14 / 44
Electronic Nicotine Delivery Systems: Key Facts,
continued
12
New Mexico Dental Journal, Summer 2016
ENDS are not an FDA-approved
quit aid.
• The evidence is currently insuffi-
cient to conclude that ENDS are
effective for smoking cessation.
• Seven medicines are approved by
the FDA for smoking cessation,
and are proven safe and effective
when used as directed.
10
ENDS aerosol is NOT harmless
“water vapor” and is NOT as
safe as clean air.
18
• ENDS generally emit lower levels of
dangerous toxins than combusted
cigarettes. However, in addition
to nicotine, ENDS aerosols can
contain heavy metals, ultra fine
particulate, and cancer-causing
agents like acrolein.
11
• ENDS aerosol s a l so cont ain
propylene glycol or glycerin and
f lavorings. Some ENDS manu-
facturers claim that the use of
propylene glycol, glycerin, and food
flavorings is safe because they meet
the FDA definition of “Gener-
ally Recognized as Safe” (GRAS).
However, GRAS status applies to
additives for use in foods, NOT
for inhalation. The health effects
of inhaling these substances are
currently unknown.
E NDS a r e a g g r e s s i ve l y
marketed using similar tactics
as those proven to lead to youth
cigarette smoking.
• Although the advertisement of ciga-
rettes has been banned from tele-
vision in the United States since
1971, ENDS are now marketed on
television and other mainstream
media channels.
• Spending on advertising of ENDS
tripled each year from 2011 to
2013.
12,13
Sales of ENDS also
increased dramatically over a
similar period.
14
• ENDS marketing has included
unproven claims of safet y and
use for smoking cessation, and
statements that they are exempt
from clean air policies that restrict
smoking.
4
These messages could:
◊ Promote situational substitu-
tion of ENDS when smokers
cannot smoke cigarettes, rather
than complete substitution of
ENDS for cigarettes.
◊ Undermine clean indoor air
standards, smoke free policy
enforcement, and tobacco-free
social norms.
• In a randomized controlled trial,
adolescents who viewed e-cigarette
TV advertisements reported a
significantly greater likelihood of
future e-cigarette use compared
with the control group. They were
also more likely to agree that e-ciga-
rettes can be used in places where
smoking is not allowed.
15
• Some ENDS companies are using
techniques similar to those used
by cigarette companies that have
been shown in the 2012 Surgeon
General’s Report to increase use
of cigarettes by youth, including:
candy-f lavored products; youth-
resonant themes such as rebellion,
glamour, and sex; celebrity endorse-
ment s; and sport s and music
sponsorships.
13,16
• Visual depictions of ENDS use
in advertisements may serve as
smoking cues to smokers and
former smokers, increasing the
urge to smoke and undermining
efforts to quit or abstain from
smoking.
17
Given the currently available
evidence on ENDS, several
policy levers are appropriate
to protect public health:
• Prohibitions on marketing or sales
of ENDS that result in youth use
of any tobacco product, including
ENDS.
◊ States laws prohibiting sales of
ENDS to minors that feature
strong enforcement provisions
and allow localities to develop
more stringent policies are
more likely to help prevent
youth access.
18
• Prohibitions on ENDS use in
indoor areas where conventional
smoking is not allowed could:
18
◊ Preserve clean indoor air stan-
dards and protect bystanders
from exposure to secondhand
ENDS aerosol.
◊ Support tobacco-free norms.
◊ Support enforcement of smoke-
free laws.
• When addressing potential public
health harms associated with
ENDS, it is important to simulta-
neously uphold and accelerate strat-
egies found by the Surgeon General
to prevent and reduce combustible
tobacco use, including tobacco
price increases, comprehensive
smoke-free laws, high-impact media
campaigns, barrier-free cessa-
tion treatment and services, and
comprehensive statewide tobacco
control programs.
4,18