Chuck Schumer goes after marketing of e-cigarettes to kids

BY / NEW YORK DAILY NEWS

Fearful big tobacco could hook a new crop of smokers, Sen. Chuck Schumer says he’s backing legislation to stub out the marketing of e-cigarettes to children.
Schumer said tobacco companies are upping the appeal of vaping devices by making kid-friendly flavors like cotton candy and gummy bears.
“They are making a campaign to go after kids and that must stop,” Schumer said Sunday.
He vowed to push the so-called Protecting Children From Electronic Cigarette Advertising Act through the Senate. The legislation would close loopholes in advertising laws that tobacco companies have exploited to hook kids.
Schumer cited a study published last week in JAMA Pediatrics, which found that adolescents who smoke e-cigarettes are seven times more likely to smoke traditional cigarettes.
http://www.nydailynews.com/news/politics/chuck-schumer-e-cigarette-marketing-kids-article-1.1716091#ixzz2vgNEUEZf

On e-cigarettes, many questions but few answers

By Consumer Reports
Maybe a friend or family member uses one. Or maybe you’re using one yourself to try to kick a tobacco habit.
Whatever your experience with electronic cigarettes, it seems that the battery-powered devices, which deliver a form of nicotine and mimic the feel of traditional cigarettes, are here to stay, according to Consumer Reports. Sales grew from about $500 million in 2012 to an estimated $1.5 billion in 2013. That’s a fraction of the cigarette market — roughly $100 billion per year — but reflects a 200 percent growth, in contrast to the steady decline in tobacco sales.
E-cigarettes are marketed as a more socially permissible alternative to smoking. But what exactly are users — and the people around them — breathing in? Are the cigarettes safe? And with flavors such as Cherry Crush, Peach Schnapps, and Vivid Vanilla, to whom are they really marketed? Consumer Reports supplies answers to some key questions about electronic cigarettes.
What’s in them? The main component is a refillable or replaceable cartridge of liquid “juice” that contains nicotine, solvents, and flavors. When users draw on the device, it causes the battery to heat the liquid solution, which is then atomized into a vapor that can be inhaled. The claimed levels of nicotine vary. Blu e-cigs, for example, offer cartridges of different strengths, from no nicotine to approximately 13 to 16 milligrams, with each cartridge containing enough for 250 or more “puffs.”
How are they regulated? At the moment, they aren’t. The Food and Drug Administration is expected to release a proposed rule that would allow the agency to regulate them as they do other tobacco products. That could result in restrictions on advertising or sale to minors. It also would probably require companies to disclose ingredients and conform to certain manufacturing standards.
In the meantime, some states and municipalities — most recently New York City — have enacted bans on e-cigarettes in public parks and indoor venues where cigarette smoking isn’t allowed. You can find a list of local bans at no-smoke.org/pdf/ecigslaws.pdf.
Are they safe to use? We don’t know yet. They expose users and people around them to fewer toxins than tobacco cigarettes, but that doesn’t mean they’re risk free. Nicotine is very addictive, so e-cigs — especially the fruit and candy-flavored ones — could hook young people on the stimulant, or serve as a gateway to real cigarettes, health officials warn.
And because they’re unregulated, you don’t necessarily know what’s in them. In 2009 the FDA detected diethylene glycol, a toxic chemical used in antifreeze, in some e-cig samples and carcinogens called nitrosamines in others. Questions also linger over secondhand “vapor.”
Do they help smokers quit? They might, though Consumer Reports points out that they’re not approved for that by the FDA. And, as with approved quitting methods, the results aren’t that impressive. In a study of 657 smokers published last fall, e-cigs were about as effective as nicotine patches and were slightly better than placebo e-cigarettes, which contain no nicotine.
But the differences were minor, and the overall number of people who quit with any method was low. After six months, about 7 percent of those in the e-cigarettes group and 6 percent of those who used nicotine patches stopped smoking compared to 4 percent of those who used placebo e-cigs.
Bottom line. The main reason it’s so hard to say whether e-cigarettes are safe is that they simply haven’t been around long enough to know. If you’re trying to give up real cigarettes, stick with better studied methods: nicotine gum, patches, and counseling. And if you don’t smoke, don’t start with e-cigs just for fun.
Consumer Reports writes columns, reviews, and ratings on cars, appliances, electronics, and other consumer goods. Previous stories can be found at consumerreports.org.
http://www.bostonglobe.com/business/2014/03/09/cigarettes-still-many-questions/bxMmW3157LVoOQh91hLOBJ/story.html

Letter: Big tobacco goes after ‘replacement smokers’

By: Beth Hughes, Bismarck, INFORUM
Even though the risks of using tobacco are well documented, it remains the No. 1 cause of preventable death and disease in the country. This year alone, nearly 500,000 Americans will die prematurely because of smoking. Unfortunately, tobacco marketing efforts recruit two new young smokers to replace each tobacco user who dies.
It’s well documented that tobacco companies market to youth in an effort to recruit “replacement smokers.” Research from the Centers for Disease Control and Prevention tells us that smoking and smokeless tobacco use are initiated and established primarily during adolescence. In fact, nearly 9 out of 10 smokers start smoking by the age of 18. Tobacco companies know this and continually look for new ways to hook our youth.
Tobacco companies pay convenience stores – many located near schools – and other tobacco retailers to prominently display advertisements for their products near the entrances, exits and checkouts. Tobacco companies also target a new generation of potential tobacco users by designing items to appeal to youth, such as fruit-flavored products in colorful packaging that make tobacco look and smell like candy.
In addition to new flavors and packaging, price is another factor that affects tobacco use. In states with low tobacco taxes, like North Dakota, it’s easier to make tobacco products affordable, and that makes it easier for youth to obtain tobacco. Research supported by the CDC and the American Lung Association shows that increasing a tobacco tax is one of the most effective ways to reduce youth tobacco use; by making tobacco less affordable, kids are less likely to buy it.
The Center for Tobacco Prevention and Control Policy uses media campaigns to educate the public about the dangers of tobacco use. The Center also works with local public health units across the state to educate our communities on tobacco prevention so our children live healthier lives as fewer of them become addicted to nicotine.
We are committed to preventing tobacco use among our youth and adult populations. We’ve made great progress, but there is more work to be done. Showing support for tobacco prevention efforts in your community is a great start to help reduce youth tobacco use rates. Here is what you can do:
• Support tobacco-free and smoke-free policies within your community. When youth are not exposed to tobacco, it increases their chance to remain tobacco free.
• Support policies that restrict how tobacco is marketed. Tobacco companies are aggressive marketers that target youth through retail displays, internet marketing and magazines that are popular with teens.
• Support tobacco tax increases. Our youth are less likely to use tobacco if it is less affordable.
These strategies are CDC Best Practice strategies – strategies that are proven to reduce youth tobacco use rates. We ask the community to join us in this fight by showing your support for tobacco prevention.

Hughes, Ph.D., is a registered respiratory therapist, and chairwomen, North Dakota Tobacco Prevention and Control Committee.
http://www.inforum.com/event/article/id/428702/group/Opinion/

Players find tobacco habit hard to shake

By Peter Abraham |  BOSTON GLOBE

FORT MYERS, Fla. — The sequence when Red Sox slugger David Ortiz walks to home plate has been the same for years now.
Big Papi tucks his bat under his right arm, spits into the palm of his batting glove, and slaps his hands together before staring out at the pitcher.
But there’s one aspect of the routine that Ortiz wishes he could stop: the need to have a pinch of tobacco in his right cheek.
It’s a habit he picked up in the minor leagues and can’t break.
“I use it as a stimulator when I go to hit,” Ortiz said. “But the minute I finish my at-bat I spit it out. It keeps me smooth and puts me in a good mood. I don’t do it in the offseason. I don’t really like it that much, to be honest with you.”
Smokeless tobacco use stubbornly remains a part of baseball, even though Major League Baseball has tried to discourage its use for the last few years because it is known to increase the risk of cancer. While smokeless tobacco use is not as prevalent in baseball as it was several years ago, a survey of the 58 Red Sox players invited to spring training this year found 21 who admitted to using it.
“It’s a nasty habit, but it’s one of those traditions in baseball,” said Red Sox manager John Farrell, who “dipped” smokeless tobacco when he played and admits to using it now on occasion.
Major League Baseball rules prohibit teams from providing tobacco products to players and strongly encourages clubhouse attendants not to purchase tobacco for players. Players cannot have tobacco tins in their uniform pockets or do televised interviews while using smokeless tobacco. Violators are subject to fines; no Red Sox players have been fined.
The rules were put in place in 2011 as part of the latest collective bargaining agreement with the Players Association. An initial proposal to ban tobacco use entirely was rejected by the players. The idea behind the rule change was to look out for the health of the players, present a better example to children, and clean up the image of a game long stained by disgusting brown spit.
“When I first started playing, everybody did it,” said Ortiz, the team’s most veteran player. “Now you see fewer guys because everybody knows it’s bad for you. They try to educate us about it, but some people don’t listen.”
As part of the effort to discourage use, the Red Sox provide alternatives to their players. There are five flavors of bubble gum available in the clubhouse, along with tubs of sunflower seeds. There’s even a big box of fruit chews imported from Japan.
Most players who use smokeless tobacco actually use snuff, finely ground tobacco usually placed under the lower lip. A few players chew leaf tobacco, creating telltale bulging cheeks.
In the Globe’s informal poll, the only Red Sox player who said he didn’t want to quit was outfielder Jonny Gomes. He’s also the only one interviewed who uses chewing tobacco, not snuff.
“I’d quit if my family wanted me to,” Gomes said. “The kids aren’t old enough to realize what’s going on. People are baffled I don’t do it in the offseason because I do it all the time when we’re playing. But I don’t have an addictive personality. There’s just something about it that goes with baseball. There’s something attached to hitting. I can’t describe it.
“Once I stop playing, I’ll never do it again. I know it’s a bad idea.”
For each player, the habit takes on different forms. Pitchers Jake Peavy and Felix Doubront said they use smokeless tobacco only when they’re on the mound. Fellow pitchers Andrew Miller and Clay Buchholz use it during games but not when they’re pitching.
“It’s just part of my routine when I play,” first baseman Mike Napoli said. “It would feel weird without it. I’ve gone a couple of months without it. But as soon as I step on a field, I feel like I need it.”
The dangers of smokeless tobacco are evident.
It increases the risk of various forms of oral cancer, gum disease, and lesions in the mouth that can become cancerous, according to the American Cancer Society and other medical groups. Hall of Famer Tony Gwynn was found to have mouth cancer in 2010 and required extensive surgery. He believes it was from tobacco use.
Smokeless tobacco delivers a greater dose of nicotine — the addictive ingredient in tobacco — than a cigarette, according to the National Institute on Drug Abuse. Although the nicotine is absorbed more slowly, a greater amount stays in the bloodstream.
Starting in 2012, teams were required to have dentists screen players for signs of oral cancer. The Red Sox had their exams when they reported to spring training.
“You certainly understand what MLB is trying to do,” Peavy said. “I respect that. At the same time, it’s really, really hard to tell grown men who have been in this game and done it for a long time that they can’t do something that’s legal. Old habits die hard.
“I grew up with it,” said Peavy, who grew up and still lives in Alabama. “It was big with my family. Next thing you know, you’re buying cans and you’re addicted to nicotine.”
But Peavy wants to quit because of his three young baseball-loving sons.
“I can’t stand the idea of them seeing me do it and thinking it’s OK for them,” he said.
Doubront, who has two sons, feels the same way.
“My family hates it,” he said.
Fears that players’ children, and young fans, will follow their lead are well founded. A survey done by the Centers for Disease Control and Prevention in 2009 found that 15 percent of high school boys were using smokeless tobacco, a 36 percent increase from 2003.
Third baseman Brandon Snyder quit after he found out his wife was pregnant early last season.
“One night I had a dream that I died from something having to do with dip,” he said. “When I woke up I didn’t have the slightest want or need for a tobacco product. I had been doing it since I was 13.”
Because tobacco use is prohibited in the minor leagues and most levels of amateur baseball, many younger players arrive in the majors unfamiliar with it. But two Sox prospects, outfielder Bryce Brentz and lefthander Drake Britton, said the minor league tobacco ban is only casually enforced.
“I did it in the minors,” Britton said. “The people who want to can still do it. They’ll look in your locker to see if you have it, but that’s really it.”
Britton was casually spitting into a water bottle as he spoke.
“I know I need to quit,” he said. “I don’t want to be one of those guys who never quits, dips the rest of my life, and gets cancer.”
Brentz, 25, is trying to quit now. He’s worried he’ll reach for a tin once he goes hitless in a game.
“It doesn’t take much for a baseball player to blame something,” he said. “I should feel the same chewing gum, but I don’t. It’s addicting.”
Snyder and Gomes have tried chewing a mint product manufactured in Danvers. Jake’s Mint Chew, founded in 2010, has provided a tobacco alternative to players from the Red Sox, Orioles, Dodgers, and Twins, along with a few NFL players.
Adam Benezra, who founded the company with Jake Sweeney, said sales rose by 132 percent after the first year and have climbed steadily sense. The company now has seven employees.
“We get a lot of athletes who contact us,” Benezra said.
Miller could be the next.
“I’m torn all the time, but there are dangers in everything,” he said. “I try for moderation, and I don’t do it in the offseason. It’s a habit during baseball season for me, and it always has been. I wish it wasn’t. I feel like an idiot for doing it.”
http://www.bostonglobe.com/sports/2014/03/06/tobacco-chewing-nasty-habit-still-kicking-mlb/nZDZK9LOFDlr0MFj9X1WkO/story.html

E-cigarettes ignite debate over regulation, sales

LANSING, Mich. (AP) — Banning the sale of electronic cigarettes to kids may seem like a no-brainer, yet Gov. Rick Snyder’s administration and a number of health advocacy groups oppose legislation that does just that. They say it doesn’t go far enough.
Players on both sides of the state’s e-cigarette debate agree that the nicotine-dispensing devices should be kept away from minors, but opinions differ when it comes to regulating the relatively unstudied vaporizers.
Tobacco companies support two bipartisan Senate bills prohibiting the sale and use of e-cigarettes and other devices that deliver nicotine if the buyer is younger than 18 years old. Sen. Glenn Anderson, D-Westland, said he is sponsoring the legislation because it’s “outrageous” that a minor can legally buy and use a highly addictive product. The bills unanimously passed the Senate Thursday.
But Snyder’s administration and health advocates say the bills would give e-cigarettes a “special status” and protect them from standard tobacco regulations. They want e-cigarettes to be treated like traditional cigarettes, not only in regards to minors, but taxes and public use laws as well. Such regulations would ban e-cigarette use in workplaces or restaurants, a restriction that’s currently left up to individual businesses.
“The appropriate thing to do in Michigan now is to act to help protect the population against the potential health risks of e-cigarettes, about which we know very little,” said Dr. Matthew Davis, chief medical executive for the Community Health Department.
Electronic cigarettes are cylindrical battery-powered devices that heat a liquid to produce vapor. While the liquid often includes nicotine, which can be derived from tobacco, e-cigarettes have not been officially designated as tobacco products. The U.S. Food and Drug Administration regulates cigarettes and smokeless tobacco and has said it intends to propose changes to its authority to regulate e-cigarettes, too.
Twenty-seven states ban the sale of e-cigarettes to minors, according to the National Conference of State Legislatures. Most of those state laws are similar to the Senate legislation.
Opponents are countering with a House bill that would treat e-cigarettes as tobacco products.
Rep. Gail Haines, R-Lake Angelus, introduced the bill Wednesday after working with the administration and health groups such as the American Cancer Society and American Lung Association. She declined to comment before the bill was assigned to a committee.
Anderson said an effort to designate e-cigarettes as tobacco products would fail ahead of the FDA’s decision.
“Most of us would prefer for the FDA to make the decision, and they are going to do it probably sometime this year, but I don’t want to wait,” bill sponsor Sen. Rick Jones, R-Grand Ledge, said. “I want to stop the sale to children now, immediately.”
E-cigarettes are often produced by the same parent companies as traditional cigarettes and have grown increasingly popular over the past few years. U.S. middle and high school students’ use of e-cigarettes more than doubled from 2011 to 2012, the Centers for Disease Control and Prevention reported in September. The share of high school students who had used e-cigarettes in the past 30 days increased from 1.5 percent to 2.8 percent in the survey. More than 1.78 million middle and high school students tried e-cigarettes in 2012.
“As I read to a fourth grade last week, one of the children said, ‘My friends and I bought some and we played with them,'” Jones said on the Senate floor.
Mark Bilger, 18, asked his mother to contact Anderson about concerns over e-cigarettes in September after studying them for his debate club. Bilger, a senior at Detroit Catholic Central High School, said he noticed e-cigarettes were “becoming a real problem in my school” and that students occasionally use them in class “when the teacher’s back is turned” without getting caught “because there’s no smell, there’s only vapor.”
“I think it’s a step in the right direction,” Bilger said about the Senate legislation. “But I think they need some of the same regulations traditional cigarettes have, where you regulate what you put in it and have more testing on it.”
Lance McNally, 39, is one of Jones’ constituents who began using e-cigarettes in December. He owns three e-cigarettes and still smokes traditional cigarettes. He wants to transition fully to vaporizers because “there’s no stench.”
While McNally only uses tobacco-flavored e-cigarette liquid, he said his wife goes for more unusual flavors.
“Strawberry, cheesecake — those are the two main ones,” he said.
McNally said he’s not worried about flavors or advertisements appealing to minors because “I’m not seeing an inundation of marketing.” E-cigarette legislation is unnecessary because many retailers already won’t sell them to minors, he said.
“I don’t think they should be regulated like cigarettes,” McNally said. “I’m kind of a deregulation guy to begin with. I don’t see where the government needs to be wasting its energy and time and my money on another product.”
http://www.usatoday.com/story/news/nation/2014/03/07/e-cigarettes-regulation-sales/6181091/

Teenage E-Cigarette Use Likely Gateway to Smoking

By Caroline Chen, Bloomberg News
E-cigarettes facing municipal bans and scrutiny by U.S. regulators received a new slap on the wrist from scientists: A report today suggests the devices may be a gateway to old-fashioned, cancer-causing smokes for teens.
Youths who reported ever using an e-cigarette had six times the odds of smoking a traditional cigarette than those who never tried the device, according to a study published today in the journal JAMA Pediatrics. E-cigarette use didn’t stop young smokers from partaking in regular cigarettes as well.
The global market for e-cigarettes may top $5 billion this year, according to Euromonitor International Ltd. estimates. Makers of the devices, including Altria Group Inc. (MO), the largest U.S. tobacco company, market them online and on TV, where traditional tobacco ads are banned, and some have added flavors such as bubble gum to the nicotine vapor that may have extra appeal for youths. That allure is why the U.S. Food and Drug Administration needs to restrict the devices, opponents say.
“The FDA needs to act now,” Vince Willmore, spokesman for the Washington-based Campaign for Tobacco-Free Kids, said in a telephone interview. “We think it’s overdue.”
Concerns about underage use of e-cigarettes were raised last year when the U.S. Centers for Disease Control and Prevention in Atlanta reported that use of the devices by youths doubled in 2012 from a year earlier.
“E-cigarettes are likely to be gateway devices for nicotine addiction among youth, opening up a whole new market for tobacco,” said Lauren Dutra, a post-doctoral fellow at the University of California at San Francisco and the report’s lead author. “We’re most worried about nicotine addiction initiation in youth.”

Enticing Product

E-cigarettes “are enticing for kids,” said Donovan Robinson, dean of students at Chicago’s Lincoln Park High School. He said today’s findings weren’t surprising. “They’ll say, ‘Hey, now let’s try the real thing.’”
Children in middle and high school, the target of the research, don’t think about health consequences, he said.
“Everything is a fad with teenagers,” Robinson said. They use e-cigarettes “because it looks cool. Teenagers see somebody doing something cool, and they want to do it.”
The latest research analyzed data from the 2011 and 2012 National Youth Tobacco Survey, conducted by the Centers for Disease Control and Prevention. Almost 40,000 middle and high school students from about 200 schools across the U.S. participated in the survey. Students were asked about their frequency of use of e-cigarettes, conventional cigarettes, cigars, pipes, and other tobacco products.

No Tar

While battery-powered e-cigarettes enable the ingestion of heated nicotine, users avoid the tars, arsenic and other chemicals common in tobacco products that have been linked to cancer, supporters have said.
The study today shows correlation, not causation, said Cynthia Cabrera, executive director of Smoke-Free Alternatives Trade Association, the Washington-based e-cigarette association.
“I’ve yet to see any science that shows there’s a gateway effect,” Cabrera said in a telephone interview. “We want to work with facts and science, we don’t want to make knee-jerk decisions based on emotional responses.”
Cabrera warned against drawing inferences on teen use based on the use of flavors in e-cigarettes.
“We do know that thousands of people were able to switch over to vapor products because of the flavors,” she said in a telephone interview. “Would we deny people who were in a group who could die from tobacco to use flavors that helped them get off killer tobacco?”

Nicotine Effects

Opponents have countered that nicotine alone is so toxic it’s been used in the past as a pesticide. They say the health effects of nicotine, which has proven to be habit forming, are unclear and deserve more study. Until that’s done, they’ve said, advertising of the devices should be closely monitored to make sure it isn’t aimed at underage smokers.
“We’re concerned that the marketing for e-cigarettes risks re-glamorizing smoking” among youths who won’t make the distinction between electronic and conventional cigarettes, Willmore said.
In December, a billboard in Miami used Santa Claus to market e-cigarettes and in the recent Sports Illustrated bathing suit issue there was an ad for one of the devices “right in the middle of a bikini bottom,” he said.
“You couldn’t design an ad more appealing to a teenage boy,” Willmore said.

Pivotal Year

This is expected to a pivotal year for producers of electronic cigarettes, with all major tobacco companies either launching new products or expanding their e-cigarette sales exposure, said Kenneth Shea, a Bloomberg analyst. Altria, Reynolds American Inc. and Lorillard Inc. are all expected to pursue U.S. exposure for their e-cigarettes, while closely held Logic Technology Development LLC and Sottera Inc., the maker of the e-cigarette NJoy, try to keep pace, Shea wrote in a report this month.
While tobacco companies have been under the FDA’s watchful eye since Congress gave the agency authority over the $90 billion industry in 2009, e-cigarettes haven’t been subject to the same oversight. The agency is now in the process of readying new rules for the industry designed to establish clear manufacturing standards and set boundaries for how the products can be marketed.
Federal regulators aren’t the only government officials moving to control use of e-cigarettes. On March 4, the Los Angeles City Council voted to join New York and Chicago in banning the use of the electronic products in in workplaces, restaurants and many public areas.

Bans Criticized

The municipal restrictions were criticized by Miguel Martin, president of Logic Technology, the second-largest independent e-cigarette maker in the U.S. Localities should wait for the FDA to make its views known before taking action, Martin said in an interview before the council vote.
“I find it odd that everybody looks to the FDA for guidance on everything else, but because it’s politically expedient, they don’t on this,” Martin said.
http://www.bloomberg.com/news/2014-03-06/teenage-e-cigarette-use-likely-gateway-to-smoking.html

Researchers claim electronic cigarettes "gateway" to real smoking but experts unsure

ByRYAN JASLOW / CBS NEWS
A new study may confirm some fears health officials had about electronic cigarettes. Researchers found teens who use e-cigarettes may be more likely to become addicted to actual cigarettes, doctors at the University of California San Francisco reported on March 6 in JAMA Pediatrics.
“E-cigarettes are likely to be gateway devices for nicotine addiction among youth, opening up a whole new market for tobacco,” Dr. Lauren M. Dutra, a postdoctoral scholar at UCSF School of Medicine, said in a university press release.
But, the study did not definitively prove that young e-cigarette smokers turned to tobacco after smoking the products, since it examined two large data pools of teens in 2011 and 2012 rather than tracking the same people for two years. Some experts have questioned the conclusions drawn by researchers.
Part of the findings suggest kids who used the products also experimented with conventional cigarettes and weren’t any more likely to quit using them, as some proponents had suggested.
E-cigarettes are metallic tubes that allow liquid nicotine to be converted into an inhalable vapor without the use of combustion. The battery-powered devices look like pens or cigarettes, and can come in flavors including strawberry, licorice and chocolate.
Researchers looked at survey data collected from more than 17,000 middle and high school students in 2011 and more than 22,500 in 2012.
In 2011, 3.1 percent of adolescents said they tried an e-cig once and 1.1 percent were current users. By 2012, 6.5 percent of adolescents had tried the products and 2 percent were current users.
Ever using and current use of e-cigarettes increased odds of experimenting with conventional cigarettes, smoking at least 100 cigarettes (ever smoking), or smoking at least 100 cigarettes and smoking within the past 30 days (current smoking). Teens who smoked both conventional cigarettes and e-cigarettes smoked more cigarettes per day than non-e-cigarette users, they also found.
Teens who used e-cigarettes and conventional cigarettes were much less likely to have abstained from cigarettes in the past 30 days, 6 months or the last year, despite some proponents claiming it could be used to help people quit smoking, Dutra added.
“Our results suggest that e-cigarettes are not discouraging use of conventional cigarettes,” she said.
Product users however were more likely to say they planned to quit smoking real cigarettes in the next year compared to smokers who did not also use e-cigs.
Previously, the Centers of Disease Control and Prevention had reported upticks in the number of adolescents and adults using electronic cigarettesin recent years. Nationally, cigarette-smoking rates have fallen in adults.
“This rapid rise has stimulated a vigorous debate in the tobacco control community over the potential public health impact of (e-cigarettes) and about how best to regulate them,” wrote Dr. Frank J. Chaloupka, a professor of economics who directs the Health Policy Center at the University of Illinois at Chicago in an editorial published in the same issue.
The article highlights some of the concerns about the public health harms, he added, noting the doubling of ever use of e-cigarettes among teens between 2011 and 2012, and the reduced likelihood to stop smoking conventional cigarettes among the experimenters.
“While much remains to be learned about the public health benefits and/or consequences of (e-cigarettes) use, their exponential growth in recent years, including their rapid uptake among youths, makes it clear that policy makers need to act quickly,” he wrote.
The Food and Drug Administration does not currently regulate e-cigarettes unless they claim health benefits, such as getting people to quit smoking.The FDA has previously announced intentions to tighten regulation of the products.
However, some experts questioned the conclusion drawn by the authors that e-cigs could be a gateway to smoking the real thing.
“The data in this study do not allow many of the broad conclusions that it draws,” Thomas J. Glynn, a researcher at the American Cancer Society, told The New York Times.
“The authors seem to have an axe to grind,” Dr. Michael Siegal, a professor of community health sciences at Boston University School of Public Health who has previously spoken in favor of e-cigarettes, told Reuters. “I could equally argue that what this study shows is that people who are heavy smokers are attracted to e-cigarettes because they are looking to quit.”
Last September, 40 state attorneys general asked the federal government to tighten regulation, charging e-cigarettes are marketed to young people through its fruit and candy flavors and cartoon-like advertising.
New York City, Chicago and Los Angeles have banned e-cigarette uses in some public places, putting them in the same category of other tobacco products.
http://www.cbsnews.com/news/researchers-claim-electronic-cigarettes-gateway-to-real-smoking-but-experts-unsure/

