E-

Cigarettes

Deborah Hutchinson &

Jordyn Murch
What are E-Cigarettes?
The first international patent for it was in
2007 and marketed as smoking cessation.
An e-cigarette is a battery-powered device
that converts liquid nicotine solution
through heat into a mist, or vapour, that is
inhaled.
Unlike traditional cigarettes there is no
flame, ash or smoky smell.
An e-cigarette has three main parts:
1. a rechargeable lithium battery
2. a vaporisation chamber
3. a cartridge
Types of e-cigarettes
There are three main types of electronic cigarettes or
vapourisers:

1. Disposable products (non-rechargeable)

2. An electronic cigarette kit that is rechargeable with

replaceable pre-filled cartridges

3. An electronic cigarette that is rechargeable and has a tank

or reservoir which has to be filled with liquid nicotine
 First Generation Second
Generation Devices
Devices
Designed to look and feel like Devices are larger and typically do not
traditional cigarettes resemble a cigarette
Sometimes referred to as “cigalikes” Sizes, shapes, and colours vary widely
Battery-operated, initially composed of Large, separate cartridges (“tanks”)
3 pieces for liquids and flavourings
• Battery (provides power) (Sold separately)
• Atomizer (produces heat) Larger-capacity and rechargeable
• Cartridge (holds batteries, larger atomizers, and more
liquid/flavouring) powerful electronic circuits
Atomizer and cartridge now typically Some allow manual control of both puff
replaced by a combined “cartomizer” length and frequency
Disposable,Kjihihi
designed for 1-time use
o various nicotine
Available in
concentrations and flavourings
 Third Generation Fourth Generation
D Devices Devices

Are known as advanced personal Are innovated regulated mods.

vaporizers (APV) or mods. An APV Mods with automatic temperature
will normally look like a fat tube control and ability to handle very
reminiscent of a torch. Mods low ohm builds, as well as sub-ohm
typically use replaceable 3.7 volt clearomizers (or re-buildable tanks)
lithium ion cells and incorporate featuring adjustable and dual
functions you won’t find on other airflow slots and they are much
devices, i.e., variable voltage more advanced even than the
and / or wattage settings, full majority of mods released in 2014.
electronic control and digital
readouts.
 Is there a public health
issue?
 RSPH – April 2016 support Royal College of
Physicians report that they are vastly safer than
tobacco & can be a useful smoking cessation tool.
 WHO – Nov 2016 advised banning their use in
public places.
 Surgeon General (USA) – Nov 2016 informs of
the dangers of their use in young people, stating
that nicotine affects the brain up to the age of 25.
 Yale University – Feb. 2017 found that 1 in 4 U.S. teen e-
cigarette users have tried “dripping”
 Public Health England – ambition to have
tobacco free generation by 2025 & believe that
these have potential to contribute significantly to
this.
E-Cigarettes in the Media
Jan. 2017, The Guardian: “I’ll say it again: E-
cigarettes are still far safer than smoking”

Feb. 2017, Independent: “Vaping backed as

healthier nicotine alternative to cigarettes after
latest study”

Feb. 2017, The Telegraph: “E-cigarettes act as

gateway to smoking for teens, scientists warn”

Feb. 2017, The Daily Mail: “E-cigarettes

DO increase your risk of heart disease, study
claims”
 How are they regulated?
E-cigarettes containing up to 20mg/ml come under the EU Tobacco
Products Directive (TPD) 2014/14/EU Article 20.
UK &EU: Consumer product regulated under General Product Safety Directive

Since October 2015 it has been an offence to sell e -cigarettes to under 18’s,
including proxy purchasing..

In May 2016 e–cigarettes were classified as a tobacco related product under

EU rule.

From 20th May 2016 new regulations came into force (compliance by 26 th May
2017) these include:
• Smaller refill containers with a max strength of 20ml
• Smaller tanks and cartridges of 2ml
• Child proof
• Labelling of ingredients
• Products will carry health warning and information to make informed
choice
Regulation in the U.S.
 May 2016: FDA imposed new rules for e-
cigarettes

 Cannot be sold to anyone under 18

 E-cig
producers must register with the FDA
and provide detailed account of product
ingredients and manufacturing processes

 Producers are subject to FDA inspections

 Producerscannot market products as “light”

or “mild” w/o agency approval
EU Tobacco Products Directive

• May 2016 Committee of Advertising Practice

(CAP) UK set regulations on media advertising for
e-cigarettes domestic only advertising:

• Can be advertised on tv but not before 9pm and

the device must not be shown
• No health claims without proof
• No under 25’s to be used in advertising
• Advertisements are prohibited from encouraging
non smokers or non nicotine users to use e-
cigarettes
• Marketing positioning (PoS)
• Flavours and packaging – not to be glamorised
and aimed at young people.
Advertising in the U.S.
• Very strict regulations
• No ads on TV, radio, magazines, bill
boards, etc.
• Ads cannot present cigarette smoking as
the way to be cooler or better known
• Actors/Models in ads have to be at least
25 years old and ads cannot depict any
of them as athletes
• Ads can be placed in facilities where only
those 21 and up can be admitted
Confused?
 Where can I vape?
 In England it is individual business’s
decisions whether or not to allow vaping. In
2016 PHE devised new framework advice
for business's and employers for them to
create their own policies on e-cigarettes.

