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Alert: Public Health Implications of E-CIGARETTES
Even when e-cigarettes are not
Electronic Cigarette Waste littered, they should not be simply
disposed of in regular trash bins.
Health policy debates about In 2015, more than 58 million local environment and urban Because of their electronic com-
electronic cigarettes (e-cigarettes) e-cigarettes and refills were sold landscape, affecting humans and ponents, discarded e-cigarettes are
have thus far overlooked the in the United States at grocery other organisms.2,6 Like cigarette e-waste, not ordinary trash, and
potentially serious environmen- and convenience stores (exclud- butts, e-cigarette waste poses should be disposed of accordingly.
tal effects these products pose. ing vape shops or online), 19.2 choking hazards for small chil- The fact that they also contain
From mining to manufacturing, million of which were designed dren and may be inadvertently residual nicotine—in some cases
using, and disposing, each stage of for single use.4 E-waste in general eaten by birds and other animals. in substantial amounts—further
the e-cigarette product lifecycle is already an overwhelming pro- Unlike cigarette butts, however, complicates their disposal, because
presents novel environmental blem, with 99 billion pounds dis- e-cigarette waste contains sharp e-cigarettes and their cartridges
harms compared with tradi- carded annually according to 2017 and acidic elements that can may qualify as both e-waste and
tional cigarettes. The effect of global estimates.5 Even though puncture, explode, or burn.6 biohazard waste.6 Neither policy
e-cigarettes on the environ- most e-waste from Western Of the various types of nor product information currently
mental determinants of health countries is shipped to developing e-cigarettes, disposable gives consumers guidelines for
requires urgent study. Tobacco countries, displacing the hazards e-cigarettes pose the highest disposing of e-cigarettes.
companies already recognize that and pollution of reprocessing, potential environmental costs, The task of disaggregating and
e-cigarettes pose new environ- reclaiming, or incinerating because they contain e-waste recapturing the components in
mental burdens, necessitating e-waste does not eliminate the elements similar to those of re- e-cigarettes is best fulfilled by the
them to “manage new areas of problem. usable e-cigarettes but are used companies that produce them,
impact due to the increasing use only for a predetermined time through a well-worn model to
of electronics and batteries in (about 400 puffs or 20–40 ciga- close the waste loop known as
[their] products.”1(p54) Few in- rettes’ worth of vapor) before extended producer responsibility.
dependent data currently exist E-WASTE: AN becoming spent. The e-waste With extended producer re-
assessing the product lifecycle of ENVIRONMENTAL from disposable and refillable sponsibility, electronics manufac-
turers establish and publicize end-
e-cigarettes and the accompa- HEALTH PROBLEM devices is similar in terms of
nying environmental health risks. principal components, but re- of-life buyback programs to collect
No studies have yet tracked
Focusing on disposal patterns and disposal patterns of e-cigarettes, fillable ones last much longer, their used products, avoiding lit-
effects here, precedents from requiring changing out only the tered or inappropriately discarded
but research in progress suggests
traditional cigarettes and elec- that like cigarette butts, spent nicotine liquid (“juice”) or fla- e-waste and other hazardous ma-
tronic waste (e-waste) indicate vored juice-filled pod. The ad- terials (such as computer monitors
e-cigarette capsules or replace-
that e-cigarette disposal is an ditional environmental harms or paint). Easy recycling programs
able nicotine-filled plastic pods
emerging problem warranting from disposable e-cigarettes sug- with monetary incentives are
are often littered. These pods
public health’s attention. contain endocrine-disrupting gest that phasing out single-use missing from the e-cigarette re-
plastics, electronic circuitry, and e-cigarettes while instituting strict cycling ecosystem, even though
the residue of concentrated nic- product standards for reusable the material composition of
otine extracts. Some e-cigarettes e-cigarettes would achieve an en- e-cigarettes is more akin to a
MAGNITUDE OF THE contain enough toxic chemicals vironmental good. Just like ciga- smartphone than a traditional
PROBLEM to qualify as hazardous waste.6 rette butts, the disposal patterns of cigarette.
An estimated two thirds of the Highly concentrated nicotine e-cigarettes and their effects may Although some companies have
world’s 6.25 trillion plastic cel- and e-waste residuals present indicate additional environmental voluntarily instituted versions of
lulose acetate cigarette butts are biohazard risks, and the hard health burdens among already extended producer responsibility,
littered annually,2 clogging sewer plastics, lithium-ion batteries, vulnerable populations. the existing channels are difficult for
drains, blighting city parks, and and electronic circuit boards re-
costing billions of dollars annually quire disassembly, sorting, and ABOUT THE AUTHOR
to clean up in the United States further recycling and disposal. Yogi Hale Hendlin is with the Department of Medicine, Center for Tobacco Control
Research and Education, University of California, San Francisco.
alone.3 Disposal of e-cigarettes, When littered or improperly Correspondence should be sent to Yogi Hale Hendlin, PhD, Department of Medicine, Center
however, potentially poses an discarded, broken devices can for Tobacco Control Research and Education, University of California, San Francisco, 530
even graver long-term environ- leach heavy metals (including Parnassus Ave, Suite 366, San Francisco, CA 94143 (e-mail:
Reprints can be ordered at by clicking the “Reprints” link.
mental threat because of their mercury, lead, and bromines), This editorial was accepted August 3, 2018.
material composition. battery acid, and nicotine into the doi: 10.2105/AJPH.2018.304699

