Electronic Nicotine Devices and E-Cigarettes

Electronic nicotine delivery systems (ENDS) are battery powered devices that heat a liquid solution, containing nicotine and/or other additives, to produce an aerosol that is inhaled by the user.  These products include electronic-cigarettes, electronic-hookahs, vape pens, and electronic-cigars.  ENDS are relatively new products, first appearing in the U.S. in 2007.

ENDS typically contain nicotine derived from tobacco and therefore are classified as tobacco products under proposed FDA regulations. The Centers for Disease Control and Prevention has classified ENDS as a tobacco product in traditional surveillance as well.  ENDS contain other cancer-causing agents including metals such as lead, chromium, nickel and lithium, according to peer-reviewed studies.

Youth experimentation and use of ENDS has risen sharply within the last decade (King et al, 2014; SGR50), a significant concern due to the potential adverse affects of nicotine on adolescent brain development (Grana et al, 2014) and long term nicotine addiction.  Increasing use of ENDS and nicotine addition also undermines recent drops in youth cigarette smoking rates (Arrazola, 2015).

E-cigarettes and other ENDS are not yet regulated by the federal government in terms of manufacturing, product standards, and marketing.  In April 2014, the FDA proposed a rule deeming ENDS as tobacco products that would allow the FDA to regulate them.  Many tribes, states, and localities have proactively regulated e-cigarettes and other ENDS, including prohibitions on sales to minors, indoor air, and commercial tobacco smoke free policies. However, youth can readily access ENDS in many communities across Indian Country - stronger youth access laws and protections are needed to close this gap.

This is especially concerning because e-cigarette manufacturers use marketing that appeals to kids. Increasing rates of youth e-cigarette use comes as e-cigarette makers marketing their products with the same tactics used long ago to market regular cigarettes to kids, including celebrity endorsements, slick TV, magazine, and internet ads, and sponsorships of race cars and concerts.

In addition, many e-cigarette cartridges come in sweet, colorful flavors such as gummy bear and cotton candy, which helps explain both their appeal to youth and the increase in nicotine poisoning incidents.

The use of nicotine liquids presents yet another human health hazard. In 2014, there were 3,831 calls to poison control centers involving exposures to e-cigarette devices and nicotine liquids, more than double the 1,543 calls in 2013 and more than 13 times the 271 calls in 2011, according to the American Association of Poison Control Centers.

In December, 2014 a one-year-old boy died in New York from swallowing liquid nicotine. Child-resistant packaging for nicotine liquids is not currently required.

E-Cigarette Usage among Native American Youth

The recent introduction of e-cigarettes means that there is limited information on their usage, especially among Native Americans. E-cigarette monitoring and research will be an area of increased importance going forward. It is important for health practitioners to consider including language specific to e-cigarette usage when talking to clients.

The data from the CDC’s 2013 National Youth Tobacco Survey shows that 10.38% of the respondents from grades 6-12 who identified as Native American had ever tried e-cigarettes and 4.37% had used e-cigarettes within the past 30 days.

E-cigarette use (within the past 30 days) among all races of high school students tripled between 2011 and 2013 (from 1.5% to 4.5% who reported using e-cigarettes in the past 30 days).

The 2014 National Youth Tobacco Survey found that for the first time, e-cigarette use exceeded cigarette use among students in all three grades surveyed (8th, 10th and 12th), with more than twice as many 8th and 10th graders reporting using e-cigarettes compared to regular cigarettes (Arrazola et al 2015).

The Data:

• Among 8th graders, 8.7% e-cigarette v. 4% traditional cigarette use in past month.
• Among 10th graders, 16.2% e-cigarette v. 7.2% traditional cigarette use.
• Among 12th graders, 17.1% e-cigarette v. 13.6% traditional cigarette use.