Use of E-Cigarettes and Vaping

Position Statement From the Oncology Nursing Society Regarding E-Cigarettes and Vaping

 

Some individuals who smoke combustible tobacco products, such as cigarettes, cigars, and pipes, have been turning to electronic cigarettes (e-cigarettes) as an alternative to combustibles and as a smoking cessation tool. E-cigarettes are also commonly referred to as electronic nicotine devices, alternate nicotine devices, hookahs, vape pens, or e-cigs. Use of e-cigarettes and inhalation of their contents is known as vaping (American Cancer Society, 2022).

The liquids used in e-cigarettes do not contain tobacco, but they do contain nicotine derived from tobacco, and thus the U.S. Food and Drug Administration (FDA) classifies them as a tobacco product. FDA regulates the manufacture, import, packaging, labeling, advertising, promotion, sale, and distribution of e-cigarettes that meet the definition of a tobacco product. E-cigarettes may also be used to aerosolize other substances for inhalation, including cannabinoid products.

Although evidence is lacking, e-cigarettes for inhalation of nicotine may be beneficial in reducing adverse health effects related to the use of combustible tobacco products. However, e-cigarettes are not FDA approved as a smoking cessation tool and the amount of nicotine and other substances a person inhales from each nicotine cartridge remains unclear.

E-cigarettes emit toxins and harmful ultrafine particles, both of which pose potential health risks similar to secondhand smoke. Many nicotine refill bottles or cartridges are not adequately packaged to prevent children from coming into contact with or accidentally ingesting toxic amounts of the vaping liquids. Studies also have shown that vaping may cause respiratory and cardiac changes (Gotts et al., 2019; Qasim et al., 2017).

Flavorings and scents have been added to e-cigarette liquids, leading to a dramatic increase in e-cigarette use among adolescents and young adults, sparking national concerns (U.S. Department of Health and Human Services, 2016). Also concerning is the increasing number of unexplained vaping-associated pulmonary illnesses and deaths, causing some states to ban vaping. In 2018, the U.S. Office of the Surgeon General declared e-cigarette use among underage smokers a national epidemic (Stone, 2019).

It is the position of ONS that:

• FDA continues to regulate e-cigarettes and vaping liquids to protect underage users from adverse health effects and potential nicotine addiction. Specifically, FDA continues to:
  • Deem e-cigarette products, as meeting the statutory definition of a tobacco product and subject to the Federal Food, Drug, and Cosmetic Act.
  • Require the display of health warnings on covered tobacco product packages, vaping liquid containers, and in advertisements.
  • Deem vaping liquids hazardous to health and prohibit sale to individuals aged younger than 21 years.
• FDA and the Centers for Disease Control and Prevention (CDC) continue to collaborate to investigate respiratory illnesses and deaths reported associated with the use of e-cigarettes (CDC, 2019).
• The U.S. Consumer Product Safety Commission continues to enforce the Child Nicotine Poisoning Prevention Act, requiring all substances with liquid nicotine to be placed in child-resistant packaging.
• The U.S. Department of Transportation continues to use its regulatory authority to explicitly ban e-cigarette and vaping use on aircraft and considers usage bans for public transportation.
• Nurses will advocate for e-cigarette regulation like other tobacco products until key questions are answered related to the adverse health effects of vaping, effectiveness of e-cigarettes for smoking cessation, and health advantages of e-cigarettes over traditional combustible tobacco products.
• Nurses will acquire knowledge and inform consumers about evidence-based tobacco cessation alternatives and the potential harm of e-cigarettes.

Approved by the ONS Board of Directors, June 2015. Reviewed January 2016, September 2019, August 2022.

Download this position statement.

Statement Type

Health Care Policy and Consumer Advocacy

References

American Cancer Society. (2022). What do we know about e-cigarettes? https://www.cancer.org/healthy/stay-away-from-tobacco/e-cigarettes-vaping/what-do-we-know-about-e-cigarettes.html

Centers for Disease Control and Prevention. (2019). Statement from CDC Director Robert R. Redfield, M.D., and acting FDA Commissioner Ned Sharpless, M.D., on federal and state collaboration to investigate respiratory illnesses reported after use of e-cigarette products. https://www.cdc.gov/media/releases/2019/s0830-statement-e-cigarette.html

Gotts, J.E., Jordt, S.E., McConnell, R., & Tarran, R. (2019). What are the respiratory effects of e-cigarettes? BMJ, 366, l5275. https://doi.org/10.1136/bmj.l5275

Qasim, H., Karim, Z.A., Rivera, J.O., Khasawneh, F.T., & Alshbool, F.Z. (2017). Impact of electronic cigarettes on the cardiovascular system. Journal of the American Heart Association, 6, e006353. https://doi.org/10.1161/JAHA.117.006353

Stone, A., (2019). Surgeon general declares youth vaping a national epidemic. https://voice.ons.org/advocacy/surgeon-general-declares-youth-vaping-an-epidemic

U.S. Department of Health and Human Services. (2016). E-cigarette use among youth and young adults: A report of the surgeon general. https://e-cigarettes.surgeongeneral.gov/documents/2016_SGR_Full_Report_non-508.pdf