As the first initiative of a larger campaign, the California Department of Public Health (CDPH) recently released a health advisory and state health officer’s report centered on the dangers of e-cigarettes.
“The public needs facts, not more fiction,” said former state health officer and director of the CDPH, Ron Chapman, MD, MPH, in a media teleconference. “[As] we’ve done with other outbreaks and epidemics, we’ve taken this formal step of warning Californians about the health risks of e-cigarettes. It’s the job of the CDPH to protect the public’s health and prevent further health disparities, and we see e-cigarettes as a growing threat that needs to be addressed.”
Chapman said e-cigarettes threaten to erode 25 years of progress in tobacco cessation in California. Not only has the state’s tobacco control efforts resulted in the saving of 1 million lives and $134 billion in healthcare costs, he said, but California also has the second lowest adult smoking rate in the U.S.
“[We’re a] model for what public health efforts can achieve as we were the first state to tackle not just smoking prevention and cessation, but the first to change the social norms where tobacco use became less available, desirable and socially acceptable,” Chapman said. “E-cigarettes threaten to renormalize smoking behavior and tempt a new generation of youth and young adults into the cycle of nicotine addiction.”
State data show that the use of e-cigarettes among teen and young adults is escalating, and the concern among state officials is that many users are unaware that they pose some of the same risks as traditional tobacco products.
According to state officials, despite the fact that e-cigarettes contain a solution called “e-juice” or “e-liquid” that releases a toxic nicotine-containing aerosol when heated up by the battery-operated devices, common misconceptions are that they:
- Contain harmless water vapor;
- Will help smokers quit; and
- Have FDA-approved ingredients.
The CDPH says it hopes to set the record straight.
“There is little scientific evidence demonstrating that e-cigarettes help smokers permanently quit the use of traditional cigarettes,” Chapman said. “In fact, recent data shows that people are 30 percent less likely to quit smoking when using e-cigarettes as their only quit-smoking tool.”
According to Chapman, e-liquids and the aerosol they emit have been found to contain at least 10 chemicals—including benzene, formaldehyde, lead, nickel and nicotine—on California’s list of chemicals known to cause cancer, birth defects and other reproductive harm. Although he said that the range of chemicals can vary from product to product, he added that there really is no safe level of use.
Totally Wicked, a supplier of e-cigarettes and e-liquids, has fired back in response to the CDPH’s campaign saying that rather than educating the public, the CDPH is spreading fear about a product that is moving people away from the harms of tobacco smoke and allowing them to quit.
In a company statement, the supplier cited research that e-cigarettes are not a gateway to smoking other tobacco products and that the levels of toxins are minimal to what is found in traditional cigarettes. “If embraced, e-cigarettes could be a valuable tool in the arsenal to eradicate smoking,” the statement said.
Aggressive, unrestrictive marketing
Chapman said the availability of e-cigarettes is growing in California, with the number of stores selling them increasing fivefold from 2011 through 2013, and three out of every four teens having been exposed to e-cigarette advertising last year.
”There are over 400 brands of e-cigarettes and all three of the big tobacco companies now market their own versions, but unlike traditional cigarettes there are absolutely no restrictions,” he said. “These products are unregulated, and the companies that make them are not required by law to disclose their ingredients or where they’re made.”
Chapman added that marketing tactics used today are the same as what big tobacco companies had used to make conventional cigarettes attractive to youth, such as using celebrities and cartoons on the TV and radio where cigarette ads were eventually banned. Additionally, fruit and candy e-liquid flavors can be appealing and misleading to youths, including children who may try to drink the solution. E-cigarette cartridges and e-liquid bottles don’t use child-resistant packaging either.
The number of calls to the California poison control center regarding accidental e-cigarette poisonings to children ages 5 and under has spiked significantly, up from seven in 2012 to 154 in 2014.