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Tuesday Mar 25, 2014

The Truth About E-Cigarettes: Unregulated, Unproven and Unhealthy

Here is a burgeoning twist to the tobacco wars and a new public health risk.

In a new television advertisement, electronic cigarettes are being touted as better than traditional cigarettes because the byproduct is "only vapor," not tobacco smoke. Consumers -- including children -- are being told that e-cigarettes are the “smart alternative” to smoking. The implication is that e-cigarettes are safe for the user and the people around them. The truth is the vapor from e-cigarettes contains carcinogens, including arsenic, benzene and formaldehyde. 

Here I am speaking at a news conference to address Chicago's ban on the use of electronic cigarettes in public places. Family physicians can make a difference in public health issues not only in our exam rooms but also through advocacy.

A preliminary study recently presented at the Society for Research on Nicotine and Tobacco found that second-hand exposure to e-cigarettes can cause harm after the user has left the room or turned off an e-cigarette because nicotine released by the products leaves residue on indoor surfaces.

Tobacco companies have long tried to glamorize their deadly products, and now e-cigarette marketers are doing the same thing, including using high-profile celebrity endorsements.

But the marketers' unsavory tactics don't stop there. Although proponents will argue that e-cigarettes are tobacco cessation devices, the fact is that manufacturers are targeting the next generation of smokers by marketing their products to kids.

If you have doubts, ask yourself how many middle-aged men are reaching for the e-cigarettes that come in cotton candy and bubble gum flavors. Those clearly are intended for kids, and the percentage of middle school and high school students who have tried e-cigarettes doubled from 2011 to 2012.

That's a huge problem because the products aren't regulated, so the amount of nicotine and other chemicals can vary from cartridge to cartridge.

And those touting e-cigarettes as the "smart alternative" to tobacco are ignoring the fact that many consumers are doubling up, using both conventional cigarettes and their electronic counterparts. In fact, a CDC survey found that more than three-fourths of middle school and high school students who use e-cigarettes also smoke. A recent study in JAMA Pediatrics concluded that the use of e-cigarettes "does not discourage, and may encourage, conventional cigarette use among U.S. adolescents."

A recent survey of e-cigarette users found that only 12 percent were former smokers who use the electronic products exclusively. A study in JAMA Internal Medicine found that e-cigarette users did not quit with greater frequency than nonusers. In fact, among smokers who called a quitline, e-cigarette users were less likely to quit than nonusers.

It's also worth noting that poisoning incidents related to e-liquids increased 300 percent in the past year.

So what are we, as a society, going to do to counter a billion-dollar industry that is spending more than $20 million a year to promote an unhealthy product?

The FDA was granted the authority to regulate cigarettes and other tobacco products in 2009, and the agency has been trying to gain similar control of e-cigarettes for years. Meanwhile, children are allowed to buy products that could adversely affect their health for the rest of their lives, and targeted advertising is unregulated.

We have a duty to protect those children and our communities, and if a product looks like a cigarette and contains nicotine like a cigarette, it should be regulated like one. So while we wait for the FDA to act nationally, we can advocate locally.

Here in Chicago, the Illinois AFP supported a city ordinance passed earlier this year that will subject e-cigarettes to the same sales restrictions as tobacco, and it also subjects the products to the city's Clean Indoor Air Act.

New York, Los Angeles and several counties across the nation also have implemented similar laws that ban the use of e-cigarettes in public places. Some states, including Illinois, prohibit the sale of e-cigarettes to minors. Legislation regarding sales restrictions and use in public places is pending in several states.

But legislators aren't the only ones who need to hear from family physicians about this health issue. Our patients are hearing about e-cigarettes from paid endorsers of the products on a regular basis, but what are we telling them?

Parents need to know that children are using these products, and there are numerous possible harms. Patients who are ready to quit smoking should be encouraged to use evidence-based methods that have been proven safe and effective.

Smoking rates for adults and teens are at historic lows. We must ensure that trend isn't reversed by misinformation and questionable marketing practices.

You can read the AAFP policy on e-cigarettes here. And to learn more about how to talk to your patients about e-cigarettes, the Illinois AFP, the AMA and the Chicago Department of Public Health recently offered a free webinar that is archived online

Javette Orgain, M.D., M.P.H., is the Vice Speaker of the AAFP.

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The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.