It is critical to understand the public health impact of this new face of tobacco, especially among pregnant women and adolescents.
It’s NOT just water vapor-
ENDS (Electronic Nicotine Delivery Systems), also referred to as e-cigarettes or vapor products, are battery-operated devices designed to deliver nicotine with flavorings and other chemicals to users in vapor instead of smoke. There are over 250 different brands on the market. Many people wrongly believe that the aerosol emitted by ENDS is simply water vapor, but this is far from the truth. Most ENDS contain harmful and potentially harmful ingredients including nicotine, fine particles, volatile organic compounds, heavy metals and other compounds. Other emerging non-combusted tobacco products include snus and dissolvables. Although, some individuals credit these products as a way to curb their traditional tobacco use, these products are not an FDA approved smoking cessation aid. Also, most people who use ENDS to help them quit traditional cigarettes usually just stay addicted to nicotine, but now they are simply getting it from a new source. Similarly, while these products are often promoted as safer alternatives to traditional cigarettes, the health risks of using these devices is largely still unknown. There is also the issue of second-hand vapor. Anyone around this vapor is exposed to the same harmful chemicals as the person vaping. Also, the liquid used to refill e-cigarettes can be very dangers if it is swallowed or exposed to the skin. This has been found to be a great danger for children who often are drawn to the liquid because of its fruity and sweet aroma.
Tobacco use during pregnancy remains one of the most common preventable causes of pregnancy complications, illness, and death among infants. Regardless if it is a traditional tobacco product or a new tobacco product the recommendation remains the same, pregnant women should not use anything with nicotine. All tobacco products contain nicotine, which is a reproductive toxicant and has adverse effects on fetal brain development. Two recent studies shed light on the the appeal of ENDS among pregnant women. First, the studies found that women felt that there was less stigma in using these products while pregnant. Second, the studies reported that women felt that the use of these products was less harmful to them and their baby than traditional cigarettes. Third, women reported that they felt these products could be used to help them quit smoking. It is important that healthcare providers screen for the use of these products in pregnant women and discuss the lack of knowledge regarding their safety. Click here for resources through the perinatal tobacco cessation program, You Quit, Two Quit.
While there has been a significant decline in the use of traditional cigarettes among youth over the past decade, their use of e-cigarettes are on the rise. A recent survey by the FDA and the CDC shows current e-cigarette use among high school students has jumped from 1.5 percent in 2011 to 16 percent in 2015 (an over 900% increase). The statistics among North Carolina students has a similar trend with the use of e-cigarettes skyrocketing by 888% from 2011 to 2015. Recent studies have shown that teens using e-cigarettes are more likely to start smoking tobacco. Thankfully, the FDA recently ruled that all electronic nicotine delivery systems as tobacco products, thus under its authority to regulate products. This rule protects youth by placing e-cigarettes under existing rules that limit their access to those under 18 years of age. Unfortunately, the ruling does not address flavors or advertisements which have been found to make these products appealing to children and teens. These products pose a set of new challenges, as they are known to be harmful but their health impact is not yet fully understood. Young people need to know that these products pose negative health risks and should not be considered harmless.
US Food and Drug Administration: Takes significant steps to protect Americans from dangers of tobacco through new regulation, May 5, 2016. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm499234.htm
Tobacco Prevention and Control Branch: North Carolina Youth Tobacco Survey, 2015. http://tobaccopreventionandcontrol.ncdhhs.gov/data/yts/index.htm
US Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.
Centers for Disease Control and Prevention Tobacco Use Among Middle and High School Students — United States, 2011–2015, April 15, 2016
Lucinda J. England, Van T. Tong, Amber Koblitz, Julia Kish-Doto, Molly M. Lynch, Brian G. Southwell, Perceptions of emerging tobacco products and nicotine replacement therapy among pregnant women and women planning a pregnancy, Preventive Medicine Reports, Volume 4, December 2016, Pages 481-485, ISSN 2211-3355, http://dx.doi.org/10.1016/j.pmedr.2016.09.002.
Mark K. S., Farquhar B., Chisolm M. S., Coleman-Cowger V. H., Terplan M. (2015). Knowledge, attitudes, and practice of electronic cigarette use among pregnant women. Journal of Addiction Medicine, 9, 266-272. doi:10.1097/ADM.0000000000000128