the recreational marijuana product market decline. Comparing the sales data on August 19 and September 16, California: 32.8% decreased to 29%; Colorado: 19.2% decreased to 14.5%; Nevada: 22.3% decreased to 19.2%; Washington: 17.8% decreased to 14.6 %. (Report time: 2019/9/12) Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, and September 9 Total sales from Japan to 15th fell to US$689,924, a decrease of 25%. (Reporting time: 2019/9/19)As of September 18, 2019, the United States has reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaporized products, and 7 people have died. This has made the United States attach great importance to e-cigarettes and vaporized products. Congressional hearings, down to the states and e-cigarette manufacturers, are closely following relevant developments and successively issued attitudes and statements. In particular, flavored e-cigarettes have attracted attention due to their strong appeal to young people. The FDA in September It was announced on the 12th that it would issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention and even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . But from the market point of view, the reaction was strong. On the one hand, the health of e-cigarettes is being questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. The following is the important content of recent reports: On September 24, the United States held a congressional hearing on the issue of e-cigarettes. The preliminary results of the CDC investigation showed that about 80% of patients reported using tetrahydrocannabinol or THC e-liquid, and about 60% said they used e-cigarettes containing tetrahydrocannabinol or THC. Nicotine e-liquid, and about 10-20% of people claim that they only use nicotine-containing products. Although the source of the disease has not been determined, it can be clearly related to chemical exposure. The state of Illinois initially envisages banning the sale of flavored nicotine products. The American Lung Association report stated that 27.5% of young people now use e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The main reason for teenagers to use these products is the attraction of candies and fruit flavors. The American Lung Association will urge the FDA and Congress to ban all flavored tobacco products as soon as possible, including flavored cigars and menthol cigarettes. U.S. states have banned or are preparing to ban the sale of e-cigarettes. On June 25, the San Francisco City Supervisory Committee unanimously passed a ban on the sale of e-cigarettes. On September 15, New York State stated that it would ban the sale of flavored e-cigarettes, but retain the mint flavor. On September 18, Michigan announced a ban on the sale of flavored nicotine e-cigarettes, and the ban took effect immediately. On September 20, Wal-Mart announced that it would stop selling e-cigarettes after it sold out. On September 24, Massachusetts suspended the sale of all vaping products related to e-cigarettes for 4 months. The e-cigarette manufacturing company issued a statement that British Tobacco: 1) never added e-liquid containing THC and vitamin E acetate to its atomized products; 2) for 4 VUSE products planned to be launched in the United States, the company is confident in Submit PMTA before May 2020. Japan Tobacco International: In the Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. The market share and sales decline of cannabis-related atomized products compare the sales ratio of cannabis-related atomized products in the recreational cannabis product market on August 19 and September 16, and the ratio is showing a downward trend. Among them, California: decreased from 32.8% to 29%; Colorado: decreased from 19.2% to 14.5%; Nevada: decreased from 22.3% to 19.2%; Washington: decreased from 17.8% to 14.6%. Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, while the total sales of September 9-15 decreased to 689,924 U.S. dollars, a decrease of 25%. Risk warning: new tobacco policy changes risk, sales are not as expected; industrial hemp should be strictly distinguished from intermediate cannabis, recreational cannabis/drugs, and resolutely opposed to legalization of recreational cannabis. As of September 18, 2019, the United States has reported 530 confirmed cases Seven people died of lung diseases suspected to be related to the use of e-cigarettes or vaping products, making the United States attach great importance to e-cigarettes and vaping products, from congressional hearings to states and e-cigarette manufacturers. All are paying close attention to relevant developments and issuing attitudes and statements one after another, especially flavored e-cigarettes because of their strong appeal to young people. The FDA announced on September 12 that it will issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention to or even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . However, from the market point of view, the response was strong. On the one hand, the health of e-cigarettes has been questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. In order to give you a clearer understanding of recent reports on e-cigarettes in the United States, we have sorted out important content including relevant statements issued by congressional hearings, FDA, CDC, and states and e-cigarette manufacturers for reference. 1. Statement by relevant US agencies 1.1. Congressional hearing (2019/9/24) 1.1.1. Anne Schuchat, MD's speech (CDC, Chief Deputy Director of the Department of Health and Human Services) August 1, 2019, the first time in Wisconsin The Center for Disease Control and Prevention (CDC) was notified of a series of lung diseases that have appeared in young people since July 2019. As of September 18, 2019, 38 states and 1 region in the United States have reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaping products. There are already 6 states (California, Illinois, Indiana). States, Kansas, Minnesota and Oregon). These tragic deaths have exacerbated the urgency of the CDC and the FDA to jointly investigate the cause and provide states with the necessary resources to solve this emerging public health problem. CDC established a case investigation team in August and activated the Emergency Operations Center on September 16 to enable it to devote more resources to this investigation. 