Chapter 2:

Products

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In the United States, tobacco use is the leading cause of preventable disease, disability, and death. There are many different forms of tobacco, such as electronic nicotine delivery systems (ENDS), traditional cigarettes, alternative products and smokeless products. No form of tobacco is completely safe, because any type of tobacco use can cause heart disease, stroke, lung disease, or cancer.

1. National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). (2019, March 18). Tobacco Use. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/chronicdisease/resources/publications/factsheets/tobacco.htm

This video talks about the history of e-cigarettes and vapes, how they’ve evolved, and the risks of using these products.

 

Young adults say their reason for trying ENDS are curiosity, flavor, taste, and they believe that e-cigs are less harmful than other tobacco products. Of all young adults who have used tobacco (even once), 81% started with a flavored product. 1

 

There are currently more than 460 e-cigarette brands on the market.2 Researchers have been able to find over 15,500 distinctive e-cigarette flavors accessible online.3

1. Villanti, A. C., Johnson, A. L., Ambrose, B. K., Cummings, K. M., Stanton, C. A., Rose, S. W., Feirman, S. P., Tworek, C., Glasser, A. M., Pearson, J. L., Cohn, A. M., Conway, K. P., Niaura, R. S., Bansal-Travers, M., & Hyland, A. (2017). Flavored Tobacco Product Use in Youth and Adults: Findings From the First Wave of the PATH Study (2013–2014). American Journal of Preventive Medicine, 53(2), 139–151. https://doi.org/10.1016/j.amepre.2017.01.026

2. University of North Carolina Health Care. (2019, October 24). E-cigarette flavors decrease perception of harm among youth. ScienceDaily. Retrieved August 16, 2020 from www.sciencedaily.com/releases/2019/10/191024122559.htm

3. Zhu, S-H, et al., “Evolution of Electronic Cigarette Brands from 2013-2014 to 2016-2017: Analysis of Brand Websites,” Journal of Medical Internet Research, 20(3), published online March 12, 2018. 20 . 

 

What’s in a Vape/E-Cig?

   Tour the chemical factory!   

Propylene Glycol

Used to create: artificial smoke, fog, antifreeze

1. Agency for Toxic Substances and Disease Registry. (2011). Propylene Glycol. Centers for Disease Control and Prevention. Retrieved from https://www.atsdr.cdc.gov/substances/toxsubstance.asp?toxid=240

2. Song, M.-A., Reisinger, S. A., Freudenheim, J. L., Brasky, T. M., Mathé, E. A., McElroy, J. P., Nickerson, Q. A., Weng, D. Y., Wewers, M. D., & Shields, P. G. (2020). Effects of Electronic Cigarette Constituents on the Human Lung: A Pilot Clinical Trial. Cancer Prevention Research, 13(2), 145–152.https://doi.org/10.1158/1940-6207.CAPR-19-0400

Acetaldehyde

Found in: perfumes, basic dyes, fish preservative, fuel

1. U.S. Environmental Protection Agency. (2000). Health Assessment Document for Acetaldehyde. Environmental Criteria and Assessment Office, Office of Health and Environmental Assessment, Office of Research and Development. Retrieved from https://www.epa.gov/sites/production/files/2016-09/documents/acetaldehyde.pdf

Acrolein

Used in: herbicide primarily used to kill weeds

1. U.S. Dept of Health and Human Services. (2007). TOXICOLOGICAL PROFILE FOR ACROLEIN. Agency for Toxic Substances and Disease Registry. https://www.atsdr.cdc.gov/toxprofiles/tp124.pdf

Formaldehyde

Found in: glues, paints, fertilizers and pesticides, dishwashing liquids, and fabric softeners

1. Agency for Toxic Substances and Disease Registry. (2016, Februrary 10). Formaldehyde and Your Health. Centers for Disease Control and Prevention. Retrieved fromhttps://www.atsdr.cdc.gov/formaldehyde/index.html

Diacetyl

Chemical linked to serious lung disease

1. National Institute for Occupational Safety and Health (NIOSH). (2017, October 3). Flavorings-Related Lung Disease: Exposures to Flavoring Chemicals—NIOSH Workplace Safety and Health Topic. https://www.cdc.gov/niosh/topics/flavorings/exposure.html

Benzene

Shown to cause damage to DNA
Found in: car exhaust

1. U.S. Environmental Protection Agency. (2009). TEACH Chemical Summary for Benzene. Environmental Criteria and Assessment Office, Office of Health and Environmental Assessment, Office of Research and Development. Retrieved from https://archive.epa.gov/region5/teach/web/pdf/benz_summary.pdf

