The Double-edged Sword of Oppositional Category Positioning: A Study of the U.S. E-cigarette Category,2007–2017

Stage 1: Historical reconstruction

The first step in our data analysis was historical reconstruction (Kahl and Grodal, 2016). We began by creating a temporal overview of important events that took place during the emergence of the e-cigarette category, grouped by broad stakeholder types; see Table A1 in the Online Appendix, https://journals-sagepub-com.web.bisu.edu.cn/doi/suppl/10.1177/0001839220914855. This table functioned as an anchor for our analysis; we frequently referred to and updated it.

Stage 2: Initial puzzling observations

Drawing on Golden-Biddle and Locke’s (2006) advice that central theoretical insights are driven by empirical puzzles, we focused data analysis on a set of initial empirical observations. First, we observed that some stakeholders stated that e-cigarettes were healthier than regular cigarettes, while others declared e-cigarettes to be more dangerous than cigarettes. Second, some stakeholders claimed e-cigarettes were a method for smoking cessation, while others claimed e-cigarettes were a gateway to combustible cigarettes. Lastly, some stakeholders talked mainly about independent e-cigarette producers, while others focused on tobacco companies involved in e-cigarettes.

Stage 3: Open coding

To address these puzzles, we engaged in inductive theory building. Given the large size (1,201 articles) and heterogeneous nature of our sample (nine stakeholder groups spanning 11 years, 2007–2017), we began by coding a subset of documents that were representative across stakeholder type and time. We created this subset by choosing two articles from each stakeholder group per year. After uploading our subsample in Atlas.TI, each author took a turn coding this initial sample, adding and applying codes from the Atlas.TI file. We then compared codes—merging, splitting, relating, and dropping codes along the way. We simultaneously grouped codes into initial categories: “category,”“stigma,”“identity,”“physical design,”“cognitive legitimacy,”“interests,” and “regulatory legitimacy.” After a number of iterations, we arrived at a set of 75 agreed-upon codes, grouped into the seven categories listed above.

Stage 4: Generating propositions

We used this open coding as a springboard to generate initial propositions about patterns observed in the data (Lofland et al., 1995), including that early e-cigarette producers emphasized similarities between e-cigarettes and cigarettes while also highlighting the new category’s distinctiveness and that major tobacco companies’ entry into e-cigarettes drew in new stakeholder groups. See Online Appendix Figure A1 for a summary of initial propositions.

Stage 5: Systematic coding

After generating guiding propositions, we applied our 75 codes to all 1,201 documents. Throughout the coding process, we continually worked on updating our coding scheme and refining our propositions. After each change to our coding scheme, we went back and applied the adjusted scheme to the entire sample. At the end of our coding process, we had 78 codes and had applied these codes to the data 6,702 times for an average of about 5.6 codes per document.

Stage 6: Data triangulation

The next step was to update and refine our propositions by triangulating between the qualitative archival analysis, a quantitative analysis of the data, and the supplementary interviews. In our quantitative analysis, we first tracked the degree to which the e-cigarette category became established over time by measuring the proportion of media articles in our sample that included an explicit definition of what an e-cigarette is (e.g., “The e-cigarette is a battery-powered device that provides inhaled doses of nicotine”). Lack of explicit definition indicates the extent to which e-cigarettes had become readily familiar to and understood by market audiences (Colyvas and Powell, 2006; Hsu and Grodal, 2015). To capture e-cigarette category stigmatization, we tracked codes relating to whether e-cigarettes had a positive evaluation (e.g., “e-cigs as distinct b/c healthier or safer,”“proof of beneficial effects of e-cigarettes”) and codes relating to whether e-cigarettes had a negative evaluation (e.g., “concern about health effects of e-cigarettes,”“e-cigs as gateway or normalizing cigs”).

As another quantitative measure, we tracked patterns in the backgrounds of researchers publishing studies on e-cigarettes over time. Our primary aim was to assess when—and the degree to which—researchers with expertise in combustible cigarette research turned their focus to e-cigarettes. We first collected all articles from PubMed whose abstracts/titles referenced e-cigarettes or one of the related terms. We then examined the extent to which researchers who published studies on e-cigarettes had crossed over from previously researching combustible cigarettes. We determined whether authors had previously published research specific to cigarettes by comparing authors/publication dates with PubMed articles whose abstracts/titles referenced cigarettes or tobacco (without reference to e-cigarettes).

The last part of our efforts to triangulate between our initial findings and additional data sources was to code interviews using the same coding scheme used to analyze the archival data. The interview data provided a slightly different perspective on the stigmatization of e-cigarettes than the archival data because informants would often verbally express thoughts more freely than in written text. Our interview coding confirmed and added nuance to our archival-based assessments.

Stage 7: Identifying phases

During this analysis stage, we identified three key phases in our data. We chose the starting and ending points of these phases when we perceived “continuity in the activities within each period and . . . certain discontinuities at [their] frontiers” (Langley, 1999: 703). Statements in our data consistently pointed to the 2012 entry of major tobacco companies into the e-cigarette category as a watershed moment for the category’s evolution. The transition between the second and third phases was marked by a substantial increase in attention from stakeholders who challenged the e-cigarette category and heightened language about the social threat and danger posed by e-cigarettes.