1) Case summary For many reasons, investigating the causes of lung injury related to the use of e-cigarettes or aerosol products is quite challenging. a. The investigation involves many states; b. The diversity of the e-cigarette or atomized product market, the wide variety of products, the wide range of ingredients, and the connection with potentially illegal substances such as marijuana all complicate the investigation. Consumers do not know what their e-cigarettes or atomized products contain, and many products and substances themselves can be modified by consumers. They can be obtained from physical stores, online retailers, on the street, or through social channels. Preliminary results: According to data collected in two states and recently published in the New England Journal of Medicine, most patients (about 80%) report using cigarettes containing tetrahydrocannabinol or THC (the psychoactive compound of cannabis) Oil, and half (about 60%) of people said they use nicotine-containing e-liquid, while about 10-20% said they only use nicotine-containing products. However, no e-cigarette or atomized product, a certain brand or a specific substance has a clear connection with the epidemic. CDC has received complete gender and age data for 373 of the 530 cases. Almost three-quarters of the cases are men. Two-thirds of the cases were between 18 and 34 years old, 16% were under 18 years old, and 17% were over 35 years old. The lung damage observed in this incident does not seem to be caused by infection. The pathological findings and the results of the non-infectious diagnosis indicate that the cause of the disease is related to exposure to chemical substances. Patients first showed signs of illness within a few days to a few weeks after using e-cigarettes or aerosol products, and gradually developed symptoms such as dyspnea, shortness of breath, or chest pain before hospitalization. Some patients developed mild to moderate gastrointestinal diseases. There are other symptoms including fatigue, fever and weight loss. So far, investigators have not found any specific products or compounds related to all cases. 2) Youth e-cigarette use data Preliminary data from the 2019 National Youth Tobacco Survey show that the use of youth e-cigarettes continues to rise. Data show that in 2019, more than a quarter of high school students currently (in the past 30 days) use e-cigarettes, a significant increase compared to 2017. From 2017 to 2018, the number of e-cigarettes used by high school students increased by 77.8%, and more than a quarter of high school students are currently using tobacco products. 3) Hazards associated with cannabis use CDC is committed to monitoring cannabis use, identifying related health effects, and improving the monitoring capabilities of CDC and state/local jurisdictions. In this outbreak, many patients used e-cigarettes or vaporized products containing THC, which indicates the need to understand the health effects of the increasing use of cannabis and the changing market in the United States, as states are working on the legalization of cannabis. For medical or recreational purposes. In 2018, it is estimated that 16% of the population 12 years and older uses marijuana. 4) CDC鈥檚 recommendations to manufacturers, states, and the public. CDC recommends that the public who are worried that e-cigarettes or vaping products may cause lung diseases should consider avoiding e-cigarettes or vaping products. Teenagers, pregnant women, or non-smokers do not Electronic cigarettes should be used. Anyone who uses electronic cigarettes or vaping products should not buy these products on the street, and should not modify or add ingredients on their own. 1.1.2. NgoziO. Ezike's speech (Director of the Illinois Department of Public Health) 69 people in Illinois suffered from serious respiratory diseases after using e-cigarettes or aerosol products, and 1 person died. The patients were between 15-42 years old, with a median of 22 years old, and most of them were men. Although the cause of the illness has not yet been determined, it is certain that smoking e-cigarettes is not a healthy behavior and is not conducive to the health of young people. Illinois began investigating after learning that some residents had respiratory diseases related to e-cigarettes on July 31, 2019, and issued an alert to the Department of Health on August 2 to conduct a cooperative investigation with the CDC and start investigating the effects of e-cigarettes. The prevalence and habit of smoking e-cigarettes among adolescents, and measures such as youth education, case studies, and related legal studies. Nevertheless, on the one hand, the number of patients per day is still increasing. More than 90% are admitted to the hospital for treatment, 72% of which are sent to the intensive care unit, and nearly 30% require medical devices to help breathe. On the other hand, the use of flavored e-cigarettes is increasing. The survey shows that 1) 68% of young people used flavored e-cigarettes in 2019, accounting for 61% in 2017; 2) The 2017 survey found that 63% of young people did not understand The JUUL products they use contain nicotine; 3) From 2011 to 2015, the number of e-cigarettes used by middle school students increased by 900%. 4) A 2018 study found that more than 3.6 million young people use e-cigarettes. The focus group found that the number of young people using e-cigarettes is increasing and there is a trend of addiction. From 2008 to 2018, the number of high school students in Illinois who smoked in the total tobacco market fell from 21% to 5%, but in 2016-2018 , The proportion of e-cigarette usage among high school students rose from 18.4% to 26.7%. The current preliminary idea is to ban flavored nicotine products and study the long- and short-term effects of atomized products on health. The governor of Illinois supported the enactment of legal provisions in the legislative session in October to ban the sale of flavored vaping products specifically targeted at young people. 