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E-cigarettes: Risks, Marketing, and Regulation
- 1. Electronic (e)-cigarettes by Maria Azzarelli Southern Nevada Health District Tobacco Prevention and Control Program
- 2. Electronic Cigarettes Background • Nicotine delivery device first developed in China in 2004 • Include a battery component, a vaporizer, a cartridge filled with liquid nicotine and an inhaler. • Commonly known as e-cigarette, e-cig, vape pens, or vapor. • When the user puffs on the inhaler, the battery causes the tip of the e- cigarette to glow and the heat created by the battery turns the liquid nicotine into an aerosol of liquid, flavorings and nicotine. • Available in numerous flavors • Using an e-cigarette is commonly referred to as vaping.
- 3. The Doctors
- 4. Refillable and Disposable • The e-cigarette can be sold as a metal tube that requires refillable containers of nicotine and flavorings, often called juice, and the cartridge can contain up to 20mg of nicotine or more. • Some of the flavors available include coffee, tobacco, apple, strawberry, banana and bubble gum. • There are numerous inexpensive e-cigarettes available that are disposable and don’t require refilling the cartridge. These products can be discarded once the user depletes the liquid nicotine. These products can look like a marker or pen.
- 5. E-cigarette Prevalence • A nationally-representative survey conducted by the American Legacy Foundation found that 40.2% of Americans have heard of e- cigarettes and more than 70.0% of smokers believe that e-cigarettes are less harmful than regular cigarettes. • The most commonly cited reasons for use by e-cigarette users include: the perception that they are healthier/less toxic than traditional cigarettes, aid in tobacco craving/withdrawal symptoms, smoking cessation facilitator, and relapse avoidance. • Results from the 2012 National Youth Tobacco Survey (NYTS) indicate that more than 1.78 million middle and high school students nationwide tried e-cigarettes. • The 2012 NYTS also found that 76.3% of middle and high school students who used e- cigarettes within the past 30 days also smoked conventional cigarettes. This raises concerns that e-cigarettes may be an entry point to conventional tobacco products. 11 yr olds Instagram Vape post
- 6. E-cigarette Safety and Quality • 2009 FDA studied 2 brands of e-cig and found: – Carcinogens and heavy metals found in juice and vapor – Quality control was inconsistent or non-existent – Nicotine free e-cigs contained nicotine – Nicotine levels varied, sometimes twice as high as FDA approved devices – Not recognized as quit smoking devices • Nicotine is highly addictive and is a vasoconstrictor meaning it instantly narrows blood vessels.
- 7. Secondhand Aerosol • E-cigarettes do not just emit “harmless water vapor.” Secondhand e-cigarette aerosol (incorrectly called vapor by the industry) contains nicotine, ultrafine particles and low levels of toxins that are known to cause cancer. • E-cigarette aerosol is made up of a high concentration of ultrafine particles, and the particle concentration is higher than in conventional tobacco cigarette smoke. • Exposure to fine and ultrafine particles may exacerbate respiratory ailments like asthma, and constrict arteries which could trigger a heart attack. • At least 10 chemicals identified in e-cigarette aerosol are classified as carcinogens and reproductive toxins. The compounds that have already been identified in mainstream (MS) or secondhand (SS) e-cigarette aerosol include: Acetaldehyde (MS), Benzene (SS), Cadmium (MS), Formaldehyde (MS,SS), Isoprene (SS), Lead (MS), Nickel (MS), Nicotine (MS, SS), N- Nitrosonornicotine (MS, SS), Toluene (MS, SS). Data from Americans for Nonsmokers’ Rights Fact Sheet http://no-smoke.org/pdf/ecigarette- secondhand-aerosol.pdf
- 8. Secondhand Aerosol Continued • E-cigarettes contain and emit propylene glycol, a chemical that is used as a base in e-cigarette solution and is one of the primary components in the aerosol emitted by e-cigarettes. – Short term exposure causes eye, throat, and airway irritation. – Long term inhalation exposure can result in children developing asthma. • Even though propylene glycol is FDA approved for use in some products, the inhalation of vaporized nicotine in propylene glycol is not. Some studies show that heating propylene glycol changes its chemical composition, producing small amounts of propylene oxide, a known carcinogen. Data from Americans for Nonsmokers’ Rights Fact Sheet http://no-smoke.org/pdf/ecigarette- secondhand-aerosol.pdf
- 9. E-cigarette Marketing and Commercial Appeal •The e-cigarette companies advertise their products as a better- smelling, cheaper, and guilt-free alternative to smoking. They are also marketed as a way to circumvent some smoking bans. •E-cigarettes are promoted heavily online and are more widely searched than NRTs (nicotine replacement therapy). •There is concern that e-cigarettes may appeal to youth because of their high-tech design, easy availability online or via mall kiosks, and the wide array of flavors of cartridges.
