E-cigarettes

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E-cigarettes




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Presentations text content in E-cigarettes

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E-cigarettes

Shelia Evans L.P.N.

Manager Community Health Program

353-5767

Slide2

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

Slide3

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 e-cigarette device as “

an electronic

atomization cigarette

that functions as substitutes

for cigarettes and quitting smoking

Slide4

Components

Slide5

Available Products

Disposable e-cigarette

Rechargeable e-cigarette

Pen-sized Rechargeable e-cigarette

Tank-style, large size, rechargeable e-cigarette

Slide6

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.

Halo $44.99

VaporFi

$29.99

V2 Cigs

$34.95+

Green Smoke

$59.99+

blu

$79.95

$99.95

Slide7

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.

Slide8

E-cigs and E-liquid

Comes in a variety of flavors and nicotine levelsMany of the products leak creating the potential for dermal nicotine exposure and potential nicotine poisoningMany fluids are from China, but are now being made in United States, Germany, and Europe

Slide9

Terminology

E-cigarettes - often called e-cigs, personal vaporizers, PVs, Electronic Nicotine Delivery Devices (ENDS)Liquid nicotine - E-liquid, e-juice or smoke juiceVaper - Person who uses electronic cigarettesVape or Vaping - the act of smoking an e-cigVape or Vapor Shops - Retail stores selling electronic cigarettes

Slide10

Rationale for E-cigarettes

Traditional cigarette sales are declining Tobacco industry needed alternative product to redefine itselfDesigned to mimic cigarettesPresented as a safe alternativeAvoids tobacco laws and taxation

Slide11

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

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

Slide12

Tobacco Free Campaign

Slide13

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: Diethylene glycol TSNAs (low levels) Formaldehyde CarcinogensAcetaldehyde Acrolein

Slide14

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

Slide15

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

Slide16

Do E-cigarettes Reduce Harm?

There are still a lot of unknowns about e-cigarettesThe hope that they will reduce harm by delivering "clean" nicotine is debatable and will not be realized in continuing dual users including the cardiovascular riskCancer risk may only be modestly affected because smoking duration is more important than intensity

Slide17

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Can be Used for Other Drugs

E-cigarettes can be altered by users and be used to deliver other drugs

Slide19

Second-Hand Smoke

E-cigarettes pollute the air less than conventional cigarettes, but they pollute the airThey do not just emit "harmless water vapor"People passively exposed to e-cigarettes aerosol absorb nicotine (measured as cotinine), with one study showing levels comparable to passive smokers

Slide20

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 determinedThere is a high level of dual use of e-cigarettes and conventional cigarettes among adultsUsed as a way to circumvent smoke-free laws by enabling users to “smoke anywhere”

Slide21

Do They Help People Quit

E-cigarettes

have not

been proven to help people quit smoking

Longitudinal

population studies show that e-cigarette 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

Slide22

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

Slide23

Marketing

E-cigarettes are evolving rapidly and being marketed like cigarettes were in the 1950s and 1960sAggressive placement in convenience stores (next to candy or medications)E-cigarettes are marketed via television, the Internet, and print advertisements (that often feature celebrities)

Slide24

Youth

Youth are rapidly adopting e-cigarettesE-cigarettes contain candy flavors (e.g., cherry, chocolate, turkish delight)Youth who use e-cigarettes are heavier smokersYouth who use e-cigarettes are much less likely to have stopped smoking There are high levels of dual use

Slide25

Promotion of E-cigarettes

Jenny McCarthy promoting

blu e-cigarettes.Logo: Take Back Your Freedom

Slide26

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)

Slide27

Tobacco Industry

E-cigarette companies were competing with conventional cigarette companies, but now all the major cigarette companies are in the e-cigarette 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

)

Slide28

http://

www.transformtobacco.com/Pages/default.aspx

Slide29

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 ​

Transform Tobacco:

Issues in Indiana

Slide30

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

e-cigarettes

Slide31

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

Slide32

What to Tell Your Patient

Be sure the advice you are giving doesn’t undermine their motivation to quitFollow the 5 As of evidence-based treatment:ask, advise, assess, assist, and arrangeRefer to the Quit line (1-800-QUIT-NOW)If previous failure and wants to try e-cigarettes, support them butInform patients that products are unregulated, contain toxic chemicals, and are not proven cessation devices

Slide33

Cessation Interventions

Key recommendations: Clinicians should prescribe the first-line medications that reliably increase long-term smoking abstinence ChantixZybanNRTclasses

Slide34

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

.

Slide35

Questions

What questions do you have?

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