1.1.3. Albert A. Rizzo's speech (Chief Medical Officer of the American Lung Association) There are two different e-cigarette crises in our country. One is the prevalence and increasing popularity of young people using e-cigarettes; the other is the recent outbreak of lung diseases caused by vaping products in adults and adolescents. According to the 2019 National Tobacco Youth Survey, 27.5% of young people are now using e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The survey asked students whether they had smoked for at least 20 days in the past 30 days? 12% of Grade 12 students, 7% of Grade 10 students, and 2% of Grade 8 students said they do this often. A 2018 CDC study showed that the main reason why teenagers use these products is that the taste of sweets and fruits attracts them, while their friends and family are using them, and they think that e-cigarettes are less harmful. The American Lung Association will urge the FDA and Congress to take action as soon as possible to ban the sale of all flavored tobacco products, including flavored cigars and menthol cigarettes. Regarding the health hazards of e-cigarettes, there are many misleadings, and some of the reasons lead to a high proportion of young people using e-cigarettes. In January 2018, the National Academies of Science, Engineering and Medicine released a research report that reviewed more than 800 different studies. The report clearly pointed out that the use of e-cigarettes is harmful to health, will increase the chance of children and young people starting to use e-cigarettes, and expose others to dangerous second-hand e-cigarette emissions. They concluded that there is "a large amount of evidence" that if young people use electronic cigarettes, the possibility of using traditional cigarettes will increase. A study in Pediatrics magazine also found that young people who use e-cigarettes are four times more likely to try traditional cigarettes than young people who do not use e-cigarettes. According to a study published in the Journal of the American Medical Association in 2015, 81% of young people have ever used tobacco products made from flavored products. Fruit, mint and menthol are the most popular flavors among middle school students who use e-cigarettes. Among them, 65.9% of children use fruit-flavored e-cigarettes, and 63.9% of children use mint or menthol e-cigarettes. The taste in e-cigarettes is produced by a combination of chemicals, which carry a serious risk of lung damage. A 2015 study at Harvard University tested 51 different flavors of e-cigarettes, including marshmallow, bubble gum, and cupcakes, and found that 47 of them were related to at least one chemical substance related to respiratory diseases. E-cigarettes are not smoking cessation products. Smokers who switch to e-cigarettes may also be using traditional cigarettes. "Annals of Internal MedicinA study on "e" found that the probability of wanting to use e-cigarettes to help quit smoking is lower. Only 10.1% of smokers who used e-cigarettes for six months quit smoking, while 26.6% of smokers who did not use e-cigarettes quit smoking . 1.2. FDA intends to ban the sale of flavored e-cigarettes (2019/9/12) On September 12, the FDA stated that in order to reduce the use of e-cigarettes among young people, it will issue a policy to ban the sale of flavored e-cigarettes (including mint flavored e-cigarettes) within a few weeks. ). 1.3. CDC released its views on the causes of death from e-cigarettes (2019/9/19) The latest report from the Centers for Disease Control and Prevention (CDC) of the United States stated that the number of people suffering from lung diseases due to e-cigarettes has soared to 530 in 38 states, as of At present, 7 people have died, causing the Governor of Indiana to pay attention to the ban on flavored e-cigarettes, and corresponding measures may be taken. The CDC is currently unable to determine the specific cause, but they believe that it is caused by chemical exposure. Most of the cases are related to illegal e-cigarette liquid, which contains THC ingredients. These products are from the black market and are not formal e-cigarette stores. But even so, e-cigarette retailers Will also be greatly affected. The American Lung Research Association believes that the country should take action as soon as possible, hoping to remove the flavored e-cigarettes before further research. 2. U.S. states have banned or are preparing to ban the sale of e-cigarettes 2.1. San Francisco became the first city to ban the sale of e-cigarettes (2019/6/25) On June 25, the San Francisco City Supervisory Committee unanimously approved a total ban on the sale of e-cigarettes The regulations stipulate that e-cigarettes will be banned unless they have been reviewed by the FDA鈥檚 PMTA. The regulations are planned to be fully implemented in six months. 2.2. New York State will ban the sale of flavored e-cigarettes, but retain the mint flavor (2019/9/15) Como signed an executive order on September 12 requiring e-cigarettes to be included in New York鈥檚 anti-smoking activities. According to the Cuomo office, 1) Dr. Howard Zucker, commissioner of the State Department of Health, will recommend this week to the State Public Health and Health Planning Commission to issue emergency regulations, which will take effect within two weeks at the earliest. 2) Como has instructed the New York police and the Department of Health to strengthen law enforcement, and retailers who sell e-cigarettes to minors may be subject to criminal penalties; in addition, Como plans to promote legislation to prohibit deceptive marketing of e-cigarettes to teenagers and children. However, the decree does not affect tobacco-based and menthol-flavored e-cigarettes. Trump said last week that an investigation by the Department of Health found hundreds of respiratory disease cases among consumers who use e-cigarettes, so the federal government plans to ban the sale of thousands of flavors in e-cigarettes. Although many cases involve smoking marijuana, problems with the devices, ingredients or additives have not yet been discovered. 2.3. Michigan bans the sale of flavored e-cigarettes (2019/9/18) On September 18, Michigan announced the ban on the sale of flavored nicotine e-cigarettes. The ban will take effect immediately, but there is still a 14-day buffer period for merchants, and the ban will be It lasts for 6 months, but the governor has the right to extend the period. 