- 10. E-cigs industry using Big Tobacco’s Playbook • Celebrity spokespeople • Print ads feature rugged men and glamorous women • Sex sells • Sponsor sports and music festivals • Products available in sweet flavors • Use cartoons • Their ads say “Switch, Don’t quit.”
- 11. Celebrity Use/Endorsements of e-cigs/Glamorization • Other celebrities that have been known to smoke electronic cigarettes, but haven’t been caught on a camera yet include Mel Gibson, Miley Cyrus, Kate Moss, Ryan Seacrest, Ashley Greene, Nikki Reed, Harrison Ford, Jeremy Piven, and Kate Middleton Leonardo DiCaprio Robert Pattinson Katherine Heigl Lindsay Lohan Johnny Depp Jenny McCarthy Dennis Quaid Charlie Sheen Courtney Love Stephen Dorff Brittany Spears Paris Hilton Catherine Zeta Jones Zayn Malik Michelle Rodriguez Carrie Fisher Tom Petty
- 12. Print ads feature rugged men and glamorous women
- 13. Sex sells
- 14. Sponsor sports and music festivals
- 15. Products available in sweet flavors
- 16. Cartoons
- 18. Local TV Ad during Superbowl
- 20. E-cigs for Marijuana smoking • Orange County, California reporting increasing number of teens filling e-cigs with THC (psychoactive substance in marijuana) oil, Hemp oil, hash wax, which can deliver a more potent high than using marijuana via traditional smoking methods. • Numerous videos on YouTube demonstrating how to use e- cigarettes to smoke marijuana derivatives. • Some web forum discussions around smoking meth using e-cigs.
- 21. E-cigarette Legal Status and Regulation • FDA does have authority over e-cigs as tobacco products – Marketing restrictions – Mandated ingredient listing – Pre-market review • No FDA rules yet • As of 1/2/14, 108 municipalities and three states prohibit e-cig use in smoke free environments. – Others are banning or limiting the sale of e-cigarettes to minors. – Another approach is to regulate who can sell e-cigarettes, by requiring tobacco retailer licensure in order to sell. – Taxing e-cigarettes and liquid nicotine (juice) as tobacco products. – Limiting flavors
- 22. E-cigarettes in Nevada • Result of 2013 Legislative session: Local regulation is NOT permitted • NO age restriction for purchase or use • NOT covered under Nevada Clean Indoor Air Act • NO restrictions on advertising • NOT taxed as tobacco products • NO tobacco retailer license required to sell e-cigs in Nevada • Sept. 2013: 41 Attorneys General including NV AG Masto asked FDA to regulate. AG’s office will work on limiting youth e-cig access next legislative session. • Numerous NV businesses and organizations have voluntarily implemented restrictions on the use of e-cigs indoors and outdoors. • Added e-cig use question to 2013 Behavioral Risk Factor Surveillance Survey to determine adult e-cig prevalence.
- 23. E-cigarette Attitudes and Concerns • 40% of Americans have heard of e-cigs • 70% of smokers believe they are less harmful • 10% of high school students have used them • May increase “dual” use • May “re-normalize” tobacco • May be a gateway to cigarettes
- 24. Acknowledgments and Resources •Many of the slides in this presentation were developed from content contained in fact sheets, websites, and other materials developed by the American Legacy Foundation, Campaign for Tobacco Free Kids, Americans for Non Smoker’s Rights, Centers for Disease Control and Prevention and Public Health Law Policy Center. Resources: http://no-smoke.org/pdf/ecigarette-secondhand-aerosol.pdf http://health.nv.gov/PDFs/Tobacco/TobaccoBurdenDocument_FINAL.pdf http://www.tobaccofreekids.org/facts_issues/toll_us/nevada http://www.legacyforhealth.org/content/download/582/6926/file/LEG-FactSheet- eCigarettes-JUNE2013.pdf http://www.cdc.gov/tobacco/data_statistics/fact_sheets/
- 25. Questions For more information on SNHD’s Tobacco Control Program visit www.gethealthyclarkcounty.org or call (702) 759-1270.
