Phoebe: Welcome to Beyond the Data.
I'm Dr. Phoebe Thorpe and here with me today is Dr. Brian King
from CDCs Office of Smoking and Health.
Thank you for joining us Brian.
Brian: Thanks for having me.
Phoebe: The session today was on e-cigarettes.
Very interesting.
I was very surprised that the number of problems there are
with e-cigarettes especially regarding people's health.
Can you tell me some of them for our audience?
Brian: There's still a lot we don't know about e-cigarettes.
These products came to the United States around 2007
and they're currently unregulated
at the federal level.
So there's still a lot we don't know about what the ingredients
of these products are or what the long-term health
effects are.
But we do know enough to say that they are dangerous
for youth, and that youth shouldn't be using any form
of tobacco products irrespective of whether it's electronic,
combustible, or a smokeless tobacco product.
And one of the common ingredients
in all these price including e-cigarettes is nicotine.
Which we know is not risk free.
Outside from being highly addictive,
it can also harm the developing adolescent brain and also lead
to fetal toxicity among pregnant women.
So the nicotine is a concern in these products
for these populations, youth, and pregnant women.
But there's also other ingredients
that have been identified in e-cigarettes
that could potentially be harmful to people,
including ultrafine particulate matter
of volatile organic compounds
and other potentially dangerous ingredients.
Phoebe: And those, the ultrafine particulate matter,
those are all in the aerosols.
So it's not just water vapor that you are breathing in...
Brian: Yes, it's really important to know
that it's not harmless water vapor
and it's actually an aerosol that can contain harmful,
and potentially harmful ingredients
and since the products aren't regulated it can vary
from product to product.
Phoebe: And one of the things that I had heard today
that I was, I actually found quite alarming was the mention
of the flavorings.
One of the flavorings is associated
with Bronchiolitis obliterans which is a big word
for permanent scarring of the airways of your lungs.
That means so permanent and the airways
of your lungs you'd have difficulty breathing.
What else, what else is known about the flavorings
that they're adding the e-cigarettes?
Brian: So there's a large diversity products currently
on the marketplace.
There's over 450 brands and thousands of flavors.
And users can even create their own flavors
if they go to bait shops.
But what we're seeing is an emerging body
of evidence demonstrating there are some potentially harmful
flavors that are being used.
It's also important to remember that some of these flavors,
although they may be recognized as safe for ingestion,
for people to ingest in food,
we don't know what the health effects are for inhalation
and that's what how people use e-cigarettes,
they inhale the product into their lungs.
And so there's concern that some of these a flavorings
in particular can really harm the lungs particularly among
vulnerable populations.
Phoebe: And coming back to the vulnerable populations,
you briefly mentioned the youth.
Tell me again what is it that we're
so worried about with youth?
Brian: So with youth, one
of the primary concerns is the inclusion of nicotine
in these products and the 2014 50th anniversary Surgeon
General's report was clear that there's potential for nicotine
to harm the developing adolescent brain.
And in addition to harming the brain we also know
that nicotine is highly addictive
and so it could potentially lead youth to a lifetime of nicotine
and tobacco addiction.
Phoebe: What have we learned about tobacco that we could use
with the e-cigarettes as far as concerning controlling and use?
Brian: So there's a strong evidence-base
from several decades.
50 years of tobacco prevention and control interventions.
And we really know what works to effectively prevent tobacco use
and e-cigarette can be included in a lot of those interventions.
Of the most notable of which is youth access restrictions.
We know that it's dangerous for youth to use these products
and the interventions to restrict the sale
and an access can reduce youth use of these products.
There's currently several states across United States
where it's still legal for youth to walk into a mall kiosk
or a convenience store and legally purchase these products.
And there's also widespread Internet sales as well.
So youth restrictions are really a key lever
to prevent youth access.
Another is including e-cigarettes
in clean indoor air restrictions.
Where conventional cigarette smoking is otherwise prohibited
and this helps to maintain a clean indoor air standard
so that we can prevent exposure of nonusers, particularly kids
and pregnant women from exposure
to the aerosol from these products.
Phoebe: And, those are both things that are regulated
at the state level of the age that the nicotine
and e-cigarettes would be available and the indoor air.
Some of the other things that we mentioned today was just knowing
yourself as a parent or as a clinician what the risks are
so that you could speak to somebody about what they,
what they might not know.
What are some of the other things
that could be done beyond the things that we've mentioned
so far to make people more aware of the risks of e-cigarettes?
Brian: So I think it comes down a lot to education,
particularly parents and clinicians
on the individual level can become educated
about the potential harms of e-cigarettes among kids.
Because we know that most adult tobacco users begin before the
age of 18.
So if we can implement interventions to prevent them
from starting before the age of 18,
we could still see prevent them from a lifetime
of a nicotine and tobacco use.
And, the same would go for e-cigarettes.
And so at the individual level education is really key
but we can't underscore enough the importance
of population interventions which we know work
to effectively reduce tobacco use
and help de-normalize these products among youth
and young adults, across the broader population.
Phoebe: And do you have some examples of that?
I was wondering, we had at the end
of the session a great presentation about mass,
mass media and hard-hitting campaigns.
Can you speak a little bit to that?
Brian: Yes, so we know
that emotionally evocative hard-hitting mass media
campaigns are a very effective mechanism to educate people
about the adverse health effects of tobacco use.
CDC's tips from former smokers is a prime example
of a campaign that's been implemented since 2012
to educate people about the adverse health effects
of smoking from former smokers themselves who've experienced
adverse health effects.
Currently there's no broad based mass media campaigns
to address the issue of e-cigarette use,
focused on youth and young adults and the potential harms.
But it still speaks to the importance of education.
And it's important to reach out to youth and to counter some
of the messaging because e-cigarettes are advertised
heavily by a television
for which conventional cigarette advertising has been banned
in this country since the early 1970s.
So there's definitely a pro marketing influences
for e-cigarettes and multiple different media
and it's important to counter that message for youth
and young adults so they understand the harms
of using e-cigarettes and what that impact is
in their long-term health.
Phoebe: So if somebody was interested in finding out more
about e-cigarettes and tobacco where would you tell them to go?
Brian: They can go to CDC's tobacco website
which is www.CDC.gov/tobacco, and that has several resources
on proven tobacco control interventions as well
as information on e-cigarette use and interventions
and educational materials.
Phoebe: Sounds like a great place to go to find out more.
Thank you so much for joining us.
Brian: Thanks for having me.
Phoebe: And thank you for joining us!
See you next time for Beyond the Data.