2.4. Wal-Mart stops selling e-cigarettes (2019/9/20) On September 20, Wal-Mart announced that it would stop selling e-cigarettes. After the current inventory is sold out, it will stop selling e-cigarettes in Wal-Mart stores and Sam’s Clubs. In July of this year, Wal-Mart raised the minimum age for purchasing tobacco products, including all e-cigarettes, to 21 years old, and has indicated that it is discontinuing the sale of fruit-flavored and dessert-flavored e-cigarettes. E-cigarettes are mainly sold through e-cigarette specialty stores, and there are approximately 115,000 specialty stores in the United States. The e-cigarette business only occupies a small part of Wal-Mart, so it has little impact on Wal-Mart. However, Wal-Mart Store + Sam’s Clubs has more than 5,000 stores in the United States. Wal-Mart鈥檚 suspension of sales will reduce the chance of direct contact between e-cigarettes and consumers. It is also difficult to find a replacement for this huge sales channel. 2.5. The state of Massachusetts suspends the sale of all vaping products related to e-cigarettes (2019/9/24) The state of Massachusetts has decided to suspend the sale of all vaping products related to e-cigarettes for 4 months (as of January 25 next year) No.), 1) This emergency suspension is mainly to cooperate with expert doctors to find out the cause of the disease; 2) Currently, the FDA laboratory is testing more than 150 suspicious product samples, but the cause of the patient鈥檚 lung disease has not yet been determined. 3. E-cigarette manufacturing company statement 3.1. British American Tobacco 3.1.1. Response to the US FDA's announcement of atomized products (2019/9/9) British American Tobacco Research Director Dr David O & rsquo; Reilly said that company toxicologists misted the company Each single ingredient in the chemical product has been carefully checked to see if they are suitable for atomization. And the company has never added e-liquid containing THC and vitamin E acetate to atomized products. The tragic incident was because these e-liquids were not purchased from well-known manufacturers and contained ingredients not used by the manufacturers (including THC and vitamin E acetate). The company supports the FDA鈥檚 view that users of vaping products should always buy smoking sets and e-liquids from reputable manufacturers, and should avoid modifying or adding substances to the products they buy, and should use these according to the manufacturer鈥檚 intentions. product. 3.1.2. Statement on supporting strong product quality standards, measures to prevent the use of young people in the United States, and preparing to apply for PMTA at any time (2019/9/12) 1) The company expressed its concern about the marketing of certain flavored products like the FDA Attract the attention of young people. At the same time, it is difficult to overestimate the role of flavored products in helping adult consumers switch from combustible products to alternative tobacco and nicotine products. The company has established corresponding procedures to ensure that its products are only sold to adult smokers and users of vaping products. 2) For the four VUSE products planned to be launched in the United States, the company is confident that it can submit Pre-Market Tobacco Applications (PMTA) before the deadline announced by the FDA (May 2020). If approved, our Reynolds Tobacco will be able to continue to sell its VUSE brand atomized products within the new regulatory framework in the United States. 3.1.3. Statement on the need for strong and effective atomization product supervision (2019/9/20) The company stated that no products developed or produced by British American Tobacco were involved in recent e-cigarette lung disease cases, and it supports investigations made by relevant agencies , And hopes to introduce strong and effective regulations to ensure high product standards, especially in testing and reporting the ingredients used in the e-liquid of atomized products. At the same time, the government also needs to ensure that relevant agencies force manufacturers to comply with these regulations, only through effective With supervision and law enforcement, consumers can maintain confidence in the harm reduction effects of atomized products compared to traditional tobacco. 3.2. Japan Tobacco International 3.2.1. Regarding the response to lung disease cases in the United States (2019/9/13) So far, the US Department of Health is investigating 450 cases of lung disease that may be related to the use of e-cigarettes. Currently, there is little information about the products involved and the underlying causes. We are not aware of any Logic products associated with these cases and are under investigation. We have learned from media reports that many patients have admitted to using e-cigarettes containing THC e-liquid. In addition, it is reported that vitamin E acetate, a chemical substance related to hemp oil, was found in many relevant samples analyzed by the authorities. In our Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. At JTI, we will know exactly the ingredients of Logic: all Logic e-liquids undergo a strict product management plan, including toxicological evaluation and quality control of all ingredients used. Logic e-liquid can only be sold after passing a comprehensive inspection. Nebulizer users should not use the e-liquid produced by manufacturers that have not undergone strict safety and quality inspections. After design and testing, smoking sets and cartridges that can be used together should always be paired with each other. 4. Market share and sales decline of marijuana-related vaping products Since the first death case related to e-cigarettes was reported on August 23, the sales proportion of marijuana-related vaping products in the recreational marijuana product market decline. Comparing the sales data on August 19 and September 16, California: 32.8% decreased to 29%; Colorado: 19.2% decreased to 14.5%; Nevada: 22.3% decreased to 19.2%; Washington: 17.8% decreased to 14.6 %. (Report time: 2019/9/12) Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, and September 9 Total sales from Japan to 15th fell to US$689,924, a decrease of 25%. (Reporting time: 2019/9/19)As of September 18, 2019, the United States has reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaporized products, and 7 people have died. This has made the United States attach great importance to e-cigarettes and vaporized products. Congressional hearings, down to the states and e-cigarette manufacturers, are closely following relevant developments and successively issued attitudes and statements. In particular, flavored e-cigarettes