Electronic nicotine delivery systems (ENDS), otherwise known as “e-cigs or vapes,” were introduced to the U.S. in 2007, reports CNN. Although touted as a “safe” alternative to cigarette smoking, little evidence existed to suggest further regulations of the industry. Yet, the stereotypes were growing out of control. ENDS were being marketed in a new, “flavor-filled” fashion, and the Food and Drug Administration (FDA) struggled to find a way to control the situation.
When Did ENDS Start to Impact Community Health?
The conversation about ENDS started with a goal of allowing individuals to “smoke” indoors.
Public settings had no reason to prevent the use of vapes, e-cigs or other ENDS initially. These substances were commonly referred to as “water-based” and “completely harmless.” Commercials from this time showed employees “smoking” in the workplace, and who can forget the odd colors to resemble the lit-end of the e-cig?
However, public perception toward smoking is not so easily changed. As the conversation started to shift. Public places, such as restaurants, libraries and hospitals, put up signs like the following:
- “No Smoking/ Vaping Indoors.”
- “Use of E-Cigs or Vapes Prohibited.”
- “Smoke-Free/ Vape-Free Environment.”
These signs indicate how community health has taken precedence over ENDS. At the same time, advocacy groups began to consider how ENDS could impact children, youth and families. Would children be tempted to taste “bubble gum” flavored e-liquids, and how would marketing efforts play out? Would minors be able to purchase ENDS freely? Think about that for a moment. Why would a child’s flavoring be introduced into an addictive habit?
Questions like these captured the interest of the FDA. While manufacturers have pushed toward fewer regulations for the “safer alternative to smoking,” the FDA sees these devices quite differently.
Smoking Rates Drop, But Use of ENDS Is Up
Across the nation, smoking rates are down, reports the Centers for Disease Control and Prevention (CDC). In 2014, approximately 17 percent of U.S. adults smoked, but the statistics on the use of ENDS show a greater problem in community health. ENDS appear centered around today’s youth. Some of the most concerning statistics, reports the FDA, include the following:
- E-cig use among high school students rose from 1.5 percent to 16.0 percent between 2011 and 2015.
- For the same time period, the use of e-cigs rose from 1.5 percent to 5.3 percent among middle school students.
- When asked about rationale behind using e-cigs, 81 percent of school-age users identified “appealing flavor” as the defining factor.
Regardless of manufacturers’ intents, ENDS seem to have impacted children, youth and families the most.
FDA Announces New Regulations on E-Cigs
ENDS that are used for smoking cessation have been regulated by the FDA through the CDC since their arrival. On May 5, 2016, the FDA extended regulatory authority to all ENDS, eliminating confusion over what can and cannot be sold to minors and defining manufacturers’ testing and distribution responsibilities, explains CNN. Moreover, the cost of using ENDS is likely to change as they become taxed as tobacco products.
Impact of New Regulations on Community Health
Community health centers and care providers will likely see an uptick in the number of underage individuals in need of smoking cessation counseling and support. Under the new regulations, ENDS will be unavailable for sale to minors, and minors who have developed an addiction to nicotine will need treatment. Yet, the implications for care providers does not stop there.
More health centers are focusing on becoming smoke-free, and some do not hire employees who smoke. Some may argue this infringes on privacy, but the goal continues to revolve aroundcommunity health.
If a patient sees a provider smoking or vaping, why would he be inclined to stop? The hypocrisy in this example is evident, and now, it will extend to the use of vaping for recreational purposes. It can no longer be viewed as a safer alternative. It must be seen in the same light as tobacco use unless a smoker is using ENDS under medical guidance for smoking cessation.
In mental health settings, patients will need to be made aware of how the FDA’s new regulation could impact their health and financial status. For example, insurance companies will reclassifyvaping as smoking for premium determination. In other words, vaping could increase insurance premiums.
The announcement is not only about the negative aspect of how regulations for ENDS will impact the community. These regulations will open doors for patients who want to stop using tobacco and ENDS entirely. Coverage for tobacco cessation therapies and counseling may be expanded for those who have only used e-cigs or other ENDS in the past.
The FDA’s new regulations will have far-reaching impacts across all health settings. Those with a high risk of using e-cigs, especially youth and adolescents, will need to be informed of ENDS-related dangers. These dangers will become evident as further testing on the safety of ENDS is undertaken and publicized. In contrast, those with chronic health conditions will need to consider how ENDS could contribute to worsening addiction to tobacco.
As it stands now, the financial burden of tobacco use will increase dramatically, but the future has returned to an ideal of being smoke-free, vape-free and healthy. Rather than thinking about how the regulations will hurt manufacturers, society has chosen to make community health a priority over convenience and perception.