E-cigarettes - PowerPoint Presentation

Slide1

E-cigarettes

Shelia Evans L.P.N.

Manager Community Health Program

353-5767Slide2

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-cigarettesSlide3

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

ComponentsSlide5

Available Products

Disposable e-cigarette

Rechargeable e-cigarette

Pen-sized Rechargeable e-cigarette

Tank-style, large size, rechargeable e-cigaretteSlide6

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

$99.95Slide7

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 levels

Many

of the products

leak creating

the potential for dermal nicotine exposure and potential nicotine

poisoning

Many fluids

are from

China, but are now being made in United States, Germany, and EuropeSlide9

Terminology

E-cigarettes - often

called

e-cigs

, personal vaporizers, PVs, Electronic Nicotine Delivery Devices (ENDS)

Liquid nicotine - E-liquid

, e-juice or smoke juice

Vaper

- Person

who uses electronic cigarettesVape or Vaping - the act of smoking an e-cigVape

or Vapor Shops - Retail stores selling electronic cigarettesSlide10

Rationale for E-cigarettes

Traditional cigarette sales

are declining

Tobacco

industry needed alternative

product to

redefine

itself

Designed

to mimic cigarettesPresented as a safe alternativeAvoids tobacco laws and taxationSlide11

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 millimeterHigh strength = 16-18mg per millimeter

Extra-high strength = 24-54mg per millimeterSlide12

Tobacco Free CampaignSlide13

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 Carcinogens

Acetaldehyde 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

irritationSlide15

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 ListSlide16

Do E-cigarettes Reduce

Harm?

There are still a lot of unknowns about e-cigarettes

The

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 intensitySlide17

Slide18

Can be Used for Other D

rugs

E-cigarettes can be altered by users

and

be used to deliver other

drugsSlide19

Second-Hand Smoke

E-cigarettes

pollute the air less than

conventional

cigarettes, but they pollute the air

They

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 smokersSlide20

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 adults

Used 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 lowSlide22

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 themSlide23

Marketing

E-cigarettes are evolving rapidly and being marketed like cigarettes were in the 1950s

and 1960s

Aggressive 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-cigarettes

E-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 useSlide25

Promotion of E-cigarettes

Jenny McCarthy promoting

blu

e-cigarettes

.

Logo

:

Take Back Your FreedomSlide26

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.aspxSlide29

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 IndianaSlide30

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 cigarettesBan the use of characterizing flavors in e-cigarettesSlide31

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 cigarettesSlide32

What to Tell Your Patient

Be sure the advice you are giving doesn’t undermine their motivation to quit

Follow the 5 As of evidence-based treatment:

ask, advise, assess, assist, and arrange

Refer to the Quit line (1-800-QUIT-NOW)

If previous failure and wants to try e-cigarettes, support them but

Inform patients that products are unregulated, contain toxic chemicals, and are not proven cessation devicesSlide33

Cessation Interventions

Key recommendations:

Clinicians should prescribe the

first-line

medications that reliably increase long-term smoking

abstinence

Chantix

Zyban

NRT

classesSlide34

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?