Nickel

Found in: meteorites

Emitted from: volcanoes

Used to make: batteries, coins, jewelry

1. Agency for Toxic Substances and Disease Registry. (2011, March 3). Toxic Substances Portal: Nickel. Centers for Disease Control and Prevention. Retrieved from https://www.atsdr.cdc.gov/substances/toxsubstance.asp?toxid=44

Tin

Found in: toothpaste, perfumes, soaps

Used to make: pesticides, paints, rodent repellents, plastics

1. Agency for Toxic Substances and Disease Registry. (2005). Toxic Substances Portal: Tin and Compounds. Centers for Disease Control and Prevention. Retrieved from https://www.atsdr.cdc.gov/phs/phs.asp?id=541&tid=98

Lead

Used in: paint, ceramics, pipes, gasoline, batteries

1. National Institute of Environmental Health Sciences. (n.d.). Lead. Retrieved August 23, 2020, from https://www.niehs.nih.gov/health/topics/agents/lead/index.cfm

Volatile Organic Compounds 

Released from burning: gasoline, wood, coal

1. U.S. National Library of Medicine. (2017, May 31). Volatile Organic Compounds (VOCs): Your Environment, Your Health. Tox Town. Retrieved August 23, 2020, from https://toxtown.nlm.nih.gov/chemicals-and-contaminants/volatile-organic-compounds-vocs

 

Manganese

Found in: plant fertilizers, animal feed

1. U.S. Geological Survey. (n.d.). National Minerals Information Center. Manganese Statistics and Information. Retrieved August 23, 2020, from https://www.usgs.gov/centers/nmic/manganese-statistics-and-information

Toluene

Found in: car exhaust, paint thinners, nail polish, and stain removers, TNT, degreasers

1. Wisconsin Department of Health Services. (2019, October 1). Toluene. Retrieved from https://www.dhs.wisconsin.gov/chemical/toluene.htm

Chromium

Used in: leather tanning, paint pigments

1. Agency for Toxic Substances and Disease Registry. (2008, December 18). Chromium Toxicity. What is Chromium? Centers for Disease Control and Prevention. Retrieved from https://www.atsdr.cdc.gov/csem/csem.asp?csem=10&po=4

 

show me Propylene Glycol
show me Acetaldehyde
show me Acrolein
show me Formaldehyde
show me Diacetyl
show me Benzene
show me Nickel
show me Tin
show me Lead
show me Volatile Organic Compounds 
show me Manganese
show me Toluene
show me Chromium
ENDS Risks

The mid to long-term effects of ENDS are not yet understood, given that ENDS have been available in the U.S. for less than a decade. However, the use of e-cigarettes leads to health risks, and scientists continue to research more about the long-term effects of using ENDS products.1

What We Know
  • Many people using e-cigarettes or other vaping products have recently reported severe lung disease1
  • ENDS produce aerosol that contain chemicals linked to central nervous system problems, long-term negative health effects, and cancer2,3
  • Defective e-cigarette batteries have caused fires and explosions, resulting in serious injuries4

1. Centers for Disease Control and Prevention (CDC). (2020, February 25). Outbreak of Lung Illness Associated with Using E-cigarette Products. Retrieved from https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.htm

2. Williams, M., Villarreal, A., Bozhilov, K., Lin, S., & Talbot, P. (2013). Metal and Silicate Particles Including Nanoparticles Are Present in Electronic Cigarette Cartomizer Fluid and Aerosol. PLOS ONE, 8(3), e57987. https://doi.org/10.1371/journal.pone.0057987

3. Olmedo, P., Goessler, W., Tanda, S., Grau-Perez, M., Jarmul, S., Aherrera, A., Chen, R., Hilpert, M., Cohen, J. E., Navas-Acien, A., & Rule, A. M. (2018). Metal Concentrations in e-Cigarette Liquid and Aerosol Samples: The Contribution of Metallic Coils. Environmental Health Perspectives, 126(2). https://doi.org/10.1289/EHP2175

4. National Academies of Sciences, E., and Medicine. (2018). Public Health Consequences of E-Cigarettes—Chapter: 14 Injuries and Poisonings. The National Academies Press. https://doi.org/10.17226/24952

5. Olfert, I. M., DeVallance, E., Hoskinson, H., Branyan, K. W., Clayton, S., Pitzer, C. R., Sullivan, D. P., Breit, M. J., Wu, Z., Klinkhachorn, P., Mandler, W. K., Erdreich, B. H., Ducatman, B. S., Bryner, R. W., Dasgupta, P., & Chantler, P. D. (2018). Chronic exposure to electronic cigarettes results in impaired cardiovascular function in mice. Journal of Applied Physiology (Bethesda, Md.: 1985), 124(3), 573–582. https://doi.org/10.1152/japplphysiol.00713.2017

6. Soneji, S., Barrington-Trimis, J. L., Wills, T. A., Leventhal, A. M., Unger, J. B., Gibson, L. A., ... & Spindle, T. R. (2017). Association between initial use of e-cigarettes and subsequent cigarette smoking among adolescents and young adults: a systematic review and meta-analysis. JAMA pediatrics, 171(8), 788-797.

