Transcript E-cigarette review - iowa counties public health association

A REVIEW OF E-CIGARETTES
Prepared by University of Iowa undergradutes:
Maisara Abdelrazig & LauRen Gaines
Introduction
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According to the FDA, electronic cigarettes, or ecigarettes (EC), are devices that allow users to
inhale a vapor containing nicotine or other
substances.1
Unlike traditional cigarettes, e-cigarettes are
generally battery-operated and use an atomizer to
heat a refillable cartridge that then releases a
chemical-filled vapor.1
Introduction cont.
E-cigarettes are often available in flavors that
may appeal to children and teens, including
cotton candy, bubble gum, chocolate, strawberry
and mint.1
 It is estimated that there are more than 400
brands of E-cigarettes available.
 Several organizations such as The World Health
Organization (WHO) and The Food and Drug
Administration (FDA) have expressed concerns
about the health effects of using ECs.2
 The American Lung Association supports
prohibiting the use of e-cigarettes under
smokefree laws.
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Examples of EC flavors
What Are E-cigarettes used for?:
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Researchers and public health officials believe E-cigarettes can be
considered a stepping stone, gateway, or bridge to start smoking
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Some journals indicated that E-cigarettes are being used by
cigarette companies to renormalize smoking
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Many people believe they have the same “oral fixation, personal
experience, and public performance of smoking”
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Several surveys indicated that many E-cigarettes users used this
product because they felt it:
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“Helped them quit smoking, prevented exposure to smoke, allowed people to
smoke in smoke free zones, and better flavor”
What does the EC Industry Claim?
Who Uses E-cigarettes?
According to CDC:
 During 2010 to 2011, adults reporting that they have
used an e-cigarette increased among both sexes, those
aged 45-54 years old, non-Hispanic Whites, those
living in the South, and current and former smokers. One
in five current cigarette smokers has used an ecigarette, with their use higher than that of former or
never-smokers.3
 From 2011 to 2012, the number of youth in grades 612 who ever used EC has doubled, and the number of
those who recently used EC have almost doubled.4
Can E-Cigarettes Help Someone Quit
Smoking?
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The FDA has not approved e-cigarettes as an
effective method to help smokers quit.5
The American Lung Association does not support any
direct or implied claims that e-cigarettes help
smokers quit.5
The Vapor Content and the Health
Effects of ECs
ECs release numerous detectable levels of
several significant carcinogens and toxins
compounds into the “indoor environment”.
Selected compounds that are also present in the
second hand smoke of regular cigarettes
include the following6 :
The Vapor Content and the Health
Effects of ECs cont.
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1,2-Propanediol
1-Hydroxy-2-propanone
2,3-Butanedione
2,5-Dimethylfuran
2-Butanone (MEK)
2-Furaldehyde
2-Methylfurane
3-Ethenyl-pyridine
Toluene
Acetaldehyde
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Acetic acid
Acetone
Benzene
Isoprene
Limonene
m, p-Xylene
Phenol
Pyrrole
Formaldehyde
Propanal.6
The Vapor Content and the Health
Effects of ECs cont.
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No brand of e-cigarettes has been submitted to the FDA for
evaluation of their safety.5
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Threatens ban on public smoking
In initial lab tests conducted in 2009, FDA found detectable levels of
toxic cancer-causing chemicals, including an ingredient used in antifreeze, in two leading brands of e-cigarettes and 18 various
cartridges.5
The lab tests also found that cartridges labeled as nicotine-free
had traceable levels of nicotine.5
A study has found out that the nicotine content of the studied ECs’
liquids varied and was 1.2-fold higher than what the manufacturer
claimed.7
There is no evidence that shows the vapors emitted by e-cigarettes
are safe for non-users to inhale.5
The Vapor Content and the Health
Effects of ECs cont.
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A research on the “Acute impact of active and
passive electronic cigarette smoking on serum
cotinine and lung function” concluded that, for the
e-cigarettes tested, the effect of active and
passive e-cigarette smoking on serum cotinine levels
is similar to that generated by tobacco cigarette
smoking.8
The Vapor Content and the Health
Effects of ECs cont.
