E-Cig Info


PRODUCT FEATURES

Typically e-cigarettes have three integrated components:

  1. a reservoir or cartridge containing solution,
  2. a heating element (atomizer) which vaporizes the solution, and
  3. a battery (at varying sizes and capacities)

When activated, the heating element produces a vapor from a solution containing the humectant carrier (e.g., vegetable glycerine), nicotine, flavorings, and other ingredients.


HEALTH & SAFETY

Nicotine

  • Nicotine is derived from tobacco and has psychoactive and physiological effects. Nicotine can be harmful to those with cardiovascular diseases and diabetes or other chronic medical illnesses. Nicotine is a potent poison when mishandled, ingested or absorbed through the skin. It is known to cause birth defects during pregnancy and affects the developing brain so should not be used by youth.
  • Nicotine is an addictive substance, but its level of addictiveness can vary depending on its mode of delivery. For example, in cigarettes, nicotine is highly addictive. On the other hand, FDA-approved NRTs are minimally addictive and can be used long term. Studies suggest that the current generation of e-cigarettes on the market are less addictive than combustible cigarettes and closer in profile to NRTs. [9,57]
  • User experience and e-cigarette product selection may influence nicotine delivery from e-cigarettes. Several studies indicate that e-cigarettes, under certain conditions, can deliver nicotine reliably and effectively.[5,58-64] Some e-cigarette brands may yield little or minimal nicotine delivery due to design and/or mislabeling of the nicotine amount.[3,8,10,65] Some e-cigarette solutions and vapors contain nicotine doses that are not consistent with manufacturer specifications.[9-11,65-67]

Vapor

  • Health effects associated with exposure to e-cigarette vapor are not fully studied, but available data suggest that e-cigarette vapor is less harmful than cigarette smoke.[68-72] However, e-cigarette vapor is not water vapor.
  • E-cigarettes and e-liquid vary in quality and vapor constituents.
  • In contrast to combustible products, existing studies of e-cigarettes report that e-cigarette vapor produces no carbon monoxide and fewer chemicals.[64,69,73] The chemicals that are present are at lower levels of toxicity than in smoke from combustible tobacco products like cigarettes, cigars, pipes, or hookah.
  • Potentially harmful constituents have been identified (typically 1-3 orders of magnitude lower than in cigarettes) in some e-cigarette liquid and vapor, including nitrosamines, heavy metals, and carbonyls. [57,64,65,68,69,72,74,75]
  • Some e-cigarettes/e-liquid contain propylene glycol, which has not been studied for long-term safety via inhalation.[57,64,65]
  • Mainstream vapor from e-cigarettes contains measurable levels of nicotine. Some studies also show that e-cigarette vapor when exhaled by the user emits low levels of nicotine and particulate matter into the air. [64,69,70,72] There is concern with exposing bystanders, including youth and pregnant women, to nicotine in the air, even at low levels.[69]

Adverse Events

  • Studies demonstrate e-cigarettes do not produce the same acute adverse health effects observed with conventional cigarette smoking (e.g. eye, nose, and throat irritation, coughing and bronchitis, inflammation of tissues in the mouth, nose, and throat, bronchitis, increased heart rate and blood pressure).[5,76]
  • Common adverse effects associated with e-cigarette use include minor complaints or irritation relating to the mouth, eyes, and upper respiratory system.[77]
  • Nicotine is a potent poison and can cause death if not properly stored and handled. Small ingestions could be deadly. With an estimated median lethal dose between 1 and 13 mg per kilogram of body weight, 1 teaspoon (5 ml) of a 1.8% nicotine solution could be lethal to a 90-kg person.[78]
  • The number of calls to poison centers involving e-cigarette liquids containing nicotine rose from one per month in September 2010 to 215 per month in February 2014. More than half of these calls involved young children 5 years old and under.[79] A serious poisoning of a 10 month old infant occurred.80
  • Poisoning related to the nicotine in e-cigarette liquid can occur by ingestion, inhalation, or absorption through the skin or eyes. The most common adverse health effects mentioned in e-cigarette calls were vomiting, nausea, and eye irritation.[79]

 

 

 

 

 

 

 

 

Sources:

Legacy – Tobacco Fact Sheet http://www.legacyforhealth.org/content/download/582/6926/version/6/file/LEG-FactSheet-Topical-E-Cigarettes-May2014.pdf

Meta-Sources:

1 U.S. Department of Health and Human Services. The Health Consequences of Smoking-50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. 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. Printed with corrections, January 2014. Page 19 of Executive Summary.

2 Abrams DB. Promise and peril of e-cigarettes: can disruptive technology make cigarettes obsolete? JAMA : the journal of the American Medical Association. Jan 8 2014;311(2):135-136.

3 Williams M, Talbot P. Variability among electronic cigarettes in the pressure drop, airflow rate, and aerosol production. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco. Dec 2011;13(12):1276-1283.

4 Foulds J, Veldheer S, Berg A. Electronic cigarettes (e-cigs): views of aficionados and clinical/public health perspectives. International journal of clinical practice. Oct 2011;65(10):1037-1042.

5 Dawkins L, Turner J, Roberts A, Soar K. ‘Vaping’ profiles and preferences: an online survey of electronic cigarette users. Addiction (Abingdon, England). Jun 2013;108(6):1115-1125.

6 Cobb NK, Byron MJ, Abrams DB, Shields PG. Novel nicotine delivery systems and public health: the rise of the “e-cigarette”. American journal of public health. Dec 2010;100(12):2340-2342.

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9 Goniewicz ML, Kuma T, Gawron M, Knysak J, Kosmider L. Nicotine levels in electronic cigarettes. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco. Jan 2013;15(1):158-166.