have attracted attention due to their strong appeal to young people. The FDA in September It was announced on the 12th that it would issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention and even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . But from the market point of view, the reaction was strong. On the one hand, the health of e-cigarettes is being questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. The following is the important content of recent reports: On September 24, the United States held a congressional hearing on the issue of e-cigarettes. The preliminary results of the CDC investigation showed that about 80% of patients reported using tetrahydrocannabinol or THC e-liquid, and about 60% said they used e-cigarettes containing tetrahydrocannabinol or THC. Nicotine e-liquid, and about 10-20% of people claim that they only use nicotine-containing products. Although the source of the disease has not been determined, it can be clearly related to chemical exposure. The state of Illinois initially envisages banning the sale of flavored nicotine products. The American Lung Association report stated that 27.5% of young people now use e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The main reason for teenagers to use these products is the attraction of candies and fruit flavors. The American Lung Association will urge the FDA and Congress to ban all flavored tobacco products as soon as possible, including flavored cigars and menthol cigarettes. U.S. states have banned or are preparing to ban the sale of e-cigarettes. On June 25, the San Francisco City Supervisory Committee unanimously passed a ban on the sale of e-cigarettes. On September 15, New York State stated that it would ban the sale of flavored e-cigarettes, but retain the mint flavor. On September 18, Michigan announced a ban on the sale of flavored nicotine e-cigarettes, and the ban took effect immediately. On September 20, Wal-Mart announced that it would stop selling e-cigarettes after it sold out. On September 24, Massachusetts suspended the sale of all vaping products related to e-cigarettes for 4 months. The e-cigarette manufacturing company issued a statement that British Tobacco: 1) never added e-liquid containing THC and vitamin E acetate to its atomized products; 2) for 4 VUSE products planned to be launched in the United States, the company is confident in Submit PMTA before May 2020. Japan Tobacco International: In the Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. The market share and sales decline of cannabis-related atomized products compare the sales ratio of cannabis-related atomized products in the recreational cannabis product market on August 19 and September 16, and the ratio is showing a downward trend. Among them, California: decreased from 32.8% to 29%; Colorado: decreased from 19.2% to 14.5%; Nevada: decreased from 22.3% to 19.2%; Washington: decreased from 17.8% to 14.6%. Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, while the total sales of September 9-15 decreased to 689,924 U.S. dollars, a decrease of 25%. Risk warning: new tobacco policy changes risk, sales are not as expected; industrial hemp should be strictly distinguished from intermediate cannabis, recreational cannabis/drugs, and resolutely opposed to legalization of recreational cannabis. As of September 18, 2019, the United States has reported 530 confirmed cases Seven people died of lung diseases suspected to be related to the use of e-cigarettes or vaping products, making the United States attach great importance to e-cigarettes and vaping products, from congressional hearings to states and e-cigarette manufacturers. All are paying close attention to relevant developments and issuing attitudes and statements one after another, especially flavored e-cigarettes because of their strong appeal to young people. The FDA announced on September 12 that it will issue a policy to ban the sale of flavored e-cigarettes within a few weeks. On September 18, Michigan has announced the ban on the sale of flavored e-cigarettes, and other states are also paying attention to or even preparing for the ban. So far, officials still cannot explain the relationship between e-cigarettes and atomized products and lung diseases. The reasons are still under investigation. Only the CDC claims that most of the cases are related to illegal cigarette liquids (including THC), so it is speculated that the source of the disease is related to THC. . However, from the market point of view, the response was strong. On the one hand, the health of e-cigarettes has been questioned again, consumers have a certain panic, and the sales of related cannabis atomized products have declined; on the other hand, due to e-cigarettes There is a certain correlation between atomized products and cannabis and THC. The market is worried that the impact of e-cigarette-related policies in the future will continue to the cannabis industry, thereby affecting the development of the cannabis industry. We believe that only after the FDA's final policy is issued and the relationship between e-cigarettes and lung diseases is diagnosed, the e-cigarette market can return to a stable state. In order to give you a clearer understanding of recent reports on e-cigarettes in the United States, we have sorted out important content including relevant statements issued by congressional hearings, FDA, CDC, and states and e-cigarette manufacturers for reference. 1. Statement by relevant US agencies 1.1. Congressional hearing (2019/9/24) 1.1.1. Anne Schuchat, MD's speech (CDC, Chief Deputy Director of the Department of Health and Human Services) August 1, 2019, the first time in Wisconsin The Center for Disease Control and Prevention (CDC) was notified of a series of lung diseases that have appeared in young people since July 2019. As of September 18, 2019, 38 states and 1 region in the United States have reported 530 confirmed and suspected lung diseases related to the use of e-cigarettes or vaping products. There are already 6 states (California, Illinois, Indiana). States, Kansas, Minnesota and Oregon). These tragic deaths have exacerbated the urgency of the CDC and the FDA to jointly investigate the cause and provide states with the necessary resources to solve this emerging public health problem. CDC established a case investigation team in August and activated the Emergency Operations Center on September 16 to enable it to devote more resources to this investigation. 