The Expansion of E-Cigs: Legal Ramifications, Health Concerns, and Prevention

August 2019

Electronic Cigarettes

A variety of electronic cigarettes (e-cigs) or electronic nicotine delivery systems (ENDS) are available to the public. However, electronic cigarettes generally consist of a heating element, a power source, and liquid. Electronic cigarette liquids commonly contain propylene glycol, vegetable glycerin, nicotine, and flavoring.1,2 The electronic cigarette liquids produce a vapor when heated, which is inhaled by the user.

Popularity Among A Critical Market

While use of combustible (traditional) cigarettes is down among youths, electronic cigarettes are expanding the nicotine market and reducing smoking cessation.3,10 Youths are a critical market for the tobacco industry, as approximately 90% of cigarette smokers start before their 18th birthday.2,10 Electronic cigarettes are the most commonly used tobacco product among middle school and high school students in the United States.10

Unlike combustible cigarettes, electronic cigarettes are advertised widely on the internet and television. In 2014, electronic cigarette companies spent $125 million on marketing.3 Effective marketing strategies, combined with the availability of flavors, product design, and perceptions of safety and acceptability make electronic cigarettes more appealing to youths.2,8,3

Perceptions and social norms regarding electronic cigarette use differ by location. Research suggests that adolescents in urban areas are more likely to use electronic cigarettes than adolescents in rural areas.11 Additionally, use of electronic cigarettes by friends or family members is a contributing factor for electronic cigarette use.9

Legal Ramifications and Health Concerns

With the passing of Senate Bill 21 in the 86th Texas Legislature, beginning September 1, 2019, individuals under the age of 21 may not purchase tobacco products, including e-cigarettes, in the state of Texas. However, individuals who are 18 years of age on or before August 31, 2019 and individuals with valid military identification may still purchase tobacco in the state of Texas if they are over the age of 18.

E-cigarettes are not always used with tobacco products. One-third of students in the United States who use e-cigarettes reported using them for cannabis.7 Using THC wax or oil can result in a felony under the Texas Controlled Substances Act (§ 481.116), as it is considered a concentrate (§ 481.002).

Electronic cigarettes are the most commonly used tobacco product among middle school and high school students in the United States.

Although content varies, electronic cigarettes may act as a delivery system for potentially toxic substances, which can be particularly harmful to youths.1,2,6,4,3 Common contents of electronic cigarettes include propylene glycol, vegetable glycerin, flavoring additives, and nicotine.1,2 A common defense of electronic cigarettes is that they deliver lower levels of carcinogens than combustible cigarettes. However, it is important to note that noncancer cardiovascular and pulmonary diseases are responsible for approximately two-thirds of smoking related deaths.3 Prevention campaigns could address the harmful effects of electronic cigarette use, which include nicotine addiction, oxidative stress, respiratory problems, increased risk of cardiovascular disease, increased risk of lung disease, and air pollution among others.3,12,13

Policies and Prevention

Schools with policies and programs that specifically target electronic cigarettes have had a positive impact on student electronic cigarette use.

Schools with policies and programs that specifically target electronic cigarettes have had a positive impact on student electronic cigarette use.5 The Texas School Safety Center offers a variety of tobacco education and prevention programs. For example, the Say What! Conference is a youth-focused tobacco prevention event that equips youths with the knowledge and skills necessary to be successful in tobacco prevention. Additionally, the Regional Say What! Summits allow adult sponsors to accompany students with the shared goal of obtaining the knowledge and skills necessary to enact change in their communities. The Texas School Safety Center also provides a Texas Tobacco Law Toolkit, which includes a variety of useful resources and training videos.

References

1 Barrington-Trimis, J. L., & Leventhal, A. M. (2018). Adolescents’ use of “Pod Mod” e-cigarettes—urgent concerns. New England Journal of Medicine, 379(12), 1099-1102.

2 Ferkol, T. W., Farber, H. J., La Grutta, S., Leone, F. T., Marshall, H. M., Neptune, E., ... & Schraufnagel, D. E. (2018). Electronic cigarette use in youths: a position statement of the Forum of International Respiratory Societies. European Respiratory Journal, 51(5), 1800278.

3 Glantz, S. A., & Bareham, D. W. (2018). E-cigarettes: use, effects on smoking, risks, and policy implications. Annual review of public health, 39, 215-235.

4 Green, L. W., Fielding, J. E., & Brownson, R. C. (2018). The debate about electronic cigarettes: harm minimization or the precautionary principle. Annual review of public health, 39, 189-191.

5 Nicksic, N. E., Harrell, M. B., Pérez, A., Pasch, K. E., & Perry, C. L. (2018). School Policy, Administrator Perceptions, and Student E-cigarette Use. Health behavior and policy review, 5(4), 72-82.

6 Stratton, K., Kwan, L. Y., & Eaton, D. L. (2018). Public health consequences of e-cigarettes: consensus study report. National Academies Press.

7 Trivers, K. F., Phillips, E., Gentzke, A. S., Tynan, M. A., & Neff, L. J. (2018). Prevalence of cannabis use in electronic cigarettes among US youth. JAMA pediatrics, 172(11), 1097-1099.

8 Trumbo, C. W. (2018). Influence of Risk Perception on Attitudes and Norms Regarding Electronic Cigarettes. Risk Analysis, 38(5), 906-916.

9 Tsai, J., Walton, K., Coleman, B. N., Sharapova, S. R., Johnson, S. E., Kennedy, S. M., & Caraballo, R. S. (2018). Reasons for electronic cigarette use among middle and high school students—National Youth Tobacco Survey, United States, 2016. Morbidity and Mortality Weekly Report, 67(6), 196.

10 Wang, T. W., Gentzke, A., Sharapova, S., Cullen, K. A., Ambrose, B. K., & Jamal, A. (2018). Tobacco product use among middle and high school students—United States, 2011–2017. Morbidity and Mortality Weekly Report, 67(22), 629.

11 Noland, M., Rayens, M. K., Wiggins, A. T., Huntington-Moskos, L., Rayens, E. A., Howard, T., & Hahn, E. J. (2018). Current use of e-cigarettes and conventional cigarettes among US high school students in urban and rural locations: 2014 National Youth Tobacco Survey. American Journal of Health Promotion, 32(5), 1239-1247.

12 Reilly, S. M., Bitzer, Z. T., Goel, R., Trushin, N., & Richie, J. P. (2018). Free radical, carbonyl, and nicotine levels produced by juul electronic cigarettes. Nicotine & Tobacco Research.

13 US Department of Health and Human Services. (2014). The health consequences of smoking—50 years of progress: a report of the Surgeon General.