Electronic Cigarettes (E-Cigs)

Topic of the Month (July 2015, revised)

What is an E-Cigarette?

E-cigarettes are battery operated devices that heat a solution that contains
nicotine and other additives, producing a vapor that is inhaled. The
devices are made to look and feel like a traditional cigarette. E-
cigarettes are not currently regulated by the FDA.

Are E-cigarettes safe?

The potential user is led to believe that E-cigs are a safer alternative to
traditional tobacco products and can be used to help stop smoking.
There is no current scientific evidence that e-cigarettes are less harmful
than traditional tobacco products or that they assist with smoking
cessation. FDA tests of e-cigarettes indicate they contain carcinogens,
toxic chemicals and heavy metals (1)

What about the vapor? Is it safe?

The “second hand” vapor emitted from an e-cigarette is not just harmless water vapor. Studies have indicated
that the vapor contains nicotine, ultrafine particles and low levels of toxins known to cause cancer. The particle
concentration is higher than in conventional cigarettes. (2) Health effects associated with exposure to e-cigarette
vapor are not fully studied, but some data suggest that e-cigarette vapor may be less harmful than cigarette
smoke but still poses significant health risks. (3) (4)

What are some other safety concerns?

An e-cig user purchases refill solutions. These solutions are very concentrated and contain from 500 to more
than 1,000 mg of nicotine in a 1 oz. bottle. Solutions marketed as nicotine free have been found to also contain
nicotine. This creates a significant risk for accidental poisoning because the lethal dose of nicotine for adults is
30 to 60 mg if swallowed, and for children the lethal dose is just 10 mg.

According to the CDC, the number of calls to poison centers involving e-cigarette liquids rose from one per
month in September 2010 to 215 per month in February 2014. (3) In MN alone, 62 poisonings occurred in 2014
from nicotine ingestion in children under age 5. (5) E-Cig refills do not have to be in child proof containers.

What about use during pregnancy?

Some women may choose to use e-cigarettes during pregnancy because they believe it will be safer for their
babies, than traditional tobacco products. No studies have been performed on the safety of e-cigarettes in
pregnant women or on whether they help pregnant women reduce or stop smoking.

More research is needed to better understand the health effects of e-cigarettes on individuals and specifically
their impact on pregnant women and their babies. Use of other nicotine-containing products, such as smokeless
tobacco, during pregnancy is associated with lower birth weight, increased stillbirth rates, and preterm birth. (4)
For more information on effects of nicotine in pregnancy see Other References (1) (2).
 Tips for Discussing E-Cigs with WIC Participants/Caregivers

Pregnant Women

• If helpful, use open-ended questions to explore why a woman is using e-cigarettes. If a participant states
she has switched to e-cigs because of her baby, affirm her desire to have a healthy baby, and her
willingness to make changes to improve her health and her baby’s health, then ask permission to share
some information about e-cigs.

• Discuss with pregnant women that the safety of e-cigs is unknown, including whether e-cigs are safer
than using traditional tobacco products during pregnancy. WIC’s recommendation is to decrease and try
to eliminate use of all nicotine products, including e-cigs, during pregnancy. If the participant is
interested in why use is discouraged, share that nicotine crosses the placenta so the baby is exposed to
nicotine too. Nicotine exposure is linked to many health effects on the unborn baby including increased
risk for low birthweight and preterm births. Exposure may also increase the risk for Attention Deficit
Hyperactivity Disorder (ADHD).

• Encourage pregnant women to cut down or stop smoking while pregnant, regardless of whether they are
using e-cigs or traditional tobacco products If the participant is interested, offer referrals to smoking
cessation programs, or help mom set goals for reducing the amount of e-cigs and tobacco used.

• Encourage pregnant women to discuss e-cigs use during pregnancy with their medical doctor.

Note: Although use of e-cigs carries risks and should be addressed as appropriate, there currently is no WIC
risk code for e-cigarette use. USDA has clarified that risk codes 371 and 904 assess for use of tobacco products
and would not include e-cigarettes. E-cig use is referred to as “vaping” not “smoking” so use of this
terminology may help determine E-cig use.

Households that Use E-Cigarettes

• If the user is already a smoker, use PCS skills to assess their readiness to quit smoking, whether it is an
e-cig or a traditional tobacco product. If the participant is interested, make a referral or help participant
set realistic goals.

• If a person has never smoked, explore reasons why they are interested in information about e-cigs.
Address health concerns/cost/etc. based on interest and concern of participant.

• Discuss with the e-cig user that the “second-hand vapor” from e-cigs still contains harmful substances
just like tobacco smoke, so they should use the e-cig away from others, especially small children, and
should wash their hands thoroughly after vaping or smoking. If mom is breastfeeding, encourage her to
follow these same safety precautions if she is using e-cigs and to limit as much exposure as possible.

• Inform them that the refill liquid is highly toxic to both adults and children. They need to safeguard
against any accidental ingestion, including a spill where a child might get the liquid on their skin.
Clean up any spills or condensation of vapor, wash hands thoroughly, and store in a safe place where
small children cannot get to it. If an accidental ingestion of the liquid occurs, instruct them to call 911
immediately.
References:

(1) FDA Warns of Health Risks posed by E-cigarettes. U.S. Food and Drug Administration. (2009, July)
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2009/ucm173222.htm.

(2) Fuoco, F.C.; Buonanno, G.; Stabile, L.; “Influential parameters on particle concentration and size distribution in
the mainstream of e-cigarettes,” Environmental Pollution 184: 523-529, January 2014.

(3) Czogala J, Goniewicz ML, Fidelus B, Zielinska-Danch W, Travers MJ, Sobczak A. Secondhand exposure to
vapors from electronic cigarettes. Nicotine & tobacco research : official journal of the Society for Research on
Nicotine and Tobacco. Jun 2014;16(6):655-662.

(4) http://www.legacyforhealth.org/content/download/582/6926/version/6/file/LEG-FactSheet-Topical-E-
Cigarettes-May2014.pdf.

(5) http://www.health.state.mn.us/divs/hpcd/tpc/topics/nicotine_docs/2015nic_advisory.pdf.

(6) http://www.cdc.gov/media/releases/2014/p0403-e-cigarette-poison.html.

(7) US Department of Health and Human Services. "The health consequences of smoking—50 years of progress: a
report of the Surgeon General." 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 17 (2014).

Other Information Sources:

(1) http://contemporaryobgyn.modernmedicine.com/contemporary-obgyn/content/tags/e-cigarettes/e-
cigarettes-and-obgyn-key-safety-information-prenatal-?page=full

(2) http://lethallure.org/is-it-safe-to-use-electronic-cigarettes-while-pregnant-2/

(3) http://www.cinchcoalition.org/file/March%20of%20Dimes,%20ecigarettes%20and%20pregnancy%20fa
ct%20sheet.pdf.

(4) http://www.ndhealth.gov/tobacco/Facts/e-cigs.pdf

(5) http://www.fda.gov/newsevents/publichealthfocus/ucm172906.htm.

(6) http://www.health.state.mn.us/tobacco/

(7) http://clearwaymn.org/