PROTECTING THE YOUTH OF

CALIFORNIA FROM E-CIGARETTES

Safe Kids California | California Department of Public HealthJanuary 2016

What You Need to Know

Image from Daily Mail article: Williams, A. 2014. Now e-cigarette explodes and starts flat fire leaving one woman in hospital after the device overheated while it was charging. Daily Mail. http://www.dailymail.co.uk/news/article-2605256/Now-e-cigarette-explodes-starts-flat-fire-leaving-one-woman-hospital-device-overheated-charging.html

What do they look like?

• E‐cigs• E‐hookahs• Hookah pens• Vapes• Vape pens• MODs• Tanks• Advanced Personal Vaporizers (APVs)

What do they look like?

• The look of e‐cigarettes is customizable

• “Vaping” is common term for use, not ‘smoking’

Slide adapted from Placer County Tobacco Prevention Program educational materials. Photo credits: Food/Beverages: Red Bull, Monster, Altoids from www.pinterest.com, Mystifying Mints from www.etsy.com. Cartoon Characters: Teenage Mutant Ninja Turtles from www.pinterest.com, Superheros (top right) from www.whiterhinoproducts.com, Batman from www.pinterest.com, Superheros (bottom left) from www.veganvape.com. Toys: Wii, Nintendo, Pokemon from www.pinterest.com; Space Invaders & Gameboy from www.whiterhinoproducts.com. Jewelry: All images from www.vaperoyalty.com

www.pinterest.com

Aerosol• Nicotine• Flavoring agents• Propylene glycol or 

vegetable glycerin• Ultra fine particulate 

matter• Heavy metals and 

contaminates

Fuoco, 2014; Goniewicz, 2014

Is it harmless water vapor?

www.istockphoto.com

Developmental

Cancer

CancerDevelopmental

Cancer

Cancer

CancerDevelopmental

Developmental

Cancer

E-LIQUIDS• Nicotine• Propylene Glycol or Vegetable Glycerin• Flavorings

Why are we concerned about flavorings?

Flavorings = Chemicals• Ethylpyrazine• Dimethylpyrazine• Trimethylpyrazine• Tetramethylpyrazine• Coumarin• Acetylpyrazine• Piperonal• Damascenone• Eleutheroside• Rhodinol• Trimethylcyclohex‐2‐butene‐4‐one• Beta‐Ionone  

www.istockphoto.com

Approved food flavoring• Popcorn butter flavoring• Buttery taste in chardonnay

Workplace standards• "Popcorn lung" due to aerosol 

exposure of diacetyl

Diacetyl = Chemical Flavoring

https://www.osha.gov/dts/shib/shib10142010.html

Microsoft Office Clip Art

Do flavors attract kids?

Flavored cigarettes were “starter products” for youth and thus, Congress banned them in 2009, with the exception of menthol.

Top reasons teens report trying e‐cigarette:

• Curiosity (54%)• Appealing flavors (44%)• Peer influences (32%) 

Kong et al., 2014

www.istockphoto.com

Vape News Magazine. Volume 3, Issue 3

CA youth use e-cigarettes at higher rate than cigarettes, 2013-2014

Lung Inflammation

Eye, Throat, and Lung

Irritation

Blood Vessel Constriction

www.istockphoto.com

May have permanent consequences: • Impair attention• Impair memory• Increase risk taking behavior

What is the impact of fetal exposure to nicotine?

• Pre‐term delivery• Low birth weight• Stillbirth• Sudden Infant Death Syndrome

• Life‐long reduced lung function  

• Cleft palate and other congenital malformations

www.istockphoto.com

In 2014, poisonings to children tripled in one year, making up more than 60% of all e‐cigarette poisoning calls. 

Fairman, J. www.gettyimages.co.uk hangbooliquid.en.made-in-china.com

www.vaporvanity.com

www.ecigwerks.blogspot.com

www.njoy.com

www.ecigflashbacks.com

www.thefashionspot.com

www.behance.net

Freedom Sex Appeal

Glamour Natural

Images from Stanford School of Medicine. Stanford research into the impact of tobacco advertising – Cigs vs eCigs comparisons. http://tobacco.stanford.edu/tobacco_main/subtheme-comp.php?token=fm_tn_mt035.php

Federal State (California) Local

FDA rule to regulate e‐cigs like tobacco products –pending  

Illegal to sell e‐cigs to minors <18 

168 cities/counties include e‐cigs in smoke‐free laws

Child Nicotine PoisoningPrevention Act of 2015 ‐approved

Legislation to require child‐resistant packaging, and include e‐cigs in smoke‐free laws – pending

114 cities/counties require e‐cig retailers to have tobacco retail licenses • Some prohibit sale of 

flavored e‐cigs

Laws and Regulations

What can you do?