 Majority of Scotland banned vaping in public

institutions such as hospital grounds,
schools, sports centres etc.
Underpinning principles.
Dual use – increased risk of harm
Social status
Public perception is less harmful than smoking
(Hilton et al)

Gateway to smoking – flavours enticing and

attractive to teenagers and young people (NHS
Choices)

Potential unforeseen dangers e.g. popcorn lung

(Allen et al)

9 million regular users in the USA and 2.8

million in the UK (PHE)
¼ million young people who never smoked
used e-cigarettes in 2014 (RSPH)
Has potential to undo decades of progress in
ending tobacco epidemic (surgeon general)
Use of e-cigarettes by children (U

Among children that have heard of electronic cigarettes,

regular use is rare and confined to children who
currently or use to smoke.
Only 1% of never smokers reported having tried them
“once or twice
ASH Fact Sheet (2014). Use of electronic cigarettes in Great Britain
Public Health England 2014
How accurate are the statistics?
Effects on smoking behaviour
WHO suggest that vaping does
not help people stop smoking as
there is not enough evidence to
prove it does.
RSPH, Royal College of
Physicians, Public Health England
and ASH all are of the belief that
it can work well as a cessation
tool.
rsph e cigarette film on vimeo
Cost comparisons
What do you think?

Can you think of

five positives for the
use of e – cigarettes
and five negatives?
Positives Negatives
 E-cigarettes reduces urges  Increased appeal to teenage
to smoke tobacco. audience
 E- cigarettes useful as a  Could be viewed as a
smoking cessation tool in gateway to smoking
smokers, even those not  Not used as it’s intended
intending to quit purpose of being a smoking
 E-cigarettes with low cessation tool
nicotine vs. patches; Similar  Confusing and conflicting
effect on cessation, but e- information
cigarettes have a higher  Not enough research
user approval. conducted to assess full
 G.P’s can prescribe e- extent of benefits or
cigarettes as a cessation dangers
tool.  Not reinforcing smoking ban
 Easily available  Societal change with
 Cheaper alternative to influence of social media
smoking like YouTube and twitter
 No smoke endorsing vaping with
 Less chance of causing a fire ‘tricks’
 Still addictive
Where do we go from here?

Most agree that there is a need for

more research to be conducted in
this area, as there is much
confusion and controversy
between health agencies.

There is a requirement for all

parties to agree on the clear and
concise information specified.
Any
QUESTIONS
?
 References
Allen, J.G., Flanigan, S.S., LeBlanc, M., Vallarino, J., MacNaughton, P., Stewart, J.H. and
Christiani, D.C. (2015) ‘Flavoring chemicals in e-cigarettes: Diacetyl, 2, 3-Pentanedione,
and Acetoin in a sample of 51 products, including fruit-, candy-, and cocktail-flavored e-
cigarettes’, Environmental Health Perspectives, 124(6). doi: 10.1289/ehp.1510185.
Choices, N. (2016) Are ads for candy-flavoured e-cigs tempting teens to vape? Available
at: http://www.nhs.uk/news/2016/01January/Pages/Are-ads-for-candy-flavoured-ecigs-
tempting-teens-to-vape.aspx (Accessed: 22 February 2017).
Hilton, S., Weishaar, H., Sweeting, H., Trevisan, F. and Katikireddi, S.V. (2016) ‘E-
cigarettes, a safer alternative for teenagers? A UK focus group study of teenagers’
views’, BMJ Open, 6(11), p. e013271. doi: 10.1136/bmjopen-2016-013271.
New rules for the marketing of e-cigarettes CAP and BCAP’s joint regulatory
statement (2014) Available at:
https://www.cap.org.uk/News-reports/Media-Centre/2014/~/media/Files/CAP/
Consultations/ecig%20consultation/Regulatory%20Statement.ashx (Accessed: 31
January 2017).
Reserved, A.R. (no date) Know the risks: E-cigarettes & young people | U.S. Surgeon
general’s report. Available at: https://e-cigarettes.surgeongeneral.gov/ (Accessed: 22
February 2017).
RSPH (2014) Marketing and advertising of ‘electronic cigarettes’. London: Royal Society
of Public Health.
RSPH (2015) We must curb the growing appeal of e-cigarettes to non-smokers and
young people. Available at: https://www.rsph.org.uk/about-us/news/we-must-curb-the-
growing-appeal-of-e-cigarettes-to-non-smokers-and-young-people.html (Accessed: 22
February 2017).
RSPH (2016) Growing consensus on the harm-reduction potential of e-cigarettes.
Available at: https://www.rsph.org.uk/about-us/news/growing-consensus-on-the-harm-
reduction-potential-of-e-cigarettes.html (Accessed: 22 February 2017).