Electronic Nicotine Delivery System (ENDS) Surveillance in the United States

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1 Electronic Nicotine Delivery System (ENDS) Surveillance in the United States Brian King, PhD, MPH Deputy Director for Research Translation (Acting) Office on Smoking and Health Centers for Disease Control and Prevention American Association for Cancer Research (AACR) Congressional Briefing Washington, DC May 14, 2015 National Center for Chronic Disease Prevention and Promotion Office on Smoking and Health

2 Timeline of CDC ENDS Surveillance Activities HealthStyles NYTS NATS YRBS GATS GYTS NHIS NHANES

3 Percent Awareness of electronic cigarettes among U.S. adults Styles, Source: King, Patel, Nguyen, and Dube. Trends in Awareness and Use of Electronic Cigarettes among U.S. Adults, Nicotine Tob Res ntu191 first published online September 19, 2014 doi: /ntr/ntu191

4 Percent Ever use of electronic cigarettes among U.S. adults Styles, Source: King, Patel, Nguyen, and Dube. Trends in Awareness and Use of Electronic Cigarettes among U.S. Adults, Nicotine Tob Res ntu191 first published online September 19, 2014 doi: /ntr/ntu191

5 Percent (%) Ever Use of E-cigarettes among U.S. Adults, by Cigarette Smoking Status, Styles, Current Smoker Former Smoker Never Smoker Year Source: King, Patel, Nguyen, and Dube. Trends in Awareness and Use of Electronic Cigarettes among U.S. Adults, Nicotine Tob Res ntu191 first published online September 19, 2014 doi: /ntr/ntu191

6 Percent Past 30 day use of e-cigarettes among U.S. adults, by cigarette smoking status Styles, 2010/2011 & 2012/ % of current e-cigarette users were also current cigarette smokers in 2012/ Never Smoker Former Smoker Current Smoker Never Smoker Former Smoker 2010/ /2013 Current Smoker Source: King, Patel, Nguyen, and Dube. Trends in Awareness and Use of Electronic Cigarettes among U.S. Adults, Nicotine Tob Res ntu191 first published online September 19, 2014 doi: /ntr/ntu191

7 Cutting Back is Not Enough Even a Few Cigarettes Per Day is Dangerous Risks for dual users of cigarettes and e-cigarettes: Smoking just five cigarettes a day doubles the risk of dying from heart disease. Heavy smokers who reduce their cigarette use by half still have a very high risk for early death. Benefits of quitting smoking completely: Heart disease risk is cut in half 1 year after quitting and continues to drop over time. Even quitting at age 50 cuts your risk in half for early death from a smoking-related disease. Sources: Bjartveit K, Tverdal A. Health Consequences of Smoking 1-4 Cigarettes per Day. Tobacco Control 2005; 14(5): Tverdal A, Bjartveit K. Health Consequences of Reduced Daily Cigarette Consumption. Tobacco Control. 2006; 15(6):

8 Current (Past 30 Day) Use of E-cigarettes among U.S. Middle and High School Students, High School Middle School Source: Centers for Disease Control and Prevention & U.S. Food and Drug Administration. National Youth Tobacco Survey.

9 E-cigarettes and Nonsmoking Youth From , the number of never smoking youth who used an e-cigarette increased three-fold In 2013, over ¼ of a million never smoking youth used e-cigarettes Intention to smoke cigarettes was higher among e- cigarette users Source: Bunnell, Agaku, Arrazola, Apelberg, Caraballo, Corey, Coleman, Dube, and King. Intentions to smoke cigarettes among never-smoking U.S. middle and high school electronic cigarette users, National Youth Tobacco Survey, Nicotine Tob Res.

10 ENDS Surveillance Gaps Frequency of Use Type of Product Use Reasons for Use Temporality of Use Purchase Location Advertising Exposure Brand Attitudes/Knowledge/Beliefs

11 What We Know: 2014 Surgeon General s Report Toxicity and Health Effects The evidence is already sufficient to provide appropriately cautious messages to pregnant women and women of reproductive age as well as adolescents about the use of nicotinecontaining products such as smokeless tobacco and electronic cigarettes, and newer forms of nicotine-containing tobacco products, as alternatives to smoking Chapter 5, page 126 Source: 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.

12 Nicotine Poses Unique Dangers to the Developing Human Nicotine is highly addictive Nicotine is toxic to developing fetuses and impairs fetal brain and lung development Nicotine exposure during adolescence may produce lasting adverse consequences for brain development Poisonings have resulted among users and non-users due to ingestion of nicotine liquid, absorption through the skin, and inhalation Source: England, Lucinda J et al. Nicotine and the developing human: A neglected element in the electronic cigarette debate. Am Journ Prev Med 2015.

13 Number of calls to poison centers for cigarette or e-cigarette exposures, by month U.S., September 2010 February 2014 Source: Centers for Disease Control and Prevention. Notes from the Field: Calls to Poison Centers for Exposures to Electronic Cigarettes United States, September 2010 February Morbidity & Mortality Weekly Report. 2014;63:

14 Key Takeaways ENDS are not yet regulated as tobacco products* and are not an FDAapproved quit aid. Youth and adult e-cigarette use are rising rapidly. Most adult e-cigarette users smoke cigarettes. Even light cigarette smoking is dangerous Youth use of tobacco in any form is unsafe. Nicotine adversely affects the developing fetus and adolescent brain development CDC is advancing: Surveillance -- future surveys will address frequency of use, reasons for use, and other gaps Evidence-based tobacco control measures to address the diversity of tobacco products * FDA issued a proposed rule in 2014 to regulate e-cigarettes as tobacco products

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