E-Cigs vs Traditional - PowerPoint Presentation

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E-Cigs vs Traditional Cigs: Where do we Stand??

Geoff Wilson, LCSW, CADC

The Ridge Behavioral HealthSlide2

Are We Still Concerned??Cigarette smoking is the leading cause of preventable disease and mortality in the United States, and is usually initiated in adolescence.

That

makes

what happens

in adolescence particularly

important!Slide3

Leading Preventable DeathSlide4

Monitoring the Future 2014Slide5

TobaccoFour in every ten American young people (40%) have tried cigarettes by 12th grade, and nearly one in six (17%) 12th graders is a current smoker.Even as early as 8th grade, one in six (16%) has tried cigarettes, and 1 in 20 (5%) has already become a current smoker.

In 2012, cigarette use reached the lowest levels recorded in the life of the MTF studySlide6

Perceived Risk of Cigarette UseBy 2012 levels of perceived risk were the highest ever observed, but they leveled after that. There

is a clear age effect: by the

time most

youngsters fully appreciate the hazards

of smoking

, many already have initiated the behavior.Slide7

Trends of Cigarette UseBy 2014, 30-day prevalence levels were down from peak levels by 81%, 77%, and 63% in grades 8, 10, and 12, respectively.

An

increase

in 2009

in federal taxes on cigarettes (from $0.39

to $1.01

per pack) may have contributed to the

recent decline

in use.Slide8

AvailabilitySince 1996, availability has declined considerably, especially among 8th and 10th graders. Some 47% of 8th graders and 69% of 10th graders now say that cigarettes

would be very easy or fairly easy to

get, reflecting

declines of 39% and 24%,

respectivelySlide9

Remember when… Slide10

TobaccoIn 2012, 6.7% of middle school and 23.3% of high school students currently used tobacco products, including cigarettes, cigars, hookahs, snus, smokeless tobacco, pipes, bidis, keteks, dissolvable tobacco, and electronic

cigarettesSlide11

E-cig Use by Youth, 2011-2012In 2012, 1.78 million U.S. teens tried e-cigarettes and 160,000 of them were non-smokers!

6

th

-12

th

grades: ever use of e-cigarettes increased 3.3% to 6.8% (more than doubled)

High

school students: ever-use increased 4.7% to 10%

Dual use:

76% of middle and high school students who had used

e-cigs

in the past 30 days had also smoked conventional cigarettes in the same time

periodSlide12

Monitoring the Future: E-CigsIn 2014 more teens used e-cigarettes in the past 30 days than traditional tobacco cigarettes or any other tobacco product. MTF is the first national study to document this finding.

Specifically

,

30-day prevalence

of e-cigarette use was 8.7%, 16.2%,

and 17.1

% in 8th, 10th, and 12th grade.

The corresponding

prevalence for tobacco cigarette

use was

4.0%, 7.2%, and 13.6%. Note that in 8th

and 10th

grades e-cigarette prevalence is more

than twice

the prevalence of regular cigarettes

.

E-cigarettes have

the lowest perceived risk for

regular use

than any other drug in the survey,

including alcohol

.Slide13

E-cigs and schoolsProducts that look like pens or highlighters can easily be hidden by students in schools and classrooms. Teachers may not recognize e-cigs, and smoke detectors won’t catch the aerosol.Slide14

E-cigarette Use in KYIn 2012, the Kentucky Regional Poison Control Center of Kosair Children's Hospital reported a 333 percent increase in calls

attributed

to e-cigarette

cartridges.

E-cig sales

in participating Kentucky retail outlets

increased from $8,392

in

2011

to nearly $1.7 million in

2012 (excludes online sales).

