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Food and Drug Administration (FDA). (2016). Retailer Overview of FDA Regulations for Selling Tobacco Products. Retrieved October 12, 2016 from http://www.fda.gov/TobaccoProducts/GuidanceComplianceRegulatoryInformation/Retail/ucm205021.htm

Goniewicz, M. L., Knysak, J., Gawron, M., Kosmider, L., Sobczak, A., Kurek, J., . . . Benowitz, N. (2014). Levels of selected carcinogens and toxicants in vapour from electronic cigarettes. Tobacco Control, 23(2), 133-139. doi:10.1136/tobaccocontrol-2012-050859

Grana, R. A., Popova, L., & Ling, P. M. (2014). A longitudinal analysis of electronic cigarette use and smoking cessation. JAMA Internal Medicine, 174(5), 812-813. doi:10.1001/jamainternmed.2014.187

Hutzler, C., Paschke, M., Kruschinski, S., Henkler, F., Hahn, J., & Luch, A. (2014). Chemical hazards present in liquids and vapors of electronic cigarettes. Archives of Toxicology, 88(7), 1295-1308. doi:10.1007/s00204-014-1294-7

Jerry, J. M., Collins, G. B., & Streem, D. (2015). E-cigarettes: Safe to recommend to patients? Cleveland Clinic Journal of Medicine, 82(8), 521.

Johnston, L. D., O’Malley, P. M., Miech, R. A., Bachman, J. G., & Schulenberg, J. E. (2016). 2015 Overview: Key findings on adolescent drug use. Retrieved November 10, 2016 at http://monitoringthefuture.org/pubs/monographs/mtf-overview2015.pdf

Mantey, D. S., Cooper, M. R., Clendennen, S. L., Pasch, K. E., & Perry, C. L. (2016). E-cigarette marketing exposure is associated with E-cigarette use among US youth. Journal of Adolescent Health, 58(6), 686-690. doi:10.1016/j.jadohealth.2016.03.003

Payne, J. D., Michaels, D., Orellana-Barrios, M., & Nugent, K. (2016). Electronic cigarette toxicity. Journal of Primary Care & Community Health, doi:10.1177/2150131916668645

Pechacek, T. F., Nayak, P., Gregory, K. R., Weaver, S. R., & Eriksen, M. P. (2016). The potential that electronic nicotine delivery systems can be a disruptive technology: Results from a national survey. Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco, 18(10), 1989-1997. doi:10.1093/ntr/ntw102

Schoenborn, C. A., & Gindi, R. M. (2015). Electronic cigarette use among adults: United States, 2014. NCHS data brief, 217, 1-8.

Singh, T., Arrazola, R. A., Corey, C. G., Husten, C. G., Neff, L. J., Homa, D. M., & King, B. A. (2016). Tobacco Use Among Middle and High School Students-United States, 2011-2015. MMWR. Morbidity and Mortality Weekly Report, 65(14), 361.

Smith, L., Brar, K., Srinivasan, K., Enja M., & Lippmann, S. (2016). Cigarettes vs e-cigarettes: how does the experience (and cost) compare? Journal of Family Practice, 65(6), 383.

Vickerman, K. A., Carpenter, K. M., Altman, T., Nash, C. M., & Zbikowski, S. M. (2013). Use of electronic cigarettes among state tobacco cessation quitline callers. Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco, 15(10), 1787.

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August 2016, the Food and Drug Administration has regulatory control over all aspects of e-cigarettes and any product that contains nicotine.

E-cigarettes cannot be sold to children under 18 years of age.

May 2018, e-cigarette packaging and advertisements will require a health warning statement.

IT IS A START.....

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Decline in high school smoking comes to a halt in 2015 due to the large number who use e-cigarettes

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15. Reasons stated in #14 were primary strategies of No            Smoking campaign of the past decade:

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15. Reasons stated in #14 were primary strategies of No            Smoking campaign of the past decade:

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1. Increase cost
2. Limit smoking in public areas
3. Change social norms.

This is a concern.

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E-cigarettes do have puff per puff, less nicotine than cigarettes.

For adults, use of e-cigarettes are not proven to improve smoking cessation.

Dual use of e-cigarettes does reduce nicotine intake.

Addicted smokers do not make the switch to e-cigarettes.

More middle school and  high school students smoke than adults.

Increased marketing expenditures are associated with increased use by youth.

Based on puffs per day and nicotine content in vaping fluid, addiction with e-cigarettes is more than a possibility.

Vaping fluid is fatal to small children.

There are too many varieties on the market resulting in lack of, contents described on packaging cannot be trusted and are unsafe

FDA now has regulatory control.

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20. Fatal Dose of Nicotine to Child -- 10mg

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20. Fatal Dose of Nicotine to Child -- 10mg

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E-cigarette liquid vials sold contain up to 30 ml of liquid containing up to 22 mg of nicotine per ml (Jerry, Collins & Streem, 2015).

Due to children friendly flavors, children are in danger of fatal overdoses.

Calls to poison centers for e-cigarette exposures have increased from:
1 per month ------- > 215 per month in 2014
Half of the calls are for children < 5 years old
(Payne, Michaels, Orellana-Barrios & Nugent, 2016).

