To Consumers of Electronic Cigarettes, Electronic Nicotine Delivery Systems (ENDS) and Other Vapor Products
The Arkansas Department of Health is issuing this Public Health Advisory to consumers and is advising caution when considering e-cigarettes, Electronic Delivery Systems (ENDS), and vaping devices. These devices contain and emit harmful chemicals, are currently unregulated, and pose known and unknown health risks to users and non-users alike.
- The Arkansas Department of Health is issuing this Public Health Advisory to consumers and is advising caution when considering e-cigarette, Electronic Delivery Systems (ENDS), and vaping devices.
- These devices contain and emit harmful chemicals, are currently unregulated, and pose known and unknown health risks to users and non-users alike.
- E-cigarettes/vapor products contain chemicals, including nicotine. Nicotine is toxic and highly addictive and affects the nervous system and heart. It can be absorbed into the body through inhalation, ingestion and skin contact. The Health Consequences of Smoking—50 Years of Progress A Report of the Surgeon General Executive Summary (2014), reports that the evidence is sufficient to infer that nicotine activates multiple biological pathways through which smoking increases risk for adult onset diseases, including atherosclerosis, coronary heart disease, type 2 diabetes, obesity, and cancer.
- E-cigarettes/vapor products are not emission free and their pollutants could be a health concern for users and secondhand smokers. These products should not be used indoors or in cars.
- Secondhand vapor contains chemicals that can be inhaled by non-users. Bystanders can inhale nicotine, propylene glycol and tobacco-related contaminants, such as formaldehyde, acetaldehyde, and acrolein.
- Current scientific information about the effects of using electronic nicotine delivery systems (ENDS) is inadequate to assure the public that they are safe. Coupled with the absence of state or federal regulation of manufacture, this information should prompt consumers to be cautious about using the devices as well as exposure to secondhand emissions.
Effects on Children:
- Excessive exposure to nicotine can result in poisoning, particularly in young children and pets. Liquid contained or used in e-cigarettes or vapor devices should not be accessible to children.
- Pregnant women should avoid using these devices and children should not be exposed to them. The nicotine crosses the placenta and can damage the lungs, heart, and central nervous system of the developing fetus.
- Pregnant women should know exposure to nicotine, in conventional or electronic cigarettes, may cause the following:
- Low birth weight
- Significant health challenges for unborn babies, including complications related to blood flow, heart rate and breathing
- Sudden infant death syndrome (SIDS)
- Parents should be aware that electronic cigarettes and similar electronic nicotine delivery devices are available in a variety of flavors, such as bubble gum, strawberry, chocolate, and mint, which may be attractive to children. Arkansas Act 1188 of 2013 prohibits distribution of “alternative nicotine products” directly, indirectly by an agent or employee, or through vending machines to minors under the age of 18. “Alternative nicotine products” includes both e-cigarettes and any product containing nicotine that is intended for human consumption. The age of the individual purchasing these products must be verified using a photographic identification card, or if purchased online, verification must be performed through an independent, third-party age verification service.
- Parents should not allow children to play with electronic cigarettes or similar devices.
They contain batteries and liquid chemicals which, if swallowed, could cause serious health complications. Nicotine is a known poison. Bottles of e-juice, used in e-cigarettes, are a poison risk for small children and pets.
- E-cigarettes may lead to an increase in nicotine addiction among young people. E-cigarette use among middle and high school students in the U.S. doubled to 1.78 million students in 2012, compared with the year before, according to the U.S. Centers for Disease Control and Prevention (CDC).
Confusion on Enforcement/Normalization of Smoking:
- Many electronic cigarettes/Electronic Nicotine Delivery Systems emit a vapor that looks like cigarette smoke. The similarity of these products to combustible cigarettes creates confusion for employees and visitors and presents enforcement challenges for workplaces, restaurants/bars, state agencies, and other indoor/outdoor campuses that have existing tobacco-free policy/ordinances.
