What’s the deal with E-cigarettes?

Steve Kelder, MPH, PhD

@msdcenter

/msdcenter

@TexasTCORS

Healthy children in a healthy world.We advance health and healthy living for children and families through cutting-edge research,

innovative community-based programs, and dissemination of evidence-based practices.

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Harm Reduction• Cigarette smoking is very

dangerous.• E-cigarettes deliver

nicotine without the tar, carcinogens, etc.

Public Health Debate

Potential Harms• E-cigarettes have

nicotine.• Young people are

attracted to the novelty and flavors.

• Long term harmful consequences are not known.

Two Comprehensive Reports

This talk is divided into 4 parts

E-Cigarette Basics

Health Risks Marketing Tactics

Aerosol Contents

Number of parts in a basic e-cig▪ Battery▪ Atomizer▪ Cartridge

Components of E-Cigarettes (Ecigs)

The Rise of E-cigarettes

The closed system: ▪ The cig-alike: similar in size and shape to a traditional

cigarette. Disposable, and cannot be used again ($).

The open system:▪ Reusable with disposable parts: Contain a

rechargeable battery where the cartomizer is disposable - no need for e-liquids or refilling etc ($$).

▪ The “APV” (advanced personal vaporizer) or “mod” (modification): These e-cigs have a rechargeable battery and refillable cartomizers ($$$).

Cig-A-Likes

▪ First generation of electronic cigarettes▪ Mimic the look and feel of standard

tobacco cigarettes

Variations

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What’s wrong with this picture?(https://www.juulvapor.com/shop-pods; accessed at 2/14/2018; 12:51 pm)

No product information on the cartridge.

No product information about mg/ml.

What does .7ml with 5% nicotine mean?

“Below is a general guide that can help you work out the correct nicotine strength required. Due to Tobacco Products Directive (known as TPD for short) that came into effect on 20th of May 2017, the maximum strength of nicotine in an e-liquid sold in the UK is now limited to 20mg/ml (or 2.0%).”

http://www.vaporized.co.uk/are-you-using-the-right-strength-of-nicotine/

E-liquid nicotine strength: Suitable for people smoking:

3mg/ml or 0.3% (Very low) Up to 5 cigarettes a day6mg/ml or 0.6% (Low) Up to 10 cigarettes a day12mg/ml or 1.2% (Medium) Up to 20 cigarettes a day18mg/ml or 1.8% (High) Up to 30 cigarettes a day20mg/ml or 2.0% (Very high) Up to 40 cigarettes a day

Equivalents across differing brands and nicotine concentrations

Assumes 40 cigarettes for 20 mg/dl

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Each JUULpod should deliver around 200 puffs before it needs changingEach JUULpod contains 0.7ml of pre-filled e-liquid5% nicotine by weight (50mg nicotine)

eGos, Tanks, Mods, APV’s

E-Juice/E-LiquidYou Would Be Amazed…

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• E-Liquid strength is measured in milligrams (weight) per milliliter (volume); expressed as mg/mL

• E-Liquid, or E-Juice, comes in many strengths depending largely on the manufacturer, sometimes even as high as 42 or 56 mg/mL

• A vaping industry standard is 20 ml/dl (2% weight) is considered very strong, and is equivalent to 40 cigarettes

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Nicotine is WAY more harmful than caffeine.

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E-Cigarettes/Vape Pens: Just Water Vapor?

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•Youth and young adults are uniquely vulnerable to the detrimental consequences from nicotine exposure, including:

• Reduced impulse control

• Mood dysfunction

• Deficits in:

• Attention

• Cognition

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Nicotine is MORE harmful to adolescents and young adults.

Nicotine exposure during adolescence can cause addiction and can harm the developing brain.

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What is Propylene Glycol (PG) and why is it used

▪ Propylene glycol is a clear, colorless liquid at room temperature.

▪ To exist in aerosol form, must be heated.▪ Propylene glycol is generally recognized as safe by

FDA for ingestion, but little is known about the effects of inhaling it as a aerosol.

▪ In E-cigs, PG is added in the liquid to dilute the pure liquified form of nicotine and to serve as a vaporizable base.

▪ PG also allows atomization to take place at much lower temperatures than tobacco cigarettes.

