Clearing the Smoke About E-Cigarettes

Clearing the Smoke About E-Cigarettes Kristina Torok, MSc, CTTS Mary Vecchio, MSN, RN, APN, OCN, CTTS Hunterdon Regional Cancer Center

What are e-cigarettes? • Battery-powered heating devices, often resembling cigarettes, cigars or pipes • Designed to deliver nicotine to users in the form of a vapor (instead of smoke) • The vapor comes from heating liquid nicotine • First invented in the 1960’s, • E-cigarette first entered the market in China in 2004 • Currently over 250 brands available • 3 Main Components of the E-Cigarette: • Battery • Atomizer • Inhaler

Diagram of the Electronic Cigarette *When heated, the cartridge that contains the liquid nicotine converts the contents into a vapor that the user inhales.

NRT Inhaler vs. Electronic Cigarette • Inhaler • Nicotine Replacement Therapy • Licensed quit smoking aid – approved method for smoking cessation • 4mg nicotine delivered in 10mg cartridges, no battery required • Electronic Cigarette • Not FDA approved (contains traces of toxins) • No evaluation of any e-cigarettes for safety or effectiveness • No standard dose of nicotine

Legal Guidelines • NJ Smoke Free Air Act: P.L. 2009, c.182 • Sponsored by Assm. Connie Wagner (Bergen) • Approved on January 11, 2010 • E-Cigarettes are included in this legislation • In the state of New Jersey: • Tobacco product is only sold to persons 19 yrs of age or older • Cannot be used in enclosed indoor places of public access or work places • Violations shall impose fines of $250, $500, and $1000

FDA Regulations • Family Smoking Prevention & Tobacco Control Act • Signed by President Obama on June 29,2009 • “Products containing nicotine derived from tobacco but making no therapeutic claims must be regulated as tobacco products” (not seen as drug delivery system) • Grants the FDA the authority to regulate tobacco products, including e-cigarettes

FDA Regulations • The Federal Government has not exercised it’s regulatory authority over e-cigarettes: • Manufactured without regulations or quality controls • No health warnings on packaging • No legal age restrictions • 41 State Attorney Generals sent a letter to the FDA asking them to begin regulation (Sept 2013), NJ was not among them

Concerns of Misuse • FDA requires that all nicotine-delivery products intended for use by humans to be clinically proven for safety and efficacy and regulated. • No clinical trials have been conducted to determine e-cig’s impact on the body’s structure and function

Concerns of Misuse • E-cigarettes developers are making unfound claims in marketing and packaging • E-cigarettes are NOT an approved intervention for tobacco cessation • Concerns that “renormalizing smoking-like behavior” can result in higher youth initiation rates and a slower decline in adult cessation

Concerns of Misuse • Many cartridges of e-cigarettes are interchangeable and refillable causing concern that users may substitute designated liquid with synthetic nicotine or other substances • You tube videos for DIY E-juice recipes • Canibus oil • Heroin

MarketingAspect of Electronic Cigarettes • E-cigarette brands are employing a number of marketing strategies used by tobacco companies • Among them: fun flavors, endorsements using kids and celebrities • E-cigarette ads currently fall into a loophole for federal regulation • Control misleading or false product claims

Trending in New Jersey • Accessibility on internet • Request “free sample” • Store locations throughout NJ • Accessories • Mods (modifications of size, voltage, etc.) • Tastings/Custom design e-liquids • Targeting youth with bubblegum, gummy bear, cotton candy flavors

Example E-cigarette Commercials http://www.youtube.com/watch?v=bk7LeC_1-IA http://www.youtube.com/watch?v=6tcu1ZLGwi8 http://www.youtube.com/watch?v=ysGyfLwwr1s

Resources JOURNEYWORKS PUBLISHING www.journeyworks.com CDC www.cdc.gov FAQ – FDA www.fda.gov

Clearing the Smoke About E-Cigarettes