Stage 8: Reaching saturation on mechanisms

During the process of iterating through the qualitative and the quantitative data, we worked on identifying the mechanisms that drove the stigmatization of the e-cigarette category. As we iterated, we considered the importance of different stakeholder groups in driving each mechanism we had identified. We also considered intertextual references between documents from different stakeholder groups when associating mechanisms with particular groups (Kahl and Grodal, 2016). We eventually reached saturation on the mechanisms and their associated stakeholders; see Online Appendix Figure A1 and Table A2 for details on key mechanisms.

Promoting similarities with the existing category

From a technological design perspective, the e-cigarette bore little resemblance to the combustible cigarette. The e-cigarette is an electronic device, typically consisting of a mouthpiece, battery, heating element, and liquid-solution reservoir (HHS, 2016). The battery powers the heating element, which converts the liquid solution into an aerosol that is inhaled through the mouthpiece. While this technology could be delivered through a wide diversity of product formats, early e-cigarettes—now referred to as “cigalikes”—were designed to mirror cigarettes as closely as possible. As a 2010 e-cigarette press release described:

At first glance the electronic cigarette appears to be a regular cigarette. As the user inhales, a sensor atomizes the contents of the e-cigarette refill cartridge into a smoke-like vapor which causes an LED light on the tip to glow like a burning cigarette. (SS Choice LLC, 2010)

Even the color scheme was chosen to resemble a cigarette: the mouthpiece of e-cigarettes was often colored orange, whereas the rest of the device was white to resemble cigarette paper. By imitating a cigarette’s physical features, entrepreneurs aimed to ensure that users could easily recognize what e-cigarettes were for and how to use them (see Hargadon and Douglas, 2001). This physical resemblance also underscored the e-cigarette’s intention to simulate the experience of smoking a cigarette.

E-cigarette producers also used labeling/discursive strategies that framed the e-cigarette as similar to cigarettes in function, experience, and intended audience. Their strategies included incorporating the term “cigarette” in their labeling, portraying the e-cigarette as replicating the experience provided through cigarettes, and emphasizing that the audience for this new product was existing cigarette smokers.

In early press releases, a variety of terms were used to label what came to be known as e-cigarettes, including “electronic smoking device,”“smoking substitute,” and “smokeless cigarette substitute.” These various terms gave way to a more consistent reference to the label “electronic cigarette” and then “e-cigarette.” The use of the term “cigarette” in the new product’s labels succinctly connoted their intended function and was important in facilitating communication and interest among potential market participants. As an e-cigarette blogger explained, smokers “only want to try something if it looks, feels, and tastes like a cigarette . . . unless the term ‘electronic cigarette’ or ‘e-cigarette’ is used, no one will (a) have a clue what you are talking about, (b) be able to find the products with a web search, or (c) want to switch from smoking” (E-cigarette Politics, 2014).

Accompanying the use of the label “e-cigarette” were descriptive phrases that emphasized e-cigarettes’ similarities in look and experience to cigarettes, such as “fully re-creates the smoking experience complete with smoke and nicotine” (E Cigarettes Choice, 2011) and “mimics traditional tobacco cigarettes in look, feel, and sensation that a smoker gets from a tobacco cigarette” (World of E Cigarettes, 2010). E-cigarette manufacturers frequently emphasized that existing adult smokers constituted their core market, presenting their products as cigarette alternatives for “committed adult smokers looking to avoid the toxins found in combustible cigarettes” (Electronic Cigarette Association, 2009) or who craved cigarettes but were constrained by regulations (i.e., in bars, restaurants, and workplaces). In keeping with this emphasis on existing smokers, producers provided smoking-related metrics to explain how the new product compared with cigarettes. For example, e-cigarette producers translated the amount of vapor a user experiences through an e-cigarette to its equivalent in terms of cigarette cartons through statements such as “approximately 1800 mouthfuls of vapor, nearly the equivalent vapor to the mouthfuls of smoke produced in a carton of conventional cigarettes” (Ruyan America, Inc., 2008).

Highlighting distinctive appeal and goals vis-à-vis the existing category

As e-cigarette producers primarily emphasized the e-cigarette’s similarities to cigarettes, they secondarily described its superior normative status along culturally valenced dimensions such as health and safety. Take, for example, the text directly following the excerpts noted above emphasizing similarities in look and experience between the two types of products (distinctive text italicized for emphasis):

The E-cigarette resembles a traditional tobacco cigarette and fully re-creates the smoking experience complete with smoke and nicotine. The smoke, which is actually water vapor, vanishes quickly and does not create offensive odors. (E Cigarettes Choice, 2011)

The electronic cigarette is a simple product that mimics traditional tobacco cigarettes in look, feel, and sensation that a smoker gets from a tobacco cigarette, but it lacks well over 95% of the chemicals that traditional cigarettes emit. (World of E Cigarettes, 2010)

Early press releases generally first mentioned physical and experiential similarities between e-cigarettes and cigarettes, followed quickly by statements about the absence of harmful chemicals and/or secondhand smoke in e-cigarette vapor. Producers also portrayed e-cigarettes as a product that would “not offend non-smokers” (PremiumEcigarette, 2009) and avoided “the social and health concerns that smoking entails” (NE-WHERE, Inc., 2013). These benefits highlighted a key oppositional goal that some e-cigarette producers promoted with respect to the cigarette category: to aid in reducing or quitting smoking. In an interview, one e-cigarette producer recalled that many entrepreneurs in the newly emerging category expressed an “anti Big Tobacco sentiment” and believed “they had finally found the new holy grail to quit.” Several other interview respondents recalled that their initial interest in the category stemmed from personal experiences with family members or friends using e-cigarettes successfully to quit smoking. Similar to early press releases, interviewees described the e-cigarette as an effective alternative for smokers struggling with addiction because it closely simulated the smoking experience.