- ENDS re-normalize smoking behaviors and reverse clean indoor air gains. Some national organizations have released policy statements on ENDS including the American Academy of Pediatrics in December 2013 suggesting ENDS should be treated like other combustible tobacco products and that sales to minors should be prohibited. The World Health Organization (WHO) in July 2013 advised that consumers not use ENDS until safety has been demonstrated.
- It is illegal for e-cigarettes to be marketed as a smoking cessation aid. A number of electronic cigarette companies have received warning letters from the FDA for making such claims.
- Electronic cigarettes and similar electronic nicotine delivery devices have not been tested adequately as tobacco cessation devices. Until Food and Drug Administration approval is given, the Arkansas Department of Health recommends that FDA-approved nicotine replacement therapy products, such as nicotine patches which contain controlled doses of nicotine, be used for tobacco cessation efforts.
FDA citations of unsubstantiated claims, poor manufacturing practices. Are retrieved from http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2010/ucm225224.htm
Brody A, Mandelkern M, London E, Khan A, Kozman D, Costello M, Vellios E, Archie M, Bascom R & Mukhin A. (2011). “Effect of Secondhand Smoke on Occupancy of Nicotine Acetylcholine Receptors in Brain”. Arch Gen Psychiatry, 68(9):953-960.
Bullen C et al. Electronic cigarettes for smoking cessation: A randomized controlled trial. Lancet 2013; 382: 1629-37.
Centers for Disease Control and Prevention. (2013, September 6). Notes from the Field: Electronic Cigarette Use Among Middle and High School
Students – United States, 2011-2012. Morbidity and Mortality Weekly Report, 62(35), 729-730.
Executive Summary Center for Tobacco Control, Research and Education, Univ of California, San Francisco. The Health Consequences of
Smoking—50 Years of Progress: A Report of the Surgeon General, 2014 | SurgeonGeneral.gov
Cheah, N.P., Chong, N.W.L., Tan, J., Morsed, F.A., & Yee, S.K. (2012). Electronic nicotine delivery systems:
regulatory and safety challenges: Singapore perspective. Tobacco Control, doi: 10.1136/tobaccocontrol-2012 050483.
Counotte, D.S., Goriounova, N.A., Li, K.W., Loos, M., van der Schore, R.C., Schetter, D. . . . & Spijker, S. (2011). Lasting synaptic changes underlie attention deficits caused by nicotine exposure during adolescence. Nature Neuroscience, 14, 417 – 419. Abstract retrieved from http://www.nature.com/neuro/journal/v14/n4/full/nn.2770.html
Davies, A (2013, Feb. 27). Sorry Smokers, You Can’t Use Electronic Cigarettes On Airplanes. Business Insider. Retrieved from http://www.businessinsider.com/you-cant-smoke-e-cigarettes-in-planes-2013-2#ixzz2lOZTb3c5 on November 22, 2013.
Dwyer JB, McQuown SC & Leslie FM. (2009). “The dynamic effects of nicotine on the developing brain”. Pharmacol Ther, 122(2),125-139. Doi: 10.1013/j.pharthera.2009.02.003.
Flouris AD, Chorti MS, Poulianti KP, Jamurtas AZ, Kostikas K, Tzatzarakis MN…Koutedakis Y. (2013). “Acute impact of active and passive electronic cigarette smoking on serum cotinine and lung function”. Inhal Toxicol, 25(2), 91 -101. Do:10.1136/tobaccocontrol-2012-050859
Flouris, Andreas D.; Poulianiti, Konstantina P.; Chorti, Maria S.; Jamurtas, Athanasios Z.; Kouretas, Dimitrios; Owolabi, Emmanuel O.; Tzatzarakis, Manolis N.; Tsatsakis, Aristidis M.; Koutedakis, Yiannis.“Acute Effects of Electronic and Tobacco Cigarette Smoking on Complete Blood Count. Food and Chemical Toxicology”. http://dx.doi.org/10.1016/j.fct.2012.07.025,
Givens, A. & Chang, P. (2013, Oct. 11). E-cigarettes, used to smoke marijuana, spark new concerns. NBC New York. Retrieved from http://www.nbcnewyork.com/investigations/ECigarettes-Drugs-Marijuana-Vapor-Pens-Smoking-I-Team227269001.html on November 22, 2013.
