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 Also contains replaceable cartridges that contain liquid nicotine or other chemicals, and an atomizer (vaporizer), that, when heated, converts the contents of the cartridge into a vapor that a user inhales 3 Main parts of the electronic cigarette: Battery, Atomizer and Inhaler

Diagram of the Electronic Cigarette Battery: The largest part of the e-cig is the battery, at the end of which is often located the LED indicator which lights when the puffer inhales. Atomizer: Located between the battery and the inhaler, the atomizer diffuses the nicotine liquid from a cartridge into a vapor mist that can be inhaled. Inhaler: All e-cig’s come of course with an inhaler piece through which the atomized and heated vapor passes to the puffer’s lips. This piece is also traditionally where the Nicotine liquid is contained. *When heated, the cartridge that contains the liquid nicotine converts the contents into a vapor that the user inhales.

NRT Inhaler vs. Electronic Cigarette 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

Marketing Aspect 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

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