Thus, while e-cigarette producers emphasized the normatively superior appeal and goals of e-cigarettes relative to cigarettes, they took care to position these virtuous distinctions within the dominant framing of e-cigarettes as similar to cigarettes in performance, function, and intended audience. The intention of this strategy was to familiarize consumers with e-cigarettes and their use while simultaneously shielding e-cigarettes from the stigma associated with combustible cigarettes.

Reifying producers’ proposed categorization

Whether stakeholders would accept producers’ framing of e-cigarettes as similar to cigarettes was unclear, as early regulator and retailer documents reflect considerable uncertainty about e-cigarettes’ classification. Initially, the U.S. Food and Drug Administration (FDA) construed e-cigarettes to be drug-delivery devices like nicotine patches and gum based on manufacturers’ claims that they satisfied smokers’ cravings (i.e., withdrawal symptoms) by delivering nicotine. Both the FDA and anti-tobacco organizations expressed concern about the safety and marketing of e-cigarettes as drug-delivery devices designed for smoking cessation (Zezima, 2009). For example, Tobacco Free Kids (2010a) stated that “like other drugs and delivery devices, electronic cigarettes should be regulated to protect public health.” A key concern was that e-cigarette producers were making unsubstantiated claims about this “unproven and unapproved alternative to smoking cessation therapies that have been approved by the FDA as safe and effective” (Tobacco Free Kids, 2010b).

Public health officials and researchers also interpreted e-cigarettes as drug-delivery devices early on and warned about a lack of scientific evidence for claims made about their effectiveness in quitting smoking. In 2008, the World Health Organization (WHO) noted that e-cigarettes were often promoted as alternatives to nicotine replacement therapy and recommended banning the dissemination of information about their health benefits without conclusive evidence. Lack of association with tobacco companies may have played a role in these early interpretations of the e-cigarette as an unproven, yet potentially beneficial, tool for smoking cessation. One tobacco expert we interviewed reflected on the importance of organizational identity to shaping his early positive perception of e-cigarettes:

They were independent e-cigarette companies that were just producing e-cigarettes and nothing else that just sprung up. They were all new companies. They had nothing to do with tobacco. . . . [H]ad it been the tobacco companies marketing it I would have been very suspicious, like, okay this is just repeating history. . . . [But] this can’t be a Big Tobacco ploy because there is no Big Tobacco involved. (Public health researcher, interview)

In 2008, the FDA took its first major action involving e-cigarettes by instructing U.S. Customs and Border Protection to confiscate e-cigarette imports based on their status as “unapproved drug/device combination products” (Federal Register, 2014). The e-cigarette manufacturer Smoking Everywhere filed a suit against the FDA in 2009, challenging this categorization and the FDA’s authority to confiscate the products. In evaluating the arguments, the District Court was persuaded by Smoking Everywhere’s position that e-cigarettes were for smoking enjoyment and designed to encourage rather than reduce or prevent nicotine use. ² That is, the court accepted the framing of e-cigarettes as similar to combustible cigarettes. This suggested a less stringent set of regulations relative to the alternative of regulating them as drug-delivery devices. E-cigarette manufacturers viewed this ruling as a victory for the industry, predicting that it would lead to industry growth (Kress, 2011). After this court decision was upheld on appeal, the FDA announced in 2011 that it would issue regulations for e-cigarettes under the 2009 Family Smoking Prevention and Tobacco Control Act’s “Deeming Rule,” which gave the FDA authority over all tobacco products. The legal codification of e-cigarettes as tobacco products reduced uncertainty about whether e-cigarettes would be regulated under the same framework as cigarettes.

These regulatory actions made e-cigarettes “more appealing to retailers,” encouraging retailer adoption of the new product (Stagnito Media, 2011). With e-cigarettes increasingly on display in convenience stores and gas stations, customers could see and better understand this novel technology up close (Bishop, 2014). Retailers increasingly allocated shelf space to e-cigarettes next to cigarettes (Caley, 2016), both raising customers’ familiarity with the new product and further institutionalizing its categorization as a cigarette-like product.

Yet as the next section details, the accepted positioning of e-cigarettes as highly similar to cigarettes and regulatory equivalence of these two categories opened a path for stigma to transfer by establishing a weak symbolic boundary between the two categories. This positioning encouraged retailers’ attention and growth, which influenced consumers’ acceptance. At the same time, it made tobacco company diversification into e-cigarettes seem like a natural competitive move into a related category, despite differences in the fundamental technology and goals of the two categories. Tobacco companies’ participation influenced how collective understandings of e-cigarettes developed in the next phase.

Diversification from the existing category

Major tobacco companies began to show active interest in the e-cigarette category in 2012, the year following the FDA’s announcement that it would regulate e-cigarettes as tobacco products (Adams and Branca, 2012). Tobacco companies faced strong pressure to diversify from their core product, sales of which had been steadily declining in the U.S. since the 1980s with “[p]rice increases, restrictions on advertising and promotions, increase in regulation and excise taxes, health concerns, decline in the social acceptability of smoking, and other factors” (MarketLine, 2013). Tobacco companies had thus far experimented unsuccessfully with other products that might be viewed as safer or lower in risk than cigarettes, such as nicotine inhalers and heat-not-burn products (Hsu and Grodal, 2015). E-cigarettes were another potential product in this vein.

