The Changing Landscape of Tobacco: E-Cigarettes, E-Hookahs and More
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1 38th Annual Family Medicine Intensive Review Course The Changing Landscape of Tobacco: E-Cigarettes, E-Hookahs and More Debbie Rushing, LADAC, CTTS-M Associate Branch Chief Tobacco Prevention and Cessation Office Arkansas Department of Health 5/12/2016
2 Objectives Identify and discuss various electronic smoking devices (ESD). Identify how ESD impacts clean indoor air, social norming and cessations efforts.
3 Introduction of Electronic Cigarettes
4 ESD Over 450 Brands and 7,000 flavor combinations of E-Liquid
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6 Different electronic cigarette product types Rachel Grana et al. Circulation. 2014;129:
7 Tank Systems
8 Tin Nickel No restriction on ingredients or aerosol emissions Chromium Aluminum Acrolein Di-ethylene Glycol Arsenic Volatile Organic Compounds Formaldehyde Copper Acetaldehyde Nicotine Benzene Xylene Lead Propylene-Glycol Carcinogenic compounds It s Not Water Vapor.. Toluene Ethylbenzene Heavy Metals
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10 Marketing to Youth July 13, 2015 Company Behind Fruit Stripe Gum Suing E-Cig Company Over Vape Flavor Chicago Tribune Rutgers School of Public Health:
11 Non Resistant Packaging Federal ACT: Child Nicotine Poisoning Prevention Act of 2015
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15 Specific Nicotine Toxicity Cancer - Nicotine induces alteration of H3K27 demethylase UTX in kidney cancer cells. Hum Exp Toxicol Aug 7 Nicotine signaling and progression of chronic kidney disease in smokers. Biochem Pharmacol Jul 26. Heart Disease - Cardiovascular effects of exposure to tobacco products and harmful constituents. Biomarkers of exposure and injury symposium. Conklin D. Feb. 2016
16 Other Effects of ESDs Reproductive effects - Judith Zelifkoff. Feb, Sperm counts and sperm DNA damage Immune - Ilona Jaspers, Feb Suppression of key immune genes in the nasal mucosa similar to cigarette smokers Epithelial physiology and barrier function (cinnamaldehyde particularly)
17 Impact of maternal tobacco use on infant neurological outcomes Low birth weight Decreased brain volume Increased pre-term births Direct brain injury
18 Resilience and innovation keeps an industry on top destroy millions of lives utilizing methodical, innovative, and sophisticated techniques innovative advertising schemes how difficult it is to create social norm changes
19 When: December 1953 In attendance: Tobacco executives, lawyers and an advertising firm. Purpose: Develop a strategy to confront scientific reports linking cigarettes to lung cancer. We always have and always will cooperate closely with those whose task it is to safeguard the public health. We accept an interest in people s health as a basic responsibility, paramount to every other consideration in our business. We believe the products we make are not injurious to health. American Legacy Foundation Tobacco Trial Archive
20 ESDs is it a tobacco product? US Court of Appeals DC Circuit 2010 Sottera v. FDA Ruling: Products made or derived from tobacco can be regulated as tobacco products under the FD & C Act unless they are marketed for therapeutic reasons
21 Banned in Australia, Brazil, and Turkey
22 Marketing Movies & T.V. Video Games P.O.S. Give Away Items Online
23 Millions ESDs Advertising Dollars Spent in US for Materials and Accessories
24 Marketing
25 A premium lifestyle brand to redefine the act of smoking. Coapman, VP of Lorillard Motorsports Music festivals Events (SXSW) Educate Give-away Products Brand Positioning
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27 James Dean Stephen Dorff Blu E-cigs, May 2013
28 Vaping s Appeal Across Sub-Cultures Source:
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31 Current E-Cigarette Smoking Among High School Students % (APNA) US AR Source: National Youth Tobacco Survey and APNA 2014
32 Nicotine & Tobacco Research Advance Access published May 8, 2013
33 Downloaded from by guest on April 15, 2016
34 Arkansas General Assembly 2013/2015 Act 1451 Prohibits sales to minors Act 1099 Prohibits use on school grounds and at school functions Act 1235 Enforcement of sales to minors law, Child resistant packaging, Regulation and licensing of vape shops, Prohibits ESDs use on any school, childcare or healthcare facility Act 1722 Prohibits use on college campuses Multiple businesses, county and city properties now prohibit ESD use.
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