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MINUTES-Final ORANGE COUNTY BOARD OF HEALTH January 27, 2016 S:\Managers Working Files\BOH\Agenda & Abstracts\2016 Agenda & Abstracts/ February Page 2 Dr. Johnathan Thornburg, Director of Exposure and Aerosol Technology, Research Triangle Institute International (RTI), began with a brief overview of electronic cigarettes. Electronic cigarettes, also known as e-cigarettes, are battery-operated products designed to deliver nicotine, flavor and other chemicals. They turn chemicals into an aerosol that is inhaled by the user. E-cigarettes were created in 2007 and have become a global health issue. They have attracted the attention of the World Health Organization but there still is very little information on them due to a lack of scientific evidence. They contain a wide range of additives, some of which can be transformed into carcinogens during the process of using the product. The engineering of e-cigarettes has rapidly evolved. In spite of this, there is still a risk of overheating if they are tampered with. E-cigarettes are the most prevalent tobacco product used by teenagers. Currently, there are about 450 companies in the United States with an estimated 7,500 different liquid flavors available for purchase. E-cigarettes liquids, which are comprised of propylene glycol and/or glycerin, are available with or without nicotine and can contain flavorings. Dr. Thornburg also described the structure of an e-cigarette and noted that they generate a mixture of vapors and aerosols. He also detailed the composition of e-cigarette emissions by chemical class which included nicotine, glycerin and glycol, alkylated cyclic compounds and phenolic compounds based on their presence in the gas, aerosol or bulk liquid form. When speaking about emissions and health implications, he noted that the particle size of their emissions, which is very small, determines where the particles deposit in the lungs. He continued by stating that the concentration determines how many particles deposit in the lungs. Size and concentration determine the toxicity of the particles inhaled by the user and included in secondhand exposure. The health effects and toxicity of nicotine are well known. In addition, the toxicity of some ingredients, such as flavors with diacetyls and cinnaldehyde, is based on industrial hygiene inhalation toxicology. However, the toxicity of other ingredients, as well as the acute and chronic impacts that result from inhalation of high concentrations of many e-liquid ingredients, are still largely unknown. About 50% of what is inhaled is exhaled. Approximately 47% of inhaled emissions are deposited into the lungs. Dr. Thornburg also mentioned that exhaled e-cigarette vapors from a single user were detected indoors as far as 6 feet away; concentrations were 25 times lower than adjacent to the user. He also stated that the tertiary effects such as exposure to nicotine or other components of e-cigarette emissions that deposit on surfaces have not been investigated. Lastly, Dr. Thornburg commented that there is still much unknown as science has not kept up with technology; however, the Food and Drug Administration (FDA) is currently funding research on e-cigarettes. The BOH members had several questions that were addressed by Dr. Thornburg. B. E-Cigarettes: Trends and Policy Options Coby Austin, Senior Public Health Educator, opened her presentation by providing an overview of the trends in adult and youth use of e-cigarettes. Some of the data Ms. Austin covered included: • About 16% of cigarettes smokers are “dual users” meaning that they may smoke cigarettes as well as e-cigarettes. • About 22% of former smokers now use e-cigarettes. • The percentage of long-term former adults who currently use e-cigarettes is 2.3%. • Younger people are using e-cigarettes more than combustible, regular cigarettes.