Transcript E-cigarettes

E-cigarettes
Shelia Evans L.P.N.
Manager Community Health Program
353-5767
Objectives
• Understand what e-cigarettes are and how they
work
• How e-cigarettes are marketed and the laws
regarding them
• Know health implications of e-cigarettes
• How to counsel patients on e-cigarettes
E-cigarette Defination & History
• Electronic cigarettes (e-cigarettes) are products
that deliver a nicotine-containing aerosol
(commonly called vapor) to users by heat
• It was invented in the current form by a Chinese
pharmacist in the early 2000s
• The US patent application describes the ecigarette device as “an electronic atomization
cigarette that functions as substitutes for
cigarettes and quitting smoking”
Components
Available Products
Disposable e-cigarette
Rechargeable e-cigarette
Pen-sized Rechargeable e-cigarette
Tank-style, large size, rechargeable
e-cigarette
Popular E-cigarettes on Market
• They range in size from cigarette size, to compact
flashlight size, and you can get one in almost any
color and style.
V2 Cigs $34.95+
Halo $44.99
blu $79.95
Green Smoke
$59.99+
$99.95
VaporFi™
$29.99
Additional Components
• Every e-cigarette has at least three main
components inside - the battery, the tank, and
the atomizer.
• Sometimes there is another component
between the liquid and the atomizer. This can
be either a clearomizer or a cartomizer.
E-cigs and E-liquid
• Comes in a variety of flavors and nicotine levels
• Many of the products leak creating the potential
for dermal nicotine exposure and potential
nicotine poisoning
• Many fluids are from China, but are now being
made in United States, Germany, and Europe
Terminology
• E-cigarettes - often called e-cigs, personal
vaporizers, PVs, Electronic Nicotine Delivery
Devices (ENDS)
• Liquid nicotine - E-liquid, e-juice or smoke juice
• Vaper - Person who uses electronic cigarettes
• Vape or Vaping - the act of smoking an e-cig
• Vape or Vapor Shops - Retail
stores selling electronic cigarettes
Rationale for E-cigarettes
• Traditional cigarette sales are declining
• Tobacco industry needed alternative product to
redefine itself
• Designed to mimic cigarettes
• Presented as a safe alternative
• Avoids tobacco laws and taxation
Dangers of Liquid Nicotine
• Poison Control Centers shows that poisoning
incidents involving e-cigarettes and liquid nicotine
jumped by 156% in the past year
• More than half the calls involved a child under the
age of six, and one child has died
• A typical cigarette has approximately 9 mg of
nicotine but we only consume about 2-3 mgs
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Low strength = 4-8mg of nicotine per milliliter
Mid strength = 10-14mg nicotine per millimeter
High strength = 16-18mg per millimeter
Extra-high strength = 24-54mg per millimeter
Tobacco Free Campaign
Main Ingredients in Vapor
• Basic ingredients (as listed by most e-cigarette
manufacturers): propylene glycol or glycerin,
nicotine, flavoring chemicals
• Additional chemicals found through product
testing:
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Diethylene glycol
TSNAs (low levels)
Formaldehyde
Acetaldehyde
Acrolein
Carcinogens
Propylene Glycol
• The Dow Chemical Company, a major
manufacturer of propylene glycol, states in its
product safety materials that the “inhalation
exposure to [propylene glycol] mists should be
avoided” (Dow Chemical Company, 2013)
• The American Chemistry Council warns against
its use in theater fogs due to its potential to
cause eye and respiratory irritation
Health Risks of E-cigs
• There is little research on direct health effects
• One study shows short-term pulmonary effects
• There is evidence of cytotoxicity in animals and
humans
• No safety standards for e-cigarette components
• A few of the additional toxins in vapor:
– Ethylbenzene, Benzene, Toluene, Acetaldehyde, Naphthalene,
Styrene, Acrolein, Nickel, Chromium, Cadmium, Selenium,
Arsenic , Lead, Cobalt, Chlorobenzene, Crotonaldehyde,
Chrysene, Retene FDA 2012, Harmful and Potentially Harmful
Substances – Established List
Do E-cigarettes Reduce Harm?