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Regarding short-term usage, the studied ecigarettes generate smaller changes in lung
function but similar nicotinergic impact to
tobacco cigarettes.8
The Vapor Content and the Health
Effects of ECs cont.
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Another study indicated that some EC samples have
cytotoxic properties on cultured myocardial cells,
associated with the production process and
materials used in flavorings.9
However, all EC vapor extracts were significantly
less cytotoxic compared to regular cigarette smoke
extract.9
The Vapor Content and the Health
Effects of ECs cont.
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A review of chemical analyses of EC liquid found that nitrosamines
were present at levels 500–1,400 times lower compared to
smoking10.
Goniewicz et al. observed that the amount of carbonyls produced
by EC use in laboratory conditions was 9–450 times lower compared
to tobacco cigarettes.10
Another study concluded that: “Our data confirm that e-cigarettes
are not emission-free and their pollutants could be of health
concern for users and secondhand smokers. In particular, ultrafine
particles formed from supersaturated 1,2-propanediol vapor can be
deposited in the lung, and aerosolized nicotine seems capable of
increasing the release of the inflammatory signaling molecule NO
upon inhalation. In view of consumer safety, e-cigarettes and nicotine
liquids should be officially regulated and labeled with appropriate
warnings of potential health effects, particularly of toxicity risk in
children.”7
The Vapor Content and the Health
Effects of ECs cont.
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However, it is not known, and is still too early to
evaluate, whether reduction or complete substitution
of smoking by EC use has any long-term health
benefits.10
Can EC Cause Passive Vaping?
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The consumption of e-cigarettes (vaping) causes
emissions of aerosols and volatile organic
compounds (VOCs), such as 1,2-propanediol,
flavoring substances, and nicotine, into indoor air.11
During inhalation of e-cigarette vapor, the aerosol
size distribution alters in the human lung and leads
to an exhalation of smaller particles.11
Can EC Cause Passive Vaping? Cont.
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The quantity of the inhaled vapor could be
observed to depend on the liquid delivery system
of the e-cigarette in use.11
As a consequence, passive vaping must be
expected from the consumption of e-cigarettes.11
The e-cigarette is a new source of VOCs and
ultrafine/fine particles (FP/UFP) in the indoor
environment.11
The Health Hazards of ECs
Generally, the overall picture of the health hazards of
ECs is still unclear, especially for long term use, and
further research needs to be done.
Legislation of EC
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E-cigarettes have been banned in Australia, Canada,
Singapore, and Brazil because of the lack of data about their
safety or efficacy
On April 25, 2011, the U.S. Food and Drug Administration (FDA)
announced that e-cigarettes will be regulated as tobacco
products unless the products are marketed as therapeutic,
making a claim that e-cigarettes can help someone quit smoking
for example.5
Over 14 Agencies including American Heart and Lung
Association, American Public Health Association, The American
Academy of Pediatricians, The American College of Preventative
Medicine, and the American Cancer Society (to name a few)
have sent a letter to the FDA Urging Regulation.5
Legislation of EC cont.
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In September 2013, Iowa Attorney General (AG) Tom
Miler said he and 36 state attorneys general and
attorneys general in three U.S. territories, signed a
bipartisan letter asking the US Food and Drug
Administration (FDA) to prohibit the sale of ECs to
minors, and restrict their ingredients and advertising.12
The attorneys general asked the FDA to immediately
take all available measures to regulate ECs as tobacco
products under the Tobacco Control Act.12
Legislation of EC cont.
Currently many US states and counties have passed
laws to regulate the use of EC.
3 states that passed laws restricting EC use in 100%
smokefree venues: North Dakota, New Jersey, and
Utah.
 9 states that passed laws restricting EC use in other
venues: AR, CO, DE, KS, MD, NH, OK, OR, and SD.
