Tobacco continues to be the leading cause of preventable death and illness in the United States and the world (World Health Organization, 2011). In addition, tobacco is responsible for one in three cancer deaths in the United States (American Cancer Society, 2015). Prevention of tobacco-related disease, disability, and death could be achieved by promoting tobacco control (i.e., preventing uptake, helping smokers quit, and protecting against exposure to secondhand smoke).
Electronic nicotine devices (ENDs) are advertised as a safe alternative to tobacco products and as a smoking cessation tool. Although evidence is lacking, ENDs may be beneficial in reducing adverse health effects related to tobacco products. However, the safety profile of the devices is unclear (International Society of Nurses in Cancer Care, 2014).
ENDs are not a U.S. Food and Drug Administration (FDA)–approved smoking cessation tool, and the amount of nicotine and other substances a person gets from each cartridge is unclear. As outlined in a report by the Division of Pharmaceutical Analysis (Westenberger, 2009), test results found ENDs to contain nitrosamines and formaldehyde, which are known carcinogens. This analysis also found that ENDs contain toxic chemicals, including diethylene glycol, a chemical found in antifreeze, and impurities found in tobacco (e.g., anabasine, myosmine, β-nicotyrine) that are suspected of causing adverse health effects.
ENDs users not only ingest but also emit toxins in addition to harmful ultrafine and fine particles. These emissions pose potential health risks similar to secondhand smoke. Many nicotine refill bottles or cartridges are not adequately packaged to prevent children’s contact or accidental ingestion of toxic amounts of nicotine. Studies also have shown that ENDs can cause respiratory and cardiac changes much like those caused by regular cigarettes. Whether these are short- or long-term physiologic changes is unclear (Brandon et al., 2015; Goniewicz et al., 2014).
In another study of more than 1,000 smokers, ENDs users were found to be less likely to stop or cut back on smoking traditional tobacco products (Kim, 2015). According to the study, smokers with any history of ENDs use were less likely after one year to decrease cigarette smoking, or completely quit for one month or more, than smokers who have never smoked ENDs (Kim, 2015).
Some ENDs contain flavorings that seem to appeal to youth. Findings from the National Youth Tobacco Survey showed that ENDs use (at least one per day in the past 30 days) among high school students is on the rise, with about 660,000 students in 2013 and 2 million students in 2014, a percent increase of 4.5% to 13.4%, respectively (Centers for Disease Control and Prevention [CDC], 2015). ENDs use in middle school has more than tripled from 120,000 students (1.1%) in 2013 to 450,000 students (3.9%) (CDC, 2015). This is the first time since the survey started in 2011 that ENDs use has surpassed use of every other tobacco product, including conventional cigarettes. CDC (2015) noted that the number of calls to poison centers involving ENDs nicotine-containing liquids increased from one per month in September 2010 to 215 per month in February 2014. The number of calls per month involving conventional cigarettes did not demonstrate a similar pattern during the same time period (CDC, 2015).
Nurses can effectively deliver evidence-based interventions for tobacco dependence that reduce tobacco use. Nursing involvement in taking community action, helping patients quit, promoting an environment free of tobacco smoke, and supporting effective tobacco control policies is essential to solving this problem (Sarna, Bialous, Rice, & Wewers, 2009).
Approved by the ONS Board of Directors, June 2015. Reviewed January 2016.
Health Care Policy and Consumer Advocacy
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Brandon, T.H., Goniewicz, M.L., Hanna, N.H., Hatsukami, D.K., Herbst, R.S., Hobin, J.A., . . . Warren, G.W. (2015). Electronic nicotine delivery systems: A policy statement from the American Association for Cancer Research and the American Society of Clinical Oncology. Journal of Clinical Oncology, 33, 952–963. doi:10.1200/JCO.2014.59.4465
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