1. Clearing the Smoke About E-Cigarettes Kristina Torok, MSc, CTTS Mary Vecchio, MSN, RN, APN, OCN, CTTS Hunterdon Regional Cancer Center

2. 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

3. Diagram of the Electronic Cigarette *When heated, the cartridge that contains the liquid nicotine converts the contents into a vapor that the user inhales.

4. NRT Inhaler vs. Electronic Cigarette Inhaler 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

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