Glantz, S. (2013, Oct. 3). Comments on Electronic Cigarettes In Philip S. Gardiner (Chair), Electronic Cigarettes: The vapor this time. Conducted by the Tobacco Related Disease Research Program at the University of California Riverside in San Francisco, California. Retrieved from http://www.trdrp.org/ecigarettes.php
German Cancer Research Center. (2013). “Electronic Cigarettes- An Overview”. Red Series Tobacco Prevention and Control, Volume 19. Heidelberg, Germany.
Goniewicz ML, Kuma T, Gawron M, Knysak J, & Kosmider L. (2012). “Nicotine levels in electronic cigarettes”. Nicotine Tob Res. Doi: nts103 [pii] 10.1093/ntr/nts103.
Goniewicz ML, Knysa J, Gawron M, Kosmider L, Sobczak A, Kurek J…Benowitz N. (2013). “Levels of selected carcinogens and toxicants in vapour from electronic cigarettes”. Tob Control. Doi: 10.1136/tobaccocontrol-2012-050859.
King BA et al. Flavored-little-cigar and flavored-cigarette use among U. S. middle and high school students. J of Adolescent Health 2014;54:40-6. Maritz, G. S., & Rayise, S. S. (2011). Effect of maternal nicotine exposure on neonatal rat lung development: Protective effect of maternal ascorbic
acidsupplementation.ExperimentalLungResearch,37(1),57-65. doi:10.3109/01902148.2010.515650 McKenzie, Amanda (2013, Aug. 1). New law bans electronic cigarette sales to minors. News 14 Carolina. Retrieved from
http://triad.news14.com/content/news/697079/new-law-bans-electronic-cigarette-sales-to-minors on November 22, 2013.
Talbot, P. (2013, Oct. 3). Electronic Cigarettes: How Will They Impact Human Health? In Philip S. Gardiner (Chair), Electronic Cigarettes: The vapor this time. Conducted by the Tobacco Related Disease Research Program at the University of California Riverside in San Francisco, California. Retrieved from http://www.trdrp.org/ecigarettes.php
Trtchounian, A. & Talbot, P. (2010). Electronic nicotine delivery systems: Is there a need for regulation? Tobacco Control. 20, 47-52, doi: 10.1136/tc.2010.0037259.
U.S. Food and Drug Administration (2011, April). Regulation of e-cigarettes and other tobacco products. Retrieved from http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm252360.htm
U.S. Food and Drug Administration (2010). FDA acts against 5 electronic cigarette distributors
U. S. Food and Drug Admin. FDA Warns of Health Risks Posed by E-Cigarettes (2009), available at www.fda.gov/downloads/ForConsumers/ConsumerUpdates/Updates/UCM173430.pdf
Vardavas CI, Anagnostopoulos N, Kougias M, Evangelopoulou V, Connolly GN, Behrakis PK. “Acute pulmonary effects of using an e-cigarette: impact on respiratory flow resistance, impedance and exhaled nitric oxide”. Chest. 2011 Dec 22. http://www.ncbi.nlm.nih.gov/pubmed/22194587
Williams, M. (2013, Oct. 3). Electronic cigarette liquids and vapors: Is it harmless water vapor? In Philip S. Gardiner (Chair), Electronic Cigarettes: The vapor this time. Conducted by the Tobacco Related Disease Research Program at the University of California Riverside in San Francisco, California. Retrieved from http://www.trdrp.org/ecigarettes.php
Wilson LM et al. Impact of tobacco control interventions on smoking initiation, and prevalence: A systematic review. J Environ and Public Health; see: www.hindawi.com/journals/jeph/2012/961724/.