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Michael Ellis, PGY-2

What is vaping?
 Inhaling the vapor produced by an electronic
nicotine delivery system (ENDS)
 Perceived benefit: bypassing the combustion
process; thus minimizing risk of exposure to
nicotine and other dangerous chemicals
What is vaping?
Who is using it?
 E-cigarette usage has doubled among middle and high
school students.
 In 2018: 21% of high school students, 5% of middle
school students reported use in the last 30 days.
 An increase of 1.5 million youth from 2017-2018.

 E-cigarettes are falsely advertised as a way to help

smokers quit, but this has not been proven and is not
recommended by the nation's leading health
Who is using it?
Who is using it?
What’s in there?
 Nicotine
 Tobacco specific nitrosamines
 Aldehydes: formaldehyde, acetaldehyde, acrolein
 Metals: cadmium, nickel, lead, chromium, arsenic
 Volatile organic compounds: toluene, p.m.-xylene,
propylene glycol
 Phenolic compounds:
 Polycyclic aromatic hydrocarbons: anthracene,
phenanthrene, pyrene
 Tobacco alkaloids: cotinine, myosmine, etc
Substances of undetermined harm
 Flavors: meet FDA safety rules for ingestion, but not
 Carrier solvents: are oxidized to same aldehydes as
 Drugs: amino-tadalafil, rimonabant
 Particles
What’s in there?
 Higher concentrations of toxic and irritating
compounds have been found in e-cigarette vapor,
including carcinogenic tobacco-specific nitrosamines,
heavy metals such as cadmium and lead, and ultrafine
particles, compared with cigarette smoke.
Is it safe?
 Most cartridges contain
 The liquid also can be
poisonous within a matter of
minutes if spilled on the skin.
 Half teaspoon to 2 teaspoons
of e-cigarette liquid nicotine
can be fatal for a child.
 8,269 liquid nicotine
exposures reported among
children <6 years old 2012-2017
Is it safe?
 E-cigarettes do not have to follow the same rules as
other tobacco products.
 This means that the amount of nicotine and other
harmful ingredients is not always the same, and can
even differ from what is listed on the product's label.
 Nicotine dose ranges 8-100 mg/ml/cartridge
It’s not just water vapor!
 Exhaled e-cigarette vapors contains
 Nicotine
 Ultrafine particles
 Propylene glycol
 Vegetable glycerol
 Formaldehyde/acetaldehyde
Dangers to Your Health!
 Tobacco and nicotine from any method is unsafe
during adolescence.
 Critical brain development is taking place
 Increased risk of dependence
 Reported problems:
 Pneumonia
 Seizures
 Disorientation
 Heart failure
 Hypotension
Nicotine Poisoning
 Early  Late (30minutes-4hours)
 Vomiting  Low blood pressure
 A fast heartbeat  Slow heartbeat
 Jittery and unsteady
 Lethargy
 Respiratory failure
 Difficulty breathing
 Increased saliva
 Sweating
 Seizures
 Tremor
Nicotine during pregnancy
 In-utero
 Interferes with oxygen delivery, thus affecting growth of the fetus in utero.
 Dose-dependent LBW and preterm birth has been associated with prenatal
exposure to nicotine.
 Postnatally
 Increased risk for poor arousal, irritability and hyperexcitability, hypertonicity,
and tremors.
 Poorer self-control, more negative affect, distress in response to limitations, and
decreased soothability.
 There is also an association with sudden infant death syndrome with prenatal
and postnatal use of tobacco. Long-term, into childhood and even young
adulthood, they demonstrate cognitive deficits and a diminished response to
auditory stimuli, an effect that can lead to learning and language disabilities,
which can cause poor academic achievement in school. (4)
 Associated with lower IQ throughout childhood.
 Higher risk for attention deficits, depression, anxiety, and conduct disorders.
 Prenatal tobacco exposure appears to increase the likelihood of tobacco use in
childhood and early adolescence.
Long-term Health Problems

We don’t know

Are you willing to risk it?

Additional safety risks
 2,035 explosion and burn injuries seen in US
Emergency Departments from 2015-2017
 “E-cig explosion blows bloke’s teeth out and leaves him covered in burns”
Battery explosions
 A cylindrical lithium-ion battery is made by winding alternating
layers of metallic anode and cathode material separated by a
porous film. The porous separator film holds a liquid electrolyte.
This core is placed into a cylindrical metal can through the open
 All of the electrolytes currently used in lithium-ion batteries are
either flammable or combustible liquids.
 The electrolyte is heated to its boiling point, the internal
pressure in the battery builds to a point where the seal at the end
of the battery ruptures, and the pressure is abruptly released
through the sealed end of the battery case.
 The electrolyte then ignites, and expanding gas from the rapid
combustion will further increase the pressure. The fire is
sustained briefly after initial ignition by the porous separator
film, which is made of plastic.
Battery explosions
 Title: Man Smokes Vapor E Cigarette & Explodes on
Author: City of Fresno Public Transportation (FAX)
Date: 21 December 2016
Legislation and Regulation
 2016 Child Nicotine Poisoning Prevention Act
 Requires packaging safety standards. Under this law, liquid nicotine
must be packaged in child-proof packaging, in accordance with
Consumer Product Safety Commission standards.
 In 2016, the (FDA) expanded its regulatory authority to include the
manufacture, import, packaging, labeling, advertising, promotion, sale,
and distribution of all tobacco products, including (electronic nicotine
delivery systems) ENDS.
 Requires health warnings on ENDS and other tobacco products.
 Prohibits the sales of ENDS to youth under the age of 18.
 Bans free samples and prohibits the sale of ENDS in vending machines.
 Requires that ENDS manufacturers receive marketing authorization
from the FDA.
 Requires vape shops that mix e-liquids to comply with legal
requirements for tobacco manufacturers.
Legislation and Regulation
 The U.S. Preventive Services Task Force concludes that
the current evidence is insufficient to recommend
ENDS for smoking cessation
 2016, U.S. Surgeon General report conclusions:
 Youth use of ENDS products is a public health concern.
 Youth use of e-cigarettes is associated with the use of
other tobacco products.
 Youth use of nicotine in any form, including ENDS, is
 Secondhand exposure to ENDS aerosol contains
nicotine and other harmful constituents
Screening Patients
 Ask the right questions
 “Do you smoke?”
 “Do you vape or use electronic cigarettes?”
 Many don’t consider ENDS use to be smoking or a
tobacco product
 AAP Julius B. Richmond Center of Excellence
 AAP Section on Tobacco Control
 AAP Pediatrics in Review
 Common Substances of Abuse
 E-Cigarettes: Effects on the Fetus
 Effect of Maternal Substance Abuse on the Fetus, Neonate,
and Child
 New Alternative Tobacco Products – A Threat to Adolescent
 Substance Abuse, General Principles