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    E-cigarettes and the ob/gyn: Key safety information for prenatal counseling


    What are the regulations and legislation regarding these alternative products?

    The FDA currently regulates cigarettes and smokeless tobacco. The FDA does not currently regulate novel products such as e-cigarettes (including the additives and flavorings) but has requested such authority from Congress.

    There are commonly no age limitations regarding who can purchase these products, although many individual states are enacting such legislation. Flavoring options and marketing are commonly directed toward teens and young adults. In the past year, the rate of e-cigarette use by teens has doubled, raising concerns that alternative products may act as gateways to nicotine addiction.6

    Concerns also exist about attempts to circumvent clean air laws with use of methods that do not release smoke as the result of combustion (except the hookah). In addition, unlike cigarettes, which are subject to federal tax, alternative nicotine delivery systems are not taxed, making them potentially less expensive than regular cigarettes and enhancing the potential for addiction.

    It is obvious that clean air regulations, age requirements, and the heavy tax burden imposed on cigarettes has decreased the number of smokers and, for those continuing to smoke, the number of cigarettes used.7

    Without these barriers in place around alternative nicotine delivery systems, it is possible that nicotine users (ie, smokers) will be able to maintain or even increase their daily nicotine intake and that rates of nicotine addiction will begin to increase again.

    Promoters of the alternative nicotine delivery systems say they help individuals to cut down or cease nicotine use. However, it is common that e-cigarette users continue to smoke. More studies are necessary to determine if industry claims are valid regarding smoking cessation.8


    Sharon T. Phelan, MD
    Dr. Phelan is a Professor in the Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque.
    Jeanne Mahoney, RN, BSN
    Ms. Mahoney is Director, the Providers Partnership Project, American College of Obstetricians and Gynecologists, Washington, DC.


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