Kevin Chatham Stephens, MD1, Royal Law, MPH2, Ethel Taylor, DVM2, Paul Melstrom, PhD3, Rebecca Bunnell, ScD3, Baoguang Wang, MD4, Benjamin Apelberg, PhD4, Joshua G. Schier, MD2 (Author affiliations at end of text)

Electronic nicotine delivery devices such as electronic cigarettes (e cigarettes) are battery powered devices that deliver nicotine, flavorings (e.g., fruit, mint, and chocolate), and other chemicals via an inhaled aerosol. E cigarettes that are marketed without a therapeutic claim by the product manufacturer are currently not regulated by the Food and Drug Administration (FDA) (1). In many states, there are no restrictions on the sale of e cigarettes to minors. Although e cigarette use is increasing among U.S. adolescents and adults (2,3), its overall impact on public health remains unclear. One area of concern is the potential of e cigarettes to cause acute nicotine toxicity (4). To assess the frequency of exposures to e cigarettes and characterize the reported adverse health effects associated with e cigarettes, CDC analyzed data on calls to U.S. poison centers (PCs) about human exposures to e cigarettes (exposure calls) for the period September 2010 (when new, unique codes were added specifically for capturing e cigarette calls) through February 2014. To provide a comparison to a conventional product with known toxicity, the number and characteristics of e cigarette exposure calls were compared with those of conventional tobacco cigarette exposure calls.

An e cigarette exposure call was defined as a call regarding an exposure to the e cigarette device itself or to the nicotine liquid, which typically is contained in a cartridge that the user inserts into the e cigarette. A cigarette exposure call was defined as a call regarding an exposure to tobacco cigarettes, but not cigarette butts. Calls involving multiple substance exposures (e.g., cigarettes and ethanol) were excluded. E cigarette exposure calls were compared with cigarette exposure calls by proportion of calls from health care facilities (versus residential and other non health care facilities), demographic characteristics, exposure routes, and report of adverse health effect. Statistical significance of differences (p<0.05) was assessed using chi square tests.

During the study period, PCs reported 2,405 e cigarette and 16,248 cigarette exposure calls from across the United States, the District of Columbia, and U.S. territories. E cigarette exposure calls per month increased from one in September 2010 to 215 in February 2014 (Figure). Cigarette exposure calls ranged from 301 to 512 calls per month and were more frequent in summer months, a pattern also observed with total call volume to PCs involving all exposures (5).

E cigarettes accounted for an increasing proportion of combined monthly e cigarette and cigarette exposure calls, increasing from 0.3&#37 in September 2010 to 41.7&#37 in February 2014. A greater proportion of e cigarette exposure calls came from health care facilities than cigarette exposure calls (12.8&#37 versus 5.9&#37 ) (p20 years (42.0&#37 ). E cigarette exposures were more likely to be reported as inhalations (16.8&#37 versus 2.0&#37 ), eye exposures (8.5&#37 versus 0.1&#37 ), and skin exposures (5.9&#37 versus 0.1&#37 ), and less likely to be reported as ingestions (68.9&#37 versus 97.8&#37 ) compared with cigarette exposures (p<0.001).

Among the 9,839 exposure calls with information about the severity of adverse health effects, e cigarette exposure calls were more likely to report an adverse health effect after exposure than cigarette exposure calls (57.8&#37 versus 36.0&#37 ) (p<0.001). The most common adverse health effects in e cigarette exposure calls were vomiting, nausea, and eye irritation. One suicide death from intravenous injection of nicotine liquid was reported to PCs.

Calls about exposures to e cigarettes, which were first marketed in the United States in 2007, now account for 41.7&#37 of combined monthly e cigarette and cigarette exposure calls to PCs. The proportion of calls from health care facilities, age distribution, exposure routes, and report of adverse health effects differed significantly between the two types of cigarette.

This analysis might have underestimated the total number of e cigarette and cigarette exposures for several reasons. Calls involving e cigarettes or cigarettes and another exposure were excluded, and the code indicating a case of e cigarette exposure might have been underused initially. In addition, health care providers, including emergency department providers, and the public might not have reported all e cigarette or cigarette exposures to PCs. Given the rapid increase in e cigarette related exposures, of which 51.1&#37 were among young children, developing strategies to monitor and prevent future poisonings is critical. Health care providers the public health community e cigarette manufacturers, distributors, sellers, and marketers and the public should be aware that e cigarettes have the potential to cause acute adverse health effects and represent an emerging public health concern.

