policies. by promoting e-cigarettes as the healthier option, tobacco companies are working to rebrand themselves. e-cigarettes are marketed as a smoking cessation tool, and their use is increasing particularly among middle and high school students in the us, but among adults as well. despite the high prevalence of use, e-cigarettes have not been thoroughly investigated; the benefits and risks of their use are unknown, including the chemicals being consumed. voluntary consumer and health-care reports cite hospitalization for pneumonia, seizures, disorientation, congestive heart failure, and hypotension as e-cigarette related. however, studies so far show mixed evidence, including no significant relationship regarding smoking cessation and e-cigarettes and potential for cessation, while others suggest e-cigarettes encourage "dual use" in conjunction with smoking tobacco. the usage of e-cigarettes is actively promoted. they are advertised on radio and television, and in print as occurred in the 1950s with tobacco. in 2016, in an analysis in the bmj, researchers stated: the tobacco industry's acquisition of many formerly independent e-cigarette producers and importers is a cause for concern. the continued aggressive marketing of cigarettes, including to children, as well as lobbying and legal challenges to tobacco control measures, make it clear that the global tobacco industry has no serious interest in reducing the harm it causes. the industry is therefore likely to try to exploit e-cigarettes to enhance its core business of selling tobacco. tobacco promotion and advertising is directly associated with tobacco consumption among the general public. tobacco promotion and advertising is an important cause of tobacco use initiation and escalation among youth. television and radio advertising of tobacco have been prohibited in the us since 1971, and the family smoking prevention and tobacco control act of 2009 established, through the us fda center for tobacco products, new advertising and promotions restrictions. these new regulations, however, do not extend the congressional ban on cigarette television advertisements to e-cigarettes or limit promotion tactics and the use of flavored liquids, all of which increase the appeal of these products to youth. e-cigarette companies market their products to children and adolescents by promoting flavors and using a wide variety of media channels – approaches used (with success) by the tobacco industry to market traditional tobacco products to youth. e-cigarette companies, almost all of which are either owned or have an investment stake by major tobacco companies, use promotional tactics including: television advertisements targeted to stations with clear youth appeal; advertisements at the point of sale at retail stores; product web sites and social media; targeted advertisements through search engines and web sites that focus on music, entertainment, and sports; and sponsorships and free samples at youth-oriented events. the use of social media and youth influencers, in particular, seems to be the primary mechanism through which e-cigarette promotion has occurred. for example, while juul appears to have spent little to no money on traditional advertising, it has had one of the most effective social media campaigns which help promote its product across the nation. many of these e-cigarette methods of advertising are illegal for traditional cigarettes, precisely because such tactics promote youth initiation and ongoing tobacco product use. meanwhile, e-cigarette advertising has effectively reached youth. in 2016, 78.2% of middle and high school students – 20.5 million youth – were exposed to e-cigarette advertisements from at least one source. exposure to advertisements increases intention to use e-cigarettes among adolescent non-users, and is associated with current e-cigarette use, even in a dose-dependent fashion, as increasing exposure is associated with increased odds of use. the increased use of and exposure to e-cigarettes among youth, combined with dramatic increases in advertising, have serious potential to undermine successful efforts to deglamorize, restrict, and decrease the use of tobacco products. incorporating and extending tobacco advertising restrictions to include bans on e-cigarette product advertising and promotion in forms that are accessible to children and adolescents would be a crucial, evidence-based measure to decrease youth e-cigarette use. external video promoting the tobacco epidemic – glantz on e-cigs – part 1 (reg watch) & part 2 the social media landscape is being dominated by pro-vaping messages disseminated by the vaping industry and vaping proponents, whereas the uncertainty surrounding e-cigarette regulation expressed within the public health field appears not to be reflected in ongoing social media dialogues. latest generation e-cigarettes are resembling less and less their first generation cig-a-like counterparts and are being promoted not only as a smoking cessation device and safer alternative to smoking but also as a recreational activity whereby the user can create their own unique vaping experience with the use of flavors, device modification, and vape tricks. marketing expenditure in contrast to cigarette and smokeless tobacco businesses, e-cigarette businesses are not mandated to provide their marketing and promotional spending to the us federal trade commission, therefore, the total amount they spend is uncertain, as of 2018. e-cigarette businesses have largely expanded their marketing spending. as of 2017, e-cigarette advertisement spending across every media channel is rising every year. as of 2016, the majority of the large tobacco businesses own at least one e-cigarette brand and these products are quickly becoming a substantial part of the total advertising spending. as of 2017, all of the large tobacco businesses are engaging in the marketing of e-cigarettes. some traditional transnational tobacco businesses are vigorously competing against the independent e-cigarette businesses for market share. a 2017 review states that the "increased concentration of the ends market in the hands of the transnational tobacco companies is concerning to the public health community, given the industry's legacy of obfuscating many fundamental truths about their products and misleading the public with false claims, including that low-tar and so-called "light" cigarettes would reduce the harms associated with smoking. although industry representatives are claiming interest in ends because of their harm-reduction potential, many observers believe that profit remains the dominant motivation." between january 1, 2008, and june 30, 2012, 131 different brands advertised their e-cigarette products. the majority were e-cigarette brands and there were a few retailer brands such as vaporium. in 2013, blu accounted for more than 60% of expenses. in 2013, njoy, fin, mistic, and 21st century smoke accounted for the remaining top 5 promotional expenses. six large e-cigarette businesses in the us spent $59.3 million