electronic cigarettes and tobacco products: hidden...

ELECTRONIC CIGARETTES AND

TOBACCO PRODUCTS: HIDDEN

DANGERS AND IMPLICATIONS

FOR PUBLIC HEALTH

John E. Biegel, III, MA, HO, REHS

Layal Helwani, BS, CHES

The Beginning of ENDS

• Early designs for a smokeless, non-tobacco cigarette originated as early as the 1960s

• In 2003, Chinese Pharmacist, Hon Lik, created the first commercially successful electronic cigarette after his father, a heavy smoker, died of lung cancer

• Introduced to the United States by 2007

What are ENDS?

• Battery-powered devices that people use to inhale an aerosol,

which may contain nicotine, flavorings, and other chemicals

• Usually consist of:

• a cartridge or reservoir, which holds a liquid solution

• a heating element (atomizer)

• a power source (usually a battery)

• a mouthpiece that the person uses to inhale

National Institutes on Drug Abuse-

https://www.drugabuse.gov/publications/drugfacts/electronic-cigarettes-e-cigarettes

First Generation: “Cig-a-Like”

• Designed to look and feel like traditional cigarettes

• Consisted of a battery, atomizer, and cartridge

• Disposable

https://www.cdc.gov/tobacco/data_statistics/sgr/e-cigarettes/pdfs/2016_sgr_entire_report_508.pdf

Second Generation: Mid-size E-Cigs

• Larger and typically do not resemble a cigarette

• Large, have separate cartridges (“tanks”) for liquids and flavorings

• Larger-capacity and rechargeable batteries, larger atomizers, and more powerful electronic circuits


Third Generation: Advanced Personal

Vaporizers• Generally larger and more customizable and contain a

range of different cartridge, atomizer, and battery options

• Cartomizers produce higher heating element

temperatures, generating more heat and affecting the

amount and quantity of the aerosol

• Overheating has been a problem


Who is Using

Electronic Cigarettes?

Estimated Percentage of Middle School

Students who Currently use any

Tobacco Products, 2011–2016


Estimated Percentage of High School

Students who Currently use any Tobacco

Products, 2011–2016


Trends in Ever E-cigarette Use among U.S. Middle

and High School Students; National Youth

Tobacco Survey (NYTS) 2011–2015


Trends in Past-30-day E-cigarette use among U.S.

Middle and High School Students; National Youth

Tobacco Survey (NYTS) 2011–2015


ENDS and Youth

• Current use of electronic cigarettes increased among

middle and high school students from 2011 to 2016

• About 4 of every 100 middle school students (4.3%)

reported in 2016 that they used electronic cigarettes in

the past 30 days—an increase from 0.6% in 2011

• About 11 of every 100 high school students (11.3%)

reported in 2016 that they used electronic cigarettes in

the past 30 days—an increase from 1.5% in 2011


Trends in Ever E-cigarette Use among U.S.

Adults by Age Group; 2010–2014


What’s in E-Cigarette

Aerosol?

What Teens Think is in their E-

Cigarette Aerosol

Source: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.

What’s Really in E-Cigarette Aerosol

• The e-cigarette aerosol that

users breathe from the device

and exhale can contain

harmful and potentially

harmful substances,

including:

• Nicotine

• Ultrafine particles that can be

inhaled deep into the lungs

• Flavoring such as diacetyl

• Volatile organic compounds

(e.g. Benzene)

• Cancer-causing chemicals

• Heavy metals (e.g. nickel, tin,

and lead)Source: National Institute on Drug Abuse;

National Institutes of Health; U.S. Department of

Health and Human Services.

E-Cigarette Aerosol Composition

Compounds in yellow are from FDA

2012, Harmful and Potentially Harmful

Substances – Established List

• Propylene glycol

• Glycerin

• Flavorings (many)

• Nicotine

• NNN

• NNK

• NAB

• NAT

• Ethylbenzene

• Benzene

• Xylene

• Toluene

• Acetaldehyde

• Formaldehyde

• Naphthalene

• Styrene

• Benzo(b)fluoranthe

ne

• Cadmium

• Silicon

• Lithium

• Lead

• Magnesium

• Manganese

• Potassium

• Titanium

• Zinc

• Zirconium

• Calcium

• Iron

• Sulfur

• Vanadium

• Cobalt

• Rubidium

• Benzo(ghi)perylene

• Acetone

• Acrolein

• Silver

• Nickel

• Tin

• Sodium

• Strontium

• Barium

• Aluminum

• Chromium

• Boron

• Copper

• Selenium

• Arsenic

• Nitrosamines,

• Polycyclic

aromatic

hydrocarbons

• Chlorobenzene

• Crotonaldehyde

• Propionaldehyde

• Benzaldehyde

• Valeric acid

• Hexanal

• Fluorine

• Anthracene

• Pyrene

• Acenaphthylene

• Acenapthene

• Fluoranthene

• Benz(a)anthracene

• Chrysene

• Retene

• Benzo(a)pyrene

• Indeno(1,2,3-

cd)pyrene

All of these have been

found in e-cigarette/vape

pen aerosol

http://www.who.int/fctc/cop/cop7/FCTC_COP_7

_11_EN.pdf

Nicotine

• Most e-cigarettes contain nicotine, which has known health

effects

• Nicotine is highly addictive

• Affects ability to pay attention, reason, learn, control impulses

• Nicotine is toxic to developing fetuses

• Nicotine can harm adolescent brain development

https://www.cdc.gov/tobacco/data_statistics/sgr/e

-cigarettes/pdfs/2016_sgr_entire_report_508.pdf

Nicotine Poisonings

Year Number of Cases

2011 271

2012 460

2013 1,543

2014 4,024

2015 3,774

2016 2,886

2017 2,454

2018 237

# of Nicotine exposures/poisonings by year

due to nicotine found in e-juice


Source: National Institute on Drug Abuse;

National Institutes of Health; U.S. Department of

Health and Human Services.