1) Case summary For many reasons, investigating the causes of lung injury related to the use of e-cigarettes or aerosol products is quite challenging. a. The investigation involves many states; b. The diversity of the e-cigarette or atomized product market, the wide variety of products, the wide range of ingredients, and the connection with potentially illegal substances such as marijuana all complicate the investigation. Consumers do not know what their e-cigarettes or atomized products contain, and many products and substances themselves can be modified by consumers. They can be obtained from physical stores, online retailers, on the street, or through social channels. Preliminary results: According to data collected in two states and recently published in the New England Journal of Medicine, most patients (about 80%) report using cigarettes containing tetrahydrocannabinol or THC (the psychoactive compound of cannabis) Oil, and half (about 60%) of people said they use nicotine-containing e-liquid, while about 10-20% said they only use nicotine-containing products. However, no e-cigarette or atomized product, a certain brand or a specific substance has a clear connection with the epidemic. CDC has received complete gender and age data for 373 of the 530 cases. Almost three-quarters of the cases are men. Two-thirds of the cases were between 18 and 34 years old, 16% were under 18 years old, and 17% were over 35 years old. The lung damage observed in this incident does not seem to be caused by infection. The pathological findings and the results of the non-infectious diagnosis indicate that the cause of the disease is related to exposure to chemical substances. Patients first showed signs of illness within a few days to a few weeks after using e-cigarettes or aerosol products, and gradually developed symptoms such as dyspnea, shortness of breath, or chest pain before hospitalization. Some patients developed mild to moderate gastrointestinal diseases. There are other symptoms including fatigue, fever and weight loss. So far, investigators have not found any specific products or compounds related to all cases. 2) Youth e-cigarette use data Preliminary data from the 2019 National Youth Tobacco Survey show that the use of youth e-cigarettes continues to rise. Data show that in 2019, more than a quarter of high school students currently (in the past 30 days) use e-cigarettes, a significant increase compared to 2017. From 2017 to 2018, the number of e-cigarettes used by high school students increased by 77.8%, and more than a quarter of high school students are currently using tobacco products. 3) Hazards associated with cannabis use CDC is committed to monitoring cannabis use, identifying related health effects, and improving the monitoring capabilities of CDC and state/local jurisdictions. In this outbreak, many patients used e-cigarettes or vaporized products containing THC, which indicates the need to understand the health effects of the increasing use of cannabis and the changing market in the United States, as states are working on the legalization of cannabis. For medical or recreational purposes. In 2018, it is estimated that 16% of the population 12 years and older uses marijuana. 4) CDC鈥檚 recommendations to manufacturers, states, and the public. CDC recommends that the public who are worried that e-cigarettes or vaping products may cause lung diseases should consider avoiding e-cigarettes or vaping products. Teenagers, pregnant women, or non-smokers do not Electronic cigarettes should be used. Anyone who uses electronic cigarettes or vaping products should not buy these products on the street, and should not modify or add ingredients on their own. 1.1.2. NgoziO. Ezike's speech (Director of the Illinois Department of Public Health) 69 people in Illinois suffered from serious respiratory diseases after using e-cigarettes or aerosol products, and 1 person died. The patients were between 15-42 years old, with a median of 22 years old, and most of them were men. Although the cause of the illness has not yet been determined, it is certain that smoking e-cigarettes is not a healthy behavior and is not conducive to the health of young people. Illinois began investigating after learning that some residents had respiratory diseases related to e-cigarettes on July 31, 2019, and issued an alert to the Department of Health on August 2 to conduct a cooperative investigation with the CDC and start investigating the effects of e-cigarettes. The prevalence and habit of smoking e-cigarettes among adolescents, and measures such as youth education, case studies, and related legal studies. Nevertheless, on the one hand, the number of patients per day is still increasing. More than 90% are admitted to the hospital for treatment, 72% of which are sent to the intensive care unit, and nearly 30% require medical devices to help breathe. On the other hand, the use of flavored e-cigarettes is increasing. The survey shows that 1) 68% of young people used flavored e-cigarettes in 2019, accounting for 61% in 2017; 2) The 2017 survey found that 63% of young people did not understand The JUUL products they use contain nicotine; 3) From 2011 to 2015, the number of e-cigarettes used by middle school students increased by 900%. 4) A 2018 study found that more than 3.6 million young people use e-cigarettes. The focus group found that the number of young people using e-cigarettes is increasing and there is a trend of addiction. From 2008 to 2018, the number of high school students in Illinois who smoked in the total tobacco market fell from 21% to 5%, but in 2016-2018 , The proportion of e-cigarette usage among high school students rose from 18.4% to 26.7%. The current preliminary idea is to ban flavored nicotine products and study the long- and short-term effects of atomized products on health. The governor of Illinois supported the enactment of legal provisions in the legislative session in October to ban the sale of flavored vaping products specifically targeted at young people. 