Electronic cigarettes, or e cigarettes, are battery powered devices that provide doses of nicotine and other additives to the user in an aerosol. Depending on the brand, e cigarette cartridges typically contain nicotine, a component to produce the aerosol (e.g., propylene glycol or glycerol), and flavorings (e.g., fruit, mint, or chocolate) (1). Potentially harmful constituents also have been documented in some e cigarette cartridges, including irritants, genotoxins, and animal carcinogens (1). E cigarettes that are not marketed for therapeutic purposes are currently unregulated by the Food and Drug Administration, and in most states there are no restrictions on the sale of e cigarettes to minors. Use of e cigarettes has increased among U.S. adult current and former smokers in recent years (2) however, the extent of use among youths is uncertain.

Data from the 2011 and 2012 National Youth Tobacco Survey (NYTS), a school based, pencil and paper questionnaire given to U.S. middle school (grades 6 8) and high school (grades 9 12) students, were used to estimate the prevalence of ever and current ( 1 day in the past 30 days) use of e cigarettes, ever and current ( 1 day in the past 30 days) use of conventional cigarettes, and use of both. NYTS consists of a cross sectional, nationally representative sample of students in grades 6 12 from all 50 states and the District of Columbia (3).

During 2011 2012, among all students in grades 6 12, ever e cigarette use increased from 3.3&#37 to 6.8&#37 (p<0.05) (Figure) current e cigarette use increased from 1.1&#37 to 2.1&#37 (p<0.05), and current use of both e cigarettes and conventional cigarettes increased from 0.8&#37 to 1.6&#37 (p<0.05). In 2012, among ever e cigarette users, 9.3&#37 reported never smoking conventional cigarettes among current e cigarette users, 76.3&#37 reported current conventional cigarette smoking.

Among middle school students, ever e cigarette use increased from 1.4&#37 to 2.7&#37 during 2011 2012 (p<0.05) (Figure) current e cigarette use increased from 0.6&#37 to 1.1&#37 (p<0.05), and current use of both e cigarettes and conventional cigarettes increased from 0.3&#37 to 0.7&#37 (p<0.05). In 2012, among middle school ever e cigarette users, 20.3&#37 reported never smoking conventional cigarettes among middle school current e cigarette users, 61.1&#37 reported current conventional cigarette smoking.

Among high school students, ever e cigarette use increased from 4.7&#37 to 10.0&#37 during 2011 2012 (p<0.05) (Figure) current e cigarette use increased from 1.5&#37 to 2.8&#37 (p<0.05), and current use of both e cigarettes and conventional cigarettes increased from 1.2&#37 to 2.2&#37 (p<0.05). In 2012, among high school ever e cigarette users, 7.2&#37 reported never smoking conventional cigarettes among high school current e cigarette users, 80.5&#37 reported current conventional cigarette smoking.

E cigarette experimentation and recent use doubled among U.S. middle and high school students during 2011 2012, resulting in an estimated 1.78 million students having ever used e cigarettes as of 2012. Moreover, in 2012, an estimated 160,000 students who reported ever using e cigarettes had never used conventional cigarettes. This is a serious concern because the overall impact of e cigarette use on public health remains uncertain. In youths, concerns include the potential negative impact of nicotine on adolescent brain development (4), as well as the risk for nicotine addiction and initiation of the use of conventional cigarettes or other tobacco products.

CDC and the Food and Drug Administration will continue to explore ways to increase surveillance and research on e cigarettes. Given the rapid increase in use and youths’ susceptibility to social and environmental influences to use tobacco, developing strategies to prevent marketing, sales, and use of e cigarettes among youths is critical.

Reported by

Catherine Corey, MSPH, Baoguang Wang, MD, Sarah E. Johnson, PhD, Benjamin Apelberg, PhD, Corinne Husten, MD, Center for Tobacco Products, Food and Drug Administration. Brian A. King, PhD, Tim A. McAfee, MD, Rebecca Bunnell, PhD, Ren A. Arrazola, MPH, Shanta R. Dube, PhD, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. Corresponding contributor Brian A. King, baking , 770 488 5107.

References

  1. Cobb NK, Byron MJ, Abrams DB, Shields PG. Novel nicotine delivery systems and public health the rise of the “e cigarette.” Am J Public Health 2010 100 2340 2.
  2. King BA, Alam S, Promoff G, Arrazola R, Dube SR. Awareness and ever use of electronic cigarettes among U.S. adults, 2010 2011. Nicotine Tob Res 2013 15 1623 7.
  3. CDC. National Youth Tobacco Survey. Atlanta, GA US Department of Health and Human Services, CDC 2013. Available at
  4. Dwyer JB, McQuown SC, Leslie FM. The dynamic effects of nicotine on the developing brain. Pharmacol Ther 2009 122 125 39.

Bbc news – call for restrictions on sale of electronic cigarettes to children

Coupons for basic brand cigarettes

Research suggests about 1.3m smokers and ex smokers in the UK use the products, which are designed to replicate smoking behaviour without the use of tobacco.

E cigarettes turn nicotine and other chemicals into a vapour that is inhaled.

Mr Maxwell said an answer to a Westminster parliamentary question revealed that there were currently no age restrictions affecting the sale of e cigarettes.

“There is a real and worrying grey area when it comes to e cigarettes that needs to be addressed,” he said.

“It cannot be right that these nicotine containing products can be legally marketed and sold to children.

“There is a worrying loophole here that needs to be tightened up as a matter of urgency. I will be seeking a meeting with the Scottish government minister for public health to see if anything can be done in Scotland to close this loophole in the sale of these products, but clearly there is also need for action at Westminster.”

Electronic cigarettes will be licensed as a medicine in the UK from 2016 under new regulations to be introduced by the Medicines and Healthcare Products Regulation Agency, the body which regulates medicines in the UK.

Concerns have been raised over the lack of regulation of e cigarettes

The UK currently has few restrictions on the use of e cigarettes, despite moves in some countries to ban them.

Mr Maxwell added “Scotland currently does not have the power to restrict the advertising of these products, something that is vital if this issue is to be tackled properly.

“All our experience with tobacco products shows that advertising plays a huge role in how products like this are perceived. We cannot have a situation where we return to the bad old days where nicotine products were glamorised in advertising.

“There needs to be firmer rules on what exactly is permitted, so that we do not find ourselves in a position where products that encourage nicotine addiction are ever seen as healthy or beneficial.”

A spokesman for the Scottish government said “We will continue to consider what further advice and guidance may be required on electronic cigarettes for the benefit of public health in Scotland and the minister for public health, Michael Matheson, would be happy to meet Mr Maxwell to discuss this matter.”