Bureau of Tobacco Free Florida’s Statement Regarding Electronic Cigarette Use

Electronic cigarettes and other electronic nicotine delivery systems (also known as vaporizers, vape pens and e-hookahs) have dramatically grown in popularity over the past few years. Tobacco Free Florida is concerned about the increased use of e-cigarettes and the possible public health implications of this trend.

E-cigarettes have not been approved as a quit aid by the Food and Drug Administration (FDA). Many e-liquids contain nicotine, which is a highly addictive chemical.[1] Nicotine addiction is the fundamental reason people continue smoking, which remains the leading cause of preventable death in the United States.[2],[3]

The number of children and young adults (ages 13-24) trying e-cigarettes is especially alarming, particularly because there is evidence that adolescents who use e-cigarettes are more likely to start smoking cigarettes.[4],[5],[6],[7],[8],[9],[10] E-cigarettes are the most commonly used tobacco product among youth, surpassing conventional cigarettes in 2014 in Florida and nationally. Nearly one in four (or 24.8 percent) Florida high school students reported current e-cigarette use in 2018 – an alarming 58 percent increase compared to 2017. This increase reversed a decline observed from 2016 to 2017.[11] Further, because the adolescent brain is still developing, nicotine use during adolescence can affect teens’ susceptibility to addiction.[12]

Using e-cigarettes while continuing to smoke conventional cigarettes, which is referred to as dual use, is a serious concern. The Centers for Disease Control and Prevention estimates that nearly six in 10 e-cigarette users were also conventional cigarette smokers in 2015.[13] Further, people who have smoked and currently use e-cigarettes may use conventional cigarettes more frequently.[14]

E-cigarettes have simply not been around long enough to determine their long-term health effects. There are more than 460 brands on the market, which vary widely in chemicals used and in the amount of nicotine they deliver.[15],[16],[17]

For tobacco users looking for a proven-effective way to quit, the best plan is to talk to their healthcare providers or seek help from an evidence-based resource, like Tobacco Free Florida. Additionally, there are nicotine replacement therapies (NRT) and other quit aids that are approved by FDA to help tobacco users quit. These include: over-the-counter NRT like the patch, gum and lozenges;[18] prescription NRT, such as the nicotine inhaler and nasal spray;[19]  and prescription non-nicotine medications.[20],[21] “FDA-approved” means that these quit aids have gone through clinical trials that prove they are safe and effective.

Tobacco Free Florida’s new Quit Your Way program makes it easier than ever for tobacco users to access free tools and services to help them quit. For more information to quit tobacco or help a loved one quit, visit tobaccofreeflorida.com/quityourway.

About the Florida Department of Health

The department, nationally accredited by the Public Health Accreditation Board, works to protect, promote and improve the health of all people in Florida through integrated state, county and community efforts.

Follow us on Twitter at @HealthyFla and on Facebook. For more information about the Florida Department of Health please visit www.FloridaHealth.gov.

About Tobacco Free Florida

The department’s Tobacco Free Florida campaign is a statewide cessation and prevention campaign funded by Florida’s tobacco settlement fund. Since the program began in 2007, more than 212,000 Floridians have successfully quit using one of Tobacco Free Florida’s free tools and services. There are now approximately 451,000 fewer adult smokers in Florida than there was 10 years ago, and the state has saved $17.7 billion in health care costs.[22] To learn more about Tobacco Free Florida’s Quit Your Way services, visit www.tobaccofreeflorida.com or follow the campaign on Facebook at www.facebook.com/TobaccoFreeFlorida or on Twitter at www.twitter.com/tobaccofreefla.

[1] U.S. Department of Health and Human Services. The Health Consequences of Smoking: Nicotine Addiction. A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1988. DHHS Publication No. (CDC) 88-8406.

[2] U.S. Department of Health and Human Services. How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010.

[3] U.S. Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. Printed with corrections, January 2014.

[4] Watkins SL, Glantz SA, Chaffee BW. Association of Noncigarette Tobacco Product Use With Future Cigarette Smoking Among Youth in the Population Assessment of Tobacco and Health (PATH) Study, 2013-2015. JAMA Pediatr. Published online January 02, 2018. doi:10.1001/jamapediatrics.2017.4173. https://jamanetwork.com/journals/jamapediatrics/fullarticle/2666219.