on promoting e-cigarettes in 2013, which was more than double the amount spent in 2012. these businesses employed many techniques previously used to market traditional cigarettes that are prohibited, such as television advertisements and sponsorship of music festivals. these marketing tactics are known to lead youth to start smoking, and some, including television advertisements, have been prohibited for traditional cigarettes for well over a decade. us e-cigarette marketing expenditures increased from $3.6 million in 2010 to $125 million in 2014, which translated into rapid increases in youth e-cigarette use. in just three years leading up to 2015, the amount of money spent on advertising e-cigarettes increased more than 1,200% or 12-fold in the us. in recent years leading up to 2017, there has been an upsurge in e-cigarette marketing spending in the us. in the us and canada, over $2 million is spent yearly on promoting e-cigarettes online, according to a 2015 report. e-lites, vype, skycig, njoy, and gamucci e-cigarette businesses spent a total of approximately £8.4 million on promoting e-cigarettes in the uk in 2013, across various outlets. british american tobacco spent £3.6 million in the uk in marketing its vype product in 2014. in 2014, skycig (rebranded as blu ecigs or simply blu) stated they will invest £20 million in the uk in marketing efforts. between 2015 and 2017, juul spent $2.1 million in marketing efforts. manufacturers noticed the fast rise in consumer interest in e-cigarettes, so they quickly pushed to expand the sale of their products to brick-and-mortar retail stores. sales of cigalikes and related products were first observed in nielsen's store-scanner database in 2007, and between 2009 and 2012, retail sales of e-cigarettes expanded to all major markets in the us. this growth coincided with a surge in marketing expenditures by the e-cigarette companies across all media platforms the available evidence suggests that investments in e-cigarette advertising has been growing since 2012; that a variety of places they are being marketed such as mass media and online; and that promotional tactics differ among manufacturers. marketing expenditures in 2013 were targeted at developed countries, where purchasing of traditional cigarettes may be, at that time, diminishing. non-smoking promoters maintain the tobacco industry is marketing e-cigarettes to teens, as research indicates the developing market for traditional cigarettes will keep on dropping. in 2016, the royal college of physicians released a report, stating "this escalation of marketing expenditure reflects the increased resources available following the wave of investments in e-cigarettes by the tobacco industry, with the latter's engagement in marketing raising distinct concerns." millions of dollars spent on marketing aimed at smokers suggests e-cigarettes are "newer, healthier, cheaper and easier to use in smoke-free situations, all reasons that e-cigarette users claim motivate their use". e-cigarette manufacturers have deployed a significant amount in advertising to depict "vaping" as a publicly respectable and alluring activity. e-cigarette advertising expenditures increased sharply, while safety and long-term health effects are still opaque based on the available scientific evidence, as of 2018. although the e-cigarette marketplace is complicated by the differences in brands that are owned by tobacco businesses versus independent businesses, e-cigarette businesses continue to change and to influence the manufacturing, price, marketing and promotion, and distribution of e-cigarette products and accessories. the e-cigarette market has grown and changed rapidly, with notable increases in total sales of e-cigarette products, types of products, consolidation of companies, marketing expenses, and sales channels. quarterly promotional spending for e-cigarettes, 2010–2014 market ownership traditionally dominated by small start-up companies, the e-cigarette market has experienced rapid growth and transition, and more recently, large manufacturers and transnational tobacco companies have come to dominate the market, as of 2019. major tobacco companies have entered the vaping industry by either acquiring e-cigarette companies and brands or developing their own products. major tobacco companies now involved in the vaping industry include british american tobacco, imperial brands, the altria group, reynolds american, philip morris international, and japan tobacco international. these companies have benefited from large advertising and marketing budgets, which enable promotion across the world wide web. in 2003, hon lik created the modern e-cigarette. in 2004, the device was marketed in china as an alternative to traditional cigarettes. in 2006 it was launched worldwide. in 2012, imperial brands paid him the amount equaling eur55 million to buy the patent. vaping products are now a multibillion-dollar worldwide industry. as traditional cigarette businesses have acquired the largest e-cigarette brands, they currently benefit from a dual market of smokers and e-cigarette users while simultaneously presenting themselves as agents of harm reduction. this raises concerns about the appropriateness of endorsing a product that directly profits the tobacco industry. importantly, profit alone is unlikely to increase their market share, particularly in the highly restrictive regulatory environment in which tobacco businesses operate. in addition, the unequivocal refusal to associate with the tobacco industry which appears, if only for self-serving reasons, to support tobacco harm reduction, could unintentionally damage the credibility of the tobacco control community. regardless of their industry ownership, e-cigarette businesses would nevertheless have a vested interest in maximizing the number of long-term product users. the ethical onus then falls on governments to restrict the influence of industry through appropriate regulations targeting product manufacturing, availability, and use, devised in light of public health interests, a 2016 review stated. in 2014, the world health organization released a statement encouraging government bodies to restrict e-cigarette promotion and sponsorship, including ensuring that any advertisement does not target youth, non-smokers, or people not using nicotine. insufficient regulation might contribute to the expansion of the e-cigarette market, in which tobacco businesses have a substantial stake, potentially renormalizing smoking habits and negating years of intense campaigns against traditional tobacco use. methods and claims tobacco industry marketing tactics there are concerns that ttcs are marketing ends/ennds in order to:a. minimize the threat to tobacco sales by promoting ends as a complement rather than an alternative to tobacco, or controlling technological innovations that would prevent improvements in their efficacy as an aid to cessation;b. promote smoking through ends/ennds advertising, and promotion to adults and children;c. assert potential benefits of ends/ennds –