10 Cameron JM, Howell DN, White JR, Andrenyak DM, Layton ME, Roll JM. Variable and potentially fatal amounts of nicotine in e-cigarette nicotine solutions. Tobacco control. Feb 13 2013.

11 Kubica P, Kot-Wasik A, Wasik A, Namiesnik J. “Dilute & shoot” approach for rapid determination of trace amounts of nicotine in zero-level e-liquids by reversed phase liquid chromatography and hydrophilic interactions liquid chromatography coupled with tandem mass spectrometry-electrospray ionization. Journal of chromatography. A. May 10 2013;1289:13-18.

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13 Federal Register. Deeming Tobacco Products To Be Subject to the Federal Food, Drug, and Cosmetic Act, as Amended by the Family Smoking Prevention and Tobacco Control Act; Regulations on the Sale and Distribution of Tobacco Products and Required Warning Statements for Tobacco Products. A Proposed Rule by the Food and Drug Administration. April 25, 2014. https://federalregister.gov/a/2014-09491.

14 National Conference of State Legislatures. Alternative Nicotine Products/Electronic Cigarettes. http://www.ncsl.org/research/ health/alternative-nicotine-products-e-cigarettes.aspx. Accessed May 5, 2014.

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23 Staff of Senators Durbin, Harkin, Rockefeller, Blumenthal, Markey, Brown, Reed, Boxer, Merkley and Representatives Waxman and Pallone. Gateway to Addiction? A Survey of Popular Electronic Cigarette Manufacturers and Targeted Marketing to Youth. April 14, 2014.

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52 Etter JF, Bullen C. A longitudinal study of electronic cigarette users. Addictive behaviors. Oct 30 2013.

53 Polosa R, Morjaria JB, Caponnetto P, et al. Effectiveness and tolerability of electronic cigarette in real-life: a 24-month prospective observational study. Internal and emergency medicine. Jul 20 2013.

54 Adkison SE, O’Connor RJ, Bansal-Travers M, et al. Electronic nicotine delivery systems: international tobacco control four-country survey. American journal of preventive medicine. Mar 2013;44(3):207-215.

55 Grana RA, Popova L, Ling PM. A longitudinal analysis of electronic cigarette use and smoking cessation. JAMA internal medicine. May 1 2014;174(5):812-813.

56 Popova L, Ling PM. Alternative tobacco product use and smoking cessation: a national study. American journal of public health. May 2013;103(5):923-930.

57 Goniewicz ML, Knysak J, Gawron M, et al. Levels of selected carcinogens and toxicants in vapour from electronic cigarettes. Tobacco control. Mar 6 2013.

58 Etter JF, Bullen C. Saliva cotinine levels in users of electronic cigarettes. The European respiratory journal. Nov 2011;38(5):1219-1220.

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60 Vansickel AR, Eissenberg T. Electronic cigarettes: effective nicotine delivery after acute administration. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco. Jan 2013;15(1):267-270.

61 Vansickel AR, Weaver MF, Eissenberg T. Clinical laboratory assessment of the abuse liability of an electronic cigarette. Addiction (Abingdon, England). Aug 2012;107(8):1493-1500.

62 Eissenberg T. Electronic nicotine delivery devices: ineffective nicotine delivery and craving suppression after acute administration. Tobacco control. Feb 2010;19(1):87-88.

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64 Schober W, Szendrei K, Matzen W, et al. Use of electronic cigarettes (e-cigarettes) impairs indoor air quality and increases FeNO levels of e-cigarette consumers. International journal of hygiene and environmental health. Dec 6 2013.

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68 McAuley TR, Hopke PK, Zhao J, Babaian S. Comparison of the effects of e-cigarette vapor and cigarette smoke on indoor air quality. Inhalation toxicology. Oct 2012;24(12):850-857.

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71 Ruprecht AA, De Marco C, Pozzi P, et al. Comparison between particulate matter and ultrafine particle emission by electronic and normal cigarettes in real-life conditions. Tumori. Jan-Feb 2014;100(1):e24-27.

72 Schripp T, Markewitz D, Uhde E, Salthammer T. Does e-cigarette consumption cause passive vaping? Indoor air. Feb 2013;23(1):25-31.

73 Flouris AD, Chorti MS, Poulianiti KP, et al. Acute impact of active and passive electronic cigarette smoking on serum cotinine and lung function. Inhalation toxicology. Feb 2013;25(2):91-101.

74 Williams M, Villarreal A, Bozhilov K, Lin S, Talbot P. Metal and silicate particles including nanoparticles are present in electronic cigarette cartomizer fluid and aerosol. PloS one. 2013;8(3):e57987.

75 Kim HJ, Shin HS. Determination of tobacco-specific nitrosamines in replacement liquids of electronic cigarettes by liquid chromatography-tandem mass spectrometry. Journal of chromatography. A. May 24 2013;1291:48-55.

76 Dawkins L, Corcoran O. Acute electronic cigarette use: nicotine delivery and subjective effects in regular users. Psychopharmacology. Aug 27 2013.

77 Chen IL. FDA summary of adverse events on electronic cigarettes. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco. Feb 2013;15(2):615-616.

78 Mayer B. How much nicotine kills a human? Tracing back the generally accepted lethal dose to dubious self-experiments in the nineteenth century. Archives of toxicology. Jan 2014;88(1):5-7.

79 Chatham-Stephens K, Law R, Taylor E, et al. Notes from the field: calls to poison centers for exposures to electronic cigarettes– United States, September 2010-February 2014. MMWR. Morbidity and mortality weekly report. Apr 4 2014;63(13):292-293.

80 Bassett RA, Osterhoudt K, Brabazon T. Nicotine Poisoning in an Infant. The New England journal of medicine. May 7 2014.