• Propylene glycol• Glycerin• Flavorings (many)• Nicotine• NNN• NNK• NAB• NAT• Ethylbenzene• Benzene• Xylene• Toluene• Acetaldehyde• Formaldehyde• Naphthalene• Styrene• Benzo(b)fluoranth

ene

• Cadmium• Silicon• Lithium• Lead• Magnesium• Manganese• Potassium• Titanium• Zinc• Zirconium• Calcium• Iron• Sulfur• Vanadium• Cobalt• Rubidium• Indeno(1,2,3-cd)pyre

ne•

• Benzo(ghi)perylene• Acetone• Acrolein• Silver• Nickel• Tin• Sodium• Strontium• Barium• Aluminum• Chromium• Boron• Copper• Selenium• Arsenic••

• Chlorobenzene• Crotonaldehyde• Propionaldehyde• Benzaldehyde• Valeric acid• Hexanal• Fluorine• Anthracene• Pyrene• Acenaphthylene• Acenapthene • Fluoranthene • Benz(a)anthracen

e • Chrysene • Retene• Benzo(a)pyrene

E-cigarette Explosions

E-cigarette PoisoningAmerican Association of Poison Control Centers

Electronic Cigarettes and Liquid Nicotine Data January 31, 2018

Relative cancer potency modelled for common forms of

nicotine delivery

William E Stephens Tob Control 2018;27:10-17

Comparison of cellular toxicity and levels of released inflammatory mediators (cytokines) from H292 bronchial epithelial cells directly exposed at the air–liquid interface to 55 puffs of flavoured

ENDS aerosols.

Noel J Leigh et al. Tob Control 2016;25:ii81-ii87

©2016 by BMJ Publishing Group Ltd

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• The Family Smoking Prevention and Tobacco Control Act (2009)▪ On April 25, 2014, FDA issued a proposed rule that would extend

its regulatory capacity to additional tobacco products. • At least 40 states have laws in place restricting e-cigarettes

sales to minors (Gov. Abbott signed SB 97 in May 2015)• Cities and counties are rapidly setting restrictions on the use

of e-cigarettes ▪ Implement laws to restrict use in venues including workplaces,

restaurants and bars

Federal, state and local policies related to e-cigarettes

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E-Cigarette Constituents▪ The Tobacco Control Act provides FDA authority to regulate

cigarettes, cigarette tobacco, roll-your-own tobacco, smokeless tobacco, and any other tobacco products that the Agency by regulation deems to be subject to the law.  

▪ The Food and Drug Administration (FDA) is proposing to deem products meeting the statutory definition of "tobacco product," except accessories of a proposed deemed tobacco product, to be subject to the Federal Food, Drug, and Cosmetic Act (the FD&C Act), as amended by the Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act). 

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SB 97: Signed in May 2015. Health and Safety Code Sections 161.081-8; 161.251-6; 161.301-2; 161.356; 161.452-457

• Prohibits sale, purchase, or use of e-cigarettes or nicotine containers to a minor under the age of 18. Upon conviction, a class C misdemeanor, including a fine up to $500 may be imposed.

• Nicotine containers must be child-resistant. • Retailers must post a sign.• A retailer shall adequately supervise and train the

retailers agents to prevent a violation.• Conviction leads fine or awareness program.

https://legiscan.com/TX/text/SB97/2015

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• Section 38.006. E-Cigarettes and Tobacco Products on School Property

• The board of trustees of a school district shall:• Prohibit smoking or using e-cigarettes or tobacco as

a school –related or school-sanctioned activity on or off school property.

• Prohibit students from possessing e-cigarettes or tobacco products at a school-related or school sanctioned activity on or off school property.

• Ensure that school personnel enforce the policies on school property.

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Section 28.004. E-Cigarettes and Tobacco Products on School Property

Westlake High School Student Handbook, 2017-18Tobacco and E-Cigarettes Prohibited Students are prohibited from possessing or using any type of

tobacco product, electronic cigarettes (e-cigarettes), or any other electronic vaporizing device, while on school property at any time or while attending an off-campus school-related activity.

The district and its staff strictly enforce prohibitions against the use of all tobacco products, e- cigarettes, or any other electronic vaporizing device, by students and all others on school property and at school-sponsored and school-related activities. [See the Student Code of Conduct and policies at FNCD and GKA.]

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Section 28.004. E-Cigarettes and Tobacco Products on School Property

• A school district must publish in the student handbook and district website a statement:• Of polices adopted to ensure adequate PA.• The number of times the SHAC has met in the preceding

year.• Whether the district complies vending machine and

food service regulations. • Whether the district has adopted and enforces policies

and procedures for use of e-cigarettes and tobacco.

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Comptroller Rules

If the Comptroller finds, after notice and hearing, that a retailer has sold cigarettes, cigars and/or tobacco products to a minor, at a place of business for which a permit is issued, the Comptroller may suspend or revoke the permit for that place of business or assess an administrative fine in an amount up to $1000 per violation. (Tax Code, Sec. 154.1142 and Sec. 155.0592)

Introducing the CATCH Global Foundation

Thank You, from the Michael & Susan Dell Center for Healthy Living

Deanna M Hoelscher, RD, LD, CNS, PhDJohn P McGovern Professor, UTSPHDirector, MSD Center

Steven H. Kelder, MPH, PhDBeth T Grossman Distinguished Professor, UTSPHInvestigator, MSD Center

In the past 30 days, have you used?

Your knuckleheads wouldn’t do this??