July 23, 2014

Stanton A. Glantz, PhD

“Super High” Nicotine Youth Appealing Electronic Cigarette Flavors

Maya Ben-Efraim and Robert Jackler from Stanford just submitted this comment to the FDA on the deeming rule:
“Super High” Nicotine Youth Appealing Electronic Cigarette Flavors
Electronic cigarette liquid (ejuice) is available in a variety of nicotine strengths ranging as high as 36 mg/ml and even 54 mg/ml.  Nicotine levels of 16mg/ml are usually advertised by the electronic cigarette industry as “full flavored” while nicotine levels of 36 mg/ml are described as “super high” or “unfiltered”.
Super high nicotine concentrations are available in youth appealing flavors such as Peppermint Party, Banana Split, Marshmallow, Tutti Fruti Gumballs, My Birthday Cake, Carnival Cotton Candy, Totally Toffee, Strawberrylicious, Chocolate, and Energy Drink.   These e-liquids are marketed online with bright and colorful images (see accompanying Powerpoint) and dispensed in similarly colorful bottles.  It is quite evident that these are designed to appeal to teens.  The numerous sweet flavored variety are also attractive to younger children.
As measured by Calafat and co-workers, Marlboro has 0.92 mg nicotine per cigarette. A 10 cc bottle of 36mg/ml chocolate e-liquid has the nicotine equivalent of 391 cigarettes. 
This volume of concentrated nicotine is sufficient to kill a sizable number of kindergartners.
The Centers for Disease Control and Prevention warns on its website that the fatal human dose has been estimated to be about 50 to 60 mg for a 150 pound adult.  The lethal dose in a child is a small fraction of this.
The development of Advanced Personal Vaporizers, or Mods, has also dramatically increased the volume of vapor inhaled per puff, which further increases potential nicotine absorption.  The large clouds of exhaled vapor raises the risk of second hand nicotine exposure.
Examples of Youth Appealing Flavors with “Super High” Nicotine concentration
(see attached table for hundreds more)
Vapor Zone: Tutti Fruti Gumballs, My Birthday Cake, Carnival Cotton Candy.
White Cloud- Cola Blast. Veppo- Chocolate, Vanilla. Pink Spot Vapors- Banana Nut Bread, Blueberry Cobblers, Butterscotch, Caramel, Gummi Bear.
Vixen Vapors: Chocolate-Covered Strawberries, Fruit Striped Gum, Peachy O’s, Swedish Fish, S’mores, Pineapple Upsidedown Cake, Pink Lemonade Cupcake.
Vapor 4 Life: Peach Breeze, Vanilla Mocha Frappe, White Chocolate, Peppermint Ice Cream, Cinnamon Roll, Pancake.
Vapor Shark: Watermelon, Strawberry Kiwi, Peanut Butter Cup.
Bloog: Vanilla. Better Vapes- Apple Fritter, Banana Taffy, Candy Cane, Cream Soda, Crunch Berry, Graham Cracker, Malted Milk Balls, Maraschino Cherry, Pizza, Root Beer Float, Watermelon Bubble Gum.
 Miller, A. (2014). Nicotine poisoning increase due to e-cigs. CMAJ: Canadian Medical Association journal.
"Nicotine." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, May 1994. Web. 26 June 2014.
Calafat AM, Polzin GM, Saylor J. et. Al  Determination of tar, nicotine, and carbon monoxide yieds in the mainstream smoke of selected international cigarettes. Tob Control 2004; 13: 45-51
Maya Ben-Efraim
Robert Jackler
Stanford Research Into The Impact of Tobacco Advertising

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