Electronic Nicotine Delivery Systems Erin McClain, MA, MPH erin_mcclain@unc.edu Center for Maternal and Infant Health The University of North Carolina at Chapel Hill

How do they work?

ENDS Aerosol is Not Clean Air The National Institute for Occupational Safety and Health (NIOSH) recommends that workplaces be tobacco-free, including e-cigarette-free. The perception currently out there is that these products just produce a harmless water vapor. In fact Electronic cigarettes generate a mixture of vapors and aerosols. The aerosol contains potentially harmful ingredients that you see in the graphic here including fine and ultrafine particles that can penetrate the lungs. The CDC has stated that Air containing electronic nicotine delivery systems (ENDS) aerosol is less safe than clean air ENDS use has the potential to involuntarily expose children adolescents, pregnant women, and non-users to aerosolized nicotine, toxic substances and, if the products are altered, to other psychoactive substances. Therefore, clean air—free of both smoke and ENDS aerosol—remains the standard to protect health.

Examples of ENDS Products https://www.tobaccofreekids.org/assets/factsheets/0379.pdf

Most Popular ENDS Product: JUUL

ENDS are the Most Common Tobacco Product for Youth/Young Adults Villanti AC, Johnson AL, Ambrose BK, et al. Use of flavored tobacco products among U.S. youth and adults; findings from the first wave of the PATH Study (2013-2014). http://http://www.cdc.gov/tobacco/data_statistics/tables/trends/infographics/index.htm#youth-tobacco http://http://www.tobaccofreekids.org/press_releases/post/2016_04_14_ecigarettes Among current e-cigarette users age18–24, 40.0% had NEVER BEEN regular cigarette smokers https://www.cdc.gov/tobacco/basic_information/e-cigarettes/pdfs/Electronic-Cigarettes-Infographic-508.pdf

ENDS & Reproductive Age Women The health effects of using e-cigarettes & other ENDS before or during pregnancy have not been adequately studied, but we do know: Vegetable glycerin, propylene glycol, and flavoring compounds are respiratory irritants that have been shown to cause airway/lung cell inflammation and damage, including cell death Nicotine negatively affects the brain development of adolescents and young adults up to age 25 adversely affects cardiovascular health is a known reproductive toxicant and has adverse effects on fetal development, including lung and brain development The use of other smokeless tobacco products, such as snus, during pregnancy has been associated with preterm delivery, stillbirth, and infant apnea Recent research suggests that women perceive ENDS to be less harmful and less stigmatizing than cigarette use in general and during pregnancy. CDC; England, et al. 2016; Mark, et al. 2015; https://eliquidinfo.org/

ENDS and Poison Control Exposures to e-cigarettes & liquid nicotine can be fatal for infants and young children Even a teaspoon of liquid nicotine can be fatal; smaller amounts can cause severe illness E-cigarette Device & Liquid Nicotine Reported Exposures to Poison Centers https://aapcc.org/track/ecigarettes-liquid-nicotine

Questions? YouQuitTwoQuit.org Erin McClain 919-808-0989 erin_mcclain@unc.edu 919-808-0989 YouQuitTwoQuit.org