“WARNING: This product contains nicotine. Nicotine is an addictive chemical.“
What are e-cigarettes?
Electronic cigarettes are a pen-like apparatus with a refillable or replaceable cartridge of liquid that contains nicotine, solvents and flavors. Easily carried and offering flavors from bubble gum to mocha to pina colada, the devices are used by many Americans, including a lot of middle and high schoolers. When users draw on the device, it causes the battery to heat the liquid solution, which is then turned into an inhalable vapor.
E-cigarettes are designed to simulate the act of tobacco smoking by producing an appealingly flavored aerosol that looks and feels like tobacco smoke and delivers nicotine, but with less of the toxic chemicals produced by burning tobacco leaves. Because they deliver nicotine without burning tobacco, e-cigarettes appear as if they may be a safer, less toxic alternative to conventional cigarettes.
E-cigarettes are now the most commonly used form of tobacco among young people in the United States, having surpassed conventional cigarettes in 2014. To learn more about electronic nicotine delivery systems (ENDS) visit the FDA’s page.
Are they legal?
The FDA as of May 2016 has moved to regulate e-cigarettes, an annual $3.5 billion industry in the U.S., placing a federal ban on the sale of e-cigarettes to anyone under the age of 18 and requiring manufacturers to disclose their ingredients and submit their products to the government for approval. According to a Washington Post report, the rule bans sale of all types of tobacco products (including hookah tobacco and pipe tobacco) to people younger than 18, requires photo identification for buyers younger than 26, prohibits sales in vending machines (except those in an adult-only facility) and prohibits the distribution of free samples. The rule also requires that all products carry warnings (beginning May 2018) that they contain nicotine, an addictive chemical.
At the time of the ban, only two states had not already enacted an age restriction on e-cigarette sales, and two states (California and Hawaii) have raised their legal age for using tobacco products to 21.
Are they harmful?
Although the vapor produced by e-cigarettes contains no tar—the main cause of lung cancer—it may contain other potentially harmful chemicals in addition to nicotine, which is an addictive substance. Most of these products are made in China, and testing of some products’ vapor has shown toxic metals, possibly produced by the vaporizing mechanism itself.
The flavorings that lend such appeal to e-cigarettes are created with chemicals like diacetyl, believed to be the cause of several “popcorn lung” deaths among factory workers who breathed it in while on the job. Twenty-seven flavoring chemicals, including diacetyl, have been identified by the flavoring industry’s trade association that, while edible and safe in food, may pose a risk of respiratory injury when inhaled. This list includes chemicals found in e-cigarette liquids.
Per the new regulations announced in May 2016, manufacturers have two years to submit product applications to the FDA for review of their existing products, and the FDA has an additional year to finish their evaluation. In essence, the FDA has frozen the marketplace for this time period, since companies are not able to introduce new products, and are prohibited from making changes in their existing products. Until federal approval is granted, there can be no definitive determination that any specific e-cigarette product is safe. Meanwhile, new methods of use that intensify the experience of using an e-cigarette (e.g. “dripping”), are trending among users, with uncertain consequences to their health.
Are they as addictive as regular cigarettes?
Nicotine, whether delivered in a conventional cigarette or an electronic cigarette, is an addictive substance. Direct comparisons are not possible between tobacco and the e-cigarettes currently available because e-cigarette fluids vary widely in their nicotine concentrations, and the amount a user is exposed to probably depends on a range of factors (like how many puffs they take, how deeply they inhale, and how long they hold it), but there is clearly a potential for these products to promote addiction—especially when users start in their teens.
What is hookah?
Hookahs are water pipes, heated usually with charcoal, that are used to smoke specially made tobacco that comes in different flavors, such as apple, mint, cherry, chocolate, and more. A practice that began centuries ago in Persia and India, hookah smoking is typically done in groups, with the same mouthpiece (at the end of a flexible hose) passed from person to person. Hookah cafes are presently gaining popularity around the world, and in the U.S. the practice is increasing among our youth and college-age students.
