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Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
BRIAN A. KING, PHD, MPH | DEPUTY DIRECTOR FOR RESEARCH TRANSLATION
THE RISE OF E-CIGARETTES: WHAT YOU SHOULD
KNOW ABOUT THE RISKS FOR YOUNG PEOPLE
July 29, 2019
What’s An E-cigarette?1Who’s Using Them?
What Are The Health
Effects?
What Can We Do About It?
2
3
4
What’s An E-cigarette?1Who’s Using Them?
What Are The Health
Effects?
What Can We Do About It?
2
3
4
THE EVOLUTION OF E-CIGARETTES
Source: Campaign for Tobacco-Free Kids
MarkTen Elite
(Altria)
myBlu
(Imperial Tobacco)
Vuse Alto
(RJR)Myle Phix
Suorin Drop Suorin Air KandyPens Feather Daze MFG ZOOR
THE “4th GENERATION” E-CIGARETTE HAS ARRIVED: THE “POD MOD”
Population
Based
Surveys
Web-based cross-sectional
survey
Retail Sales
Data
0%
10%
20%
30%
40%
50%
60%
70%
80%
2013 2014 2015 2016 2017 2018
Per
cen
t of
Tota
l E
-cig
are
tte
Doll
ar
Sale
s
Year
Altria British American Tobacco Imperial Tobacco Japan Tobacco JUUL Labs… Other
2019
E-CIGARETTE MARKET SHARE, BY DOLLAR SALES, US, 2013 - 2018
Source: King, Brian A, The Rise of the Pod Mod: Trends in E-Cigarette Sales in the US, 2013-2017. Paper presented at: 25th Annual Meeting of SRNT; February 2019; San Francisco, CA.
What’s An E-cigarette?1Who’s Using Them?
What Are The Health
Effects?
What Can We Do About It?
2
3
4
CURRENT TOBACCO PRODUCT USE AMONG U.S. HIGH SCHOOL
STUDENTS – (2011–2018)
Pipe
Hookah
2011 2012 2013 2014 2015 2016 2017 2018
YEAR
E-cigarette
Smokeless
Cigarette
Cigar
1.5%
4.1%
11.6%
7.9%
4.0%
15.8%
20.8%
1.1%
4.1%
5.9%
7.6%
8.1%
Source: Gentzke AS et la.. Vital Signs: Tobacco Product Use Among Middle and High School Students — United States, 2011–2018. MMWR Morb Mortal Wkly Rep 2019; 68(6):1-8.
Advertising Flavors Nicotine
WHAT CAUSES YOUTH E-CIGARETTE USE?
MOST YOUTH ARE EXPOSED TO E-CIGARETTE ADVERTISING
USE OF FLAVORS IS PROMINENT AMONG YOUTH
JUUL CONTAINS A HIGH AMOUNT OF NICOTINE
Benzoic Acid
00Nicotine
Salts
Free
Base
Nicotine
NICOTINE SALTS ALLOW HIGH LEVELS OF NICOTINE TO BE INHALED MORE EASILY
3.73.5
3.2
2.8
3.2
2014 2015 2016 2017 2018
Perc
en
tage
CURRENT E-CIGARETTE USE AMONG U.S. ADULTS, 2014-2018
Source: National Health Interview Survey 2014-2018
RELATIONSHIP BETWEEN CIGARETTE SMOKING ANDE-CIGARETTE USE
Source: QuickStats: Cigarette Smoking Status Among Current Adult E-cigarette Users, by Age Group — National Health Interview Survey, United States, 2015. MMWR Morb Mortal Wkly Rep 2016;65:1177.
What’s An E-cigarette?1Who’s Using Them?
What Are The Health
Effects?
What Can We Do About It?
2
3
4
Youth Initiation Adult Cessation
PUBLIC HEALTH HARM OR BENEFIT?
“The long-term safety of e-cigarettes is unknown.”
“Overall, the USPSTF found the evidence on the use of ENDS as a smoking cessation tool in adults,
including pregnant women, and adolescents
to be insufficient.”
Conclusion 17-1. Overall, there is limited evidence that e-cigarettes may be effective aids to promote
smoking cessation.
Source: Hartmann-Boyce J, McRobbie H, Bullen C, Begh R, Stead LF, Hajek P. Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews 2016, Issue 9. Art. No.: CD010216. www.uspreventiveservicestaskforce.org. Final Recommendation Statement: Tobacco Smoking Cessation in Adults, Including
Pregnant Women: Behavioral and Pharmacotherapy Interventions. U.S. Preventive Services Task Force. September 2015.. The National Academies of Science, Engineering, and Medicine. Public Health Consequences of E-cigarettes. 2018.
E-CIGARETTE USE AS A SMOKING CESSATION TOOL AMONG ADULTS
Leads to initiation of combustible tobacco use among non-
smokers, particularly
children
Leads to relapse among former smokers
Diminishes the chances that a
smoker will quit
Discourages smokers from using proven quit methods
Exposes children, pregnant
women, and non-users to secondhand
aerosol
Glamorizes or renormalizes
tobacco use
Results in poisonings
among users or non-users
POTENTIAL HEALTH RISKS OF E-CIGARETTES
E-CIGARETTES MAKE AEROSOL, NOT VAPOR
What Are E-cigarettes?1Who’s Using Them?
What Are The Health
Effects?
What Can We Do About It?
2
3
4
https://e-cigarettes.surgeongeneral.gov/
SURGEON GENERAL’S ADVISORY ON E-CIGARETTE USE AMONG YOUTH (2018)
EVERYONE HAS A ROLE IN ADDRESSING YOUTH E-CIGARETTE USE
• Learn about the different types of e-cigarettes and the risks of e-cigarette for young people at https://e-cigarettes.surgeongeneral.gov/.
• Set a good example by being tobacco-free. If you use tobacco products, it’s never too late to quit. For free help, visit smokefree.gov or call 1-800-QUIT-NOW.
• Adopt tobacco-free rules, including e-cigarettes, in your home and vehicle.
• Get the Surgeon General’s tip sheet for parents at https://e-cigarettes.surgeongeneral.gov/.
• Seek help and get involved.
• Set up an appointment with your child’s health care provider so they can hear about the risks of e-cigarettes.
• Speak with your child’s teacher and school administrator about tobacco-free school policies and curriculum.
• Encourage your child to get tips for quitting at Teen.smokefree.gov or Truth’s App (text “DITCHJUUL” to 88709).
Parents Teachers Health professionalsStates, communities, tribes, and territories
E-cigarettes are a tobacco product that produces an aerosol by heating a liquid that typically contains nicotine, flavorings, and other chemicals.
1As of 2014, e-cigarettes were the most commonly used tobacco product among U.S. youth. Several factors have contributed to youth use, including advertising, flavors, and high nicotine content.
Youth use of any tobacco products, including e-cigarettes, is unsafe.
As the tobacco product landscape continues to diversify, it’s important to modernize tobacco control strategies to adapt.
2
3
4
For more information, contact CDC1-800-CDC-INFO (232-4636)TTY: 1-888-232-6348 www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Brian A. King, PhD, MPH
Office on Smoking and Health
www.cdc.gov/tobacco
