The Health Equity Blog’s mission is to contribute to the discussion of health policy using evidence and research, to explore the opportunities for health equity through policy change, to raise awareness about health disparities, and to increase public advocacy for health equality.

According to the CDC, “Health equity is achieved when every person has the opportunity to ‘attain his or her full health potential’ and no one is ‘disadvantaged from achieving this potential because of social position or other socially determined circumstances.’”

Achievement of full health potential is necessary in all aspects of life – from running errands to relationships with loved ones. Some people are born into environments that limit their ability to achieve their full health potential. We believe that because society created many health inequalities, society can also fix them.

Monday, November 18, 2013

E-Cigarettes: A Call for Policy Interventions

What are e-cigarettes?
E-cigarettes are battery powered devices that deliver nicotine in the form of a vapor. In appearance, e-cigarettes look like cigarettes. Below is a general depiction of an e-cigarette. 

In the United States, e-cigarettes can be legally sold to anyone and the FDA has not yet regulated e-cigarettes. However, some states and local governments do regulate e-cigarettes.  Since 2009, 25 states and the District of Columbia have passed measures to regulate the sale of e-cigarettes, including banning minors from purchasing them. In recent years, e-cigarettes have increased in popularity, both with users of traditional cigarettes and non-smokers. One reason for this may be that celebrities have been photoed smoking e-cigarettes. The below picture is from e-cigarette company Blue Smoke


Wall Street predicts sales of e-cigarettes could reach $1 billion in 2013, doubling since 2012. According to the CDC, about one in five U.S. adult smokers and about 6 percent of the total adult population have tried an e-cigarette. So, are e-cigarettes a healthy way to quit smoking traditional cigarettes or are e-cigarettes just dangerous?

Are e-cigarettes less damaging than regular cigarettes?
Very little is known about the long term health effects of e-cigarettes. When e-cigarettes are used as a tool to quit smoking, there may be health benefits. The FDA, however, does not endorse the switch to e-cigarettes as a way to quit smoking. Many researchers believe that it is not nicotine that causes lung cancer, but the other chemicals in traditional cigarettes. The e-cigarette still provides the highly-addictive nicotine, but without the chemicals which seems like a good thing for those who currently smoke traditional cigarettes.  

The economic costs of smoking cigarettes are huge. Between 2000-2004, the CDC estimated that cigarette smoking was responsible for about $96 billion in medical expenses and $97 billion in loss of productivity. Cigarette smoking also is responsible for a lost of 5.1 million of potential years of life lost annually. The switch to e-cigarettes could therefore have economic benefits.

Without the toxic fumes of regular cigarettes, e-cigarettes do not create second-hand smoke to the degree regular cigarettes do. Secondhand smoke causes lung cancer and heart disease in nonsmoking individuals and can contribute to sudden infant death syndrome, respiratory infections, and asthma attacks.  Not harming innocent bystanders is a good thing.

Although all of that sounds promising,  it is important to note that in general, research does not indicate that e-cigarettes are more helpful than other, FDA-endorsed methods to quit smoking. According to the CDC, “There is currently no conclusive scientific evidence that e-cigarettes promote long-term cessation.”

Are e-cigarettes safe, even for non-smokers?
E-cigarettes still provide the body with a dose of nicotine, which is an addictive drug. Children can (and do) legally purchase e-cigarettes. Little is known about the health effects of nicotine on children, especially in the long term. Teens and children are trying e-cigarettes.  In 2012, the percent of high school students that reported ever using e-cigarettes increased to 10 percent, a 4.7 percent increase from 2011.  In total, 1.78 million U.S. middle and high school students had tried e-cigarettes in 2012. In the same study, 1 out of 5 middle schoolers that said they used e-cigarettes, said they do not use traditional cigarettes. Since e-cigarettes do contain nicotine, they are introducing a highly addictive drug to the child.

E-cigarettes can be helpful or e-cigarettes can be harmful, depending on the situation. What is clear is that policy is needed to regulate the purchase and consumption of e-cigarettes.

E-cigarettes - Policy solutions
  1. Restrict sales of e-cigarettes from minors. In order to enforce the sale ban of e-cigarettes to minors, e-cigarettes would be kept behind the counter at retail stores and ID would be required for purchase. Similarly, there would have to be a fine for sale of e-cigarettes to a minor.  Several states have already passed laws restricting sales of e-cigarettes to those over 18. Since we don’t know the long-term effects of e-cigarettes, especially on developing lungs, a mandatory age to purchase e-cigarettes is necessary.

  1. Ban e-cigarettes in certain areas. Many jurisdictions are ‘smoke free’ meaning they do not allow traditional smoking within a certain geographic area. An option would be to include e-cigarettes in that ban. The concern is that e-cigarettes look similar enough to regular cigarettes that people would become confused and think that smoking is allowed. A ban in certain areas would still allow those to use e-cigarettes as an alternative to regular cigarettes, just not in many public spaces.

  1. Taxation of e-cigarettes. Traditional cigarettes are highly taxed. The point of taxation is that it will deter people from purchasing. Some states have redefined their tax codes so that e-cigarettes are taxed like regular tobacco products. At this time, the FDA has not determined that e-cigarettes are a way to quit smoking and therefore not considered a therapy. However, it might not be wise to tax something that is used as a less deadly alternative to normal cigarettes.

  1. Regulate advertising. E-cigarettes are not under the same FDA regulations as normal cigarettes. Therefore e-cigarettes are able to use the tactics they know boosts sales - celebrity sponsorship, adding flavors, and advertising to kids. Since e-cigarettes look the same as normal cigarettes, especially to children, it can be extremely damaging.
Here is the mascot of eJuiceMonkeys. It appears to be a cartoon monkey smoking a cigarette.

The future of e-cigarettes

A spokesperson for the FDA said that there is a proposed rule for e-cigarette regulation that was sent to the Office of Management and Budget and the Office of Information and Regulatory Affairs for review. The proposed rule is not yet open for public review. It seems appropriate to only allow those over age 18 to purchase e-cigarettes. There also has to be a serious effort to decrease any attempts to market to children. While waiting for the FDA, school districts need to address e-cigarettes both within school walls and the education curriculum. Most importantly, research needs to continue to uncover the health effects of e-cigarettes in the short-term and long-term.


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