1EIS officer, CDC 2Division of Environmental Hazards and Health Effects, National Center for Environmental Health, CDC 3Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC 4Center for Tobacco Products, Food and Drug Administration (Corresponding author Kevin Chatham Stephens, xdc4 , 770 488 3400)


  1. Food and Drug Administration. News and events electronic cigarettes (e cigarettes). Silver Spring, Maryland US Department of Health and Human Services, Food and Drug Administration 2014. Available at
  2. CDC. Notes from the field electronic cigarette use among middle and high school students United States, 2011 2012. MMWR 2013 62 729 30.
  3. King BA, Alam S, Promoff G, Arrazola R, Dube SR. Awareness and ever use of electronic cigarettes among U.S. adults, 2010 2011. Nicotine Tob Res 2013 15 1623 7.
  4. Cobb NK, Byron MJ, Abrams DB, Shields PG. Novel nicotine delivery systems and public health the rise of the “e cigarette.” Am J Public Health 2010 100 2340 2.
  5. Mowry JB, Spyker DA, Cantilena LR Jr, Bailey JE, Ford M. 2012 annual report of the American Association of Poison Control Centers’ National Poison Data System (NPDS) 30th annual report. Clin Toxicol (Phila) 2013 51 949 1229.

New york raising age to buy cigarettes to 21 –

Where can i buy duty free cigarettes online?

The legal age for buying tobacco, including cigarettes, electronic cigarettes, cigars and cigarillos will rise to 21, from 18, under a bill adopted by the City Council and which Mayor Michael R. Bloomberg has said he would sign. The new minimum age will take effect six months after signing.

The proposal provoked some protest among people who pointed out that New Yorkers under 21 can drive, vote and fight in wars, and should be considered mature enough to decide whether to buy cigarettes. But the Bloomberg administration s argument that raising the age to buy cigarettes would discourage people from becoming addicted in the first place won the day.

This is literally legislation that will save lives, Christine C. Quinn, the Council speaker, said shortly before the bill passed 35 to 10.

In pushing the bill, city officials said that the earlier people began smoking, the more likely they were to become addicted. And they pointed out that while the youth smoking rate in the city has declined by more than half since the beginning of the mayor s administration, to 8.5 percent in 2007 from 17.6 percent in 2001, it has recently stalled.

Besides raising the age to buy cigarettes, the Council also approved various other antismoking measures, such as increased penalties for retailers who evade tobacco taxes, a prohibition on discounts for tobacco products, and a minimum price of $10.50 a pack for cigarettes and little cigars.

The new law is a capstone to more than a decade of efforts by Mr. Bloomberg, like banning smoking in most public places, that have given the city some of the toughest antismoking policies in the world.

In one concession to the cigarette industry, the administration dropped a proposal that would force retailers to keep cigarettes out of sight. City officials said they were doing it because they had not resolved how to deal with the new phenomenon of electronic cigarettes, but others worried that if the tobacco industry lodged a First Amendment challenge to the so called display ban, it could have derailed the entire package.

The smoking age is 18 in most of the country, but some states have made it 19. Some counties have also adopted 19, including Nassau and Suffolk on Long Island. Needham, Mass., a suburb of Boston, raised the smoking age to 21 in 2005.

James Calvin, president of the New York Association of Convenience Stores, warned on Wednesday that thousands of retail jobs could be lost because the law would reduce traffic not just for tobacco, but also on incidental purchases like coffee or lottery tickets. He predicted that the law would do little to curb smoking, as it does not outlaw the possession of cigarettes by under age smokers, only their purchase.

Just before the vote, Nicole Spencer, 16, was in Union Square in Manhattan with a cigarette wedged between her fingers.

I don t think that s going to work, Nicole said when she heard about the plan to raise the age.

She said she began smoking when she was about 13, and had no trouble getting cigarettes. I buy them off people or I bum them off people, she said.

She said that probably half of her friends at her high school smoked.

Nicole said she thought 18 was a reasonable legal age, echoing Councilman Jumaane D. Williams, who said he voted no because it was not right for the city to ask young people to make life or death decisions as police officers and firefighters yet to have no ability to buy a pack of cigarettes.