8 Facts About E-Cigarettes and Their Impact on Public Health

E-cigarettes are a growing public health concern in Utah. Read these eight facts to learn more about e-cigarettes and Utah; including current laws, risks to teens and the reasons Gov. Herbert has proposed taxing them like tobacco products.

1. What is an e-cigarette?

E-cigarettes are part of a new class of tobacco products referred to as electronic nicotine delivery systems (ENDS), which are battery powered devices that provide doses of nicotine and other additives to the user in an aerosol. There are currently multiple types of ENDS on the US market including e-cigarettes, e-hookahs, hookah pens, vape pens, e-cigars, and others. Some of these products are disposable varieties, while others can be refilled or recharged for repeated use.

2. Are e-cigarettes worse or better than regular cigarettes?

Since e-cigarettes are not yet regulated as tobacco products, there is very little information about the ingredients of liquids or the approximate exposure to harmful and potentially harmful constituents when using e-cigarettes over the short-term or long-term.

While several studies found lower levels of carcinogens in the e-cigarette aerosol compared to smoke emitted by traditional cigarettes, both th e mainstream and the secondhand e-cigarette aerosol have been found to contain chemicals known to cause cancer, birth defects or other reproductive harm, including acetaldehyde, formaldehyde, lead and nicotine.

Nicotine is both a highly addictive drug and a neurotoxin that can cause nausea, vomiting, sweating, and an increased heart rate. Even though nicotine levels in e-cigarette refill solutions are often high enough to be fatal to small children, the FDA does not regulate e-liquid manufacturing.

Recently, Salt Lake County Health Department partnered with the Center for Human Toxicology at the University of Utah to measure the amount of nicotine in 153 e-liquid samples the department obtained from retailers around the county.  In the study, 61% of the e-liquid samples differed by at least 10% from the labeled nicotine content, with discrepancies ranging from 88% less to 840% more than stated.

3. So, is there “secondhand vapor”?

E-cigarette aerosol is not “water vapor.” It contains nicotine and can contain additional toxins. E-cigarette emissions are a health concern for those exposed to the secondhand aerosol. Although not as dangerous as secondhand smoke from combustible tobacco products, people exposed to e-cigarette aerosol absorb nicotine at levels comparable to people exposed to secondhand smoke.

4. Can e-cigarettes help people quit?

To date, no ENDS, including e-cigarettes, have been approved as a smoking cessation aid by the Food and Drug Administration’s Center for Drug Evaluation and Research, and there is very limited research on their effectiveness as a cessation aid. Several population-level longitudinal studies suggest that e-cigarette users are not more likely to quit smoking cigarettes than non-users. Currently, seven FDA-approved prescription and non-prescription smoking cessation products are available, including nicotine replacement therapies. These products have been scientifically shown to be effective for smoking cessation, and are safe when used as directed. ENDS manufacturers have the option to apply to the FDA Center for Drug Evaluation and Research for approval to market their products as a cessation aid.

In Utah, we know that people are purchasing e-cigarettes with the intention to quit. However, population surveys show that adult tobacco use rates have not declined with the rise in e-cigarette use. The e-cigarette use rate for current smokers is 29.4%. Nearly 60% of current e-cigarette users also smoke cigarettes, while nearly 15% of current e-cigarette users have never smoked conventional cigarettes.  

5. What about e-cigarettes and kids?

The statistics are alarming for e-cigarette usage among teens.  In a study of Utah students in grades 8, 10 and 12:

  • The rate of students who currently use electronic cigarettes has tripled from 2011 to 2013.

  • Youth are more likely to use e-cigarettes than any other tobacco product on the market.  E-Cigarettes are the new pathway to nicotine addiction.

  • Nearly one-third of teens who used e-cigarettes in the past 30 days have never tried a cigarette.

Due to candy-like flavors, aggressive marketing and lack of safety data, monitoring and slowing the increasing use of e-cigarettes among youth is a public health priority.

6. What are the current Utah laws around e-cigarettes?

In many ways Utah is leading the charge in this area. Thanks to the foresight of the legislature, we were among the first to pass a law prohibiting the sale of e-cigarettes to minors. We are also one of a handful of states that includes e-cigarettes in the indoor clean air law. Local health districts have also made significant strides this year in passing local regulations establishing a licensing requirement for the manufacture and in some cases sale of e-cigarettes.    

7. What more is needed?

The Utah Departments of Health recommend pursuing retail licensing for those that sell e-cigarettes. Requiring a license to sell e-cigarettes would allow the public health community to track where these products are being sold and better enforce current laws regarding youth access and zoning.  A license would also allow local health authorities to collect civil penalties for violations of the law.

8. Why does the governor believe in taxing e-cigarettes like tobacco products?

Increasing the unit price is also an important strategy in reducing tobacco use. Numerous economic studies in peer-reviewed journals concur that every 10% increase in the real price of cigarettes reduced overall cigarette consumption by 3% to 5%, and the number of adolescents who smoke by 6% or 7%. Utah’s $1.00 excise tax increase that went into effect in July 2010 is expected to prevent 10,500 Utah children from becoming smokers; motivate 5,500 current adult smokers to quit; save more than 4,800 Utahns from deaths caused by smoking; lead to $236 million in future health care savings; and raise about $43.3 million a year in new state revenue. Given all this information it makes good sense to tax e-cigarettes the same way that we tax other tobacco products.

And check out our video discussion with Dr. David Patton, the executive director of the Utah Dept. of Health.