Electronic Cigarettes in Context:
79K - views

Electronic Cigarettes in Context:

Similar presentations


Download Presentation

Electronic Cigarettes in Context:




Download Presentation - The PPT/PDF document "Electronic Cigarettes in Context:" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.



Presentation on theme: "Electronic Cigarettes in Context:"— Presentation transcript:

Slide1

Electronic Cigarettes in Context:

What we know and still need to find out

Evan L. Floyd, PhD*

#

David Johnson, PhD, PE, CIH*

Theodore Wagener, PhD

+#

*Department of Occupational and Environmental Health

+

Department

of Pediatrics,

Co-Director OTRC

#

OUHSC, Oklahoma TSET Research Scholar

Slide2

Overview

Toll of Tobacco

e-cigarettes/vapor products design

Proposed Rule by FDA (April 25, 2014)

Toxicology – mainstream and secondhand vapor

Nicotine delivery and abuse liability

Subjective effects and smoking behavior

What we still need to find out…

e-cigarettes in context of proposed “Tobacco End Game”

Slide3

Tobacco Toll: US and Oklahoma1

US

19% smoking rate

443,000 deaths per year

$193 billion in medical costs/lost productivity

Oklahoma

23.3% smoking rate

6,500 deaths per year

$2.8 billion in medical costs/lost productivity

Slide4

e-Cigarette Product Designs

Slide5

e-Cigarettes/Vapor products design

“cig-a-like” e-cigarettesAka – 1st generation e-cigsLook like regular cigarettesActivated by inhaling; cartridge-basedTobacco companies have these type of e-cigs Lorillard – acquired BluRJR – developed VuseAltria – acquired Green Smoke and developed MarkTen

Slide6

e-Cigarettes/Vapor products design

Tank system e-cigarettesDo not look like a cigaretteActivated by push button; user refillable e-liquid; some are variable voltage; different resistance atomizers availableCurrently none owned (to my knowledge) by Tobacco IndustryVape shops sell these types

Slide7

e-Cigarettes/Vapor products design

Rebuildable Atomizers (RBAs)Doesn’t look like a regular cigarette“Drip Vaping”, 2-3 drops of e-liquid at a time; Push button activatedHigh Powered; custom coils with low resistance, high voltagesCurrently none own by tobacco industryVape shops sell these typesUsed mostly by experienced users

Slide8

FDA Proposed Rule

To deem all products meeting the statutory definition of “tobacco product” except accessories… to be subject to FDAs tobacco product authorities under chapter IX of the FD&C Act as amended by the Family Smoking Prevention and Tobacco Control Act.”

Currently marketed products meeting the statutory definition of a “tobacco product” are

Dissolvables

Gels

Hookah tobacco

Electronic cigarettes

Cigars

Pipe tobacco

Slide9

FDA Proposed Rule

FDA does not intend to “deem” accessories since they are not intended or expected to be used in the consumption of the tobacco producthookah tongs, bags, cases, charcoal burners and holders, as well as cigar foil cutters, humidors, carriers, and lightersFDA does intend to “deem” components and parts of tobacco products to be subject to the TCAfilters, tubes, papers, pouches, flavorings (such as flavored hookah charcoals and hookah flavor enhancers) or cartridges for e-cigarettes

Slide10

Toxicology (only 1st gen e-cigs)

Preliminary data (20 peer-reviewed articles/reports)

e-cigarette users are exposed to lower levels of carcinogens and toxicants than cigarette smokers.

Levels 9-450x less than cigarettes and some comparable to nicotine inhaler

E-cig aerosols and liquid significantly less cytotoxic than cigarette smoke: human embryonic stem cells, pulmonary fibroblasts, mouse neural stem cells

Quality control issues

Nicotine levels reported ≠ levels contained in the product

Quality of nicotine liquid used is not currently regulated, but will be if the proposed rule goes through

Mixing of e-liquid in

vape

shops is not regulated

Secondhand vapor contains significantly less nicotine and PM than secondhand smoke by orders of magnitude, but significantly more than clean indoor air.

(

Czogola

et al., 2014)

Slide11

Toxicology – SH Vapor

Implies particles grow while within the lungs and persist longer in the environment when exhaled by a user

Slide12

Nicotine Delivery/Abuse Liability

1

st

generation delivery nicotine less effectively than tank system e-cigarettes

(

Farsalinos

et al 2014)

Nicotine delivery by combustible cigarette still the most effective (faster and larger quantities).

(

Farsalinos

et al 2014

)

What’s the difference? Dose or Absorption, Both?

Slide13

Nicotine Delivery/Abuse Liability

Naïve e-cigarette users need more puffs to get cotinine blood levels as high as regular cigarettes

(Flouris et al., 2013; Vansickel et al.,, 2012)

Experienced users do not

(Vansickel & Eissenberg, 2013)

Currently tested models of e-cigarettes suggest e-cigs have lower abuse potential than regular cigs (1

st

gen)

(Vansickel et al, 2012 Addiction; Farsalinos et al Substance Abuse 2013)

Slide14

Subjective effects and smoking behavior

Effectively reduces cravings

(Vansickel et al., 2012

Addiction;

Vansickel et al., 2013

Nic and Tob Res)

Improvement in depression and concentration

(

Dawkins et al., 2012

Addictive Behaviors)

Men show more improvement in irritability and restlessness than women

(Dawkins et al., 2012

Addictive Behaviors)

Experimentation among naïve smokers uninterested in quitting led to increased motivation and confidence to quit smoking.