Nationally, poison control centers have seen a 161 percent increase in calls from people with concerns about these devices. Slide15

Smokeless tobacco comes in a variety of candy flavorsSlide16
Slide17

HookahHookah- water pipes that are used to smoke specially made tobacco that comes in different flavors, such as apple, mint, cherry, chocolate, coconut, licorice, cappuccino, and watermelon

In the US it has become more popular among teens and young adults and in college towns, seen as a “popular social activity”Slide18

Hookah

The hookah device consists of four parts:

A base, or smoke chamber, which is partially filled with water

A bowl, which contains tobacco and the heating source

A pipe that connects the bowl to the base and dips into the water in the base

A hose, a second tube in the pipe that does not dip into the water but opens into air in the base and allows users to inhale the hookah smoke

When a smoker inhales through the tube, a pressure difference forces air past the heating source and heats the tobacco, which gives off smoke. The smoke is pulled away from the tobacco and passes through the water and into the smoke chamber — from which it is inhaled by the smoker. Slide19

The World Health Organization noted in a report from 2011 that the smoke inhaled in a typical one-hour hookah session can equal 100 cigarettes or more.The WHO report also stated that even after it has been passed through water, the tobacco smoke in a hookah pipe contains high levels of cancer-causing chemicals.Slide20

Just like a cigarette? As with cigarette smoking, hookah

smoking is linked

to lung and oral

cancers, heart

disease and other

serious illnesses.

Hookah smoking delivers about the same amount of nicotine as cigarette smoking does, possibly leading to tobacco dependence. Slide21
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E-Cigarettes &

Personal VapesSlide23

What is it? How does it work?

Electronic cigarette: smokeless, battery operated device used to deliver nicotine with flavorings or other chemicals to the lungs.

Vaporizer pen “vape pen”: hand-held device used to generate an inhalable vapor from a solid, semi-solid, or liquid substance.

Specifically designed to vaporize THC.

Both use the same technology, leave no detectable odor, and are similar in appearance.Slide24

BHO-Butane Honey Oil"Butane honey oil" is a super-potent type of hash that has surged on the marijuana market. The "dabs" of oil can be vaporized and inhaled without the pungent smell of weed, and produce a soaring high for even longtime cannabis smokers with a strong tolerance for the drug. But it has also blown up in the faces of those making it, sending at least 17 people with catastrophic injuries to burn centers in Southern California in the last 14 months. Slide25
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Teens may not call them e-cigarettes

“disposable hookah”

“hookah pen”

“e-hookah”

“vape pipe”

“vape pen”

Note

. Some e-cigs connect to other electronic devices to play music and answer callsSlide29

E-PipesE-CigarsE-HookahE-?E- EverythingSlide30

E-cigarettes have been around since the 1960s. Started to take off in the last decade with more than 250 brands and flavors like watermelon, pink bubble gum and Java.

Estimated

4

million Americans

use them, according to the Tobacco Vapor Electronic Cigarette Association.

Researchers

compared e-cigarettes to nicotine patches and other smoking cessation methods and found them statistically comparable in helping smokers quit over a six-month

period

According to a CDC study: nearly

1.8 million young people

had tried e-cigarettes and the number of U.S. middle and high school students e-smokers doubled between 2011 and 2012

.Slide31

The FDA warns…E-cigarettes can increase nicotine addiction among young people and may lead kids to try other tobacco products, including conventional cigarettes, which are known to cause disease and lead to premature death

The products may contain ingredients that are known to be toxic to humans

Conducted a preliminary analysis on some samples of electronic cigarettes and components from two leading brands. Slide32

E-cigarettes are a Tobacco ProductSottera Inc. v. Food & Drug Administration, 10- 5032, U.S. Court of Appeals, District of Columbia Circuit (Washington

)

FDA wanted to regulate e-cigarettes as electronic nicotine delivery device, but…

Judge ruled in favor of Sottera (maker of N-Joy) that

e-cigarettes are a tobacco product

.