In April 2012, the first major tobacco company, Lorillard, entered the e-cigarette category with its acquisition of the e-cigarette brand “blu.” This ignited interest among tobacco industry analysts and retailers; for example, the count of retailers selling blu products increased from 13,000 to 127,000 in the year following the Lorillard acquisition (HHS, 2016). By 2013, Altria and R. J. Reynolds launched e-cigarette brands in limited markets; in mid-2014, both expanded to national distribution (Adler et al., 2016).

Our findings show that, as major tobacco companies entered the emerging e-cigarette category, attention to e-cigarettes increased substantially among key stakeholders of the combustible cigarette category. Some attention (such as from intermediaries like financial analysts) was positive, focusing on tobacco companies’ vast resources and capabilities and what these meant for the fledgling category’s growth. Other cigarette-category stakeholders (such as anti-tobacco organizations) were alarmed at the move, focusing on tobacco companies’ past deceptive activities and what these meant for how tobacco companies would grow the category. Thus e-cigarettes’ regulatory institutionalization as cigarette-like and the subsequent entry of tobacco firms into e-cigarettes brought a transfer of categorical expectations from the cigarette to e-cigarette category, but in markedly different ways for different stakeholder groups.

Increasing attention and transfer of category expectations from existing category proponents

Before tobacco company diversification, e-cigarettes attracted moderate attention from tobacco industry financial analysts, who covered e-cigarettes along with products such as roll-your-own cigarettes and snus (a smokeless tobacco product) under the “Other Tobacco Product Segment” in their reports (Herzog, Metrano, and Gerberi, 2012). Early estimates of e-cigarette market growth were unclear because a large proportion of sales were conducted online and not easily tracked by traditional metrics like Nielsen (HHS, 2016).

Lorillard’s entry into the new category in mid-2012 appeared to ignite tobacco analysts’ interest; some quickly began to promote the idea that the category was on the precipice of incredible growth. In August 2012, the same month Lorillard formally acquired blu, Wells Fargo declared that “consumption of e-cigarettes could outpace traditional cigarettes over the next decade” and that “big tobacco needs to wake up and recognize the potential opportunity of the e-cigarette category and not make the mistakes of the large beverage companies that overlooked the potential of the energy drink category when it was in its nascent stage” (Herzog, Gerberi, and Metrano, 2012).

Compared with small, independent e-cigarette producers, major tobacco companies were viewed by analysts as having multiple competitive advantages, including substantial cash resources; entrenchment with retailers, ensuring broad, scalable distribution and premium shelf-space; expertise in building and marketing successful brands; and extensive experience interacting with the FDA. Indeed, Lorillard and R. J. Reynolds reported meeting with the FDA to help develop e-cigarette regulations (Bannon, Kessler, and Taylor, 2013a, 2016). Analysts’ growing enthusiasm for the e-cigarette category was thus influenced by tobacco companies’ entry, as it was viewed as something that “could catapult the growth of the ecigarette category, driving the total conventional cigarette and cigarette profit pool up” (Herzog, 2013).

Positive tobacco analyst reports on the nascent e-cigarette category set the stage for a positive spiral among producers, industry analysts, and retailers. Analysts exerted a strong influence on retailers by providing tangible, legitimized projections that retailers trusted. As John Wiesehan, the CEO of Mistic E-cig, noted in a call with Wells Fargo analyst Bonnie Herzog, “Quite frankly, I think your bullishness on the category has helped retailers realize this is here to stay” (Herzog, Gerberi, and Scott, 2014a). As retailers increasingly adopted e-cigarettes, producers and analysts in turn interpreted their support as an affirming signal of the category’s positive future (Bannon, Kessler, and Taylor, 2013b). NJOY’s CEO observed in 2013 that positive feedback from retailers provided “another air of legitimacy to the category, and sparked a significant amount of consumer awareness” (Herzog and Gerberi, 2013).

In this phase, proponents of the e-cigarette category, such as financial analysts, retailers, and manufacturers, increasingly interpreted e-cigarettes through the positive lens they held for the cigarette category and came to view e-cigarettes as a major growth category for the tobacco industry. Tobacco company diversification into e-cigarettes, however, generated a markedly different reaction from challengers of the existing category of combustible cigarettes—anti-tobacco organizations, public health researchers, and public health officials/regulators.

Increasing attention and transfer of category expectations from existing category challengers

The amount of discussion among anti-tobacco organizations and the public health community around e-cigarettes increased after large tobacco companies entered the new category—particularly by 2014, the year R. J. Reynolds and Altria began national distribution of their new e-cigarette brands. Among the stakeholder groups we followed, these were later than others to focus attention on the e-cigarette category; see Figure B1 in Online Appendix B. The documents collected from these stakeholder groups reflected a substantial focus on tobacco company involvement in the e-cigarette category. Among 95 post-2012 press releases issued by the American Cancer Society, American Heart Association, and Tobacco Free Kids mentioning e-cigarettes, 60 percent specifically mentioned tobacco companies and their presence in the emerging category, emphasizing their organizational similarities.

Public health and medical researcher attention to e-cigarettes also increased, as many researchers with expertise in combustible cigarette research began turning their focus to e-cigarettes. In Figure 2, we show the count of PubMed articles with abstracts/titles referencing e-cigarettes that were published by authors who had previously conducted research on cigarettes versus the count of e-cigarette articles published by authors with no prior cigarette research. As Figure 2 shows, the count of publications on e-cigarettes increased substantially after 2013, and the vast majority of articles published during that period were authored by scholars who previously conducted research on cigarettes.