[5] Coleman BN, Apelberg BJ, Ambrose BK, et al. Association between electronic cigarette use and openness to cigarette smoking among US young adults. Nicotine Tob Res. 2015; 17(2):212-218.

[6] Thomas A Wills, Rebecca Knight, James D Sargent, Frederick X Gibbons, Ian Pagano, Rebecca J Williams Longitudinal study of e-cigarette use and onset of cigarette smoking among high school students in Hawaii. Tob Control doi:10.1136/tobaccocontrol-2015-052705.

[7] Dutra Lauren M, ScD and Glantz Stanton A, PhD. E-cigarettes and National Adolescent Cigarette Use: 2004–2014. Pediatrics. American Society of Pediatrics. doi: 10.1542/peds.2016-2450. January 2017. http://pediatrics.aappublications.org/content/139/2/e20162450.

[8] Miech R, Patrick ME, O’Malley PM, et al E-cigarette use as a predictor of cigarette smoking: results from a 1-year follow-up of a national sample of 12th grade students Tobacco Control Published Online First: 06 February 2017. doi: 10.1136/tobaccocontrol-2016-053291.

[9] Soneji  S, Barrington-Trimis  JL, Wills  TA,  et al.  Association between initial use of e-cigarettes and subsequent cigarette smoking among adolescents and young adults: a systematic review and meta-analysis.  JAMA Pediatr. 2017;171(8):788-797. https://jamanetwork.com/journals/jamapediatrics/article-abstract/2634377?redirect=true.

[10] National Academies of Sciences, Engineering, and Medicine. 2018. Public health consequences of e-cigarettes. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/24952.

[11] Florida Youth Tobacco Survey (FYTS), Florida Department of Health, Bureau of Epidemiology, 2018.

[12]England, L. et al. Nicotine and the Developing Human: A Neglected Element of the E -cigarette Debate. Am J Prev Med. 2015 Mar 7. [Epub ahead of print].

[13] 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. DOI: http://dx.doi.org/10.15585/mmwr.mm6542a7.

[14] National Academies of Sciences, Engineering, and Medicine. 2018. Public health consequences of e-cigarettes. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/24952.

[15] British Medical Journal. Four hundred and sixty brands of e-cigarettes and counting: implications for product regulation. (12 May 2014). < http://tobaccocontrol.bmj.com/content/23/suppl_3/iii3.full>.

[16] World Health Organization (WHO). Questions and answers on electronic cigarettes or electronic nicotine delivery systems (ENDS). (10 Jul 2013). http://www.who.int/tobacco/communciations/statements/electronic_cigarettes/en/index.html.

[17] National Academies of Sciences, Engineering, and Medicine. 2018. Public health consequences of e-cigarettes. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/24952.

[18] Fiore MC, Jaén CR, Baker TB, Bailey WC, Benowitz NL, Curry SJ, Dorfman SF, Froelicher ES, Goldstein MG, Froelicher ES, Healton CG, et al. Treating Tobacco Use and Dependence: 2008 Update—Clinical Practice GuidelinesExternal Web Site Icon. Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, Agency for Healthcare Research and Quality, 2008.

[19] Fiore MC, Jaén CR, Baker TB, Bailey WC, Benowitz NL, Curry SJ, Dorfman SF, Froelicher ES, Goldstein MG, Froelicher ES, Healton CG, et al. Treating Tobacco Use and Dependence: 2008 Update—Clinical Practice GuidelinesExternal Web Site Icon. Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, Agency for Healthcare Research and Quality, 2008.

[20] Fiore MC, Jaén CR, Baker TB, Bailey WC, Benowitz NL, Curry SJ, Dorfman SF, Froelicher ES, Goldstein MG, Froelicher ES, Healton CG, et al. Treating Tobacco Use and Dependence: 2008 Update—Clinical Practice GuidelinesExternal Web Site Icon. Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, Agency for Healthcare Research and Quality, 2008.

[21] U.S. Food and Drug Administration The FDA Approves Novel Medication for Smoking Cessation. FDA Consumer, 2006. Page Last Update: 2013 Apr 8 <http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2006/ucm108651.htm> [accessed 2014 Apr 24].

[22] Mann, Nathan M, Nonnemaker, James M., Thompson, Jesse. “Smoking-Attributable Health Care Costs in Florida and Potential Health Care Cost Savings Associated with Reductions in Adult Smoking Prevalence.” 2016.