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Public Health Column for the Times-News

Protecting youth from dressed-up nicotine

Published: Wednesday, December 2, 2015

By KIMBERLY HORTON
Health Department columnist

What's your favorite flavor? Grape, chocolate, cotton candy, cherry crush or gummy bear? How about cappuccino, piña colada or peach schnapps? Depending on your taste, surely one of these flavors will hit the satisfaction mark.

That's exactly what electronic-cigarette (or e-cigarette) manufacturers are counting on. Adding a mouth-watering flavor to liquid nicotine enlarges the appeal factor to many populations, which includes youth who might have never picked up a tobacco product.

Unfortunately this appeal factor is working. E-cigarette use among North Carolina high school students increased 349 percent between 2011 and 2013, from 1.7 percent to 7.7 percent, according to the N.C. Tobacco Prevention and Control Branch. Similar patterns are seen nationally and in other states.

E-cigarettes (also known as electron nicotine delivery systems or ENDS) are battery-powered devices that provide doses of nicotine and other additives to users in an aerosol, often referred to as a vapor. This vapor mimics a real cigarette, cigar or pipe and is inhaled by the user instead of smoke.

We do know that nicotine is highly addictive and poses health risks in any form, particularly for young people. The evidence is also suggestive that nicotine exposure during adolescence may have lasting adverse consequences for brain development. Because the adolescent brain is still developing, nicotine use during adolescence can disrupt the formation of brain circuits that control attention, learning and susceptibility to addiction.

Not only are manufacturers luring adolescents and young adults with enticing flavors, ENDS are now being marketed on television and other mainstream media channels. Although the advertisement of cigarettes has been banned from television in the United States since 1971, ENDS manufacturers are copying old tobacco advertising by:

• Using celebrity spokespeople in television, online and print ads for e-cigarettes that feature catchy slogans and celebrity endorsers.

• Depicting e-cigarette use as masculine, sexy or rebellious. Do you remember the Marlboro man and the Virginia Slims woman?

• Sponsoring sports, music festivals and other entertainment events that appeal to youth. (Cigarette sponsorships are banned.)

Then there's the "cool" factor. A survey conducted by the Yale School of Medicine asked 5,400 Connecticut teens what was cool about e-cigarettes. The top answers were the different flavors of nicotine liquids and being able to do tricks with the vapor that e-cigarettes produce.

Youth are not the only group affected by e-cigarettes. The Carolinas Poison Center has noted a steady increase in calls related to children accessing e-cigarette nicotine liquids since the products were introduced. Liquid nicotine can cause harm when ingested or if it comes into contact with the skin, and small doses can be dangerous. Depending on the concentration, less than one teaspoon may be enough to kill a child.

In response, North Carolina began requiring new packaging and label requirements on electronic cigarette products sold in the state on Dec. 1. Refill containers must feature child-resistant packaging and must state if they contain nicotine.

Another concern for anyone should be the possibility of inhaling the aerosol that someone is exhaling. E-cigarettes don't produce what we know as secondhand smoke, but they do emit secondhand aerosol.

Those who sell and use e-cigs claim that the vapor is safe, yet there is growing evidence that exposure to this aerosol may be hazardous. ENDS aerosols can contain heavy metals, ultrafine particulate and cancer-causing agents like acrolein. They also contain propylene glycol or glycerin and flavorings, which some ENDS manufacturers claim are safe because they meet the FDA definition of "Generally Recognized as Safe." However, GRAS status applies to additives for use in foods, not for inhalation. The health effects of inhaling these substances are currently unknown.

In Henderson County, we no longer worry about secondhand smoke when dining out because of the North Carolina Smoke-Free Restaurants and Bars Law. However, since this law does not include e-cigarettes, you could inhale the e-cigarette aerosol from someone exhaling even in your smoke-free restaurant. If this is important to you, talk to the owner/managers of places you frequently dine. An owner of any dining establishment may ban the use of e-cigarettes for the benefit of other diners.

With the rapid increases in use of e-cigarettes, concern for youth is evident. North Carolina extended its tobacco sale to minor laws to include e-cigarettes. It also placed a tax on the consumable nicotine solution used in e-cigarettes (often called e-juice). The FDA announced its intention to assert jurisdiction over e-cigarettes in 2010 but did not issue a "Proposed" Rule until April 25, 2014. Currently this rule is in the eighth step of a nine-step regulatory process.

Prior to the emergence of e-cigarettes, youth smoking rates were falling. From 1975 to 2014 after marketing restrictions and other changes, youth increasingly disapproved of cigarette use. That is changing with the appeal of e-cigarettes. Once again, we are fighting unregulated marketing of these e-cigarettes to our youth. The danger is that while cigarettes clearly pose the more significant health risk, e-cigarettes may prove to be the gateway drug to nicotine addiction in a new generation.

North Carolina residents who want confidential free help to quit tobacco use, including e-cigarette addiction, can contact QuitlineNC at 1-800-Quit-Now (1-800-784-8669) or, in Spanish, 1-800-Dejelo-Ya (1-800-335-3569).


Kimberly Horton is the communications manager at the Henderson County Department of Public Health. She can be reached at khorton@hendersoncountync.org.

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