Clearing the Smoke About
E-Cigarettes
Kristina Torok, MSc, CTTS
Mary Vecchio, MSN, RN, APN, OCN, CTTS
Hunterdon Regional Cancer Center
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
Diagram of the Electronic Cigarette
*When heated, the cartridge that contains the liquid
nicotine converts the contents into a vapor that the
user inhales.
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
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
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
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
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
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
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
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
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
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
Resources
JOURNEYWORKS PUBLISHING
www.journeyworks.com
CDC
www.cdc.gov
FAQ – FDA
www.fda.gov