• There are still a lot of unknowns about ecigarettes
• The hope that they will reduce harm by delivering
"clean" nicotine is debatable and will not be
realized in continuing dual users including the
cardiovascular risk
• Cancer risk may only be modestly
affected because smoking duration is
more important than intensity
Can be Used for Other Drugs
• E-cigarettes can be altered by users and be
used to deliver other drugs
Second-Hand Smoke
• E-cigarettes pollute the air less
than conventional cigarettes, but
they pollute the air
• They do not just emit "harmless
water vapor"
• People passively exposed to ecigarettes aerosol absorb nicotine
(measured as cotinine), with one
study showing levels comparable to
passive smokers
Cessation
• Marketed as healthier alternative to
tobacco smoking and as useful for quitting
• The temporal and causal relationships
between e-cigarette use and smoking
have not been determined
• There is a high level of dual use of ecigarettes and conventional cigarettes
among adults
• Used as a way to circumvent smoke-free
laws by enabling users to “smoke
anywhere”
Do They Help People Quit
• E-cigarettes have not been proven to help
people quit smoking
• Longitudinal population studies show that ecigarette use is associated with a lower odds of
quitting
• The randomized trial comparing e-cigarettes to
nicotine patch shows that in the context of low
level behavioral support, the quit rate for those
using e-cigarettes is low
The Rise of E-cigarettes
• Retail sales of over 1 billion
• U.S. comprises 30% of the 6 billion global
market
• Could surpass consumption of traditional
cigarettes in the next decade
• Youth use rose from 4% in 2011 to 10% in
2012
• In 2012 over 1.78 million middle and high
school students used them
Marketing
• E-cigarettes are evolving rapidly and being
marketed like cigarettes were in the 1950s and
1960s
• Aggressive placement in convenience stores
(next to candy or medications)
• E-cigarettes are marketed via television, the
Internet, and print advertisements
(that often feature celebrities)
Youth
• Youth are rapidly adopting e-cigarettes
• E-cigarettes contain candy flavors
(e.g., cherry, chocolate, turkish delight)
• Youth who use e-cigarettes are heavier smokers
• Youth who use e-cigarettes are much less likely
to have stopped smoking
• There are high levels of dual use
Promotion of E-cigarettes
Jenny McCarthy
promoting blu
e-cigarettes.
Logo: Take Back Your
Freedom
Marketing Sponsorships
Blu E-Cigs was the
primary sponsor of an
Indy car at the Toyota
Grand Prix of Long
Beach Race Event
(April 2013)
Tobacco Industry
• E-cigarette companies were competing with
conventional cigarette companies, but now all
the major cigarette companies are in the ecigarette business
• E-cigarette companies are using the same
political and public relations strategies as
cigarette companies (most notably organizing
users, similar to how the cigarette companies
organized smokers)
http://www.transformtobacco.com/Pages/default.aspx
Transform Tobacco: Issues in Indiana
Higher Taxes Affect You. State legislators can push for higher
cigarette taxes at any time. That’s why it’s important for you to
make your voice heard on this important issue by contacting your
elected officials today.
Call your elected officials: 1.866.658.8337 (toll-free)
• The excise tax on one pack of cigarettes in Indiana is currently
$0.995.
• Take a closer look at the cigarette tax dollars being collected in
Indiana in FY2013.
$434,473,203 Cigarette Excise Taxes
$31,159,532 Other Tobacco Products Taxes
$161,866,120 Cigarette Sales Taxes
$129,467,003 Tobacco Settlement
$756,965,858 Total Smoker Payments FY2013
Policy Making
• At a minimum, these policies should be
implemented immediately:
• Prohibit the use of e-cigarettes anywhere where
the use of conventional cigarettes is prohibited
• Apply the same restrictions on e-cigarette
advertising and promotion that apply to
conventional cigarettes
• Ban the use of characterizing flavors in ecigarettes
Policy Making Continued
• Prohibit claims that e-cigarettes are effective
smoking cessation aids until such time as there
is convincing scientific evidence that such
claims are true for e-cigarettes as they are
actually used in the general population.
• Regulate e-cigarettes to set standards for
product performance in order to minimize risks
to users and bystanders
• Tax them like cigarettes
What to Tell Your Patient
• Be sure the advice you are giving doesn’t
undermine their motivation to quit
• Follow the 5 As of evidence-based treatment:
– ask, advise, assess, assist, and arrange
• Refer to the Quit line (1-800-QUIT-NOW)
• If previous failure and wants to try
e-cigarettes, support them but
– Inform patients that products are unregulated,
contain toxic chemicals, and are not proven
cessation devices
Cessation Interventions
• Key recommendations:
• Clinicians should prescribe the first-line
medications that reliably increase long-term
smoking abstinence
– Chantix
– Zyban
– NRT
– classes
Three Phases of Nicotine Addiction
• Physical addiction – when your body and brain
feel different from lack of tobacco.
• Psychological addiction – when you need
tobacco to feel normal or deal with stress.
• Social addiction – when you see one of your
smoking friends and it triggers you to want to
use tobacco.
In order to quit, you must approach all three
aspects of the addiction.
Questions
• What questions do you have?