Tallahassee, Fla. – The emergence of electronic cigarettes and other electronic nicotine delivery systems (also known as vaporizers, vape pens, and e-hookahs) has triggered a considerable debate regarding their safety and ability to help smokers quit.
E-cigarettes have not been approved as a quit aid by the Food and Drug Administration. Many e-liquids contain nicotine, which is a highly addictive chemical.1 Nicotine addiction is the fundamental reason people persist in using tobacco, which remains the leading cause of preventable disease and death in the United States. 2,3
Using e-cigarettes while continuing to smoke conventional cigarettes, which is referred to as dual use, is a serious concern. The Centers for Disease Control and Prevention estimates that three out of four e- cigarette users do not quit smoking, but continue to smoke conventional cigarettes.4
The number of Americans using e-cigarettes is increasing dramatically each year. Between 2010 and 2013, the percentage of cigarette smokers who have used an e-cigarette increased from 9.8 percent to 36.5 percent.5 Though current cigarette smokers and recent former smokers are more likely to use e- cigarettes than adults who have never smoked, people who have never used conventional cigarettes are also trying e-cigarettes.6
The number of children and young adults (ages 13-24) trying e-cigarettes is especially alarming, particularly because there is evidence that adolescents who use e-cigarettes are more likely to start smoking cigarettes.7,8 In Florida, the number of high school students who were current e-cigarette users tripled from 5.4 percent in 2013 to 15.8 percent in 2015.9 Further, because the adolescent brain is still developing, nicotine use during adolescence can affect teens’ susceptibility to addiction.10
E-cigarettes have simply not been around long enough to determine their long-term health effects. However, some studies that have been conducted show troubling results. According to preliminary analysis from FDA, e-cigarette samples found detectable levels of known carcinogens and toxic chemicals.11 Additionally, chemicals that are harmful or may be harmful have been found in some e- cigarettes, according to various studies. These substances include traces of metal, volatile organic compounds and nitrosamines, which are carcinogenic. The levels tend to be lower than in conventional cigarettes, but there is no way to be certain because e-cigarettes are not yet regulated.12 There are more than 460 brands on the market, which vary widely in chemicals used and in the amount of nicotine they deliver. 13,14
For tobacco users looking for a proven-effective way to quit, the best plan is to talk to their health care providers or seek help from an evidence-based resource, like Tobacco Free Florida. Additionally, there are nicotine replacement therapies (NRT) and other quit aids that are approved by FDA to help tobacco users quit. These include: FDA-approved over-the-counter NRT like the patch, gum and lozenges;15 FDA- approved prescription NRT such as the nicotine inhaler and nasal spray;16 and FDA-approved prescription non-nicotine medications.17,18 “FDA-approved” means that these quit aids have gone through clinical trials that prove they are safe and effective.
Tobacco Free Florida offers free cessation services that can increase the chances of quitting by five times.19 These services provide free FDA-approved nicotine replacement therapy, including the patch or a combination of the patch and gum, if medically appropriate and while supplies last. Floridians who want to quit smoking are encouraged to find the cessation services that work best for them at www.tobaccofreeflorida.com.
What the Public Health Community Has Said About Electronic Cigarettes
“The increased use of e-cigarettes by teens is deeply troubling. Nicotine is a highly addictive drug. Many teens who start with e-cigarettes may be condemned to struggling with a lifelong addiction to nicotine and conventional cigarettes.” 20
– Dr. Tom Frieden, Director of the Centers for Disease Control and Prevention (CDC)
“If the marketers of the electronic cigarette want to help smokers quit, then they need to conduct clinical studies and toxicity analyses and operate within the proper regulatory framework. Until they do that, WHO cannot consider the electronic cigarette to be an appropriate nicotine replacement therapy, and it certainly cannot accept false suggestions that it has approved and endorsed the product.” 21
– Dr. Douglas William Bettcher Director the Department for Prevention of Noncommunicable Diseases, World Health Organization (WHO)
“In today’s rapidly evolving tobacco marketplace, the surge in youth use of novel products like e- cigarettes forces us to confront the reality that the progress we have made in reducing youth cigarette smoking rates is being threatened. These staggering increases in such a short time underscore why FDA intends to regulate these additional products to protect public health.” 22
– Mitch Zeller, J.D., Director of FDA’s Center for Tobacco Products
1 U.S. Department of Health and Human Services. The Health Consequences of Smoking: Nicotine Addiction. A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1988. DHHS Publication No. (CDC) 88-8406.
2 U.S. Department of Health and Human Services. How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010.
3 U.S. Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. Printed with corrections, January 2014.
4 King, Patel, Nguyen, and Dube. Trends in Awareness and Use of Electronic Cigarettes among U.S. Adults, 2010 -2013 Nicotine Tob Res ntu191 first published online September 19, 2014 doi:10.1093/ntr/ntu191.
