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4/ accessHealthnews.net Summer/Fall 2014 Jury's Out on E-cigs Glenda Bertz shares insight with accessHealth Glenda Bertz, RN, assistant administrator at Lafayette County Health Department leads the nonprofit Lafayette County Prevention Coalition. Currently, the organization is working on initiatives to establish smoke-free communities in the county. Q. What is the truth about e-cigarettes? A. Electronic or e-cigarettes are devices designed to mimic cigarettes. The metal tubes are designed to look like real cigarettes and contain a cartridge filled with a nicotine-laced liquid that is vaporized by a battery- powered heating element. The nicotine vapor is inhaled by smokers when they draw on the device, as they would a regular cigarette. They come in a variety of flavors, nicotine levels, and varieties. Although many tobacco companies claim that e-cigarettes are a less dangerous alternative to smoking cigarettes, e- cigarettes are not FDA regulated and have not been fully studied. Consumers don't know: ● The potential risks of e- cigarettes when used as intended. ● How much nicotine or oth- er potentially harmful chemicals are being in- haled during use. ● Whether there are any benefits associated with using these products. Additionally, it is not known whether e-cigarettes may lead young people to try other tobacco products, including conventional cigarettes, which are known to cause disease and lead to premature death. There is no proof that e-cigarettes don't cause long-term harm. "We cannot say they are good or bad because we don't have any scientific proof," said Eliana Mendes, M.D., a pulmonary researcher at the University of Miami. "They are nicotine delivery devices intended to be used like a cigarette. What happens to someone who stops inhaling the tars of cigarettes and inhales only nicotine? We don't know. There is at least the potential for harm," said Norman Edelman, M.D., chief medical officer for the American Lung Association. "We are concerned about the potential for addiction and abuse of these products. We don't want the public to perceive them as a safer alternative to cigarettes," said Rita Chappelle, FDA spokeswoman. Q: How easy is it for children/teens to get? A. There are currently no FDA regulations on e-cigarettes, including a minimum age for sale. There are multiple kiosks at malls selling e-cigarettes and teens can purchase e-cigarettes on the Internet. Tom Frieden, director of the Centers for Disease Control and Prevention (CDC) states, "I've treated so many adults who are desperate – desperate – to get off tobacco. They all started as kids. I see the industry getting another generation of our kids addicted. To me, as a physician, when 1.78 million of our high school kids have tried an e-cigarette and a lot of them are using them regularly … that's like watching someone harm hundreds of thousands of children." Findings from the National Youth Tobacco Survey in the October 5, 2013 issue of Morbidity and Mortality Weekly Report showed that the percentage of high school students who reported ever using an e-cigarette rose from 4.7 percent in 2011 to 10.0 percent in 2012. In the same time period, high school students using e-cigarettes within the past 30 days rose from 1.5 percent to 2.8 percent. Use also doubled among middle school students. In 2012, more than 1.78 million middle and high school students nationwide had tried e-cigarettes. Q: What tactics do advertisers use to market to young people? A. Although cigarette makers deny they target teenage customers, researchers say the companies aggressively market glamorous and sexy images that appeal to a teenager's sense of rebellion and tendency toward risky behavior. Those same tactics are now being used for e-cigarette ads. E-cigarettes do not fall under the same restrictions as cigarettes and may advertise on television and magazines. E-cigarettes also come in a variety of flavors like strawberry, watermelon and licorice. There are far more restrictions on tobacco cigarettes, including a ban on offering sweet or fruity flavors, as well as restrictions on advertising and sales to minors. The FDA is currently considering whether and how much to regulate electronic cigarettes. After the surgeon general's report 50 years ago showing the harmful health effects of tobacco, some of the glamour was taken away from tobacco. Initially, there was a large decrease in the number of people using tobacco products. Since e-cigarettes have come out, the tobacco industry is using the same old tricks to try to get people to use these products. Ads stating "Take back your freedom," appeal to teens' rebellious side. Tobacco companies have also gotten well-respected actors to promote their products, touting them as less harmful and a healthier alternative to smoking. Q: Do e-cigarettes contain health risks? If so, please elaborate. A. As stated above, since e- cigarettes are not FDA regulated there is still much unknown about its health effects. E-cigarettes don't fill the lungs with harmful smoke, but that doesn't make them a healthy alternative to regular cigarettes. When you use an e-cigarette, you are still putting nicotine into your system. In addition to being an addictive drug, nicotine is also toxic in high doses. It was once even used as By Tonia Wright an insecticide to kill bugs. Nicotine affects your brain, nervous system, and heart. It raises blood pressure and heart rate. "Nicotine addiction is bad and people with the habit need help quitting, not help continuing their habit in more socially acceptable ways," said American Lung Association's Chief Medical Officer Norman H. Edelman, M.D. There is no evidence that people switch from tobacco cigarettes to e-cigarettes or other smokeless products. Smokeless products (including e-cigarettes) are marketed to use at times when you can't smoke. This just encourages people to increase their nicotine exposure, not reduce smoking. This marketing encourages people to use more nicotine, by using the smokeless products in "smoke-free public places" and use tobacco cigarettes the rest of the time. What FDA regulations would you like to see? On April 24, 2014, the FDA proposed to extend its tobacco authority to additional tobacco products, including e-cigarettes. Consistent with currently regulated tobacco products, this would require e-cigarette manufacturers to: ● Register with the FDA and report product and ingredient listings. ● Market new tobacco products after FDA review. ● Make direct and implied claims of reduced risk if the FDA confirms that scientific evidence supports the claim and that marketing the product will benefit public health as a whole. ● Eliminate free samples. ● Apply minimum age and identification restrictions to prevent sales to underage youth. ● Include health warnings. ● Prohibit vending machine sales, unless in a facility that never admits youth. The proposed rule will be available for public comment for 75 days. "The challenge that the FDA has is that they will be challenged by the tobacco industry, as they have been at every step of the way," said Frieden. "The federal agency tried to regulate e-cigarettes earlier and they lost to the tobacco industry… So the FDA has to balance moving quickly with moving in a way that's going to be able to survive the tobacco industry's highly paid legal challenge."