The Risk Bites video series is touching on many of my favorite emerging technologies topics. Every now and then, I’m hoping to take some of their topics and dig into the issues a little more. Today’s topic is e-cigs, which I’ve blogged about here before. Earlier this week, the e-cigarette panel discussion at the annual meeting of the American Public Health Association (#APHA14) attracted a great deal of attention, including attendance from the current Surgeon General.
In addition, APHA endorsed a public call to the FDA to push forward on regulating electronic cigarettes.
20149 Regulation of electronic cigarettes — Calls on the U.S. Food and Drug Administration to develop regulations that hold e-cigarettes to the same marketing and advertising standards as conventional tobacco cigarettes and calls for the federal funding of research on the short- and long-term health consequences of e-cigarette use. Urges the Consumer Product Safety Commission to require special packaging, including warning labels, on e-cigarette cartridges to help prevent childhood poisoning. Also calls on state and local official to restrict the sale of e-cigarettes to minors as well as the use of e-cigarettes in enclosed public areas and workplaces. APHA News Releases: New 2014 policy statements http://www.apha.org/news-and-media/news-releases/apha-news-releases/2014-policy-statements
This all makes this topic especially timely, and worthwhile of reviewing once more. Please note, I am NOT saying these are the reasons behind the APHA call for action, or even that there is research to support the points below. I am saying only that these are things I’ve noticed and found interesting. If there isn’t research, maybe there needs to be. If existing research doesn’t yet answer important safety questions, maybe we should act with caution until we do have those answers. It there is, then maybe I could share some in another post. I do believe that the issue of e-cigs is more nuanced than we might be led to believe by much of the public dialog around it — that there are both benefits and risks. So, with that caveat, here we go!
Electronic cigarettes and health – the basics https://www.youtube.com/watch?v=mToznqKD5Ac
Primary public health perspectives mentioned in this video:
– What are the impacts of use by children?
– E-Cigs reduce toxins from smoke for regular smokers
– Are e-cigs simply an easier path to nicotine addiction?
– Aside from the intended nicotine, there may be impurities & contaminants from e-liquid solutions
– The FDA only has oversight over certain aspects of e-cigs, and there may be a lack of regulation for other potentially risky aspects of the device & liquids.
This is a truly excellent introduction in very few minutes to the most important considerations of e-cigarette use. The best quick overview I’ve seen. There are a few other issues to possibly address. See the following videos for a broader picture of public health aspects of e-cigarettes.
There have been (few, but some) reports of e-cigarette devices that were flawed in manufacture and did nasty stuff like explode in someone’s face. This is another aspect for the attention of regulators. Some of the explosions have been when on charge (as in this video), or have been modified in some way by the user (“at your own risk” becomes a very meaningful phrase). There are reports of this happening while in use and damaging the user’s face. Because this is not a medical device, these events are not being recorded in a way that allows healthcare systems to document and define the level of risk. Without that, you are basically depending on the industry to self-police manufacturing standards and error rates.
E-cigarette on charge explodes in bartender’s face: CAUGHT ON CCTV CAMERA https://www.youtube.com/watch?v=x1VrzgeG7jk
We live in a MAKER world. People hack their medical devices, and people hack their home devices. Why should e-cigarettes be any different? According to this video people hack their e-cig devices to make them hotter, and to have less of a draw, so they can get more vapor with less effort. According to the scientists, this changes the risks associated with the chemicals. We need to ask not only what people are already doing to hack these devices, but what else they might do with them or their components. I’m sure we have yet to imagine everything that could be done with vape pens.
Mashable: How to Hack Your Own E-Cigarettes https://www.youtube.com/watch?v=rmxwnuTRMiw
Vaping is a drug delivery mechanism. Nicotine is only one drug. There is talk about using vaping as a tool for delivering other medications that require inhalation, such as asthma meds. Of course, it needn’t be used solely for prescription meds, either. Vaping is also a tool for delivering street drugs, illegal drugs, and home made drugs. This, again, could be good or bad, depending on the circumstances.
How To Mix & Make Your Own E Juice Liquid DIY https://www.youtube.com/watch?v=x57PaibrOag
SPECIAL REPORT: Teens using E-Cigs to smoke marijuana http://www.nbc11news.com/home/headlines/SPECIAL-REPORT-Teens-using-E-Cigs-to-smoke-marijuana-245882671.html
Remember the phrase “gateway drugs”? There are recipes all over the Internet for how to make your own e-cig liquid, and those recipes include directions for how to make e-cig liquid to deliver illegal drugs. I think the genie is out of the bottle on that one, but it is certainly an issue to address in public health circles. Of course, also keep in mind that e-cigs may be a alternate way to provide medical marijuana to patients.
