E-cigarette data update and regulatory gapsAnna Guymon, B.S., CHESaguymon@co.weber.ut.us(801)399-7182

20102003 2006-2007

2008 2009

2006

Brief History of E-cigarettes

Typically consists of 3 parts: Battery – powers the e-cigarette Atomizer - heating element Cartridge – contains nicotine and flavor (including

propylene glycol)

E-cigarette Description

Marketing of e-cigarettes• E-cigarettes are rapidly evolving

and being marketed like cigarettes were in the 1950s and 1960s• Marketing is back on television and

radio• All the major cigarette companies

are now in the e-cigarette business• The tobacco industry has a history

of making false and misleading public statements regarding their control of the nicotine content and delivery of their products

Sources: Tobacco Control Legal Consortium, The Verdict Is In: Findings From United States v. Phillip Morris, Nicotine Levels (2006). Full text of the Court’s 1700pg Final Opinion is available at: http://www.tobaccolawcenter.org/dojlitigation.html ; Grana, R., Benowitz, N., & Glantz. S. 2013. Background paper on e-cigarettes (Electronic Nicotine Delivery Systems). Center for Tobacco Control Research and Education. University of California, San Francisco. WHO Collaborating Center on Tobacco Control.

E-juice

Solutions come in a small bottle without a child safety cap, and are often fruit flavored.

Nicotine solutions come in varied strengths and concentration methods.

Product labeling is inconsistent and ambiguous

Creates risk for nicotine overdose/poisoning

Public Health Concerns -Product

Environmental Health Services DivisionE-Juice Nicotine Content TestingAugust 13, 2013

Sample 1 Sample 2 Sample 3 Sample 4 Sample 5 Sample 60

2

4

6

8

10

12

14

2.4

0

1.2

2.41.8

3.6

7.1

0.00150000000000001

4.6

7.67

12

Results of Lab Tests

Retailer labeled level of nicotine on e-juice sampleActual level of nicotine present in sample

Youth and e-cigarettes• Youth are rapidly adopting e-cigarettes

• High levels of dual use • Youth who use e-cigarettes are heavier (not lighter) smokers

• Youth who use e-cigarettes are much less likely to have stopped smoking

Sources: Lee, S., Grana, R. & Glantz, S. 2013. Electronic cigarette use among Korean adolescents: A cross-sectional study of market penetration, dual use and relationship to quit attempts and former smoking. Journal of Adolescent Health, in press. Camenga, D.R., Delmerico, J., Kong, G. Cavallo, D., Hyland, A., Cummings, K.M., & Krishnan-Sarin, S. 2013. Trends in use of electronic nicotine delivery systems by adolescents. Addictive Behaviors, http://dx.doi.org/10.1016/j.addbeh.2013.09.014,

Youth E-cigarette Use & PrevalenceNational Data 2013

Ever e-cigarette use among middle and high school students has doubled in one year.

Source: National Youth Tobacco Survey, United States. 2011-2012

Utah Surveillance Data• Prevention Needs Assessment (PNA) – Youth Data

(Grades 8, 10, 12)• Conducted in Utah schools in odd years with a sample

of more than 50,000 students in grades 6, 8, 10, 12• Is considered a randomized, representative sample.

• Use rates doubled among youth who reported they had tried e-cigarettes

• Despite having no legal access to e-cigarettes, Utah youth are three times more likely to report current use than adults

• Nearly one-third of Utah youth who tried e-cigarettes report they never tried conventional cigarettes: 31.7%

Youth experimentation with e-cigarettes, state and local data

State

Weber-

Morgan

Bear

River

Centra

lDav

is

Salt L

ake

South

east

South

west

Summit

Tooe

le

TriCou

nty

Utah Cou

nty

Wasatch

0%5%

10%15%20%25%30%35%

20112013

Source: Tobacco Prevention and Control Program. Prevention Needs Assessment Tobacco Questions, 2013. Salt Lake City: Utah Department of Health. Tobacco Prevention and Control Program. Prevention Needs Assessment Tobacco Questions, 2011. Salt Lake City: Utah Department of Health.

Youth E-cigarette Use, Local and state data 30 day-use Grades 8, 10 ,12

State

Weber-

Mo...

