Public Health Advisory: To Consumers of Electronic Cigarettes, Electronic Smoking Devices (ESDs) and Other Vapor Products

E Cigs

The Arkansas Department of Health is issuing this Public Health Advisory to consumers and is advising caution when considering e-cigarettes, Electronic Smoking Devices (ESDs), and other vapor products. These devices contain and emit harmful chemicals and pose known and unknown health risks to users and non-users alike.

Dangers 

  • The Arkansas Department of Health is issuing this Public Health Advisory to consumers and is advising caution when considering e-cigarette, electronic smoking devices (ESDs), and other vapor products.
  • These devices contain and emit harmful chemicals and pose known and unknown health risks to users and non-users
  • E-cigarettes/electronic smoking devices 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 Nicotine is toxic to developing fetuses and impairs fetal brain and lung development.
  • Explosions and fire involving e-cigarettes/vaping devices have been reported in Arkansas and across the United Sates resulting in serious burns and injuries.
  • E-cigarettes/electronic smoking devices are not emission free “secondhand aerosol” and their pollutants could be a health concern for users and secondhand smokers. Aerosols contain heavy metals, ultrafine particulates, and cancer-causing agents.
  • Secondhand aerosol contains chemicals that can be inhaled by non-users. Bystanders can inhale nicotine, propylene glycol and tobacco-related contaminants, such as formaldehyde, acetaldehyde, acrolein, and heavy metals.
  • Flavorings used in electronic smoking devices contain propylene glycol, glycerin, and food flavorings like diacetyl which are NOT recognized as safe for inhalation. The FDA recognizes these products as “Generally Recognized as Safe” for ingestion ONLY. Diacetyl is hazardous when inhaled.
  • Current scientific information about the effects of using electronic smoking devices (ESDs) is inadequate to assure the public that they are safe.

sos_main-image_secondhand3

Effects on Children

  • Excessive exposure to nicotine has resulted in poisoning and death, in young children and pets. Liquid contained or used in e-cigarettes or electronic smoking devices (ESDs) should not be accessible to
  • 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
  • Pregnant women should know exposure to nicotine, in conventional or electronic smoking devices, may:
    • cause a miscarriage;
    • cause low birth weight, creating significant health challenges for their babies;
    • affect the unborn baby’s blood flow, heart rate, and breathing;
    • contribute to sudden infant death
  • 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.
  • 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/electronic smoking devices may lead to an increase in nicotine addiction among young people. E-cigarette use among middle and high school students in the U.S. tripled to 2.45 million students in 2014, compared with 2013, according to the U.S. Centers for Disease Control and Prevention (CDC).
  • E-cigarettes, smoking, or the use of tobacco products is prohibited on the grounds of Arkansas public schools, public charter schools, and state supported colleges and universities, A.C.A. 6-21-609, A.C.A. 6-60-803.

ecigs

Confusion on Enforcement/Normalization of Smoking

  • Many electronic cigarettes/electronic smoking devices (ESDs) emit an aerosol 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.
  • Electronic smoking devices (ESDs) re-normalize smoking behaviors and reverse clean indoor air gains. Some national organizations have released policy statements on ESDs including the American Academy of Pediatrics in December 2013 suggesting ESDs 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 ESDs until safety has been The Center for Disease Control and Prevention (CDC) has issued key facts and statistics about the use, risks, and myths all consumers, bystanders, and parents should know.

Cessation

  • 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
  • Adequate testing for electronic cigarettes and similar electronic smoking devices for tobacco cessation has not occurred. Until Food and Drug Administration approval is given, the Arkansas Department of Health recommends only FDA-approved nicotine replacement therapy products, such as nicotine patches which contain controlled doses of nicotine, be used for tobacco cessation

References:

 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. Electronic Nicotine Delivery Systems: Key Facts. CDC Office on Smoking and Health. July 2015.

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/highlights-news-events/13-10-03-ecigarettes-the-vapor-this-time.html

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 acid supplementation. Experimental Lung Research, 37(1), 57-65. doi:10.3109/01902148.2010.515650

North Carolina Department of Health and Human Services Division of Public Health. E-cigarettes. February 12, 2014. http://www.ncafp.com/sites/default/files/e-cig_providerletter_DPH%202-12-14%20(4).pdf

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/files/e-cigarettes/talbot-slides.pdf

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. Fire Administration. Electronic Cigarette Fires and Explosions. U.S. Department of Homeland Security Federal Emergency Management Agency. October 2014.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.

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

  1. 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/files/e-cigarettes/williams-slides.pdf

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/.