How To: Potent Water-Soluble Cannabis Concentrate in Glycerin https://www.youtube.com/watch?v=MQyx8br65N0&list=PLpKaVRowbJ84eVJTLbAyVUUdzSXfJwLVS
People have mentioned the issues of e-cig flavors that are clearly being marketed specifically to children, and how the devices are being marketed as cool/fun/sexy for young adults.
Do Vape Pens Trick Teens? https://www.youtube.com/watch?v=HnKwHWyHH4g
A Sexy View of the ECC 2014 Expo – Vape Club https://www.youtube.com/watch?v=i6SQiu08DxQ
It really makes it look like fun, doesn’t it? That was actually the first thing that attracted my attention to e-cigarettes. I saw so many incredibly beautiful photos streaming thru the sites marketing the devices, it seemed like there was an awful lot of money and genius being poured into the campaigns. It made me wonder why.
Recent research from the CDC reveals that e-cig use among children and teens is skyrocketing. It may take time to learn the long term outcomes of this trend.
CDC: More kids lighting up e-cigarettes https://www.youtube.com/watch?v=zJ_BEiKpqaE
Growing Number of Youth Smoking Vaporizers https://www.youtube.com/watch?v=0L3so_qfpuo
Research also seems to show that youth who start with e-cigs are more likely to convert to conventional cigarettes. This is, obviously, the reverse of using e-digs as a smoking cessation device.
Study: Youth who have used e-cigarettes are twice as likely to smoke conventional cigarettes http://kimt.com/2014/09/24/study-youth-who-have-used-e-cigarettes-are-twice-as-likely-to-smoke-conventional-cigarettes/
Teenage E-Cigarette Use Likely Gateway to Smoking http://www.bloomberg.com/news/2014-03-06/teenage-e-cigarette-use-likely-gateway-to-smoking.html
Intentions to Smoke Cigarettes Among Never-Smoking U.S. Middle and High School Electronic Cigarette Users, National Youth Tobacco Survey, 2011–2013 http://ntr.oxfordjournals.org/content/early/2014/09/16/ntr.ntu166
This video seems to me to be intentionally designed to scare people, BUT, despite the hyperbole and drum rolls, the content is largely factual, just framed to be extra exciting. I’m including links to the source content so you can dig into it more, and don’t have to depend on the video.
CDC Releases Negative Findings of E-Cigarettes https://www.youtube.com/watch?v=3bMUxSw1BoM
CDC: Youth Tobacco Prevention: Electronic Cigarettes: Key Findings: Intentions to smoke cigarettes among never-smoking U.S. middle and high school electronic cigarette users, National Youth Tobacco Survey, 2011-2013 http://www.cdc.gov/tobacco/youth/e-cigarettes/
CDC News Room: E-cigarette use more than doubles among U.S. middle and high school students from 2011-2012 http://www.cdc.gov/media/releases/2013/p0905-ecigarette-use.html
CDC News Room: More than a quarter-million youth who had never smoked a cigarette used e-cigarettes in 2013: http://www.cdc.gov/media/releases/2014/p0825-e-cigarettes.html
CDC: Youth and Tobacco Use: http://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/
CDC Newsroom: Emerging tobacco products gaining popularity among youth; Increases in e-cigarette and hookah use show need for increased monitoring and prevention http://www.cdc.gov/media/releases/2013/p1114-emerging-tobacco-products.html
CDC Newsroom: New CDC study finds dramatic increase in e-cigarette-related calls to poison centers; Rapid rise highlights need to monitor nicotine exposure through e-cigarette liquid and prevent future poisonings http://www.cdc.gov/media/releases/2014/p0403-e-cigarette-poison.html
Electronic cigarettes: What we know so far https://www.youtube.com/watch?v=f6KBGH2F63A
Among other issues, she points out that excessive regulation of vape pens and e-digs could lead to people making their own devices. The genie is out of the lamp — people know what these are and how they work. It isn’t going to be that hard to make your own, but it may create other kinds of risks and quality control issues. Right now, you can actually buy kits to make your own vape pen at home.
How To Make A Home Made Vaporizer Out Of House Hold Items http://www.youtube.com/watch?v=2N0w34OWVx0
Just for balance, here are a couple of infographics about e-cigs and the balance of research, information, and evidence currently available.