1. Quick facts about E-cigarettes for mental health and addiction clinicians and administrators Associate Professor of Psychiatry, Geisel School of Medicine

2. What are E-Cigarettes? Plastic or metal device that delivers vapor
Sensor detects when smoker takes a drag
Heater vaporizes liquid and nicotine
Microprocessor controls heater and light
Cartridge holds nicotine dissolved in propylene glycol
LED lights up when smoker inhales
Battery
Stream inhalation
Plastic or metal device that delivers vapor
Many types and brands, new ones emerging all the time
E-juice has varying strengths from 0 nicotine to high levels of nicotine
Typical cartridge = about 2 packs of cigarettes worth of nicotine
Other substances can be added to tank style cigarettes
First manufactured in China in 2003.
Device resembling cigarette with a battery, microchip, red LED tip, cartridge with liquid (nicotine in propylene glycol), vaporization chamber (produces an aerosol)
Mechanical sensor detects inhalation and triggers the microchip controlling the heater which raises the temp in the vaporization chamber, which generates the aerosol (vapor), which condenses quickly in ambient air into visible fog
Size of the aerosol particles in ecigs is bigger so often is absorbed in the mouth, not the alvioli in the lungs

3. E-cigarette safety
As of 2015, toxins in vapor of tested brands of e-cigarettes were times lower than levels of toxins in cigarette smoke (Goniewitz, 2014; Rabinowitz 2014)
Nicotine is addictive but not toxic in cigarettes doses
Nicotine e-juice is concentrated – an irritant and harmful if taken as overdose
Most e-cigarette products have not been tested for safety
Some of the flavorings added to e-juice are toxic
Like alcohol and cigarettes, the FDA does not yet monitor the safety of these products

4. Who is using e-cigarettes and what are the implications?
In children, use of e-cigarettes is associated with using other combustible tobacco products (Collaco 2015)
In adults, use of e-cigarettes is most common among cigarette smokers who wish to cut down/quit/be healthier (Cummins 2014; Wang 2016)
Naturalistic use of e-cigarettes was not associated with different cessation outcomes in studies of people with mental illness who were trying to quit - didn’t help or harm outcomes (Prochaska 2014; Brunette 2016)
Controlled trials suggest that e-cigarettes are equivalent to NRT for smoking cessation (McRobbie 2014)

5. What should clinicians do?
Find out people’s reasons for using e-cigarettes
Educate people using e-cigarettes about the facts
Support people’s efforts to quit smoking with evidence-based cessation treatments
Teach people behavioral cessation strategies
Ebbert, 2015

6. Summary: 4 facts about e-cigarettes
E-cigarettes are devices that can deliver nicotine in vapor
Kids are experimenting with e-cigs before combustible cigarettes; adult chronic smokers are using e-cigarettes to cut down, avoid toxins in smoke, and to quit
Some brands of E-cigarette vapor have lower levels of toxins than cigarette smoke, but some flavorings are clearly toxic. Overall safety is unknown as of January 2016
Clinicians can provide education and evidence based cessation treatment to smokers who are using e-cigarettes to try to cut down and quit

7. references
Ebbert JO, Agunwamba AA, Rutten LJ. Counseling patients on the use of electronic cigarettes. Mayo Clin Proc. 2015;90(1): PMID:
McRobbie H, Bullen C, Hartmann-Boyce J, Hajek P. Electronic cigarettes for smoking cessation and reduction. Cochrane Database Syst Rev. 2014; PMID:
Prochaska JJ, Grana RA. E-Cigarette Use among Smokers with Serious Mental Illness. PloS one. 2014;9(11):e PMCID: Pmc
Wang M, Wang JW, Cao SS, Wang HQ, Hu RY. Cigarette Smoking and Electronic Cigarettes Use: A Meta-Analysis. Int J Environ Res Public Health. 2016;13(1). PMID: