E-Cigarette Sales to Minors: Hooking a New Generation?

Margaret I. Cuomo, M.D., HuffPost Healthy Living Blog
“Vaping” is the term used by many middle and high schoolers to describe the inhalation of vapors from an electronic cigarette. Celebrities have advertised e-cigarettes in advertisements and in the movies, and until now, it has been legal for a teenager to purchase them.
In April, 2014, the FDA issued a document in the Federal Register, which would regulate electronic cigarettes nationally as a tobacco product, including age restrictions similar to those for conventional cigarettes. The proposed rule will be enforceable once it is finalized. The American Medical Association, the American Lung Association, and the American Association for Cancer Research are all in support of the FDA’s announcement.
This proposed regulation will also include cigars, pipe and water pipe tobacco, nicotine gels and some dissolvable tobacco products, and anything else that meets the definition of a “tobacco product” according to the Tobacco Control Act.
At this point, the FDA will not restrict flavored e-cigarettes or advertising on television or print media. Hopefully those restrictions will follow soon, because Gummy bear, Fruit Loop and bubble gum flavors clearly target middle and high school students. Only menthol is permissible as a flavor for conventional cigarettes, as mandated by the Tobacco Control Act.
Originally, e-cigarettes were designed as an aid to quit smoking conventional cigarettes.
Nicotine is a highly addictive substance, and is present in most e-cigarettes.
E-cigarettes also contain cancer-causing nitrosamines and diethylene glycol, a toxic chemical found in anti-freeze. Are they effective in helping people quit smoking? Until large, randomized controlled trials are conducted, no one will know for sure.
We do know that e-cigarette manufacturers have been very clever in marketing to middle- and high-school students with colorful packaging, fun flavors and cool accessories.
The Centers for Disease Control and Prevention (CDC) reported in September, 2013 that the use of electronic cigarettes doubled in young people between 2011 and 2012, increasing to 10 percent for high school students, and 2.7 percent for middle schoolers. In total, 1.78 million United States students have used e-cigarettes as of 2012.
Should we allow manufacturers to entice our youth with a nicotine-delivery device that can lead to addiction to conventional cigarettes?
Some researches warn that e-cigarettes are a gateway device for nicotine addiction among youth. In a study of nearly 40,000 youth around the USA, the authors, Lauren M. Dutra, ScD and Stanton A. Glantz, PhD, of the Center for Tobacco Control Research and Education at UCSF concluded that, “Use of e-cigarettes does not discourage, and may encourage, conventional cigarette use among U.S. adolescents.”
We have come too far, and battled far too long with the tobacco industry, to make the mistake of trusting the e-cigarette manufacturers to do what is right for America’s children. How long was it before the tobacco industry would admit that smoking causes cancer?
Dr. Janie Heath, Associate dean and professor of nursing at the University of Virginia School of Nursing, and an expert on the effects of tobacco on smokers, offers this insight into the problem: “When we look at 95 percent of individuals that smoke cigarettes, they all started that initiation before age 21. So, there’s the likelihood of these younger ones starting on electronic cigarettes, and wanting to have more and more of a hit.”
Dr. Heath also warns that “It’s harder to help an individual quit smoking than it is to get them off crack cocaine, heroin or any of the other drugs.”
Hopefully celebrities will resist the allure of advertising e-cigarettes in magazines, and also in movies, knowing that their endorsement have a powerful effect on teenagers.
Where are the famous athletes. actors and athletes who are willing to say: “There’s nothing cool about smoking or vaping, because there is nothing cool about cancer”?
While we wait for the scientific data to prove the harms of vaping, let’s protect our middle and high schoolers from a lifelong addiction and a high risk of cancer.
http://www.huffingtonpost.com/margaret-i-cuomo-md/healthy-living-news_b_5213382.html?ncid=fcbklnkushpmg00000063

E-Cigarette Poisoning on the Rise, CDC Says

By Neha Sharma, DO, ABC News
They’re supposedly a safer alternative to conventional cigarettes. But electronic cigarettes may actually pose a serious danger to others in your home — particularly children.
The U.S. Centers for Disease Control and Prevention warned in report released today that the number of phone calls to U.S. poison control centers related to e-cigarette use has increased from just one call per month on average in 2010 to nearly 200 calls per month in early 2014.
“The rise in the numbers of e-cigs related calls to poison centers leads us to view this as a major public health concern,” said report author Dr. Kevin Chatham-Stephen, a pediatrician and an epidemiologist with the CDC.
He said that though e-cigs comprise less than 2 percent of all tobacco-related sales, they now account for more than 40 percent of poison center calls. More than half of the calls involved children younger than 5 years old.
“This is a very dramatic finding,” Chatham-Stephen said.
According to the report, most of these emergencies are linked to the liquid nicotine within the e-cigs. If the liquid is released from the cylinder that holds it, the result can be acute nicotine toxicity from direct skin or eye exposure, ingestion, or inhalation.
“Cigarettes are the most dangerous consumer product on the planet, and smokers need to treat e-cigs with considerable caution especially since the product is unregulated.” said Dr. Tim MacAfee, director of the Office on Smoking and Health at CDC and contributor to the report.
Those within the e-cigarette industry said concerns are overblown. Jason Healy, the president of e-cigarette manufacturer Blu-cigs, called the findings in the report “a weak argument” against the devices and is evidence of “an ongoing attack on the e-cigs industry by various anti-smoking groups.”
“The product is for adult smokers, and therefore the responsibility for children’s safety falls on the parents, just like bleaches and prescription medications,” Healy said. “The focus should be on parenting and education, and not regulation.”
Healy did say, however, that the findings should prompt the e-cig industry to formulate effective child safety measures.
Still, toxicology experts not involved in the study said the report reveals a concerning threat to kids.
“Nicotine is probably the most toxic plant chemical ever discovered,” said Dr. Richard Clark, medical director for the California Poison Control System and a professor of toxicology. Clark said poison centers like his are seeing a steady increase in calls related to e-cigs. Of particular concern, he said, is that unlike the conventional cigarette, which is usually very bitter, these devices are flavored and thus more attractive to children. The solution is also easily absorbed through the skin if spilled, unlike the contents of regular cigarettes.
Doctor’s Take
Despite decades of admonitions against smoking, an estimated 42 million people in the United States still smoke cigarettes. Cigarette smoking is the leading cause of preventable death in the United States, accounting for one of every five deaths each year. So for many, the electronic option may hold a certain appeal.
But though e-cigarette use is increasing among U.S. adolescents and adults, its overall impact on public health remains unclear. The dramatic rise in E-cigarette related calls to the country’s poison control centers is alarming. And the fact that the product is not childproof should alert parents to keep the product out of reach and in an enclosed container.
http://abcnews.go.com/blogs/health/2014/04/03/e-cigarette-poisoning-is-on-the-rise-cdc-says/

E-Cigarettes: Friend or Foe for the LGBT Communities?

By: Scout, PhD, Director of CenterLink’s Network for LGBT Health Equity – HuffingtonPost Blog
Working in tobacco control sometimes elicits interesting reactions from people. Some try to hide their smoking. While I certainly appreciate not being near the smoke itself, I’ve got great empathy for smokers. In fact, since most smokers have already tried to quit, they’re much more likely to be fellow fighters against tobacco than non-smokers. Sometimes they ask me how to best quit and I’m happy to tell them (hint, call 1-800-QUITNOW). These days everyone’s asking me something new: What about e-cigarettes? The shortest answer is “they could be helpful for a few, but we all worry about our youth.”
First, if you’re not familiar with e-cigs, they are battery-powered imitators of old-school cigarettes, designed to deliver nicotine, flavor and other chemicals through vapor inhaled by the user. Most of them have a swag little electronic light at the tip to make it seem more like an old-school cig. Some now have other names like e-hookah to avoid any cigarette associations. The claim is here’s a no-combustion device to get your nicotine fix, great for cessation and great to smoke in places where cigarettes are banned.
There is one study supporting the effects of e-cigs in helping people quit smoking but now another study is out contravening it. Considering how toxic cigarette smoke is, we all applaud anything that helps reduce the amount of cigarette smoke in the air. But if you’re trying to use e-cigs as a cessation device it’s a bit dicey right now because they’re unregulated, so the amount of nicotine you get in each dose varies, and sometimes does not match the advertising. It’s commonly known that it only takes about two weeks to kick the nicotine addiction of smoking, but anyone who’s quit will tell you, it’s the social habit of smoking that draws you back again and again. I’m not sure how putting a cigarette replacement in your mouth helps you kick that social habit — sounds to me like it’s just perpetuating it. Plus there is a new study showing other toxic chemicals in the vapor. To top it off, there’s no real science on the long-term effects of inhaling nicotine vapor. So while I’m willing to bet it’s better than inhaling tobacco smoke, that’s like saying I bet it’s better than inhaling truck exhaust. Nicotine is so toxic, poison control centers just issued an alert about high numbers of calls on accidental exposure. Just touching the liquid is enough to cause vomiting andingesting as little as a teaspoon of some of the liquid nicotine concentrations can be fatal. I hope people set a higher bar for their own cessation journey.
The real problem is, as anyone who’s visited a vaporium can see, it’s not a cessation game. Vaporiums and e-cigs are all about enticing, and particularly enticing young people. Wander into your local vaporium belly up to the “bar” and you’ll be shocked to see how many vaporiums look like the lovechild of a hip coffee shop and a candy store. I’m not sure exactly which adult Marlboro user would switch to cotton candy flavored nicotine cartridges, or banana nut bread, or cherry limeade. Sounds to me more like flavors I’d find at a little league game. To make it worse, these products are easily available online and many states aren’t yet doing anything to restrict access to minors. Data show LGBT youth continue to smoke at rates much higher than their non-LGBT counterparts and the number of youth experimenting with e-cigs is rising rapidly… the very last thing we need is to have some fancy new gadgetry on the market enticing LGBT youth to start using a highly addictive drug to deal with the stress of stigma against us all.
We pass on smoking down through the LGBT generations socially. I’ve always called it an STD for us, a socially transmitted disease. So I also worry about adult e-cig use. Every time you “light up” you’re perpetuating the huge LGBT cigarette culture, all of us laughing and having fun and hanging out, with cigarettes in our mouths.
We already have cessation aids that deliver you nicotine in controlled regulated doses, you can find those on every drugstore shelf. Nicely, there’s not one gummy bear or watermelon flavored nicotine patch, spray or gum. So while e-cigs might help a few in quitting, I say the big picture on e-cigs for the LGBT communities is we need to think of our youth and “beware of the wolf in sheep’s clothing.”
http://www.huffingtonpost.com/scout-phd/e-cigarettes-friend-or-foe_b_5024583.html
 

TobacNo! Surgeons General and Teens Unite for a Tobacco-Free Generation

By: Chelsea-Lyn Rudder , HuffPost IMPACT Blog
Last week, the Food and Drug Administration released its first youth-oriented anti-tobacco campaign. Unlike previous campaigns, “The Real Cost” does not feature images of smoking-related illnesses, such as cancer and emphysema. In an effort to put a new twist on prevention, “The Real Cost” will attempt to appeal to the millennial generation’s sense of vanity and dignity. Forget the old-school ads, which showed ailing elderly adults and morbid images like body bags in a morgue. “The Real Cost” reminds teens that cigarettes and other tobacco products will rob them of their good looks and bully them into becoming addicted to nicotine. One of the ads features a personified cigarette who pesters a teenage boy, who is trying to spend time with friends, until he gives into his addiction to nicotine and goes outside to smoke.
Everyone hates a bully these days, and I applaud the FDA’s attempt at innovation, but young people know that the real life costs of smoking go beyond trivial and cosmetic implications. The question still remains: How can we move beyond gimmicks and get young people to stop using tobacco products once and for all?
Ritney Castine, 27, has firsthand experience with the real costs of tobacco use. And as a result, has spent most of his life trying to answer that question: “My uncle, who I cared about very deeply died of lung cancer. I wanted to know, what it was that took my uncle away from me. Turns out, it was his lifelong addiction, of smoking a pack of Marlboro cigarettes a day.” Ritney’s uncle passed away when he was only 10 years old, but his death inspired Ritney’s palpable spirit of activism. As a student, Ritney campaigned against the tobacco industry throughout his home state of Louisiana. He was instrumental in the lobbying process, which resulted in a statewide ban against smoking in public places with the exception of bars and casinos. Ritney is now the Associate Director of Youth Advocacy for the Campaign for Tobacco-Free Kids, a not-for-profit based in Washington, D.C.
This week, Ritney will head back to Louisiana to participate in a summit on February 11 in New Orleans, which marks the 50th anniversary of the surgeon general’s landmark tobacco report. “TobacNo! Tobacco-Free Generation” will bring together former surgeons general, current Acting Surgeon General Dr. Boris Lushniak and tobacco-free youth advocates to review the legacy of the 1964 report and to develop strategies to end tobacco use amongst future generations. The summit is hosted by Xavier University of Louisiana and the Louisiana Cancer Research Center. The event is open to the public and will be live-streamed at TobaccoSummit.com.
Last week tobacco-free advocates scored a big win with the announcement of CVS’s plan to remove all tobacco products from its stores. Calling the sale of tobacco products “inconsistent with our key purpose — helping people on their path to better health,” CVS says that tobacco products will no longer be available at their pharmacies after October 1 of this year. Former Surgeon General Dr. Regina Benjamin, lead organizer of “TobacNo,” issued a statement commending CVS’s actions and urging other companies to take the same steps. “We in public health hope others will follow the CVS example because it will make a difference and help our next generation become tobacco-free.”
http://www.huffingtonpost.com/chelsealyn-rudder/tobacno-project_b_4757628.html?utm_hp_ref=impact&ir=Impact

TFND thanks Senator Stan Lyson for his service

by: Erin Hill-Oban, Executive Director, Tobacco Free North Dakota
On behalf of Tobacco Free North Dakota (TFND), our Board, and our members, I would like to publicly thank Sen. Stan Lyson for his years of service to both the residents of District 1 and of our state, especially for his work and support for investments in a comprehensive tobacco prevention program and for statewide policies that protect our kids from the harmful effects of tobacco use.
According to a statewide poll conducted earlier this year, 89% of North Dakotans support dedicating a portion of the dollars secured by the state of North Dakota through the Tobacco Master Settlement Agreement to a program that keeps our kids from ever initiating tobacco use and offers assistance to those who wish to kick the habit.  Investing in prevention isn’t only good public health policy; it also saves the taxpayers money.  Sen. Lyson recognized the significance of that public support as well as the importance of the program.
While we didn’t always agree, we knew we could count on Sen. Lyson to listen to both sides of the issues most important to our cause.  We will miss his moderate approach to policymaking, his support for tobacco prevention and control policies, and we challenge District 1 to elect legislators to both the Senate and House who will meet the public’s support for these cost-saving investments.
Sen. Lyson spent much of his life protecting the public as a county sheriff and as a legislator, and TFND extends our most sincere appreciation and well wishes to him in his retirement.
-Submitted to the Williston Herald.

E-cigarettes: Should They Be Regulated as Cigarettes?

., Commissioner, Chicago Department of Public Health

Should e-cigarettes be regulated as cigarettes?
I think so.
E-cigarettes are designed to look like cigarettes. They are labeled and marketed like cigarettes. They contain nicotine like cigarettes. They should be regulated like cigarettes.
The single most important reason a regulation on e-cigarettes is vital at this time is to protect kids from a product that we know is addictive. Electronic cigarettes now come in dozens of flavors like passion fruit, cotton candy, bubble gum, gummy bear, Atomic Fireball, and orange cream soda. These kid-friendly flavors are an enticing “starter” for youth and non-smokers, increasing nicotine addiction and frequently lead to use of combustible cigarettes.
Like other gateway products Big Tobacco has masked to entice its next generation of smokers, e-cigarettes follow suit as its popularity with youth nationwide more than doubledfrom 2011 to 2012. Ten percent of our students have already used these addictive products — and they have only been on the market for a few years. This meteoric rise in popularity among youth is concerning. It is also the main reason Mayor Rahm Emanuel has introduced a new ordinance to regulate e-cigarettes as tobacco products.
Simply put, kids should not have easy access to e-cigarettes any longer. Right now in Chicago, a 14-year-old can walk into a store and purchase an e-cigarette with no question asked. This is unacceptable. Retailers should be required to have a tobacco-retail license in order to sell e-cigarettes, which would place these products behind the counter with the other tobacco products and out of arms reach of our children. The government has a duty to protect children from ever picking up a nicotine habit. The preventive action Mayor Emanuel is taking right now is a long-term investment in the health and well-being of Chicago’s youth.
Some might argue that e-cigarettes should not be regulated because they are safer than regular cigarettes. While it’s true that they may be safer than regular cigarettes, they have not been proven to be safe. The truth is e-cigarette companies have not provided any scientific studies or toxicity analysis to the FDA to show that e-cigarettes pose any reduced health risk over conventional cigarettes, nor have they demonstrated that e-cigarettes are safe. Laboratory tests have found that the so-called “water vapor” from some e-cigarettes can contain nicotine and volatile organic compounds like benzene and toluene; heavy metals like nickel and arsenic; carbon compounds like formaldehyde and acrolein, in addition to tobacco specific nitrosamines.
Moreover, no federal regulations have been imposed on e-cigarettes, which means that there currently are no restrictions on ingredients manufacturers can or cannot use and no restrictions on the kinds of chemicals they can emit into the indoor environment. Until more is known about these products, limiting their use in indoor areas is just good common sense.
I am also concerned that widespread use of e-cigarettes is re-normalizing smoking in our society, which in turn, makes this a very pertinent public health issue. E-cigarettes intentionally were developed to mimic the act of smoking. This distorted reinforcement of smoking as cool and acceptable sends the wrong message to our youth and undermines the existing smoking bans put in place to protect the health of the public.
In Chicago, smoking rates are lower than ever. This progress is a direct result of life-saving policies like the Chicago Clean Indoor Air Act. Health advocates worked tirelessly to ensure we all have the right to breathe clean in-door air. We’re not turning our backs on their hard work to promote clean air.
Our residents expect a healthy environment when they walk into a restaurant, bar or theater. We can’t allow any regression in our progress to change the landscape of public health by reverting back to a culture we’ve worked so hard to change. We need to, and can do, better for the children in our city.
Chicago’s new ordinances are part of an overall comprehensive strategy to reduce the negative consequences tobacco use has on our youth.
With the introduction of these expanded tobacco-control policies, Mayor Emanuel is inspiring cities across the nation to take action to ensure that residents avoid preventable disease and live healthy and productive lives.
http://www.huffingtonpost.com/bechara-choucair-md/e-cigarettes_b_4352410.html

5 Year Anniversary of ND's Comprehensive Program

Today marks the 5-year anniversary of the passage of Initiated Measure #3, which, when passed with 54% of the vote on the General Election ballot on November 4, 2008, created a statewide comprehensive tobacco prevention and control program.
As one of only two states in the country to fully fund a comprehensive tobacco prevention program at CDC recommended levels, North Dakota – whose program is funded strictly through the Master Settlement Agreement – should be proud of the importance we have placed on doing all we can to reduce the deaths and diseases of our fellow North Dakotans caused by tobacco use.
Thanks to support from the general public, great strides have been made in the area of tobacco prevention and control.  Most recently, in November 2012, their voices were heard when another initiated measure earned 67% of the vote at the polls, receiving a majority vote in every county and legislative district in the state, passing the nation’s strongest statewide smokefree law.
Since 2008, it has become increasingly clear that North Dakotans believe an effective and worthy use for a portion of the monies settled with the tobacco industry in the Master Settlement Agreement in 1998 should be dedicated to tobacco prevention efforts through a comprehensive program.  In a poll commissioned by TFND and conducted by Keating Research, Inc, in February 2013, public support for maintaining and continuing to fund the comprehensive tobacco prevention and control program had grown to 89%.
TFND congratulates North Dakota voters for making this commitment five years ago, commends them for strengthening their support to that commitment, and challenges the state’s elected officials to reinforce this commitment in the future.