Water pipe smoking delivers nicotine—the same highly addictive drug found in other tobacco products. While many hookah smokers may think this practice is less harmful than smoking cigarettes, hookah smoking has many of the same health risks as cigarette smoking, including increased risks for smoking-related cancers, heart disease, and lung disease.
Hookah smoking exposes the user to high levels of carbon monoxide, metals, cancer-causing chemicals and toxic agents. Because of the way a hookah is used, smokers may actually absorb more of the toxic substances also found in cigarette smoke than cigarette smokers. Hookah smokers typically take more puffs and inhale more smoke when compared with cigarette smoking. Secondhand smoke from hookahs (i.e. both tobacco smoke and the heat-source smoke) can be a health risk for nonsmokers, as well.
New forms of electronic hookah smoking have been introduced. These products are battery powered and turn liquid containing nicotine, flavorings, and other chemicals into a vapor, which is then inhaled, much the way e-cigarettes operate. Like e-cigarettes, they are a delivery system for an addictive drug (nicotine), and the chemicals used to flavor the nicotine are not yet known to be safe.
Fewer teens smoke cigarettes now, so why should we be concerned?
Replacing cigarette smoking with e-cigarettes and hookah cafes should not be seen as progress. The number of young people using e-cigarettes now exceeds the number who smoke traditional cigarettes, according to the Centers for Disease Control and Prevention. About 5.3 percent of middle school students nationally (x% of Ossining’s middle schoolers) and 16 percent of high schoolers nationally (x% of OHS students) reported in 2015 that they had used e-cigarettes in the previous 30 days.
The Washington Post has reported that research is still being conducted to determine whether e-cigarettes lead people to start using traditional tobacco products or help them quit smoking. Smoking cessation is a standard argument in support of e-cigarettes, but that has yet to be proved a more effective route than patches, programs, pills, and other available supports.
Apart from the possible dangers of nicotine and the chemicals added to it to provide flavor, e-cigarette use is normalizing smoking behavior, which had been successfully stigmatized through public-health campaigns during the past decades. Teen tobacco use had been declining since the late 1990s. E-cigarette use among middle and high school students has climbed to more than 3 million in 2015, up from an estimated 2.46 million in 2014. (Source: Centers for Disease Control and Prevention)
The Monitoring the Future national survey has found that many adolescents who are using e-cigarettes are also smoking traditional cigarettes. Disturbingly, one recent study showed that students who have used e-cigarettes by the time they start 9th grade are more likely than others to start smoking traditional cigarettes and other smokable tobacco products within the next year (Rigotti, 2015).
Public health officials say that this sharp rise in use is troubling, in part, because of how much researchers still don’t know about the long-term effects of “vaping.” Tobacco-control advocates and public health leaders have insisted that the rise in the popularity of e-cigarettes stems in part from aggressive marketing campaigns that borrow from the tobacco industry playbook of earlier generations, using celebrities, sexual content, and claims of independence to glamorize these addictive products.
What should parents tell their children about tobacco products like e-cigarettes and hookahs?
Make sure your children understand the risks: Although they do not produce tobacco smoke, e-cigarettes still contain nicotine and other potentially harmful chemicals. Nicotine is a highly addictive drug, and recent research suggests nicotine exposure may also prime the brain to become addicted to other substances. Also, testing of some e-cigarette products found the vapor to contain known carcinogens and toxic chemicals (such as formaldehyde and acetaldehyde), as well as potentially toxic metal nanoparticles from the vaporizing mechanism. The health consequences of repeated exposure to these chemicals are not yet clear.
Traditional hookah smoking carries the same health risks basically as cigarette smoking. Electronic hookah smoking carries the same risks as e-cigarettes.
The surgeon general has referred to the escalating use of e-cigarettes among youth as “a major public health concern,” and is joined by the director of the Centers for Disease Control and Prevention in urging strong action to keep these products out of the hands of the nation’s young people.
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