TALK TO YOUR KIDS

SET EXPECTATIONS

BE A ROLE MODEL

REMOVE THE THREAT

GET INVOLVED

www.istockphoto.com

ResourcesTobaccoFreeCA: http://tobaccofreeca.com/

CDPH Wake Up Campaign:http://stillblowingsmoke.org/https://www.youtube.com/watch?v=jaMgWUBPeHYhttps://www.youtube.com/watch?v=jcFgRPEiQGE

CDPH E-Cigarette Brochure for Parents: https://www.cdph.ca.gov/programs/tobacco/Documents/Resources/Fact%20Sheets/E_Cigs_Brochure_English%20102914.pdf

CA State Health Officer’s Report 2015: https://www.cdph.ca.gov/programs/tobacco/Documents/Media/State%20Health-e-cig%20report.pdf

The New Joe Camel in Your Pantry: Marketing liquid nicotine to children with candy and cereal brands: http://firstfocus.org/liquid-nicotine/?CFID=19288971&CFTOKEN=59979283&utm_source=RW_2015.10_%23144--Official+Version&utm_campaign=September+2015+RW&utm_medium=email

CDC Notes from the Field: Calls to Poison Centers for Exposures to Electronic Cigarettes — United States, September 2010–February 2014:http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6313a4.htm?s_cid=mm6313a4_w

American Association of Poison Control Centers: http://www.aapcc.org/alerts/e-cigarettes/

Children’s Safety Network Infographic on E-Cigarette Poisoning: http://www.childrenssafetynetwork.org/infographics/e-cigarette-poisoning

Additional Information

References1. Allen, J. G., Flanigan, S. S., LeBlanc, M., Vallarino, J., MacNaughton, P., Stewart, J. H., & Christiani, D. C. (2015). Flavoring chemicals in e-cigarettes: Diacetyl, 2,3-Pentanedione, and Acetoin in a sample

of 51 products, including fruit-, candy- and cocktail-flavored e-cigarettes. Environmental Health Perspective. doi: 10.1289/ehp.1510185 Retrieved from http://ehp.niehs.nih.gov/wp-content/uploads/advpub/2015/12/ehp.1510185.acco.pdf

2. American Association of Poison Control Centers. E-cigarettes and liquid nicotine. Retrieved from http://www.aapcc.org/alerts/e-cigarettes/3. California Department of Public Health, California Tobacco Control Program. Protect your family from e-cigarettes – The facts you need to know.

https://www.cdph.ca.gov/programs/tobacco/Documents/Resources/Fact%20Sheets/E_Cigs_Brochure_English%20102914.pdf4. California Department of Public Health, California Tobacco Control Program. State Health Officer’s Report on E-Cigarettes: A Community Health Threat, Sacramento, CA 2015

https://www.cdph.ca.gov/programs/tobacco/Documents/Media/State%20Health-e-cig%20report.pdf5. California Department of Public Health, California Tobacco Control Program. TobaccoFreeCA. http://tobaccofreeca.com/6. California Department of Public Health, California Tobacco Control Program. (2015). Wake Up Campaign. www.stillblowingsmoke.org7. California Poison Control System. (2015). E-cigarette poisonings, 2010-2014.8. Centers for Disease Control and Prevention. Nicotine: Systemic agent. Retrieved from http://www.cdc.gov/niosh/ershdb/emergencyresponsecard_29750028.html9. Centers for Disease Control and Prevention. Tobacco use and pregnancy. Retrieved from http://www.cdc.gov/reproductivehealth/maternalinfanthealth/tobaccousepregnancy/index.htm10. Chatham-Stephens, K., et al., 2014. Notes from the field: calls to poison centers for exposures to electronic cigarettes - United States, September 2010-February 2014. Morbidity and Mortality Weekly

Report, 63(13): 292-293. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6313a4.htm?s_cid=mm6313a4_w11. Children’s Safety Network. E-cigarette poisoning. Retrieved from http://www.childrenssafetynetwork.org/infographics/e-cigarette-poisoning12. Daniels, M. (2015). The new Joe Camel in your pantry: Marketing liquid nicotine to children with candy and cereal brands. First Focus. Retrieved from http://firstfocus.org/liquid-

nicotine/?CFID=19288971&CFTOKEN=59979283&utm_source=RW_2015.10_%23144--Official+Version&utm_campaign=September+2015+RW&utm_medium=email13. Dutra, L.M. & Glantz, S. A. (2014). Electronic Cigarettes and Conventional Cigarette Use Among US Adolescents: A Cross-sectional Study. JAMA Pediatrics, 168(7): 610-617. Retrieved from

http://archpedi.jamanetwork.com/article.aspx?articleid=184077214. Fuoco, F.C., Buonanno, G., Stabile, L., & Vigo, P. (2014). Influential parameters on particle concentration and size distribution in the mainstream of e-cigarettes. Environmental Pollution, 184, 523-529.15. Golgowski, N. (2015). Man critically injured after e-cigarette explodes in his face. Huffington Post. Retrieved from http://www.huffingtonpost.com/entry/e-cigarette-explosion_56532c70e4b0879a5b0b91da16. Goniewicz, M. L., Knysak, J., Gawron, M., Kosmider, L., Sobczak, A., Kurek, J., Prokopowicz, A., et al. Levels of selected carcinogens and toxicants in vapour from electronic cigarettes. Tobacco Control,

