Public health concerns about e-cigarettes

E-cigarettes are growing in popularity, even though they are not regulated by the U.S. Food and Drug Administration (FDA) and their health effects and potential risks are, at this time, largely unknown.

While some new studies have shown that e-cigarettes are effective at helping people quit smoking cigarettes, e-cigarettes are not yet approved by the FDA as a smoking cessation product. E-cigarettes and other unrelated tobacco products, like 'little cigars,” can come in flavors cigarettes are banned from having, like bubble gum and Kool-Aid, and do not have the same label or price restrictions cigarettes have. Public health organizations across the country worry that these candy-like flavors and colorful packaging appeal to children and will hook a new generation on tobacco products.

Linn County is unique in Iowa, since it has its own tobacco ordinance that prohibits the sale of e-cigarettes and other unregulated products containing nicotine to minors and in places without a retail cigarette or tobacco products permit. Adopted in 2012, this ordinance arose from public health concerns about these products.

Many e-cigarettes do not look like cigarettes. E-cigarettes use e-liquids, which contain concentrated nicotine and can cause poisoning if ingested or absorbed through the skin. In addition to e-cigarettes, there are many new tobacco products that are not regulated by the FDA in the same way cigarettes are. Some of these products include dissolvables, which are packaged like gum, mint breath strips, and toothpicks.

The Centers for Disease Control and Prevention (CDC) recently reported e-cigarette use more than doubled among U.S. middle school and high school students from 2011-2012, and more than 75 percent of youth e-cigarette users also smoke conventional cigarettes. In addition, calls to poison centers involving e-cigarette liquids containing nicotine rose from one per month in 2010 to 214 per month in 2014. Jeffrey Meyers of ASAC says that 'some research indicates that the use of e-cigarettes can serve as a gateway to other nicotine and tobacco products. In addition, their marketing appeal to youth is very concerning, as is the risk to young children drawn by the bright colors of the nicotine vials, something we see attested to in the growing number of poisoning cases.”

The legislation Governor Branstad recently signed prohibits the sale of e-cigarettes in Iowa to anyone under the age of 18. Many health advocacy groups, including the American Cancer Society - Cancer Action Network and Iowa Public Health Association, opposed this bill, because it exempted e-cigarettes from other existing tobacco control laws and policies.

The FDA recently proposed rules related to e-cigarettes, cigars, pipe tobacco, nicotine gels, water pipe (or hookah) tobacco, and dissolvables that are not already under the FDA's authority. The FDA's news release states that makers of newly deemed tobacco products would, among other requirements, need to:

' Register with the FDA and report product and ingredient listings;

' Only market new tobacco products after FDA review;

' Only make direct and implied claims of reduced risk if the FDA confirms that scientific evidence supports the claim and that marketing the product will benefit public health as a whole; and

' Not distribute free samples.

In addition, minimum age and identification restrictions, health warning requirements, and restrictions on vending machine sales would be applied to newly deemed tobacco products.

As we learn more about e-cigarettes, it is a good time to be reminded that tobacco is the leading cause of death and disease in the U.S., including Linn County. Tobacco kills more Americans annually than AIDS, cocaine, heroin, alcohol, vehicular accidents, homicide and suicide combined. Linn County Public Health recommends that people interested in quitting use proven strategies and FDA-approved cessation medicines. Quitline Iowa is currently offering 8 weeks of free nicotine replacement therapy. Call 1-800-QUIT-NOW or visit quitlineiowa.gov to enroll.

' Pramod Dwivedi is Health Director at Linn County Public Health. Katie Jones is a Health Education Specialist with Linn County Health. Comments: (319) 892-6000; health@linncounty.org