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
Also contains replaceable cartridges that contain liquid nicotine or other chemicals, and an atomizer (vaporizer), that, when heated, converts the contents of the cartridge into a vapor that a user inhales
3 Main parts of the electronic cigarette:
Battery, Atomizer and Inhaler

3. Diagram of the Electronic Cigarette
Battery: The largest part of the e-cig is the battery, at the end of which is often located the LED indicator which lights when the puffer inhales.
Atomizer: Located between the battery and the inhaler, the atomizer diffuses the nicotine liquid from a cartridge into a vapor mist that can be inhaled.
Inhaler: All e-cig’s come of course with an inhaler piece through which the atomized and heated vapor passes to the puffer’s lips. This piece is also traditionally where the Nicotine liquid is contained.
*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
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

14. JOURNEYWORKS PUBLISHING
Resources
JOURNEYWORKS PUBLISHING
CDC
FAQ – FDA