Teens Who Try E-Cigarettes Are More Likely To Try Tobacco, Too

By Patty Neighmond, NPR
While electronic cigarettes may be marketed as alternatives that will keep teenagers away from tobacco, a study suggests that may not be the case.
Trying e-cigarettes increased the odds that a teenager would also try tobacco cigarettes and become regular smokers, the study found. Those who said they had ever used an e-cigarette were six times more likely to try tobacco than ones who had never tried the e-cig.
Researchers from the Center for Tobacco Research and Education at the University of California, San Francisco, analyzed data from the 2011 and 2012 National Youth Tobacco Survey, a federal questionnaire administered to students in grades 6 through 12 in middle and high schools nationwide. It asked teenagers whether they smoked electronic or tobacco cigarettes or both.

The survey found that students’ use of electronic cigarettes doubled from 3.3 percent to 6.8 percent in 2011 and 2012. But the number of smokers declined only slightly, from 5 percent to 2011 to 4 percent in 2012.
Teenagers who smoked were more likely to use e-cigarettes, and vice versa. In 2012, 57 percent of those who had tried cigarettes had also tried e-cigarettes. And 26 percent of current smokers used e-cigs as well. By contrast, 4 percent of teens who had never smoked had tried e-cigs, and 1 percent said they use them currently.
E-cigarettes don’t burn tobacco. Instead, a battery heats up liquid nicotine and turns it into a vapor that’s inhaled into the lungs.
Director Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, has called the rise of e-cigarette use among teenagers “alarming,” because nicotine is still an addictive drug. Frieden also has expressed concern that electronic cigarettes may be a gateway to tobacco cigarettes.

“The adolescent human brain may be particularly vulnerable to the effects of nicotine because it is still developing,” the authors write. Their study was published Thursday in the journal JAMA Pediatrics.
The study is one of the first to try to get a grip on how e-cigarettes affect tobacco use. It couldn’t look at whether e-cig use caused tobacco use, or vice versa, or why teenagers decided to use the products. And it doesn’t answer the question of whether teenagers used e-cigarettes in order to avoid tobacco.
Although cigarette makers deny they target teenage customers, researchers say the companies aggressively market glamorous and sexy images that appeal to a teenager’s sense of rebellion and tendency toward risky behavior. Those same tactics are now being used for e-cigarette ads, tobacco control advocates say.
The electronic versions also come in a variety of flavors like strawberry, watermelon and licorice. There are far more restrictions on tobacco cigarettes including a ban on offering sweet or fruity flavors, as well as restrictions on advertising and sales to minors. The Food and Drug Administraiton is currently considering whether and how much to regulate electronic cigarettes.
http://www.npr.org/blogs/health/2014/03/06/286416362/teens-who-try-e-cigarettes-are-more-likely-to-try-tobacco-too

5 Things to Know About E-Cigarettes

By , ABC News

Los Angeles is the latest city to outlaw e-cigarette smoking in some public places.

The L.A. City Council voted 14-0 in favor of the “vaping” ban, following in the footsteps of New York City and Chicago.

E-Cigarette Health Row Catches Fire

The electronic cigarette was invented in the 1960s, but it didn’t really take off until a decade ago. The Tobacco Vapor Electronic Cigarette Association now estimates that roughly 4 million Americans use the battery-powered cigs.

Here’s a look at the e-smoke trend: the good, the bad and the unknown.

What are e-cigarettes?

E-cigarettes are battery operated nicotine inhalers that consist of a rechargeable lithium battery, a cartridge called a cartomizer and an LED that lights up at the end when you puff on the e-cigarette to simulate the burn of a tobacco cigarette. The cartomizer is filled with an e-liquid that typically contains the chemical propylene glycol along with nicotine, flavoring and other additives.

The device works much like a miniature version of the smoke machines that operate behind rock bands. When you “vape” — that’s the term for puffing on an e-cig — a heating element boils the e-liquid until it produces a vapor. A device creates the same amount of vapor no matter how hard you puff until the battery or e-liquid runs down.

How much do they cost?

Starter kits usually run between $30 and $100. The estimated cost of replacement cartridges is about $600, compared with the more than $1,000 a year it costs to feed a pack-a-day tobacco cigarette habit, according to the Tobacco Vapor Electronic Cigarette Association. Discount coupons and promotional codes are available online.

Are e-cigarettes regulated?

The decision in a 2011 federal court case gives the Food and Drug Administration the authority to regulate e-smokes under existing tobacco laws rather than as a medication or medical device, presumably because they deliver nicotine, which is derived from tobacco. The agency has hinted it will begin to regulate e-smokes as soon as this year but so far, the only action the agency has taken is issuing a letter in 2010 to electronic cigarette distributors warning them to cease making various unsubstantiated marketing claims.

