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9.A. - Page 14 of 31 at least one source. This was a significant increase compared to 2014 and 2015 data. Furthermore, almost 17.7 million (7 in 10) youths were exposed to advertisements for e -cigarettes in retail stores in 2016, while about 2 in 5 had exposure on the Internet or on television, and almost 1 in 4 had exposure through magazines and newspapers. E -cigarette advertising has an association with e -cigarette use among youths. The advertising themes and strategies used are similar to traditional cigarette advertising tactics that have been found to appeal to youths.4 (d) The 2018 Monitoring the Future Survey found that over 60% of 10th grade students said it was easy to get vaping devices and e-liquids.5 The 2018 National Youth Tobacco Survey discovered that almost 15% of middle and high school e -cigarette users (younger than 18) reported that they got the devices from a vape shop in the past month, 8.4% from a gas station or convenience store, and 6.5% from the Internet.6 (e) U.S. Surgeon General Vivek H. Murthy, M.D., M.B.A. stated that "Most e - cigarettes contain nicotine, which can cause addiction and can harm the developing adolescent brain. Compared with older adults, the brain of youth and young adults is more vulnerable to the negative consequences of nicotine exposure. The effects include addiction, priming for use of other addictive substances, reduced impulse control, deficits in attention and cognition, and mood disorders."' (f) A 2018 National Academy of Sciences, Engineering, and Medicine report found moderate evidence that e -cigarette use increases the frequency and intensity of smoking cigarettes in the future.$ According to a report by the Surgeon General, any use of e -cigarettes among young people is not safe, even if the young people do not move on to future cigarette smoking.9 (g) According to the American Heart Association, research has found health risks associated with using electronic smoking devices. One study found that both e -cigarettes and traditional cigarettes are independently 4 Marynak K, Gentzke A, Wang TW, Neff L, King BA. Exposure to Electronic Cigarette Advertising Among Middle and High School Students — United States, 2014-2016. MMWR Morb Mortal Wkly Rep 2018;67:294-299. DOI: http://dx.doi.org/10.15585/mmwr.mm67lOa3 5 University of Michigan, 2018 Monitoring the Future Study, Trends in Availability — Tables 15-17. See http://monitoringthefuture.org/data/I 8data/18drtb115.pdf and http://monitoringthefuture.org/data/18data/I 8drtb116.pdf. 6 FDA, "Modifications to Compliance Policy for Certain Deemed Products: Guidance for Industry, Draft Guidance," March 13, 2019, https://www.fda.gov/media/121384/download 7 US Department of Health and Human Services. E -cigarette use among youth and young adults: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2016. https://e- cigarettes.surgeongeneral.gov/documents/2016 SGR Full Report non-508.pdfpdf icon s Moritz, T. (2019, March 18). Vaping: It's All Smoke and Mirrors. Retrieved from https://www.lung.org/about- us/blog/2019/03/vaping-smoke-and-mirrors.html US Department of Health and Human Services. E -cigarette use among youth and young adults: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2016. https://e- cigarettes.surgeongeneral.gov/documents/2016—SGR—Full—Report non-508.pdfpdf icon 291