A General Overview of Electronic Cigarettes From University of Chicago

hello this is dr. Andrea King I'm a
professor at the University of Chicago
and I specialize in addictions and today
I'm going to present a webinar on
electronic cigarettes the facts in the
myths so we're all well aware of the
monthly weekly headlines we see about
e-cigarettes in terms of they may be
helpful they may be harmful they may
hurt our children in use and they may
also be a great way to quit smoking and
so we see these and that really adds to
our confusion what I'm going to talk
about today is to give you an overview
of the products what are they what is
their harm and safety what are the rates
and youth what's the current data show
do they help with quitting smoking or
might they increase smoking and also
some bottom line in terms of what you
can convey to your students your
trainees your patients and your
colleagues about these products so we
have 460 e-cigarette products and
Counting they're increasing every month
we in a short what we've seen is first
generation products that really
resembled closely what a regular
cigarette combustible cigarette looks
like you can see them here on the left
and the field has evolved now to second
and third generation products called
vaporizers vape pens or mods and they
vary in their look and feel to customize
to the user the devices and the
e-liquids are not regulated the FDA
currently has not regulated these
products so it's unclear the
constituents and the differences in the
voltage and the nicotine delivery one
might get but we do know that second and
third generation products are becoming
more popular among users so many people
will start with a cig alike and quickly
gravitate to the second and third
generation devices they report they do
that to get a more satisfying nicotine
hit to get the flavors and the
customization of the experience so the
e-cigarette components can get to a lot
of complicated chemistry what I've done
here is to break it down into three
essential portions and we have the
inhalation portion where you breathe
into the device we have the middle
portion which is where the heating comes
by the atomizer and the battery to heat
the liquids and to help you have a vapor
to inhale and then we have a tip portion
in some cases may simulate a regular
cigarette usually in second and third
generation device
they don't and so a user will inhale the
aerosol and then exhale it out into the
environment so what's in the e-liquid so
that you put into an e-cigarette well
these vary and it's unregulated so we're
not sure of the proportions but what we
do know is that there's four main
elements we have the base which contains
may or may not contain nicotine at
different levels so it can contain no
nicotine the product might say it
contains a lower level of nicotine that
equivalent of a half a pack of
cigarettes or it could be at thirty six
milligram per mils which is much higher
than you would get even at a pack of
cigarettes we have a base which often
contains the chemicals propylene glycol
and vegetable glycerin and they're there
to create that satisfying hit to help
the augment the flavors and they're also
there to create the expired aerosol and
the vape that we see the flavors can
also vary so much in the chemicals
diacetyl and proprio know and other
chemicals can help to enhance the
buttery feeling and the satisfaction for
the person using an e-cigarette and as
many have you have seen they can range
from the traditional tobacco and menthol
flavors and also to things like rum
cotton candy coke bubble gum and things
like that that may particularly appeal
to youth and there's other water and
additives again as an unregulated
product we don't know the amounts and
the health and safety of these products
in terms of inhaling them is unknown so
e cigarettes have exploded in the last
ten to fifteen years they were invented
in 2003 by a Chinese pharmacist named
hon lik and within a few years they were
open to the United States and European
markets they were not allowed to claim
themselves as a smoking cessation device
because they don't have evidence for
that but rather they claim to be a
freedom of product or maybe a less
harmful product for a smoker to use
there's been a sharp increase in use so
recently we see about thirteen percent
of adults have tried e-cigarettes in
2010 that was about 2% of adults and we
see the rates are much higher in people
who are smokers so most users of
e-cigarettes currently are people who
are current smokers and may go back and
forth from products and but also never
in former smokers attribute to about
twenty to thirty percent of people who
do use e-cigarettes
in terms of race ethnicity the use is
highest among whites and American
Indians non-hispanic and in younger
people so 18 to 25 year olds are often
the highest users certainly under age 40
we see the highest proportion of people
using e-cigarettes it is forecasted that
e-cigarette sales will outsell
traditional cigarettes within the next
10 years given the increases in their
popularity the main concern is what
about our youth so in middle and high
schoolers East cigarette you use now
surpasses that of any other tobacco
products of cigarillos little cigars and
hookah and regular combustible
cigarettes we see e-cigarette use the
most prevalent from 22:13 alone there
was a tripling of e-cigarette use in our
youth with now over two and a half
million kids and adolescents being
exposed to the products data from last
year show higher past month use of
e-cigarettes versus regular combustible
cigarettes at all grade levels because
here in eighth grade one in 10 eighth
graders says use an e-cigarette compared
to 4% with a regular cigarette and we
see this also in the tenth and twelfth
grades with higher cigarette use so the
popularity among youth is increasing
another cause for concern has been
recent evidence that youth can also
vaporize alcohol or cannabis they can
put in that eliquid chamber and those
don't have the odor so the use may be
using the products and smoking marijuana
and not detected because there's not as
much older so e cigarettes are they
positive or negative well the proponents
would suggest that this could be the end
game for combustible tobacco use I don't
think anyone would argue that
combustible tobacco use has caused a lot