E-cigarette industry advocating for less regulation than with other tobacco products.Slide33

E-cigarettes need to be regulated just like tobacco smoking (ASHRAE & WHO, 2014)E-cigarettes emit harmful chemicals, some of which are known to cause cancer (formaldehyde, metals [cadmium

, lead,

nickel], nitrosamines).

These chemicals are contained in visible

aerosol

consisting

of condensed submicron liquid

droplets.

The

Hazards of E-cigarettes

by Offermann, ASHRAE (American Society of Heating, Refrigerating and Air-Conditioning Engineers) Journal, June 2014Slide34

FDA 2009 Study RevealedDPA's analysis revealed the following:

Diethylene

glycol

was detected in one cartridge at approximately 1%.

An

ingredient used in

antifreeze and is

toxic to humans.

Certain tobacco-specific nitrosamines which are

human carcinogens

were detected in half of the samples tested.

Tobacco-specific

impurities

suspected of being harmful to

humans

The

electronic cigarette cartridges that were labeled as containing no nicotine

had low levels of nicotine present in all cartridges tested

, except one.

Three different electronic cigarette cartridges with the same label were tested and each cartridge emitted a markedly different amount of nicotine with each puff. The nicotine levels per puff ranged from

26.8 to 43.2 mcg nicotine

/100 mL puff.

One

high-nicotine cartridge

delivered

twice as much nicotine

to users when the vapor from that electronic cigarette brand was

inhaledSlide35

E-smoking: Health ConcernsE-smoking gives off aerosol, not water vapor. The aerosol contains a mix of toxic gases and tiny particles: propylene glycol

(lung and eye irritant);

formaldehyde

and

β-nicotyrine (cause cancer);

metal

& silicate particles (toxic to human cells); and

nicotine

(addictive and harmful to unborn babies).

Not FDA-approved as a quit aid.

Nevertheless, e-cigs marketed as cessation aids, either overtly or covertly.

E-cigs may encourage dual use vs. switching altogether.Slide36

E-cigarettes pollute the airE-cigs give off tiny particles that can be inhaled deep into the lungs.Use of electronic cigarettes (e-cigarettes) impairs indoor air quality and increases FeNO levels of e-cigarette consumers

by Schober, Szendreia, Matzena, Osiander-Fuchs, Heitmann, Schettgend, Jörres,and Fromme, International Journal of Hygiene and Environmental Health, 2013.

The size & number of particles emitted from e-cigarettes are similar to conventional cigarettes.

E-Cigarettes

: A Scientific Review by

Rachel Grana, Neal Benowitz and Stanton A. Glantz, Circulation, 2014

.

The e-cigarette aerosol also contains metals and silicate particles.

Metal

and Silicate Particles Including Nanoparticles Are Present in Electronic Cigarette Cartomizer Fluid and Aerosol

by Williams, Villarreal, Bozhilov, Lin & Talbot, PLOS, 2013.Slide37

Propylene glycolFound in antifreeze, de-icing agents in cars, planes, and boats.Slide38

Strong adverse effects

Pneumonia

Congestive heart failure

Disorientation

Seizure

Low blood pressure

Chest pain

Second degree burns to face

Loss of vision

Possible infant death from choking on EC

Physically ill

PoisoningSlide39

Where’s the disconnect?Nicotine is nicotineSlide40

Nicotine causes a dopamine release in the brain’s limbic system.Slide41
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Nicotine – a POISON!Large amounts of nicotine are lethal (60 mg adult, 6 mg children)Is also an

insecticide

and

toxicant

The number of poisoning cases linked to e-cigarettes liquids was

1,351

in 2013, a

300%

increase from 2012

According to the National Poison Data System, these number are on pace to

double

in 2014Slide44

What do we know today is in the vapor?E-cigarette users exhale – passive vaping like secondhand smoke does happen.

This chemical aerosol is not “just” water vapor.