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Figure 2.

Yearly counts of PubMed e-cigarette articles by researcher background.

As anti-tobacco activists and public health researchers with expertise in cigarettes devoted increasing attention to e-cigarettes, they increasingly challenged the earlier framing of e-cigarettes as a virtuous alternative to cigarettes. We examine how this expanded set of stakeholders stretched existing framings of similarities to question the morality and intentions of the entire category.

Spotlighting actions and diffusing stigma

Our findings suggest that a key step in the process of category stigmatization was the spotlighting of a negatively viewed behavior—youth-targeted marketing—by a single tobacco-owned e-cigarette brand. Discussion about youth-targeted marketing was not new to e-cigarettes—dating back to 2009, public health regulators had expressed some concern that e-cigarette advertisements could appeal to youths (e.g., Hensley, 2009). With the entry of tobacco companies into e-cigarettes, however, this concern intensified and broadened markedly. Anti-tobacco organizations and public health community members raised increasing alarm that tobacco companies could extend marketing tactics used decades earlier to the new e-cigarette category.

A key process in the transfer of stigma from the cigarette to e-cigarette category was generalization from initial media and stakeholder claims about the questionable activities of individual tobacco-owned e-cigarette brands to the broader category. For example, in December 2012, only several months after Lorillard acquired blu, an article in the New York Times noted:

Some e-cigarette ads feature celebrity endorsers, in the way that ads for conventional cigarettes once featured actors, athletes, doctors and even cartoon characters. The actor Stephen Dorff began appearing in October in a campaign for Blu eCigs, which was acquired this year by Lorillard, the maker of mainstay cigarette brands like Kent, Old Gold and Newport. (Elliott, 2012)

This spotlighting of Lorillard’s blu campaign was echoed in other media documents that described Dorff as “oozing machismo” and “[i]nhaling with swagger” much as the “Marlboro Man strutted his stuff” decades earlier (Koch, 2013). Blu’s advertising campaign was characterized as “reach[ing] into the bag of advertising tricks” (Nasaw, 2012) and “borrow[ing] a page from glitzy tobacco company commercials that filled the airwaves before a federal ban on TV and radio cigarette ads four decades ago” (Lazar, 2013).

Slight expansions of this claim can be seen in a Tobacco Free Kids’ 2013 press release, which not only singled out blu/Lorillard but noted similar tactics by the independent e-cigarette brand NJOY:

Television and online ads for e-cigarettes have featured catchy slogans and celebrity endorsers, such as actor Stephen Dorff and TV personality Jenny McCarthy for blu eCigs and rocker Courtney Love for NJOY. Magazine ads for e-cigarettes feature today’s equivalents of the Marlboro Man and the Virginia Slims woman, depicting e-cigarette use as masculine, glamorous and rebellious. (Tobacco Free Kids, 2013a)

This expansion was again echoed in media documents, which noted that “[c]ompanies such as NJOY and Blu Ecigs are advertising on TV, forbidden for cigarettes for more than 40 years” (Felberbaum, 2013). Soon, these perceived tactical similarities were generalized to the broader set of e-cigarette companies. Links between the category’s marketing tactics and the “Big Tobacco playbook” became common:

Manufacturers of electronic cigarettes say they want to be part of the solution to the tobacco problem, but increasingly they’re behaving just like tobacco companies always have. They’re following Big Tobacco’s playbook by marketing their products in ways that appeal to kids. (Tobacco Free Kids, 2013b)

Anti-tobacco organization press releases also frequently stated that the broader e-cigarette industry was targeting youths through “sweet, kid-friendly flavors including ‘vivid vanilla,’‘cherry crush’ and chocolate” (Tobacco Free Kids, 2013a). These claims typically accompanied links made to the cigarette industry’s early history of youth-focused advertising, such as “themes and images long used to market regular cigarettes to kids” (Tobacco Free Kids, 2013a). Public officials similarly began expressing concern about tobacco industry involvement and the organizational and marketing tactics that might be used for tobacco-owned brands. Dr. Ed Ehlinger, Minnesota’s state health commissioner, declared “I have a real sense of déjà vu about e-cigarettes” with regard to the youth-focused marketing tactics cigarette companies had employed years ago (Olson, 2014).

Some e-cigarette firms attempted to assert virtuous identities. For example, Green Nicotine’s CEO proclaimed that “I intend to eliminate any opportunity for a minor to get their hands on Green Nicotine and in turn, I look toward a future where all E-Cigarettes are ethically marketed across the industry” (Green Nicotine, 2011). Another e-cigarette executive interviewed reflected on his efforts to conduct business in an “ethically and morally correct” way. He noted, “I was very careful not to co-mingle with tobacco . . . and only interested in selling to vaper specific retailers. My goal from day one was to provide a safer alternative to offset the leading cause of death, and that was combustible cigarettes.”