 108 local laws restricting EC use in 100% smokefree
venues.
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Legislation of EC cont.
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New York City is the last city that passed a bill to
regulate the use of EC.
Michael Bloomberg, the mayor of New York City,
signed the legislation on 12/30/13 to amend the
Smoke-Free Air Act, which bans smoking in public
places and places of employment. The act now
additionally prohibits the use of electronic
cigarettes in all areas where smoking is
prohibited.
Policy Options:
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Regulating Sale
Regulate Marketing
Regulate Price
Regulate Use
Clearly define Ecigarettes Laws
References
1. U.S. Food and Drug Administration. “FDA Warns of Health Risks Posed by ECigarettes.” July 23, 2009. Available at:
http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm173401.htm.
2. Farsalinos KE, Romagna G, Allifranchini E, Ripamonti E, Bocchietto E,
Todeschi S, Tsiapras D, Kyrzopoulos S, Voudris V. Comparison of the Cytotoxic
Potential of Cigarette Smoke and Electronic Cigarette Vapour Extract on
Cultured Myocardial Cells. International Journal of Environmental Research and
Public Health. 2013; 10(10):5146-5162.
3. King BA, Alam S, Promoff G, Arrazola R, Dube SR. “Awareness and Ever Use
of Electronic Cigarettes Among U.S. Adults, 2010–2011.” Nicotine
& Tobacco Research. February 2013; 15:1623-7.
References cont.
4. Centers for Disease Control and Prevention. “Electronic Cigarette Use
Among Middle and High School Students — United States, 2011–2012.”
Morbidity and Mortality Weekly Report. September 6, 2013; 62(35):72930.
5. E-cigarettes. American Lung Association Web site.
http://www.lung.org/associations/states/oregon/assets/docs/e-cigarettefact-sheet.pdf. Updated 2013. Accessed 12/25, 2013.
6. Schripp T, Markewitz D, Uhde E, Salthammer T. Does e- cigarette
consumption cause passive vaping? Indoor Air. 2013;23(1):25.
7. Schober W, Szendrei K, Matzen W, et al. Use of electronic cigarettes (ecigarettes) impairs indoor air quality and increases FeNO levels of e-cigarette
consumers. Int J Hyg Environ Health. (0).
References cont.
8. Flouris, Andreas Chorti, Maria Poulianiti, Konstantina
Jamurtas, Athanasios Kostikas, Konstantinos Tzatzarakis,
Manolis Wallace Hayes, A Tsatsakis,Aristidis Koutedakis,
Yiannis. Acute impact of active and passive electronic cigarette
smoking on serum cotinine and lung function. Inhal Toxicol.
2013;25(2):91-101.
9. Farsalinos KE, Romagna G, Allifranchini E, Ripamonti E,
Bocchietto E, Todeschi S, Tsiapras D, Kyrzopoulos S, Voudris V.
Comparison of the Cytotoxic Potential of Cigarette Smoke and
Electronic Cigarette Vapour Extract on Cultured Myocardial
Cells. International Journal of Environmental Research and Public
Health. 2013; 10(10):5146-5162.
References cont.
10. Farsalinos KE, Romagna G, Allifranchini E, Ripamonti E, Bocchietto E,
Todeschi S, Tsiapras D, Kyrzopoulos S, Voudris V. Comparison of the
Cytotoxic Potential of Cigarette Smoke and Electronic Cigarette
Vapour Extract on Cultured Myocardial Cells. International Journal of
Environmental Research and Public Health. 2013; 10(10):5146-5162.
11. Schripp T, Markewitz D, Uhde E, Salthammer T. Does e- cigarette
consumption cause passive vaping? Indoor Air. 2013;23(1):25.
12. Local news | iowa city press citizen | press-citizen.com
http://www.presscitizen.com/article/20130924/NEWS01/130924010/Iowa-AG-TomMiller-wants-FDA-ban-e-cigarette-sales-minors?nclick_check=1.
Accessed 12/20/2013, 2013.