1.1.3. Albert A. Rizzo's speech (Chief Medical Officer of the American Lung Association) There are two different e-cigarette crises in our country. One is the prevalence and increasing popularity of young people using e-cigarettes; the other is the recent outbreak of lung diseases caused by vaping products in adults and adolescents. According to the 2019 National Tobacco Youth Survey, 27.5% of young people are now using e-cigarettes, up from 20.8% in 2018, an increase of 32% over 2018, and an increase of 135% over 2017. The survey asked students whether they had smoked for at least 20 days in the past 30 days? 12% of Grade 12 students, 7% of Grade 10 students, and 2% of Grade 8 students said they do this often. A 2018 CDC study showed that the main reason why teenagers use these products is that the taste of sweets and fruits attracts them, while their friends and family are using them, and they think that e-cigarettes are less harmful. The American Lung Association will urge the FDA and Congress to take action as soon as possible to ban the sale of all flavored tobacco products, including flavored cigars and menthol cigarettes. Regarding the health hazards of e-cigarettes, there are many misleadings, and some of the reasons lead to a high proportion of young people using e-cigarettes. In January 2018, the National Academies of Science, Engineering and Medicine released a research report that reviewed more than 800 different studies. The report clearly pointed out that the use of e-cigarettes is harmful to health, will increase the chance of children and young people starting to use e-cigarettes, and expose others to dangerous second-hand e-cigarette emissions. They concluded that there is "a large amount of evidence" that if young people use electronic cigarettes, the possibility of using traditional cigarettes will increase. A study in Pediatrics magazine also found that young people who use e-cigarettes are four times more likely to try traditional cigarettes than young people who do not use e-cigarettes. According to a study published in the Journal of the American Medical Association in 2015, 81% of young people have ever used tobacco products made from flavored products. Fruit, mint and menthol are the most popular flavors among middle school students who use e-cigarettes. Among them, 65.9% of children use fruit-flavored e-cigarettes, and 63.9% of children use mint or menthol e-cigarettes. The taste in e-cigarettes is produced by a combination of chemicals, which carry a serious risk of lung damage. A 2015 study at Harvard University tested 51 different flavors of e-cigarettes, including marshmallow, bubble gum, and cupcakes, and found that 47 of them were related to at least one chemical substance related to respiratory diseases. E-cigarettes are not smoking cessation products. Smokers who switch to e-cigarettes may also be using traditional cigarettes. "Annals of Internal MedicinA study on "e" found that the probability of wanting to use e-cigarettes to help quit smoking is lower. Only 10.1% of smokers who used e-cigarettes for six months quit smoking, while 26.6% of smokers who did not use e-cigarettes quit smoking . 1.2. FDA intends to ban the sale of flavored e-cigarettes (2019/9/12) On September 12, the FDA stated that in order to reduce the use of e-cigarettes among young people, it will issue a policy to ban the sale of flavored e-cigarettes (including mint flavored e-cigarettes) within a few weeks. ). 1.3. CDC released its views on the causes of death from e-cigarettes (2019/9/19) The latest report from the Centers for Disease Control and Prevention (CDC) of the United States stated that the number of people suffering from lung diseases due to e-cigarettes has soared to 530 in 38 states, as of At present, 7 people have died, causing the Governor of Indiana to pay attention to the ban on flavored e-cigarettes, and corresponding measures may be taken. The CDC is currently unable to determine the specific cause, but they believe that it is caused by chemical exposure. Most of the cases are related to illegal e-cigarette liquid, which contains THC ingredients. These products are from the black market and are not formal e-cigarette stores. But even so, e-cigarette retailers Will also be greatly affected. The American Lung Research Association believes that the country should take action as soon as possible, hoping to remove the flavored e-cigarettes before further research. 2. U.S. states have banned or are preparing to ban the sale of e-cigarettes 2.1. San Francisco became the first city to ban the sale of e-cigarettes (2019/6/25) On June 25, the San Francisco City Supervisory Committee unanimously approved a total ban on the sale of e-cigarettes The regulations stipulate that e-cigarettes will be banned unless they have been reviewed by the FDA鈥檚 PMTA. The regulations are planned to be fully implemented in six months. 2.2. New York State will ban the sale of flavored e-cigarettes, but retain the mint flavor (2019/9/15) Como signed an executive order on September 12 requiring e-cigarettes to be included in New York鈥檚 anti-smoking activities. According to the Cuomo office, 1) Dr. Howard Zucker, commissioner of the State Department of Health, will recommend this week to the State Public Health and Health Planning Commission to issue emergency regulations, which will take effect within two weeks at the earliest. 2) Como has instructed the New York police and the Department of Health to strengthen law enforcement, and retailers who sell e-cigarettes to minors may be subject to criminal penalties; in addition, Como plans to promote legislation to prohibit deceptive marketing of e-cigarettes to teenagers and children. However, the decree does not affect tobacco-based and menthol-flavored e-cigarettes. Trump said last week that an investigation by the Department of Health found hundreds of respiratory disease cases among consumers who use e-cigarettes, so the federal government plans to ban the sale of thousands of flavors in e-cigarettes. Although many cases involve smoking marijuana, problems with the devices, ingredients or additives have not yet been discovered. 2.3. Michigan bans the sale of flavored e-cigarettes (2019/9/18) On September 18, Michigan announced the ban on the sale of flavored nicotine e-cigarettes. The ban will take effect immediately, but there is still a 14-day buffer period for merchants, and the ban will be It lasts for 6 months, but the governor has the right to extend the period. 