Still, as the cigarette category became increasingly intertwined with the categorical identity for e-cigarettes, the broader e-cigarette producer category appeared to have become tainted with the idea of targeting youths and hooking a new generation on its product. A 2014 Cowen & Co. Equity Research report noted that public health organizations’ reports on e-cigarettes were beginning to shift general public opinion about their potential benefits:

Earlier this week, e-cigs captured news headlines as: 1) the CDC released their report on underage e-cig use, and 2) the WHO’s report calling for broader e-cig regulation was also well reported. As a result, we believe, Google search trends globally for e-cigs jumped 22% this week. This is not necessarily good news, as risk perception around e-cigs had already been deteriorating. (Azer, 2014)

Claims regarding e-cigarette producers’ deceptive tactics undermined producers’ earlier framing that the intended market for e-cigarettes was existing adult smokers seeking harm reduction. By spotlighting and diffusing perceptions of tactical similarities between cigarette and e-cigarette producers, stakeholder groups recast e-cigarette producers in a way that questioned the honesty and behavior of the category as a whole as well as producers’ claims about the superior normative distinctions between the existing and new category. This process marked a major step in the transfer of stigma from the existing to the new category.

Intensifying social threat

In this phase, stakeholders intensified the perceived social threat of e-cigarettes by framing them as a gateway to cigarette use among youths and thus a danger to the health, well-being, and longevity of a new generation of Americans. Early e-cigarette manufacturers relied on physical similarities of their new products to cigarettes to gain existing smokers’ acceptance. Yet later stakeholder groups reinterpreted these similarities as a fundamental problem for public health. For years, anti-tobacco groups had worked to control the use of cigarettes in the U.S. through public service announcements and marketing campaigns that depicted smoking as a “smelly, disgusting, or irresponsible” practice (Voigt, 2015: 1968). Smoking bans and increasing regulatory constraints on marketing also contributed to general social disapproval or “denormalization” of smoking (Voigt, 2015). Given how closely e-cigarettes resembled combustible cigarettes, the new product’s increased use—particularly in locations such as schools, public buildings, and restaurants where smoking had long been banned—was viewed as having the potential to destabilize tobacco control by renormalizing cigarette smoking.

In a panel discussion hosted by Wells Fargo, a health psychology professor noted that some in the public health community argued that “if you just see people walking around, doing something that looks like smoking, we’re going to undo the de-normalization, the stigmatization, of smoking, that’s been accomplished over a lot of years” (Herzog, Gerberi, and Scott, 2014b). In a 2014 speech, Senator Dick Durbin expressed concern with how e-cigarettes were decreasing social stigma around smoking: “We just had the Golden Globe Awards, and some of these red hot actors and actresses who we all love to watch in movies were puffing away on their e-cigarettes, and I thought, you’re killing the next generation of fans in your movies” (Durbin, 2014).

The renormalization argument co-opted an earlier claim by e-cigarette producers about a key benefit of e-cigarettes—that they could be used in many places without offending bystanders and incurring social stigma. Anti-tobacco activists and public health researchers argued that the lack of social stigma for an act that closely resembled cigarette smoking threatened public health and safety. Their concerns frequently accompanied the observation that activists had worked for decades to achieve the current level of stigmatization of cigarette smoking in the U.S. Reported cigarette usage among U.S. adolescents had steadily declined from around 28 percent in 1996/7 to around 7 percent in 2015 (Johnston et al., 2019), but youth adoption of e-cigarettes has been increasing since 2011. By 2014, e-cigarettes had become the most commonly used tobacco product among youths (Cullen et al., 2018).

Researchers frequently raised concerns about whether e-cigarettes provided “a gateway to combustion cigarettes for adolescents” (Al-Delaimy, Myers, and Strong, 2015) yet admitted that scientific evidence supporting this concern remained weak (Green and Hilton, 2018). Still, youth usage of e-cigarettes represented a clear, salient metric of the potential for e-cigarettes to renormalize cigarettes among the nation’s youth. Thirty-one public health and medical organizations wrote a 2015 letter to President Obama stating that “use of e-cigarettes by youth has skyrocketed. . . . We cannot afford more [regulatory] delays that allow tobacco companies to target our kids with a new generation of tobacco products” (Tobacco Free Kids, 2015a). The increasingly strong growth in the e-cigarette category, promoted by financial analysts, retailers, and producers as a positive phenomenon, thus alarmed anti-tobacco activists and public health researchers.

Public health researchers increasingly associated e-cigarettes with the tobacco industry and warned that research into e-cigarettes is “particularly critical as the tobacco industry invests further resources into the development and marketing of noncombustible tobacco products and acquires a greater share of the [e-cigarette] business” (Richardson et al., 2014). Public health research articles continued to draw similarities between cigarettes and e-cigarettes not just in advertising but also in political tactics such as “lobbying state legislators behind the scenes and using front groups to disseminate their policy positions” (Cox, Barry, and Glantz, 2016: 542) and in organizational tactics such as vapor store community events, which researchers characterized as “similar to past and current tobacco industry marketing strategies” in that owners “intentionally created an atmosphere where people could spend time with others and be entertained” (Cheney, Gowin, and Wann, 2015). Overall, we observed this second process of reframing e-cigarettes as a threat to public health as playing a key role in the intensification of challenger stakeholders’ negatively valenced perceptions of the e-cigarette category.

