Healthy and safety concerns of e-cigarettes and e-juice.

1. E-cigarettes:
Untested & Unproven
By Kathy Garrett

3. First E-cigarette patent
1965

4. E-cigarette
• Electronic cigarettes (or e-cigarettes) first began
appearing in American markets about 2009.
• E-cigarettes vaporize a nicotine solution when the user
inhales, which gives a feeling similar to smoking.
• Models consist of a battery which powers the unit, an
atomizer that vaporizes the nicotine, and a cartridge
which houses the nicotine liquid (called e-liquid)

5. E-Cigarette
Components

7. E-Cigarette
• E-cigarettes come in all colors, shapes and sizes.
• This makes smoking very customizable.

8. Closed system

9. Open system

10. Store fronts

11. E-Juice
• Nicotine cartridges house the e-liquid or e-juice and can
either be disposable or reusable.
• The liquid is generally made up of four chemicals:
nicotine, propylene glycol, vegetable glycerin, and
flavoring.

12. E-Juice:
Health And Safety Concerns
• The lethal dose of nicotine is 30-60mg for adults and
10mg for kids. Nicotine solutions in e-juice come in
varied strengths and concentrations.
• According to the Utah Poison Control Center, e-
cigarettes have sent 79 children ages 6 and under to
hospitals since January 2012. There were 10 such
poisoning cases in 2012, 48 in 2013 and 21 in 2014 so
far.
• Nicotine can also be absorbed through the skin.

13. E-Juice:
Health And Safety Concerns
• Mixing procedures
• Sanitation
• Often imported from
China

14. Additional Concerns

15. Conflicting nicotine
concentrations
• Blue-
what the
bottle
indicated
• Red –
what the
bottle
actually
had.

16. E-Cigarette Flavoring
• While flavoring is illegal
for normal cigarettes, e-
juice come in almost any
flavor.
• The abundance of
flavors may serve to lure
youth to e-cigs, which in
turn could result in youth
eventually switching to
regular tobacco.

17. E-Juice Flavors
• Root Beer
• Cherry Bomb
• Watermelon
• Key Lime Freeze
• Bubble Gum
• Orange Dream
• Very Strawberry
• Chocolate
• Cookies & Cream
• Strawberry
Shortcake
• Tutti-Frutti
• Vanilla
Candy Cane
Captain Crunch
Hawaiian Paradise
Mango
Granny Apple
Apple Pie
Blue Coconut
Gummy Bear
Juicy Strawberry
Pom-Pom Burst
Tropical Splash
Caramel Cream
Red Razzle
Strawberry Surprise
Arctic Freeze
Blue Razzleberry
Grapelicious
Juicy Blue Frost
Maui Smooth
Red Hots
Strawberry Colada
Tigers Blood
Blueberry
Mountain Dew

18. E-Juice Flavors

19. E-Cigarettes
• While e-cigarettes have been manufactured as a nicotine
delivery system, that hasn’t stopped many users from
getting creative with them.
• E-cigarettes can be used as a delivery system for a large
number of drugs besides nicotine – including THC (the
active drug in marijuana), alcohol, and other drugs.
• (see the video at http://www.youtube.com/v/mzT7j7tWgq4

20. Advertising

21. Advertising
• With a lack of advertising restrictions, companies are re-
introducing the highly stylized ads of traditional tobacco,
featuring celebrity endorsements.

22. Electronic Cigarette
Youth rates
• According to the CDC, the number of U.S. youth who used electronic
cigarettes, but have never smoked a regular cigarette, has more than
tripled in the past three years, from 79,000 in 2011 to over 263,000 in
2013.
• These same youth are nearly twice as likely to intend to smoke regular
cigarettes as those who have never used e-cigarettes.
• In Utah, the percentage of Utah high school age students who use e-
cigarettes tripled between 2011and 2013.
• Utah, data shows that 31.7% of students who reported ever using e-
cigarettes say they have never tried conventional cigarettes.

23. E-Cigarette Regulation
 FDA is currently assessing the impact of e-cigarettes and plans to
announce proposed regulation.
 Until the FDA proposals are announced, e-cigarette regulation will
only exist at the state and local level.
 The Utah Indoor Clean Air Act prohibits electronic cigarettes
anywhere that traditional cigarettes are banned.
 In Utah, the use of e-cigarettes is illegal for anyone under 19 years
of age.
 Regulation of retail tobacco specialty business.

24. Emerging Public Health Issue
• Because e-cigarettes are currently unregulated at the federal level,
consumers do not have access to accurate information on e-
cigarette ingredients, product quality, and safe product usage.
• Relatively little is known about the impact of electronic cigarettes,
including the long-term health effects of breathing the vapor and
their efficacy as a cessation device.
• Need more scientific investigation, possibly regulations/laws .

25. What Local Health
Departments are doing
• Currently, all of the health departments in Utah are
working towards a regulation that applies to Electronic
Smoking Devices ESDs and E-Liquid samples, sold
and/or manufactured.
• Main points:
o Must contain warning label
o Have child proof caps
o Safety precautions when mixing
o Nicotine level in E-liquid

26. National Policy Options
• Adding e-cigarettes to existing smoke-free laws
• Limiting youth access
• Licensing
• Minimum sales age
• Marketing regulation
• Taxation
• Limiting Free Samples, Rebates, Discounts, Coupons
• Restricting the sale of flavors.

27. Questions?