Studies so far show it contains:

nicotine

propylene glycol

fine & ultrafine (UF) particles

low levels of toxins known to cause cancer

nanoparticles of chromium, nickel, tin

volatile organic compounds (VOCs)Slide45

Research has been so limited, but new trends are emergingPossible RisksSlide46

Health EffectsA study examining the biological effects of e-cigarettes found “strikingly similar” gene mutations in lung cells exposed to e-cig

vapor

as those found in smokers

.

This means that although e-cigarette

vapor

is tobacco and tar-free and that the device does not require combustion, it could potentially increase a user’s

risk of

cancer

.

Another study published in

Germany examined secondhand emissions from several e-cigarettes in a human exposure chamber. 

While

the e-cigarette produced

lower

levels of toxins in the air for nonsmokers to breathe than the conventional cigarette, there were still elevated levels of

acetic acid

,

acetone

,

isoprene

,

formaldehyde

and

acetaldehyde

, averaging around 20% of what the conventional cigarette put into the

air.

Putting

detectable levels of several significant carcinogens and toxins in the

airSlide47

Exploding E-CigsIn 2012 a Florida man suffered severe

injuries from an electric cigarette that exploded in his

mouth. Knocked

out all

of his

teeth and part of his tongue. The event also set fire to the room.

https

://

www.youtube.com/watch?v=x1VrzgeG7jkSlide48

“Gateway Drug”Increased risk of addiction to cocaine and other drugsNicotine greatly enhanced the effect of cocaine in miceCocaine dependence greater in heavy smokers (>100 cigarettes before using cocaine)

Nicotine acts as a gateway drug with the effects of addiction, especially in adolescentsSlide49

We’ve already fought this battle with Big Tobacco…Trends in AdvertisingSlide50
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What is the message?

Keep smoking

Take back your “right to smoke”

Rebellion

It’s

not about

quittingSlide56

Harm Reduction?Not a safe alternative but may be less harmful than conventional cigarettes

Nicotine addiction



a possible gateway to conventional smoking

Majority of

e-cig

users still

use conventional

cigarettes. This “dual-use” undermines or eliminates potential health

benefits of quitting.Slide57

Are E-cigs less harmful than conventional cigarettes?Even if less harmful, will they….

Keep

smokers smoking (bridging and/or using

methods that are not evidence-based)?

Attract

youth users who

progress

to conventional

cigarettes?

Lure

former smokers back into

smoking?Slide58

The Bottom LineE-cigarette aerosol contains toxic gases and tiny particles that are emitted into the air. For this reason, they should be covered under smoke- and tobacco-free policies.

Workers

and patrons are exposed to secondhand aerosol from e-cigarettes.

E-smoking creates

a dense mix of

aerosol

and fine particles that

looks like tobacco smoke

. If exempt from tobacco-free policies, the

‘smoky

look’

creates confusion

with enforcement

.

Note

: Electronic cigarettes are not approved as a quit aid by the FDA

!Slide59

What WorksNicotine free school campuses- school policies

Keeping the price of nicotine products high

Restricting nicotine devices’ marketing and other activities

Mass media campaigns to reduce initiation

Reinforcing a tobacco/nicotine-free norm

Kids' perceptions of how many people are smoking is a major factor in whether they decide to smokeSlide60

Ask Us!Kentucky Center for Smoke-free Policywww.kcsp.uky.edu

kcsp00@lsv.uky.edu

859-323-4587

Thank you to Amy Barkley, Campaign for Tobacco-free Kids

for allowing me

to adapt

some of her slides

,

Electronic Cigarettes:  

What

They Are,

How

They’re Marketed,

&

How We Can Protect Our

Youth

, 11/20/13, Richmond VA.Slide61

Thank You!!The presenter would like to credit:Ellen J. Hahn, PhD, RN, FAANKentucky Center for Smoke-free Policy

University of Kentucky

College of Nursing

And

The Prevention

Department

Tri- County Mental Health Services

3100 NE 83

rd

St. Suite 1001

Kansas City, MO

6411