 

  • Children and adults have been poisoned by breathing, swallowing, or absorbing e-cigarette liquid through their skin or eyes4
  • Inhaling nicotine from ENDS can damage your blood vessels5
  • Youth who use e-cigarettes are more likely to use actual cigarettes in the future6

ENDS: Myth vs. Reality

Click the myths to reveal the realities.

1. Williams, M., Villarreal, A., Bozhilov, K., Lin, S., & Talbot, P. (2013). Metal and Silicate Particles Including Nanoparticles Are Present in Electronic Cigarette Cartomizer Fluid and Aerosol. PLOS ONE, 8(3), e57987. https://doi.org/10.1371/journal.pone.0057987

2. California Youth Advocacy Network (2018). Vaping Myths & Realities [Pamphlet]. California Department of Public Health.

3. Goniewicz, M., Knysak, J., Gawron, M., Kośmider, L., Sobczak, A., Kurek, J., Prokopowicz, A., Jabłońska-Czapla, M., Rosik-Dulewska, C., Havel, C., Jacob, P., & Benowitz, N. (2013). Levels of selected carcinogens and toxicants in vapour from electronic cigarettes. Tobacco Control. https://doi.org/10.1136/tobaccocontrol-2012-050859

4. Audrain-McGovern, J., Strasser, A. A., & Wileyto, E. P. (2016). The impact of flavoring on the rewarding and reinforcing value of e-cigarettes with nicotine among young adult smokers. Drug and Alcohol Dependence, 166, 263–267. https://doi.org/10.1016/j.drugalcdep.2016.06.030

5. U.S Department of Health and Human Services. (2020). Smoking Cessation – A Report of the Surgeon General - 2020. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

6. U.S. Food and Drug Administration. (2017). Want to Quit Smoking? FDA-Approved Products Can Help. https://www.fda.gov/consumers/consumer-updates/want-quit-smoking-fda-approved-products-can-help

7. Craver, R. (2013, September 15). Analyst Projection: E-cigs will overtake traditional tobacco revenue at Reynolds in 2021. Winston-Salem Journal.

8. Truth Initiative. (2019, December 19). How Big Tobacco is trying to sell a do-gooder image and what Americans think about it. Truth Initiative. https://truthinitiative.org/research-resources/tobacco-industry-marketing/spinning-new-tobacco-industry-how-big-tobacco-trying

9. American Cancer Society. (n.d.). What Do We Know About E-cigarettes? Retrieved August 24, 2020, from https://www.cancer.org/cancer/cancer-causes/tobacco-and-cancer/e-cigarettes.html

10. California Youth Advocacy Network (2018). JUUl Myths & Realities [Pamphlet]. California Department of Public Health.

  Flip the Myths
Myth:

E-cigarettes produce a harmless water vapor. There’s no secondhand vapor.

Reality:

E-cigarettes produce a vapor that has nicotine, harmful chemicals, and toxins known to cause cancer (among other things). These chemicals and toxins include things like formaldehyde, lead, & nickel.1,2,3

Myth:

E-cigarettes aren’t addictive.

Reality:

Nicotine is a poison and a highly addictive drug. Nicotine is one of the main ingredients in
e-cigarettes and tobacco products.2,4

Myth:

E-cigarettes can help people quit tobacco.

Reality:

E-cigarettes are NOT approved by the U.S. FDA to help people quit tobacco. You may know someone who has stopped using tobacco and switched to e-cigarettes but switching isn’t quitting.2,5,6

Myth:

Big Tobacco is not involved in making
e-cigarettes.

Reality:

All major tobacco companies now make
e-cigarettes. In less than 10 years, Big Tobacco will sell the majority of
e-cigarettes in the U.S.2,7,8

Myth:

E-cigarettes are not tobacco.