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19. Exposure Threshold for Nicotine Addiction - 5mg

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19. Exposure Threshold for Nicotine Addiction - 5mg

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Nicotine in 15 puffs from e-cigarette         .25 - .77 mg

Just under 100 puffs a day will provide enough nicotine to establish an addiction, especially in children.

(Goniewicz et al., 2014)

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21. Other Contents of Vaping Fluid (Goniewicz et al., 2012)

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21. Other Contents of Vaping Fluid (Goniewicz et al., 2012)

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Flavorings: Hundreds of flavors exist, including cherry, cheesecake, cotton candy, cinnamon and hundreds more. Many of those flavoring chemicals are also used to flavor food.

Propylene glycol (PG): PG is a lab-made liquid that the FDA generally views as safe in food, drugs, and cosmetics. It's also used to make artificial smoke or fog for rock concerts and other performances. It can irritate the lungs and eyes and may be more harmful for people with chronic lung diseases like asthma and emphysema.

Jerry, Collins & Streem (2015), prolonged use to cause throat and vocal cord inflammation, cough and mild airway obstruction, headache, dizziness and drowsiness

Glycerin: Odorless and colorless, liquid glycerin has a slightly sweet taste. Like PG, the FDA generally views it as safe. It’s found in many products, including food and drugs, both prescription and over the counter.

While these items are safe in food and drugs, the effects of inhaling large amounts of these chemicals over the long term are unknown.

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The E-Cigarette market is highly varied and unreliable
Toxicity level depends on vaping strength, periodicity between puffs and effects of the model on toxicant exposure.

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18. A sample of 28 liquids from 7 manufacturers (Hutzler et al., 2014) :

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18. A sample of 28 liquids from 7 manufacturers (Hutzler et al., 2014) :

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141 different chemicals

7 of 10 declared nicotine free, contained nicotine

16 of 18 samples did not list nicotine as an additive, contained nicotine

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An E-cigarette when puffed, activates a heating element which turns a liquid into vapor that is inhaled by the individual. Basic components in any model include:

Device

Battery

Heating coil

Tank to hold vaping fluid

Models are highly varied and can have components such as microprocessors, LED lights to mimic a cigarette, charging elements and a variety of other accessories.
(Smith, Brar, Srinivasan, Enja & Lippmann, 2016)

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12. Increased Marketing Expenditures Associated with Increased Use Children (Mantey, Cooper, Clendennen, Pasch & Perry, 2016). 

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12. Increased Marketing Expenditures Associated with Increased Use Children (Mantey, Cooper, Clendennen, Pasch & Perry, 2016). 

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Designed to mimic a traditional cigarette

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A cheaper option, replaceable or refillable cartridge

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More expensive, higher quality and programmable. Great for hobbyist

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13. More Kids are Lighting up with E-cigarettes

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13. More Kids are Lighting up with E-cigarettes

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A great video on the rise of e-cigarettes and why kids should not start...

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Bubble gum, cotton candy, watermelon, pineapple. These are all flavors of slushies and electronic cigarettes -- both of which, according to some research, appeal to children as young as 12. For more information please visit http://www.hlntv.com/video/2014/02/17/e-cigarettes-and-kids

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14. Why Children Smoke                                                            (Mantey, Cooper, Clendennen, Pasch & Perry, 2016). 

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14. Why Children Smoke                                                            (Mantey, Cooper, Clendennen, Pasch & Perry, 2016). 

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1. "Low cost"

2. "More locations to smoke"

3. "Tastes good"

4. ""Parents could not tell I have been smoking"

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11. Rapid Growth in Prevalence in Just Four Years                    (Singh et al., 2016) 

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11. Rapid Growth in Prevalence in Just Four Years                    (Singh et al., 2016) 

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10. Most Popular Tobacco Product Among Middle and High School Students in 2014

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10. Most Popular Tobacco Product Among Middle and High School Students in 2014

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Teens are more likely to try e-cigarettes than cigarettes (Johnston, O’Malley, Miech, Bachman & Schulenberg, 2016)

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1. Smoking e-cigarettes have not shown to not  improve smoking cessation efforts (Pechacek, Nayak, Gregory, Weaver & Eriksen, 2016).
1a. Quit rates are better in smokers that have never tried e-cigarettes before (Vickerman, Carpenter, Altman, Nash & Zbikowski, 2013).
2. E-cigarettes do appear to reduce number of cigarettes smoked per day in adults (Grana, Popova & Ling, 2014) .

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8. Why Adults Smoke E-Cigarettes                                    (Pechacek, Nayak, Gregory, Weaver & Eriksen, 2016)

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8. Why Adults Smoke E-Cigarettes                                    (Pechacek, Nayak, Gregory, Weaver & Eriksen, 2016)

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1. "Less  harmful to smokers"

2. "Less harmful to surrounding people"

3. "To help quit smoking" (Note 1)

4. "Reduce number of cigarettes smoked per day" (Note 2)

5. "Socially acceptable"

6. "More locations to smoke"

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3.7% of adults smoke e-cigarettes (Schoenborn & Gindi, 2015)
More likely to smoke e-cigarettes: Young adults and recent quitters

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1. E-Cigarettes hit the United States Market in 2007 and its use has exploded

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1. E-Cigarettes hit the United States Market in 2007 and its use has exploded