2014. 23(2), 133-139.17. Kong, G., Morean, M. E.,Cavallo, D. A., Camenga, D. R., & Krishnan-Sarin, S. (2014). Reasons for electronic cigarette experimentation and discontinuation among adolescents and young adults. Nicotine &

Tobacco Research Advance Access, 1-8. doi:10.1093/ntr/ntu25718. Leventhal, A. M., Strong, D. R., Kirkpatrick, M. G., Unger, J. B., Sussman, S., Riggs, N. R., Stone, M. D., et al. (2015). Association of Electronic Cigarette Use with Initiation of Combustible Tobacco

Product Smoking in Early Adolescence. JAMA, 314(7):700-707. doi:10.1001/jama.2015.8950. Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=242895419. Mohney, G. (2014). First child’s death from liquid nicotine reported as ‘vaping’ gains popularity. ABC News. Retrieved from http://abcnews.go.com/Health/childs-death-liquid-nicotine-reported-vaping-gains-

popularity/story?id=2756378820. Monitoring the Future. (2015). Most youth use e-cigarettes for novelty, flavors—not to quit smoking. http://www.monitoringthefuture.org//pressreleases/15ecigpr_complete.pdf21. Occupational Safety and Health Administration. (2010). Occupational exposure to flavoring substances: Health effects and hazard control. Retrieved from https://www.osha.gov/dts/shib/shib10142010.html22. Placer County Tobacco Prevention Program. (2015). Don’t be fooled by e-cigarettes. Flyer.23. Primack, B. A., Soneji, S., Stoolmiller, M. Fine, M. J., & Sargent, J. D. (2015). Progression to Traditional Cigarette Smoking After Electronic Cigarette Use Among US Adolescents and Young Adults. JAMA

Pediatrics, 169 (11): 1018-1023. doi:10.1001/jamapediatrics.2015.1742. Retrieved from http://archpedi.jamanetwork.com/article.aspx?articleid=243653924. Taylor, K. & O’Donnell, C. (2015). Man injured, bed catches fire after e-cigarette explodes. Fox 11 News. Retrieved from http://www.foxla.com/news/7104202-story25. Tribune News Service. (2015). Exploding e-cigarette burns California man, starts fire. Sauk Valley News. Retrieved from http://www.saukvalley.com/2015/03/10/exploding-e-cigarette-burns-california-man-

starts-fire/ahe9xo1/26. University of Michigan. (2015). Most youth use e-cigarettes for novelty, flavors—not to quit smoking. Monitoring the Future. http://www.monitoringthefuture.org//pressreleases/15ecigpr_complete.pdf27. U.S. Department of Health and Human Services. The health consequences of smoking – 50 years of progress: A report of the Surgeon General, in Atlanta, CA: U.S. Department of Health and Human

Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. 28. U.S. Department of Health and Human Services. Preventing tobacco use among youth and young adults: A report of the Surgeon General, in Atlanta, CA: U.S. Department of Health and Human Services,

Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2012.3. 29. WestEd. California Healthy Kids Survey, 2013-14. San Francisco: WestEd Health & Human Development Program for the California Department of Education.30. Williams, A. 2014. Now e-cigarette explodes and starts flat fire leaving one woman in hospital after the device overheated while it was charging. Daily Mail. Retrieved from

http://www.dailymail.co.uk/news/article-2605256/Now-e-cigarette-explodes-starts-flat-fire-leaving-one-woman-hospital-device-overheated-charging.html31. Wills, T. A., Knight, R., Sargent, J. D., Gibbons, F. X., Pagano, I., & Williams, R. J. Longitudinal study of e-cigarette use and onset of cigarette smoking among high school students in Hawaii. Tobacco

Control, 2016 http://tobaccocontrol.bmj.com/content/early/2016/01/05/tobaccocontrol-2015-052705.full.pdf+html32. Zabala, L. (2015). Man burned in e-cigarette explosion that shattered store glass. NBC Bay Area News. Retrieved from http://www.nbcbayarea.com/news/national-international/San-Diego-Man-Burned-E-

Cigarette-Explosion-Ramona-291263941.html33. Zhu, S., Sun, J. Y., Bonnevie, E., Cummins, S. E., Gamst, A., Yin, L., & Lee, M. (2014). Four hundred and sixty brands of e-cigarettes and counting: implications for product regulation, Tobacco Control, 23,

iii3-iii9. doi:10.1136/tobaccocontrol-2014-051670 Retrieved from http://tobaccocontrol.bmj.com/content/23/suppl_3/iii3.full