Bear

River

Centra

lDav

is

SL Cou

nty

South

east

South

west

Summit

Tooe

le

TriCou

nty

Utah Cou

nty

Wasatch

0%

5%

10%

15%

20%

25%

E-cig 2011

E-cig 2013

Source: Tobacco Prevention and Control Program. Prevention Needs Assessment Tobacco Questions, 2013. Salt Lake City: Utah Department of Health. Tobacco Prevention and Control Program. Prevention Needs Assessment Tobacco Questions, 2011. Salt Lake City: Utah Department of Health.

Weber-Morgan All Tobacco Use Among Students in Grades 8, 10, 12

2011 20130.0%

5.0%

10.0%

15.0%

20.0%

25.0%

7.1%5.9%

3.6%

19.9%

4.4%2.9%

5.6% 5.4%

2.1% 1.3%1.6% 0.6%

CigaretteE-cigaretteCigarsHookahChewSnus

Source: Tobacco Prevention and Control Program. Prevention Needs Assessment Tobacco Questions, 2013. Salt Lake City: Utah Department of Health. Tobacco Prevention and Control Program. Prevention Needs Assessment Tobacco Questions, 2011. Salt Lake City: Utah Department of Health.

WM Community Survey (Convenience Sample Data)• 386 youth surveys collected between 7/1/2013 to

10/6/2013 from those who attended local pubic events and that were willing to take the survey

• Questions centered on e-cigarette use, as well as knowledge and attitudes toward policies, health risks and access to e-cigarettes

• Results cannot be generalized, instead it helps us to understand more of what may be happening in our community.

Youth Use E-cigs, WMHD Convenience Sample Data 2013 n=386

Series10%

5%

10%

15%

20%

25%

30%

Ever TriedCurrent use e-cigs-every dayCurrent use e-cigs-some daysCurrent use e-cigs-rarelyCurrent use e-cigs-combined

Initiation E-cigs and Cigarettes (n=those who have tried e-cigs) WMHD Convenience Sample Data 2013

Series10%

10%

20%

30%

40%

50%

60%

70%

Have not used bothUse both-tried e-cigs firstUse both-Tried cig-arettes first

How easy is it for you to get e-cigs? (scale of 1-easy to 5-difficult) WMHD Convenience Sample Data 2013 n=those who have tried e-cigarettes

Series10%

10%

20%

30%

40%

50%

60%

70%

Easy=12345=difficult

How do you usually get your e-cigs? WMHD Convenience Sample Data 2013 n=those who have tried e-cigarettes

Series10%

5%

10%

15%

20%

25%

30%A person older than 19 years old or older gave them to meBought at vapor or e-cig specialty shopBought them at a convenience store/gas stationBought them on the internetGave someone else money to buy them for me

E-cigarette Laws and Policy gaps

FDA Authority over Tobacco ProductsHas authority to regulate• Product

• Whether to regulate as new products or “modified risk products”(for which health claims can be made). The latter process much harder for manufacturers to obtain approval, so likely that e-cigarettes will mostly be marketed as new tobacco products

• How the product is marketed

• NO authority over where e-cigarettes are used and how they are taxed and whether they are even sold

Current Utah Law-E-cigarettes

• Utah Indoor Clean Air Act §26-38-2(1),(4)(c)

• Youth Access §76-10-104 and §76-10-105

• Schools §53-A-11-902(5)(a)through(d) and §76-10-101

Regulatory Gaps in Utah Law• Definition of tobacco products

• E-cigs are inconsistently defined as tobacco products in state code

• Youth access• Online sales, free samples, paraphernalia

• Retail• Local health departments do not have the authority to

conduct compliance checks on e-cigarettes. Only law enforcement currently has the authority.

• No requirement for state tobacco retail license• Schools

• Definition of paraphernalia

DR. GRO HARLEM BRUNTLAND, FORMER DIRECTOR-GENERAL of the World

Health Organization:“If we do not act decisively, a hundred years from now our grandchildren and their children will look back and seriously question how people claiming to be committed to public health and social justice allowed the tobacco epidemic to unfold unchecked.”

USDHHS. (2001). Women and Smoking: A Report of the Surgeon General. Washington, DC: PHS.