Notes de l'éditeur
- On July 22, 2009 the U.S. Food and Drug Administration’s (FDA) Division of Pharmaceutical Analysis analyzed the ingredients in a small sample of cartridges from two leading brands of e-cigarettes and found that the tested products contained detectable levels of known carcinogens and toxic chemicals. Diethylene glycol, a potentially lethal organic compound,9 was found in one cartridge, while nitrosamines were detected in several cartridges.10 Other important findings from the FDA include the following: The quality control processes used to manufacture e-cigarettes seem to be inconsistent or non-existent. Three different e-cigarette cartridges with the same label were tested and each emitted a distinct amount of nicotine with each puff.In all but one, the e-cigarette cartridges that were labeled as containing no nicotine had low levels of nicotine. The vapor from one high-nicotine cartridge delivered twice as much nicotine when inhaled than was delivered by the control, a sample of FDA-approved nicotine inhalation products. Studies suggest adverse effects associated with e-cigarettes, but additional non-biased national and international research is needed to understand the effects of both short- and long-term use E-cigarettes and nicotine containers can be deadly to children or pets, who risk nicotine poisoning from ingesting the liquid nicotine. Some refill bottles contain over 1,000 mg of nicotine, and the fatal dose for children is estimated at only 10 mg and for adults 30-60 mg.
- Many vape shop and e-cig vendors will tell you that propylene glycol is harmless because it is found in many foods and products, but heating PG produces propylene oxide a known cancer causing agent
- Perceptionthat using hookah is safer than smoking cigarettes so e-cig companies have used that same thought pattern to promote e-hookah which is an essence an e-cigarette made in fruity flavors.
- LA County ad LBC recently banned e-cig use indoors. Minnesota is taxing e-cigs. Chicago banned indoors. In mid 2008, the Food and Drug Administration (FDA) tried to establish authority over e-cigarettes as drug delivery devices and stopped all shipments of e-cigarettes from entering the US. FDA was sued by e-cigarette manufacturers and sellers to allow them to enter the country. In 2010, the court ruled that the FDA may not regulate e-cigarettes as drugs or drug delivery devices if they are not marketed as tobacco cessation aids. Shipments of e-cigarettes were allowed into the US. The court found that the FDA does have the ability to regulate e-cigarettes as tobacco products. Federal regulation development is a lengthy process with many limitations including the inability to regulate where e-cigarettes are used. Many state and local governments have passed laws to prohibit sale to minors. In April 2011, the FDA issued a statement announcing that they intend to regulate e-cigarettes as “tobacco products.” This includes: (1) marketing restrictions, (2) mandated ingredient listing, and (3) pre-market review. However, to date, FDA has not asserted its authority over e-cigarettes and they remain unregulated. Several state and local governments, including New Jersey and King County, Washington, have included or are in the process of adding e-cigarettes to their smoking bans. Additionally, the U.S. Department of Transportation banned the use of e-cigarettes on planes. California, Minnesota, New Hampshire, New Jersey, and Utah have prohibited the sale of e-cigarettes to minors since March 2011.
- As a result of 2013 Nevada legislative session, Altria aka Philip Morris introduced an amendment to a youth tobacco possession bill. The amendment resulted in preemption being reinstituted in the Nevada Clean Indoor Air Act. This means that local governments in Nevada can not create stricter-rules as it relates to e-cigarettes.Additionally, as currently written the Nevada Clean Indoor Air Act does not prohibit the use of electronic cigarettes indoors.E-cigarettes are heavily advertised in Nevada (TV, radio, print, web, billboards, kiosks in malls, store fronts )Developed free dpo
- A nationally-representative survey found that 40.2% of Americans have heard of e-cigarettes and more than 70.0% of smokers believe that e-cigarettes are less harmful than regular cigarettes.The most commonly cited reasons for use by e-cigarette users include: the perception that they are healthier/less toxic than traditional cigarettes, aid in tobacco craving/withdrawal symptoms, smoking cessation facilitator, and relapse avoidance.In addition to the health concerns cited above, recent studies suggest that e-cigarettes could be worrisome regarding relapse of former smokers, the “re-normalization” of tobacco, and a gateway for cigarettes. It is also thought that e-cigarettes can contribute to tobacco use by allowing smokers to use nicotine despite ever-increasing smoking bans (dual use). Since they recently emerged on the market, however, more research must be done to fully understand the consequences. The World Health Organization (WHO) expressed concern with e-cigarettes, stating they may undermine tobacco control efforts, such as smoking bans and FDA-approved NRTs. Several countries, including Australia, China, and Brazil have banned the sale and marketing of e-cigarettes.