5 Brian A. King, Roshni Patel, Kimberly Nguyen, and Shanta R. Dube. “Trends in Awareness and Use of Electronic Cigarettes among U.S. Adults, 2010-2013.” Nicotine & Tobacco Research. First published online September 19, 2014, doi:10.1093/ntr/ntu191.
6 Schoenborn CA, Gindi RM. Electronic cigarette use among adults: United States, 2014. NCHS data brief, no. 217. Hyattsville, MD: National Center for Health Statistics. 2015. http://www.cdc.gov/nchs/data/databriefs/db217.pdf.
7 Coleman BN, Apelberg BJ, Ambrose BK, et al. Association between electronic cigarette use and openness to cigarette smoking among US young adults. Nicotine Tob Res. 2015; 17(2):212-218.
8 Thomas A Wills, Rebecca Knight, James D Sargent, Frederick X Gibbons, Ian Pagano, Rebecca J Williams Longitudinal study of e-cigarette use and onset of cigarette smoking among high school students in Hawaii. Tob Control doi:10.1136/tobaccocontrol- 2015-052705.
9 Florida Youth Tobacco Survey (FYTS), Florida Department of Health, Bureau of Epidemiology, 2015.
10 England, L. et al. Nicotine and the Developing Human: A Neglected Element of the E -cigarette Debate. Am J Prev Med. 2015 Mar 7. [Epub ahead of print].
11 U.S. Food and Drug Administration. Summary of Results: Laboratory Analysis of Electronic Cigarettes Conducted By FDA. Silver Spring, MD. U.S. Department of Health and Human Services. U.S. Food and Drug Administration. Page Last Updated 2014 Apr 23. http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm173146.htm [accessed 2014 Apr 24].
12 Cheng T. Chemical Evaluation of Electronic Cigarettes. Nicotine & Tobacco Research 2014;23,ii11–7. 23 May 2014. http://www.ncbi.nlm.nih.gov/pubmed/24732157 [accessed 18 Aug 2015].
13 British Medical Journal. Four hundred and sixty brands of e-cigarettes and counting: implications for product regulation. (12 May 2014). http://tobaccocontrol.bmj.com/content/23/suppl_3/iii3.full.
14 World Health Organization (WHO). Questions and answers on electronic cigarettes or electronic nicotine delivery systems (ENDS). (10 Jul 2013). http://www.who.int/tobacco/communciations/statements/electronic_cigarettes/en/index.html.
15 Fiore MC, Jaén CR, Baker TB, Bailey WC, Benowitz NL, Curry SJ, Dorfman SF, Froelicher ES, Goldstein MG, Froelicher ES, Healton CG, et al. Treating Tobacco Use and Dependence: 2008 Update—Clinical Practice GuidelinesExternal Web Site Icon. Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, Agency for Healthcare Research and Quality, 2008.
16 Fiore MC, Jaén CR, Baker TB, Bailey WC, Benowitz NL, Curry SJ, Dorfman SF, Froelicher ES, Goldstein MG, Froelicher ES, Healton CG, et al. Treating Tobacco Use and Dependence: 2008 Update—Clinical Practice GuidelinesExternal Web Site Icon. Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, Agency for Healthcare Research and Quality, 2008.
17 Fiore MC, Jaén CR, Baker TB, Bailey WC, Benowitz NL, Curry SJ, Dorfman SF, Froelicher ES, Goldstein MG, Froelicher ES, Healton CG, et al. Treating Tobacco Use and Dependence: 2008 Update—Clinical Practice GuidelinesExternal Web Site Icon. Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, Agency for Healthcare Research and Quality, 2008.
18 U.S. Food and Drug Administration The FDA Approves Novel Medication for Smoking Cessation. FDA Consumer, 2006. Page Last Update: 2013 Apr 8 http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2006/ucm108651.htm [accessed 2014 Apr 24].
19 Professional Data Analysts. “BTFF Tobacco Cessation Evaluation FY15 Synthesis Report.” 15 February 2015.
20 U.S. teen use of e-cigarettes doubled, CDC reports.” Reuters, 5 Sept. 2013. http://www.reuters.com/article/2013/09/05/us-usa- health-e-cigarettes-idUSBRE9840X820130905 [accessed 2014 Apr 24].
21 O’Leary. “Marketers of electronic cigarettes should halt unproved therapy claims.” World Health Organization (WHO). 2008 Sept 19. http://www.who.int/mediacentre/news/releases/2008/pr34/en/ [accessed 2015 Aug 18].
22 Centers for Disease Control and Prevention. E-cigarette Use Triples among Middle and High School Students in Just One Year.CDC.gov. Centers for Disease Control and Prevention, 16 Apr. 2015. http://www.cdc.gov/media/releases/2015/p0416-e-cigarette-use.html.