E-Cigarettes and How They Work

Electronic cigarettes, more commonly called “e-cigarettes,” are a type of electronic nicotine delivery systems (ENDS). They look very similar to regular cigarettes. There is no standard definition of an e-cigarette and manufacturers use different designs and a range of ingredients. Most e-cigarettes consist of the following: (Summarized from American Journal of Public Health, 2010, World Health Organization, 2013).

  • A cartridge that aids in attracting and absorbing water molecules from air such as propylene glycol and nicotine. Nicotine is an addictive chemical in any form/dose and in excessive amounts can be lethal.
  • A tube through which the smoker inhales like cigarette smoke and the nicotine (and other substances) is absorbed into the lungs.
  • A battery powered heating element from which the solution is drawn, causing the vaporization of nicotine and other substances.

What You Need to Know About E-Cigarettes

  1. There is no current regulation of the use of e-cigarettes.
    • Although e-cigarettes (Electronic Nicotine Delivery Systems) are not yet regulated by the U.S. Food and Drug Administration (FDA) or other agencies, the FDA does intend to regulate them as tobacco products, putting them in the same category as traditional cigarettes (FDA Publication, 2013).
  2. There are recommendations and support from major health related organizations, other companies and US States. (World Health Organization, 2013, American Medical Association Statement 2010, American Heart Association Statement, 2013, American Lung Association, 2011).
    • The World Health Organization (WHO) has warned that the safety of e-cigarettes has not been demonstrated, and that the testing of some of these products suggests the presence of other toxic chemicals. The WHO also concludes that e-cigarettes have not been deemed safe or effective and that consumers should be strong advised not to use them.
    • The American Medical Association recommends that electronic cigarettes (e-cigarettes) be classified as drug delivery devices, subject to the same FDA regulations as all other drug delivery devices. Additional policy adopted supports prohibiting the sale of e-cigarettes that are not FDA approved.
    • The American Lung Association reports that several states have included e-cigarettes in indoor smoking bans. California, Colorado, Minnesota. North Dakota, New Jersey and Utah have explicitly banned use of nicotine vapor devices in smoke free zones, and nine others have prohibited them in specific places, such as schools and state buildings.
  3. Although the long term effects are not clear, there is evidence of potential negative health effects on users, and there is no standardization of amount of nicotine used. Electronic cigarettes are not currently regulated as a pharmaceutical treatment.
    • Electronic cigarettes are designed to deliver nicotine, which is an addictive substance. This strongly suggests that e-cigarette use will lead to dependence unless usage is stopped. No standardization of amount of nicotine is used in these products (American Cancer Society, Statement, 2013).
    • Laboratory studies of e-cigarettes cartridges conducted by the Food and Drug Administration concluded that the following: (FDA summary of laboratory analysis, 2010, FDA Statements, 2011 and 2013).
      • 50% of e-cigarette samples contained detectable levels of known carcinogens and toxic chemicals to which users could be exposed. Other impurities were also found, including one sample with diethylene glycol, a toxic ingredient found in antifreeze, tobacco specific nitrosamines which are carcinogenic to humans, and other toxic tobacco-specific impurities. E-cigarettes also contain many of the same toxic chemicals that are present in conventional cigarettes which lead to chronic inflammation and subsequently chronic diseases like bronchitis, emphysema and heart disease.
      • Quality control processes used to manufacture these products was found to be “inconsistent and even non-existent”.
      • Nicotine content and the amount inhaled cannot be determined with confidence.
        • Cartridges labeled as containing no nicotine, did contain nicotine and there was deviation from the content claimed on the label. In other words, no trustable label.
        • Vapor testing revealed similar variability, including “puff to puff” variation.
      • The Director of the Center of Tobacco Products stated that ”consumers currently have no way of knowing what types or concentrations of potentially harmful chemical are found in these products, or how much nicotine people inhale when they use these products.”
  4. E-cigarettes are not approved for use in cessation or quitting.
    • The FDA does not consider e-cigarettes as tobacco cessation devices (U.S. FDA E-cigarettes Publication, 2013).
    • No quality studies support the use of e-cigarettes for smoking cessation or quitting smoking. If a corporation communicates that a product can be used as to treat a disease or an addiction, like nicotine, it must submit studies demonstrating its safe and effective use. The FDA would then approve or not approve the product for use in cessation or quitting smoking (New England Journal of Medicine, 2011).
    • There is no long term, randomized, controlled studies conducted to determine whether e-cigarettes can be used to cut down or quit smoking long term. Short term studies with small numbers of smokers and no randomization have variable results.
    • Smokers can use multiple nicotine replacement products that are already approved, regulated, safe and effective by the Federal Drug Administration such as patches, gum, lozenges, nasal sprays and approved inhalers.
  5. There is a potential risk to non-users.
    • Second hand exposure in the areas where it is used. The Federal Drug Administration is concerned that the small particle sized mists, the content of the vapors can cause irritation and negative health effects for others (FDA, summary of laboratory analysis, 2010).

We realize that quitting the use of tobacco is one of the most difficult things a person can do. Active U.S. employees, retirees and family members enrolled in the U.S. MAP Plus Option 1 or Option 2 (formerly MAP Plus or Catastrophic) benefits plans are eligible for coverage of tobacco cessation expenses.

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