November 2018, Vol 108, No. 11 AJPH Hendlin Editorial 1489


most consumers. Altria has in- environmental effects in the as- must act quickly before products comments on an earlier version of this
stituted two different disposal sessment of any proposed federal and consumer habits become Note. The National Cancer Institute
schemes for its major e-cigarette law, such as the FDA’s laws entrenched to designate product had no role in the study.
subsidiaries: Green Smoke allows governing e-cigarettes. Under robustness standards requiring REFERENCES
consumers to mail in exactly 80 the Unfunded Mandates Reform e-cigarettes to be reusable rather 1. Philip Morris International. Sustain-
used e-cigarette (e-liquid) cartridges Act of 1995, the FDA must issue than disposable and standardize ability Report 2017. Lausanne, Switzerland:
Philip Morris International; 2017:54.
of any type or brand, in exchange Environmental Impact Assess- closed-loop manufacturing and
2. World Health Organization. Tobacco
for Green Smoke e-cigarette re- ments (EIAs) if they estimate that disposal of e-cigarettes (extended
and Its Environmental Impact: An Overview.
ward points redeemable for their the societal costs imposed by new producer responsibility) to min- 2017. Available at:
specific cartridges; MarkTen products such as e-cigarettes will imize their environmental health tobacco/publications/environmental-
impact-overview/en. Accessed Septem-
e-cigarette batteries can be recycled exceed $100 million nationally.7 harms.
ber 13, 2017.
with the organization Call2Re- Based on current quantities,
3. Wallbank LA, MacKenzie R, Beggs PJ.
cycle, which has national drop-off e-cigarettes pose an environ- Environmental impacts of tobacco prod-
locations, albeit concentrated in mental burden from e-waste uct waste: international and Australian
major metropolitan areas. Other likely far exceeding this thresh- policy responses. Ambio. 2017;46(3):

major brands such as current market old. An EIA could result in in- REDUCING HARMS 361–370.
EIAs are necessary but not 4. Marynak KL, Gammon DG, Rogers T,
leader Juul are silent on product stituting an extended producer Coats EM, Singh T, King BA. Sales of
disposal, and RJ Reynolds’ Vuse responsibility program requiring sufficient mechanisms to reduce nicotine-containing electronic cigarette
e-waste program is defunct. companies to receive, repurpose, the toxicity and amount of litter products: United States, 2015. Am J Public
and trash from e-cigarettes. Health. 2017;107(5):702–705.
and recycle e-cigarettes.
Mandating extended producer 5. Baldé CP, Forti V, Gray V, Kuehr R,
All products submitted to the Stegmann P. The Global E-Waste Monitor
FDA’s Center for Tobacco responsibility will incentivize – 2017. Bonn/Geneva/Vienna: United
REGULATORY Products require either an EIA companies to minimize the Nations University (UNU), International

SIGNIFICANCE amount and toxicity of products, Telecommunication Union (ITU), In-

or a Finding of No Significant ternational Solid Waste Association
Impact, but the deadline for favor reusable products easy to
The US Food and Drug (ISWA); 2017.
assessing this has been postponed repair, extend product robustness
Administration (FDA) has the 6. Krause MJ, Townsend TG. Hazardous
from 2018 to 2022. Currently, and durability, and decrease waste status of discarded electronic ciga-
power to require e-cigarette
e-cigarettes are sold with mini- e-cigarettes’ environmental rettes. Waste Manag. 2015;39:57–62.
manufacturers to comply with
mal oversight by regulatory health burden. 7. US Food and Drug Administration.
product robustness standards to National Environmental Policy Act; En-
ensure that these products do not institutions, including environ- vironmental Assessments for Tobacco
Yogi Hale Hendlin, PhD Products; Categorical Exclusions. Federal
needlessly cause waste and instead mental agencies, and it is unclear
Register. September 24, 2015. Available
are disposed of properly. The what environmental compliance
National Environmental Policy standards the FDA will require This research was supported by the Na- documents/2015/09/24/2015-24219/
Act and the Council on Envi- for e-cigarettes. To prevent un- tional Cancer Institute (grant T32 CA national-environmental-policy-act-
113710). environmental-assessments-for-tobacco-
ronmental Quality Regulations necessary harms to human and products-categorical. Accessed April 27,
The author is grateful to Stella A. Bia-
stipulate that all federal agencies environmental health from lous, DrPH, FAAN, Pamela M. Ling, MD, 2018.
as a rule are required to include e-cigarette disposal, the FDA MPH, and Stanton A. Glantz, PhD, for

Human Rights: The Violence Against survivors and prevent further vi-
olence. As declared by Hillary
Clinton at the United Nations
Women Act Reauthorization Is Due (UN) Fourth World Conference
on Women in 1995, “Human
The Violence Against tumultuous political environ- a human rights issue, which de- rights are women’s rights and
Women Act (VAWA; https:// ment, public health professionals mands legislation, activism, and women’s rights are human must advocate continued fund- empirical research to support rights.”1
congress/house-bill/3355), draf- ing of this important legislation.
ted by former senator Joe Biden Although all women are vul- ABOUT THE AUTHOR
and signed into law by former nerable to violence, factors that Brooke E. E. Montgomery is with the Department of Health Behavior and Health Education,
President Bill Clinton in 1994, influence access to power—in- College of Public Health, University of Arkansas for Medical Sciences, Little Rock.
Correspondence should be sent to Brooke E.E. Montgomery, PhD, MPH, Department
provides critical support to sur- cluding poverty, race, and eth- of Health Behavior and Health Education, College of Public Health, UAMS, 4301 West
vivors of violence. This year, nicity—can heighten women’s Markham St. Slot #820, Little Rock, AR 72205 (e-mail:
Reprints can be ordered at by clicking the “Reprints” link.
2018, the VAWA reauthoriza- vulnerability. Consequently, vi- This editorial was accepted August 11, 2018.
tion is due. In our current, olence against women is also doi: 10.2105/AJPH.2018.304717

1490 Editorial Montgomery AJPH November 2018, Vol 108, No. 11