Generalizing denigration

Another process driving stigmatization was a generalization from specific problematic behaviors to other, more fundamental features relating to e-cigarette companies’ values, strategic interests, core customers, and end goals. Stakeholders explicitly linked earlier critiques of e-cigarettes’ dangerous marketing tactics and potential to renormalize cigarette smoking to broader claims involving tobacco industry interests. In press releases, anti-tobacco activists began warning that tobacco companies were seeking to “define the activity of smoking an e-cigarette as ‘sexy, youthful, and vigorous’” in order to “drive people back to cigarettes, their main market” (Richtel, 2014). These warnings included accusations of tobacco companies’ lack of morality, such as “the tobacco industry continues to lure kids into nicotine addiction with a wide assortment of sweet-flavored products” (Tobacco Free Kids, 2015b). Anti-tobacco organizations argued that e-cigarettes as a category represented a strategic “gateway to nicotine addiction and use of regular cigarettes by kids and other non-users” (Tobacco Free Kids, 2013b). Proclamations such as the following by the CEO of the American Heart Association became common:

We are fiercely committed to preventing the tobacco industry from addicting another generation of smokers. Recent studies raise concerns that e-cigarettes may be a gateway to traditional tobacco products for the nation’s youth, and could renormalize smoking in our society. (American Heart Association, 2014)

In research articles studying e-cigarettes and other vaping products, researchers also mentioned the tobacco industry’s strategic interests. Such mentions were muted in tone relative to activists’ discourse, in keeping with the more neutral norms of scientific discourse. Yet Voigt (2015: 1967–1968) observed that “the increasing involvement of the tobacco industry in the [e-cigarette] market is a major source of unease for many public health experts, who are concerned that the industry could try to use [e-cigarettes] to maintain or even increase tobacco consumption.”

Anti-tobacco organizations and public health members not only portrayed the tobacco industry as having strategic interests in the new category but also began to portray organizational interests and core customers (i.e., young people) as overlapping between the two categories. Calls for researchers to “think of real world solutions to prevent e-cigarettes from becoming a back door for the return of smoking and the spread of for-profit nicotine addiction in society” (Dawson and Maziak, 2016) became more common, grouping e-cigarette and tobacco companies under the rubric of companies interested in promoting nicotine addiction.

A well-established tobacco industry researcher noted that early e-cigarette researchers in the public health community tended to view e-cigarettes with optimism. Many were focused on smoking cessation and were frustrated with the ineffectiveness of drug-delivery devices such as nicotine replacement therapies; they hoped e-cigarettes might be a more effective alternative. Yet he argued that tobacco company involvement contradicted early e-cigarette advocates’“ideological view that e-cigarettes are this disruptive technology that’s going to disrupt the big major tobacco companies. But that’s not true because now all the cigarette companies are in the e-cigarette business.”

Another tobacco industry expert reflected on the importance organizational identity played in his perceptions of e-cigarette companies’ end goals and strategic interests prior to tobacco companies’ entry:

The tobacco companies obviously have an economic incentive not to reduce smoking. Even if they are trying to build a new niche in e-cigarettes, it doesn’t help them necessarily to lose their business. But it’s very different with independent companies because their value proposition essentially is to make smoking history. . . . It’s no different than nicotine replacement therapy. They only make money if people try to quit.

He concluded that this fundamental difference in economic incentives “is why it made such a huge difference to me that this was not a tobacco industry product” early in the category’s history.

There remains considerable debate in the public health community about the role e-cigarettes play in tobacco control (Blanding and Madeline, 2015), with some researchers advancing a more positive harm-minimization perspective and others advancing a strongly cautionary perspective (Green, Fielding, and Brownson, 2018). In general, researchers studying youth adoption and use of e-cigarettes tend to take more negative stances than researchers focused on smoking cessation. The type of individual who is the primary subject of study appears to shape researchers’ general orientation toward e-cigarettes. For those studying youth adoption, e-cigarettes pose a potential threat to children and decades of work educating the public—particularly younger generations—about the harmful effects of cigarette smoking. One researcher we interviewed noted that this cautionary camp has occupied a particularly vocal role in media accounts of e-cigarettes. In contrast, researchers studying smoking cessation generally expressed cautious openness to the idea of e-cigarettes as a harm reduction tool. Their orienting perspective is of the adult smoker interested in quitting but unable to. Another researcher we interviewed reflected on the divide:

There is evidence that [the e-cigarette] helps smokers quit better than the patch or the gum. . . . The reason that public health scientists are not embracing e-cigarettes is because they are worried that e-cigarettes might be a gateway for young people to start smoking. . . . The people care about the kids and do not care about the adult smokers. They are scaring people away from e-cigarettes, but they could have a strategy for communicating differently with kids and with adults.

Overall, our findings suggest that the stigmatization of the category intensified as stakeholders generalized from specific actions deemed morally unacceptable to the broader values, strategic intentions, and end goals of the entire category. The symbolic boundary between cigarettes and e-cigarettes has faded, as e-cigarettes have become increasingly viewed as a potential replication of the tobacco industry’s past deception and the public’s addiction to their core product.

Emphasizing between-category dissimilarity

The stigmatization of e-cigarettes is an issue the e-cigarette producers we interviewed were acutely aware of, and archival documents suggest several ways the industry has tried to address it in recent years. For example, producers decreasingly referenced cigarettes, smoking, and even the label “e-cigarettes.” This is illustrated in Online Appendix Figure B2, which shows a general decrease in the proportion of press releases referencing the existing category of cigarettes over time. This pattern is consistent with studies that suggest category producers de-emphasize discursive strategies that link a new category to existing categories as the new category becomes established (Rosa et al., 1999; Kennedy, 2008; Navis and Glynn, 2010). Figure B2 also shows that producers increasingly used the labels “vaping” or “vapor” to reference their product. The choice of this distinct term appears deliberate in its intent to distance the category from cigarettes. As e-cigarette company representative Jesse Gaddis states, “The facts are that this isn’t smoking. This is vapor” (Sutherland and Greene, 2013). Indeed, e-cigarette producers have acknowledged the early choice to use the term “cigarette” as a mistake for the new category’s legitimacy. Jacob Fuller, a top executive for blu, observed, “Our biggest mistake was to call it an e-cigarette in the first place. This means that people are automatically associating it with a traditional cigarette, which it isn’t, other than the fact it looks a bit like one and produces a vapour” (Davis, 2014).