of death and disease in our society
they're proposing that e-cigarette use
if everyone switched over would help our
population health they also say they
could aid in smoking cessation although
that's yet to be determined and may play
a role in harm reduction so if we can
remove the tar and the carbon dioxide
and some of the carcinogens that are
present in a combustible cigarette by
replacing them with an e-cigarette we
could at least reduce the harm in
society the opponents people opposed to
e-cigarettes say they may reduce
people's use of approved medications we
have seven different medications that
have been shown to double or triple your
chances of quitting smoking we don't
have evidence for e-cigarettes
so it may reduce people actually getting
access to approved treatments it has
potential for long term consequences in
terms of we don't know the effects of
these chemicals on your body long term
and it could continue the addiction to
nicotine and it could increase smoking
behaviors and youth and renormalized
smoking we've worked very hard in
tobacco control to eliminate smoking in
a lot of public places but having people
vaping may actually change that so we
all know more research is needed to
support or refute these claims but the
confusion still dominates do they help
smokers quit this is a question I get a
lot and it's really unclear there are a
few studies out there few well-conducted
studies and there's methodological
problems and the ones that are out there
the studies that are out now haven't
really randomized participants to
different conditions they don't contain
a control group they may have small
sample sizes or they use products that
lack quality so we're not sure what the
smoker is trying to quit we're actually
getting in the e-cigarette product so
the quick rates in these studies
generally have range from 5 to 7 percent
and that's actually what you would see
in an unaided quit attempt by a smoker
most people who are using the product as
I said before our dual users they go
back and forth from using an e-cigarette
to a regular cigarette although there is
a small minority that might completely
switch from tobacco smoking to an
e-cigarette use maybe 5 percent of
smokers so far a recent review concluded
that people who use these cigarettes to
quit smoking actually have a lower odds
of quitting smoking and why might this
be it's an important issue because if
you look at the form and the function of
an e-cigarette it's so similar and may
trigger somebody to want to smoke and so
that's been the source of some of the
research that we've conducted in my
group at the University of Chicago we
look on this slide and we have to take a
minute to find which is the tobacco
smoke and which is the e-cigarette
product so in our work in short we've
looked at exposure to e-cigarette use
and young adults who are smokers and
they're in an environment in our
laboratory where they are exposed to
somebody else using the products or
they're seeing an advertisement so we've
looked at the cig alike product where
you're in a room engaging in
conversation with somebody using an
e-cigarette we did the vape pen
vaporizer same paradigm and we also had
young people looking at advertised
in all our studies we have a control
condition where they also look at
somebody using a bottled water or using
a combustible cigarette and so what we
see here is our results on desire for an
e-cigarette and what we see is that when
we expose somebody to somebody drinking
water their desire for an e-cigarette
does not increase over time but when
they're exposed to a combustible
cigarette they show minimal increase in
desire for an e-cigarette when they see
somebody using the vape pen what we
found is a substantial increase in their
desire to use an e-cigarette even if
they weren't regular cigarette users
already what was surprising to us was
that the desire for a regular cigarette
increased regardless of the product so
here we see the minimal increase in
desire to smoke when you see somebody
drink water but we see in both the group
exposed to a regular combustible
cigarette smoking and those exposed to
the e-cigarette we see a significant
increase that's similar from combustible
to regular cigarette smoking and it
remains high twenty minutes after that
exposure so the bottom line what do you
tell people well there's widespread
confusion due largely to the explosion
of use and the lack of having regulation
of products so we really have folklore
prevailing over the science right now
unfortunately we have little
understanding of the nicotine content
the additives the voltages the long term
harm the safety or potential benefits in
society it's unclear whether these
cigarettes are a gateway for kids to
start smoking and using other tobacco
products or other substances but we do
know that the most widely used tobacco
product now in youth at middle and high
school levels are e cigarettes we do
note that the flavorings when you have
bubble gum and candy and other flavors
that's very appealing to youth and we
also know that there's increasing use of
cannabis and alcohol that can be vaped
so there may be cause for alarm and
finally I'd like to point out that
tobacco companies are increasingly
investing in e-cigarettes products so
we've had decades of maybe potentially
lack of a science base and information
to the public on cigarettes and so it
may give us reason to pause knowing that
tobacco companies are now getting
involved in a cigarettes shortly after
filming our webinar the FDA announced
that there would be a new band
on sales going beyond those of
cigarettes to persons under age 18 to
also now include e-cigarettes little
cigars and other tobacco products my
opinion this is an important step that
will reduce access and sales to youth
and it will also inform us about the
chemicals that are in the products which
are now obfuscated in a cloud of smoke
in other words here are details of the
FDA regulation announcement in May and
the main aspects include prohibiting
each cigarette sales to persons under
age 18 requiring manufacturers of
existing products to register and report
the ingredients and potentially harmful
constituents new products would need to
undergo extensive authorization review
and there will be health warnings on
packaging and advertisements