1. Joyce Alexander Azusa Pacific University GNRS 507

2. Pico Question  Can electronic cigarettes be a safer alternative to traditional tobacco cigarettes in regards to secondhand exposure.  Why is this important?  With growing popularity, government officials are calling for regulations over electronic cigarettes to be established.

3. What is an electronic cigarette? Three piece system: Cartrage, automizer, and battery pack. Two piece system: cartomizer and battery pack. (McAuley, Hopke, Zhao, and Babaian., 2012)

4. Ingredients  Electronic cigarette  Nicotine  Propylene Glycol  Glycerin  Flavor (Czogala et al., 2013)  The concentration of nicotine found in e-liquid can vary between 0- 25mg  Conventional cigarette  Contains over 4,000 chemicals and 43 known cancer causing compounds including:  Nicotine  Tobacco  Tar  Carbon Monoxide  Formaldehyde  Ammonia (Quitsmoking.com, 2014 )

5. Mechanism of action  Emissions released from electronic cigarettes are considered an aerosol  Liquid particles dispensed in the air to give a smoke-like appearance.  Tobacco cigarettes use combustion to create smoke.  Because the cigarette is burning it releases continuous side stream smoke. (Goniewicz, Hajek & McRobbie., 2013)

6. Pollutants tested  Volatile organic compounds (VOC’s) were below the level of detection in electronic cigarettes. Average of 128.5 vs. 4875.8ng/L in tobacco smoke.  Nicotine- emissions for tobacco smoke contained nicotine levels 10 times higher then e-cigarettes. (31.60 vs. 3.32 ug/m3)  Partical Matter (PM) were below the level of detection in electronic cigarettes and 7 times higher in tobacco smoke. (Czogala et al., 2013)

7. Discussion Topics  No significant health risk. (McAuley et al., 2012)  Exposure to nicotine. (Czogala et al., 2013)  Potentially lethal levels of nicotine. (Schober et al., 2014), (Goniewicz, Hajek & McRobbie,2013)  Variation in nicotine levels. (Goniewicz, Hajek & McRobbie,2013)

8. Recommended Regulations  Consumer Protection- warning labels, child-proof lids, and sales to minors (Schober et al. 2014), (Goniewicz, Hajek & McRobbie.,2013)  Quality Control- manufacturing ( did not include nicotine levels) (Saffari et al.,2014)

9. Personal Recommended Regulation  Because electronic cigarettes cannot be individually regulated, it should fall under the same laws as traditional cigarettes which prohibits smoking in public facilities.

10. Clinical Implication  Electronic cigarettes should only be used as a smoking cessation for tobacco cigarettes.  Nurses should educate the patient about risks and benefits of electronic cigarettes, and the potential exposure of nicotine to bystanders.

11. Reference List  Czogala, J., Goniewicz, M. L., Fidelus, B., Zielinska-Danch, W., Travers, M. J., & Sobczak, A., (2013). Secondhand exposure to vapors from electronic cigarettes. Nicotine & Tobacco Research, 16(6), 655-662. doi: 10.1093/ntr/ntt203  Goniewicz, M. L., Hajek, P., & McRobbie, H. (2013). Nicotine content of electronic cigarettes, its release in vapour an its consistency accross batches: regulatory implications. Addiction, 109, 500-507. doi: 10.1111/add.12410  McAuley, T.R., Hopke, P. K., Zhao, J., & Babaian S. (2012). Comparison of the effects of e-cigarette vapor and cigarette smoke on indoor air quality. Inhalation Toxicology, 24(12), 850-857. doi: 10.3109/08958378.2012.724728  Saffari, A., Daher, N., Ruprecht, A., De Marco, C., Pozzi, P., Boffi, R.,... Sioutas, C., (2014). Particulate metals and organic compounds from electronic and tobacco- containing cigarettes: comparison of emission rates and secondhand exposure. Environmental Science: Processes & Impacts, 16, 2259-2267. doi 10.1039/c4em00415a  Schober, W., Szendrei, K., Matzen, W., Osiander-Fuchs, H., Heitmann, D., Schettgen, T.,... Fromme, H., (2014). Use of electronic cigarettes (e-cigarettes) impairs indoor air quality and increases FeNO levels of e-cigarette consumers. International Journal of Hydiene and Environmental Health, 217, 628-637. doi: 10.1016/j.ijheh.2013.11.003  What's In a Cigarette, 599 Ingredients in a Cigarette. (2014, January 1). Retrieved December 2, 2014, from http://www.quitsmokingsupport.com/whatsinit.htmhttp://www.quitsmokingsupport.com/whatsinit.htm  Picture were taken by Joyce Alexander 2014