Reality:

The nicotine in most
e-cigarettes comes from the tobacco plant, just like cigarettes.2,9,10

Young people who use ENDS, are more likely to smoke traditional cigarettes.1

Cigarette smoking accounts for more than 480,000 deaths every year, or about 1 in 5 deaths.2

1. Warner, K. E. (2016). Frequency of E-Cigarette Use and Cigarette Smoking by American Students in 2014. American Journal of Preventive Medicine, 51(2), 179–184. https://doi.org/10.1016/j.amepre.2015.12.004

2. U.S. Department of Health and Human Services. (2014). The Health Consequences of Smoking-50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

 

10x times as many people have died prematurely from smoking than have died in all the wars fought by the U.S.1

In America, tobacco use is the number one cause of preventable deaths and causes more deaths than alcohol, AIDS, car crashes, illegal drugs, murders and suicides combined.2

 

World-wide, tobacco use causes more than 7 million deaths a year.3

According to the CDC, in 2018 about 49.1 million U.S. adults, aged 18 and up, were current smokers.4

1. U.S. Department of Health and Human Services. (2014). The Health Consequences of Smoking-50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

2. Creamer, M. R., Wang, T. W., Babb, S., Cullen, K. A., Day, H., Willis, G., Jamal, A., & Neff, L. (2019). Tobacco Product Use and Cessation Indicators Among Adults—United States, 2018. Morbidity and Mortality Weekly Report, 68(45), 1013–1019. https://doi.org/10.15585/mmwr.mm6845a2

3. Mokdad, A. H., Marks, J. S., Stroup, D. F., & Gerberding, J. L. (2004). Actual causes of death in the United States, 2000. JAMA, 291(10), 1238–1245. https://doi.org/10.1001/jama.291.10.1238

4. Centers for Disease Control and Prevention. (2020, August 25). Smoking and tobacco use: Data and statistics. Retrieved from https://www.cdc.gov/tobacco/data_statistics/index.htm

The total mortality rate, for both female and male smokers in the U.S., is about 3X higher than non-smokers.

1. U.S. Department of Health and Human Services. (2014). The Health Consequences of Smoking-50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

Cigarette Risks

Centers for Disease Control and Prevention. (2020, February 5). Smoking & Tobacco Use: Health Effects Infographics. Retrieved from: https://www.cdc.gov/tobacco/infographics/health-effects/index.htm

Chronic
Diseases

Cancers

List of chronic diseases and cancers
Human body with the areas affected by Smoking related diseases

 

What’s in a Cigarette?

Cigarette smoke contains hydrogen cyanide, which has been used in
prison executions.1

Urea is found in both cigarettes and urine.2,3

 

Geraniol is found in cigarettes and pesticides.4

 

Toluene is found in gasoline, explosives, and cigarette smoke.5

World Health Organization. (2017). WHO report on the global tobacco epidemic, 2017: Monitoring tobacco use and prevention policies. Geneva: World Health Organization. https://www.who.int/tobacco/global_report/2017/en/

2. U. S. Department of Health and Human Services. (2001). Risks Associated with Smoking Cigarettes with Low Machine-Measured Yields of Tar and Nicotine: Smoking and Tobacco Control Monograph No. 13. https://cancercontrol.cancer.gov/brp/tcrb/monographs/13/

3. University of California San Francisco Library, & Covington Burling. (1993). Summary of Data on Urea. https://www.industrydocuments.ucsf.edu/tobacco/docs/#id=ptwy0082

4. R.J. Reynolds Tobacco. (n.d.). Cigarette Ingredients. R.J. Reynolds Tobacco Company. Retrieved August 24, 2020, from https://www.rjrt.com/commercial-integrity/ingredients/cigarette-ingredients/

5. Kegley, S.E., et al. (2014). "Geraniol." Pesticide Action Network. Oakland, CA.

This video talks about what happens to your body when you stop smoking after 20 minutes,
2 hours, 24 hours, etc.

Tobacco comes in a variety of different forms, none of which are completely safe.

Other forms of tobacco include hookahs, cigars, cigarillos, and smokeless tobacco.

All smokeless tobacco products can lead to nicotine addiction. Studies indicate that smokeless tobacco products keep nicotine in the bloodstream longer than cigarettes.

1. Centers for Disease Control and Prevention. (2020, January 7). Cigars. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/cigars/index.htm

True or False.
Smokeless tobacco is a safe
alternative to cigarettes, ENDS and
alternative tobacco products.

  Correct

  Wrong

No form of smokeless tobacco is a safe alternative to cigarettes.1 Smokeless tobacco can also cause oral, esophagus, and pancreatic cancer and increase the risk of heart attack and stroke.2,3

1. International Agency for Research on Cancer. (2007). Smokeless Tobacco and Some Tobacco-specific N-Nitrosamines. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Volume 89.

2. Tam, J., Day, H. R., Rostron, B. L., & Apelberg, B. J. (2015). A systematic review of transitions between cigarette and smokeless tobacco product use in the United States. BMC Public Health, 15, 258. https://doi.org/10.1186/s12889-015-1594-8

3. National Cancer Institute. (n.d.). Smokeless Tobacco and Cancer. Retrieved August 24, 2020, from https://www.cancer.gov/about-cancer/causes-prevention/risk/tobacco/smokeless-fact-sheet

 

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