Public Health Advisory- To Consumers of Electronic Cigarettes, Electronic Nicotine Delivery Systems (ENDS) and Other Vapor Products

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The Arkansas Department of Health is issuing this Public Health Advisory to consumers and is advising caution when considering e-cigarettes, Electronic Nicotine Delivery Systems (ENDS), and vaping devices. These devices contain and emit harmful chemicals, are currently unregulated, and pose known and unknown health risks to users and non-users alike.

Dangers

• The Arkansas Department of Health is issuing this Public Health Advisory to consumers and is advising caution when considering e-cigarette, Electronic Nicotine Delivery Systems (ENDS), and vaping devices.
• These devices contain and emit harmful chemicals, are currently unregulated, and pose known and unknown health risks to users and non-users alike.
• E-cigarettes/vapor products contain chemicals, including nicotine. Nicotine is toxic and highly addictive and affects the nervous system and heart. It can be absorbed into the body through inhalation, ingestion and skin contact. The Health Consequences of Smoking — 50 Years of Progress A Report of the Surgeon General Executive Summary (2014), reports that the evidence is sufficient to infer that nicotine activates multiple biological pathways through which smoking increases risk for adult onset diseases, including atherosclerosis, coronary heart disease, type 2 diabetes, obesity, and cancer.
• E-cigarettes/vapor products are not emission free and their pollutants could be a health concern for users and secondhand smokers. These products should not be used indoors or in cars.
• Secondhand vapor contains chemicals that can be inhaled by non-users. Bystanders can inhale nicotine, propylene glycol and tobacco-related contaminants, such as formaldehyde, acetaldehyde, and acrolein.
• Current scientific information about the effects of using electronic nicotine delivery systems (ENDS) is inadequate to assure the public that they are safe. Coupled with the absence of state or federal regulation of manufacture, this information should prompt consumers to be cautious about using the devices as well as exposure to secondhand emissions.

Effects on Children

• • Excessive exposure to nicotine can result in poisoning, particularly in young children and pets. Liquid contained or used in e-cigarettes or vapor devices should not be accessible to children.
  • Pregnant women should avoid using these devices and children should not be exposed to them. The nicotine crosses the placenta and can damage the lungs, heart, and central nervous system of the developing fetus.

• • Pregnant women should know exposure to nicotine, in conventional or electronic cigarettes, may:
    • cause a miscarriage;
    • cause low birth weight, creating significant health challenges for their babies;
    • affect the unborn baby’s blood flow, heart rate and breathing;
    • contribute to sudden infant death syndrome.
  • Parents should be aware that electronic cigarettes and similar electronic nicotine delivery devices are available in a variety of flavors, such as bubble gum, strawberry, chocolate, and mint, which may be attractive to children. Arkansas Act 1188 of 2013 prohibits distribution of “alternative nicotine products” directly, indirectly by an agent or employee, or through vending machines to minors under the age of 18. “Alternative nicotine products” includes both e-cigarettes and any product containing nicotine that is intended for human consumption.The age of the individual purchasing these products must be verified using a photographic identification card, or if purchased online, verification must be performed through an independent, third-party age verification service.
  • Parents should not allow children to play with electronic cigarettes or similar devices. They contain batteries and liquid chemicals which, if swallowed, could cause serious health complications. Nicotine is a known poison. Bottles of e-juice, used in e-cigarettes, are a poison risk for small children and pets.
  • E-cigarettes may lead to an increase in nicotine addiction among young people. E-cigarette use among middle and high school students in the U.S. doubled to 1.78 million students in 2012, compared with the year before, according to the U.S. Centers for Disease Control and Prevention (CDC).

Confusion on Enforcement/Normalization of Smoking

• • Many electronic cigarettes/Electronic Nicotine Delivery Systems emit a vapor that looks like cigarette smoke. The similarity of these products to combustible cigarettes creates confusion for employees and visitors and presents enforcement challenges for workplaces, restaurants/bars, state agencies, and other indoor/outdoor campuses that have existing tobacco-free policy/ordinances.

• • ENDS re-normalize smoking behaviors and reverse clean indoor air gains. Some national organizations have released policy statements on ENDS including the American Academy of Pediatrics in December 2013 suggesting ENDS should be treated like other combustible tobacco products and that sales to minors should be prohibited. The World Health Organization (WHO) in July 2013 advised that consumers not use ENDS until safety has been demonstrated.

Cessation

• It is illegal for e-cigarettes to be marketed as a smoking cessation aid. A number of electronic cigarette companies have received warning letters from the FDA for making such claims.
• Electronic cigarettes and similar electronic nicotine delivery devices have not been tested adequately as tobacco cessation devices. Until Food and Drug Administration approval is given, the Arkansas Department of Health recommends that FDA-approved nicotine replacement therapy products, such as nicotine patches, which contain controlled doses of nicotine, be used for tobacco cessation efforts