2.4. Wal-Mart stops selling e-cigarettes (2019/9/20) On September 20, Wal-Mart announced that it would stop selling e-cigarettes. After the current inventory is sold out, it will stop selling e-cigarettes in Wal-Mart stores and Sam’s Clubs. In July of this year, Wal-Mart raised the minimum age for purchasing tobacco products, including all e-cigarettes, to 21 years old, and has indicated that it is discontinuing the sale of fruit-flavored and dessert-flavored e-cigarettes. E-cigarettes are mainly sold through e-cigarette specialty stores, and there are approximately 115,000 specialty stores in the United States. The e-cigarette business only occupies a small part of Wal-Mart, so it has little impact on Wal-Mart. However, Wal-Mart Store + Sam’s Clubs has more than 5,000 stores in the United States. Wal-Mart鈥檚 suspension of sales will reduce the chance of direct contact between e-cigarettes and consumers. It is also difficult to find a replacement for this huge sales channel. 2.5. The state of Massachusetts suspends the sale of all vaping products related to e-cigarettes (2019/9/24) The state of Massachusetts has decided to suspend the sale of all vaping products related to e-cigarettes for 4 months (as of January 25 next year) No.), 1) This emergency suspension is mainly to cooperate with expert doctors to find out the cause of the disease; 2) Currently, the FDA laboratory is testing more than 150 suspicious product samples, but the cause of the patient鈥檚 lung disease has not yet been determined. 3. E-cigarette manufacturing company statement 3.1. British American Tobacco 3.1.1. Response to the US FDA's announcement of atomized products (2019/9/9) British American Tobacco Research Director Dr David O & rsquo; Reilly said that company toxicologists misted the company Each single ingredient in the chemical product has been carefully checked to see if they are suitable for atomization. And the company has never added e-liquid containing THC and vitamin E acetate to atomized products. The tragic incident was because these e-liquids were not purchased from well-known manufacturers and contained ingredients not used by the manufacturers (including THC and vitamin E acetate). The company supports the FDA鈥檚 view that users of vaping products should always buy smoking sets and e-liquids from reputable manufacturers, and should avoid modifying or adding substances to the products they buy, and should use these according to the manufacturer鈥檚 intentions. product. 3.1.2. Statement on supporting strong product quality standards, measures to prevent the use of young people in the United States, and preparing to apply for PMTA at any time (2019/9/12) 1) The company expressed its concern about the marketing of certain flavored products like the FDA Attract the attention of young people. At the same time, it is difficult to overestimate the role of flavored products in helping adult consumers switch from combustible products to alternative tobacco and nicotine products. The company has established corresponding procedures to ensure that its products are only sold to adult smokers and users of vaping products. 2) For the four VUSE products planned to be launched in the United States, the company is confident that it can submit Pre-Market Tobacco Applications (PMTA) before the deadline announced by the FDA (May 2020). If approved, our Reynolds Tobacco will be able to continue to sell its VUSE brand atomized products within the new regulatory framework in the United States. 3.1.3. Statement on the need for strong and effective atomization product supervision (2019/9/20) The company stated that no products developed or produced by British American Tobacco were involved in recent e-cigarette lung disease cases, and it supports investigations made by relevant agencies , And hopes to introduce strong and effective regulations to ensure high product standards, especially in testing and reporting the ingredients used in the e-liquid of atomized products. At the same time, the government also needs to ensure that relevant agencies force manufacturers to comply with these regulations, only through effective With supervision and law enforcement, consumers can maintain confidence in the harm reduction effects of atomized products compared to traditional tobacco. 3.2. Japan Tobacco International 3.2.1. Regarding the response to lung disease cases in the United States (2019/9/13) So far, the US Department of Health is investigating 450 cases of lung disease that may be related to the use of e-cigarettes. Currently, there is little information about the products involved and the underlying causes. We are not aware of any Logic products associated with these cases and are under investigation. We have learned from media reports that many patients have admitted to using e-cigarettes containing THC e-liquid. In addition, it is reported that vitamin E acetate, a chemical substance related to hemp oil, was found in many relevant samples analyzed by the authorities. In our Logic series of nicotine-containing products, we do not provide THC e-liquid or hemp oil. In addition, we confirmed that vitamin E acetate is not used as an ingredient in Logic's e-liquid. At JTI, we will know exactly the ingredients of Logic: all Logic e-liquids undergo a strict product management plan, including toxicological evaluation and quality control of all ingredients used. Logic e-liquid can only be sold after passing a comprehensive inspection. Nebulizer users should not use the e-liquid produced by manufacturers that have not undergone strict safety and quality inspections. After design and testing, smoking sets and cartridges that can be used together should always be paired with each other. 4. Market share and sales decline of marijuana-related vaping products Since the first death case related to e-cigarettes was reported on August 23, the sales proportion of marijuana-related vaping products in the recreational marijuana product market decline. Comparing the sales data on August 19 and September 16, California: 32.8% decreased to 29%; Colorado: 19.2% decreased to 14.5%; Nevada: 22.3% decreased to 19.2%; Washington: 17.8% decreased to 14.6 %. (Report time: 2019/9/12) Among licensed cannabis stores in Massachusetts, the total sales of cannabis-related vaping products during the week of August 11-17 reached the highest value of US$919,776, and September 9 Total sales from Japan to 15th fell to US$689,924, a decrease of 25%. (Reporting time: 2019/9/19)