Flavorings

• Numerous flavorings

used in electronic

cigarettes

• The flavorings are

generally recognized

as safe (“GRAS”) for

ingestion, but not for

inhalation

Propylene Glycol

• Commonly used as a base for e-liquids; helps

produce vapor

• Used to maintain moisture in certain

medicines, cosmetics, or food products

• Short-term exposure in indoor air causes

irritations in the eyes, throat and airways

• Long-term exposure in indoor air may raise

children’s risk of developing asthma

http://www.gaspforair.org/gasp/gedc/pdf/E-CigSmoke.pdf

Diacetyl

• A buttery-flavored chemical found in microwave popcorn, caramel, and dairy products

• Linked to deaths and hundreds of cases of bronchiolitis obliterans (“popcorn lung”), a serious and irreversible lung disease

• Researchers at Harvard found that 39 of 51 e-cigarette brands contained diacetyl

http://www.lung.org/about-us/blog/2016/07/popcorn-lung-risk-ecigs.html

Formaldehyde

• A colorless, flammable, strong-smelling chemical found in pressed-wood products, cigarette smoke, and fuel-burning appliances

• A known human carcinogen by the International Agency for Research on Cancer

• Associated with the development of several cancers, including nasopharyngeal cancer and leukemia


Cadmium

• The main sources of cadmium in the air are the burning of fossil fuels such as coal or oil and the incineration of municipal waste

• Acute effects in humans through inhalation exposure consist mainly of effects on the lung, such as pulmonary irritation

• Chronic (long-term) inhalation or oral exposure leads to a build-up of cadmium in the kidneys that can cause kidney disease

• Animal studies have demonstrated an increase in lung cancer from long-term inhalation exposure to cadmium


Other Risks Associated

with E-Cigarettes

E-Cig Explosions• Between 2009-2016, 195

separate incidents of explosion and fires involving an electronic cigarette were reported by the U.S. media

• The shape and construction of electronic cigarettes can make them more likely than other products with lithium-ion batteries behave like “flaming rockets” when a battery fails

https://www.usfa.fema.gov/downloads/pdf/publications/electronic_cigarettes.pdf

https://www.usfa.fema.gov/downloads/pdf/publications/electronic_cigarettes.pdf

Trends in Advertising

E-Cigarette Advertising and Youth

Point-of-Sale Audits in Essex and Passaic

Counties• Looked at advertising and pricing patterns among South

Orange and Clifton tobacco retailers near schools

• 49 out of 59 tobacco retailers were located within ¼ of a school

• 29 out of 49 tobacco retailers near a school displayed exterior advertising

• Both highest/lowest priced e-cigarettes were sold for cheaper prices at tobacco retailers near a school

• At tobacco retailers near schools, even cheapest cigarettes were sold for higher prices than those within 4+ blocks from a school

7,700+ E-Juice Flavors…

FDA Regulation of

E-Cigarettes

FDA Regulation of E-Cigarettes:

Manufacturers2016-

• Stop distributing products with modified risk claims (other than

“light,” “low,” or “mild”)

2017-

• Submit tobacco health documents

• Register establishment and submit list of products, including

labeling and advertising

• Stop manufacturing products with modified risk claims unless you

have a Modified Risk Tobacco Product order in place by November

8, 2017

• Include required warning statements on packages and

advertisements

2019-

• Submit quantities of harmful and potentially harmful constituents

FDA Regulation of E-Cigarettes:

Retailers• Check photo ID of everyone under age 27 who attempts to purchase

e-cigarettes or other ENDS

• Only sell e-cigarettes and other ENDS to customers age 21 and older

• Do NOT sell e-cigarettes or other ENDS in a vending machine unless in an adult-only facility

• Do NOT give away free samples of e-cigarettes or other ENDS to consumers, including any of their components or parts

Beginning August 10, 2018, • Do NOT sell or distribute e-cigarettes or other ENDS without a health warning

statement on the package

• Do NOT display advertisements for e-cigarettes or other ENDS without a health warning statement

What is the Clifton Health

Department doing about Vaping?

Education

Enforcement

NJ Smoke

Free Air

Act

What Other Cities in NJ are Doing about

Vaping

E-Cigarettes: A Growing

Trend

• Good Guy Vapes-Clifton:

• https://www.youtube.com/watch?v=JU1SpzNTVSg

• Good Guy Vapes-East Brunswick:

• https://www.youtube.com/watch?v=gnf_eMLCOEg

https://www.youtube.com/watch?v=JU1SpzNTVSg

https://www.youtube.com/watch?v=gnf_eMLCOEg

John E. Biegel, IIIHealth Officer

Clifton Health Department

973-470-5763

[email protected]

Layal Helwani

Health Educator

Clifton Health Department

973-470-5760

[email protected]

mailto:[email protected]

mailto:[email protected]

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