Strategic differentiation from the existing category also involved differentiation of the physical product. While tobacco companies continued to create cigalike devices, other producers have shifted away from cigalikes and increasingly adopted open-systems designs that resemble technological devices (for example, box-shaped and using materials such as glass and aluminum) and allow customizable e-liquid solution, nicotine yield, and puff volume (Hsu, Sun, and Zhu, 2018). In documents starting around 2014, industry insiders began noting a decrease in demand for closed-system (prefilled) cigalikes and increasing preference among e-cigarette users for open-system (customizable) designs (Modi et al., 2014; Kress, 2015).

While consumers’ desire for customizable products was a factor in shifting demand, their desire to avoid the social stigma associated with cigarettes appears to have also played a role. The president of CB Distributors noted in 2014 that “the cigarette-like appearance was once a selling point, but now users do not want to be chastised when they use the product in a restaurant or other non-smoking area” (Caley, 2014). Another e-cigarette company spokesperson observed: “We think it is important to counteract the negativity of the cigarette factor. By their very nature, most e-cigarettes look like cigarettes. We think this is an issue because some smokers don’t want a product that makes them look like they’re smoking” (Grocery Headquarters, 2017).

Yet recent e-cigarette designs that do not resemble cigarettes have brought a new set of concerns from anti-tobacco and public health officials. In 2018, a slew of media articles highlighted the allure to youths of products such as Juul, which physically resemble USB flash drives and deliver highly addictive levels of nicotine (Belluz, 2018; Kaplan and Hoffman, 2018). In Nielsen-tracked retail channels, sales of Juul products increased sharply in 2017, while tobacco industry e-cigarette brands’ retail sales have stagnated since 2015 (Huang et al., 2019). ³ The FDA has characterized Juul’s products as “troubling” and “wildly popular with kids,” and it announced investigations into whether the company was intentionally targeting the youth market (Zernike, 2018). The FDA also announced in September 2018 that it had issued over 1,300 warning letters and fines to retailers “who illegally sold JUUL and other e-cigarette products to minors during a nationwide, undercover blitz of brick-and-mortar and online stores” (U.S. Food & Drug Administration, 2018a). A September 2018 statement from FDA Commissioner Scott Gottlieb noted that the popularity of Juul among teenagers should be regarded as “an epidemic of addiction” and acknowledged tradeoffs that would have to occur in tobacco control:

[T]he youth risk is paramount. It’s now clear to me, that in closing the on-ramp to kids, we’re going to have to narrow the off-ramp for adults who want to migrate off combustible tobacco and onto e-cigs. (U.S. Food & Drug Administration, 2018b)

The potential dangers posed by youth adoption of Juul products are something noted with concern even among the e-cigarette producers we interviewed, who regarded the product’s potent nicotine deliveries as potentially harming the reputation of the broader category. Juul’s marketing tactics, crafted to make the product appealing to youths, were also seen as a potential problem for the entire industry. And it is important to note that many e-cigarette producers engage in actions that may promote e-cigarette use among youths. For example, many producers sell e-liquid flavors that appeal to youths, such as dessert and fruit flavors, and some do not take action to restrict youth access to their products (Hsu, Sun, and Zhu, 2018). Still, the idea of e-cigarettes as a gateway to nicotine and tobacco product addiction remains even as the industry has made efforts to distance itself from cigarettes in labels, discourse, and physical design. As Figure 1 illustrates, during the most recent period, media documents have increasingly labeled e-cigarettes as dangerous or unhealthy.

We conclude our findings section by noting that the UK provides a contrast to this account of how e-cigarettes were stigmatized in the U.S.—one that highlights the socially constructed nature of shared categorical understandings. In the U.S., the expert opinions of prominent public health researchers, as well as health-related organizations such as the Mayo Clinic and American Heart Association, were often used to justify and bolster claims about the potential harm of e-cigarettes. In contrast, a number of prominent UK health organizations, including the Royal College of Physicians, Cancer Research UK, and the British Medical Association, have endorsed a more positive view of e-cigarettes as substantially less harmful than combustible cigarettes (Dockrell, 2018). UK government agencies’ stances reflect this position. In an e-cigarette evidence update, the government agency Public Health England (2019) stated that “vaping remains an accessible and appealing alternative to smoking” in the UK. In response to a 2019 U.S. outbreak of lung diseases associated with vaping THC products, Public Health England posted updated guidance that stated “PHE has not changed its advice on nicotine containing e-cigarettes: Smokers should consider switching completely and vapers should stop smoking. We are certain as ever that e-cigarettes are far less harmful than smoking, which kills almost 220 people in England every day” (Newton, 2019). While a detailed comparison of the factors giving rise to these differences is beyond the scope of the current study, we highlight this divergence in stigmatization of e-cigarettes to help make clear the socially constructed nature of category stigma in our focal case.