(Wagener et al., 2014)

Slide15

Subjective effects and smoking behavior

Smoking Behavior & cessation

Nicotine free e-cigarettes effective at reducing craving and number of cigarettes smoked

(Bullen et al.,

2010,Tobacco Control)

Smokers uninterested in quitting

(Polosa et al., 2011

BMC Public Health

)

e-cigarettes helped a majority of smokers reduce (45%) or completely quit (22.5%) regular cigarettes

Smokers, uninterested in quitting

(Caponetto et al., 2013)

At least 50% reduction in 22.3% at 12 weeks and 10.3% at 52 weeks.

10.7% quit regular cigarettes at 12 weeks, and 8.7% at 52 weeks

26.9% of quitters continued to use e-cigarettes at 52 weeks

Smokers, uninterested in quitting

(Wagener et al., 2014)

Mean 44% reduction in reg cigs at 1 week after initial e-cig experimentation.

Slide16

Subjective effects and smoking behavior

Smokers interested in quitting

(Bullen et al 2013)

E-cigarette versus patch

At 6 months, 7.3% of e-cigarette users versus 5.8% of patch were abstinence (not significantly different)

Smokers with Schizophrenia, uninterested in quitting

(Caponnetto, Auditore, Russo et al., 2013)

64.3% participants reduced number of cig/day (52-weeks)

50% of participants reduced number of cig/day by at least 50% (52-weeks)

Surveys of current EC users show abstinence rates from regular cigarettes at rates as high as 74% to 96%

(Dawkins et al., 2013,

Addiction;

Etter et al., 2011,

Addiction)

Slide17

Subjective effects and smoking behavior

Preliminary data suggests that a majority of vape store customers are exclusive e-cig users (64%). (Lechner…Wagener, in press)

Slide18

Aerosol Size Distribution of Modern Variable Voltage e-Cigarette (Prelim Data)

Floyd and Johnson, 2014 unpublished

Slide19

Vaping aerosol mass evolution (Prelim Data)

DC Volts appliedEnergy applied (Joules)Mass consumed per puff (mg)Aerosol mass per puff (mg)3.08.820.250.0063.411.4240.550.0303.814.4782.070.0844.217.5142.800.0834.621.1143.270.1055.024.753.590.1265.428.9986.560.1465.833.4088.200.1676.035.827.290.155

E-cigarettes consume milligram quantities of e-juice

All of which is inhaled (though not necessarily retained)

Measured aerosol (<20,000 µm) account for about 2% of the consumed e-juice

Suggests the rest is gas phase or particles >20 µm in size

Floyd and Johnson, 2014 unpublished

Slide20

Tobacco cigarette vs e-cigarette aerosols (prelim data)

Vaping aerosol may greatly exceed tobacco cigarette smoke mass concentrations

Nicotine concentrations in the gas and particulate phases have not been compared

Floyd and Johnson, 2014 unpublished

Slide21

What we still need to find out…

What are the long-term effects of e-cig use? How common will dual use be?What will the research outcomes look like with 2nd generation e-cigs?What will be the net population effect of e-cigarettes?

Slide22

End Game Scenarios – role of e-cigs

Slide23

End Game Scenarios – role of e-cigs

Slide24

End Game Scenarios – role of e-cigs

Slide25

End Game Scenarios – role of e-cigs

Slide26

Continuum of Risk

Slide27

End Game Steps – 1 potential way

2009 Tob Control Act – FDA has the authority to issue mandatory product standards to control permissible levels of compounds in tobacco products

Reduce nicotine in all combustible products to very low levels, rendering them non-addictive. (studies already underway).

To help prevent counterfeit tobacco…allow non-combustible products to remain at addictive levels though regulated by the FDA (also with product standards) to allow smokers who are unable or uninterested in quitting nicotine to switch.

First steps taken with the currently proposed rule

Slide28

End Game Scenarios – role of e-cigs

Slide29

References

FDA proposed rule 25 April 2014

, section D

http://www.regulations.gov/#!

documentDetail;D=FDA-2014-N-0189-0001

Czogola

et

al, 2014

Farsalinos

et

al, 2014

Flouris

et

al, 2013

Vansickel

et al., 2012

Addiction

Vansickel

&

Eissenberg

,

2013

Farsalinos

et

al, 2013 Substance Abuse

Vansickel

et

al,

2013

Nic

and

Tob

Res

Dawkins et

al,

2012

Addictive

Behaviors

Wagener et

al, 2014

Bullen

et

al,

2010,Tobacco

Control

Caponnetto

,

Auditore

, Russo et al.,

2013

Dawkins

et

al,

2013,

Addiction

Etter

et

al,

2011,

Addiction

Lechner

…Wagener, in

press

Floyd and Johnson, 2014 unpublished data

Slide30

Questions?

Slide31