For now, the devices remain uncontrolled by any governmental agency, a fact that worries experts like Erika Seward, the assistant vice president of national advocacy for the American Lung Association.

“With e-cigarettes, we see a new product within the same industry — tobacco — using the same old tactics to glamorize their products,” she said. “They use candy and fruit flavors to hook kids, they make implied health claims to encourage smokers to switch to their product instead of quitting all together, and they sponsor research to use that as a front for their claims.”

Thomas Kiklas, co-owner of e-cigarette maker inLife and co-founder of the Tobacco Vapor Electronic Cigarette Association, countered that the device performs the same essential function as a tobacco cigarette but with far fewer toxins. He said he would welcome any independent study of the products to prove how safe they are compared to traditional smokes.

The number of e-smokers is expected to quadruple in the next few years as smokers move away from the centuries old tobacco cigarette so there is certainly no lack of subjects,” he said.

What are the health risks of vaping?

The jury is out. The phenomenon of vaping is so new that science has barely had a chance to catch up on questions of safety, but some initial small studies have begun to highlight the pros and cons.

The most widely publicized study into the safety of e-cigarettes was done when researchers analyzed two leading brands and concluded the devices did contain trace elements of hazardous compounds, including a chemical which is the main ingredient found in antifreeze. But Kiklas, whose brand of e-cigarettes were not included in the study, pointed out that the FDA report found nine contaminates versus the 11,000 contained in a tobacco cigarette and noted that the level of toxicity was shown to be far lower than those of tobacco cigarettes.

However, Seward said because e-cigarettes remain unregulated, it’s impossible to draw conclusions about all the brands based on an analysis of two.

“To say they are all safe because a few have been shown to contain fewer toxins is troubling,” she said. “We also don’t know how harmful trace levels can be.”

Thomas Glynn, the director of science and trends at the American Cancer Society, said there were always risks when one inhaled anything other than fresh, clean air, but he said there was a great likelihood that e-cigarettes would prove considerably less harmful than traditional smokes, at least in the short term.

“As for long-term effects, we don’t know what happens when you breathe the vapor into the lungs regularly,” Glynn said. “No one knows the answer to that.”

Do e-cigarettes help tobacco smokers quit?

Because they preserve the hand-to-mouth ritual of smoking, Kiklas said e-cigarettes might help transform a smoker’s harmful tobacco habits to a potentially less harmful e-smoking habit. As of yet, though, little evidence exists to support this theory.

In a first of its kind study published last week in the medical journal Lancet, researchers compared e-cigarettes to nicotine patches and other smoking cessation methods and found them statistically comparable in helping smokers quit over a six-month period. For this reason, Glynn said he viewed the devices as promising though probably no magic bullet. For now, FDA regulations forbid e-cigarette marketers from touting their devices as a way to kick the habit.

Seward said many of her worries center on e-cigarettes being a gateway to smoking, given that many popular brands come in flavors and colors that seem designed to appeal to a younger generation of smokers.

“We’re concerned about the potential for kids to start a lifetime of nicotine use by starting with e-cigarettes,” she said.

Though the National Association of Attorneys General today called on the FDA to immediately regulate the sale and advertising of electronic cigarettes, there were no federal age restrictions to prevent kids from obtaining e-cigarettes. Most e-cigarette companies voluntarily do not sell to minors yet vaping among young people is on the rise.

A Centers for Disease Control and Prevention study found nearly 1.8 million young people had tried e-cigarettes and the number of U.S. middle and high school students e-smokers doubled between 2011 and 2012.

A version of this story previously ran on ABCNews.com.

http://abcnews.go.com/Health/things-cigarettes/story?id=22782568#5

E-Cigarettes, by Other Names, Lure Young and Worry Experts

By , NY Times

SAN FRANCISCO — Olivia Zacks, 17, recently took a drag of peach-flavored vapor from a device that most people would call an e-cigarette.

But Ms. Zacks, a high school senior, does not call it that. In fact, she insists she has never even tried an e-cigarette. Like many teenagers, Ms. Zacks calls such products “hookah pens” or “e-hookahs” or “vape pipes.”

These devices are part of a subgenre of the fast-growing e-cigarette market and are being shrewdly marketed to avoid the stigma associated with cigarettes of any kind. The products, which are exploding in popularity, come in a rainbow of colors and candy-sweet flavors but, beneath the surface, they are often virtually identical to e-cigarettes, right down to their addictive nicotine and unregulated swirl of other chemicals.

The emergence of e-hookahs and their ilk is frustrating public health officials who are already struggling to measure the spread of e-cigarettes, particularly among young people. The new products and new names have health authorities wondering if they are significantly underestimating use because they are asking the wrong questions when they survey people about e-cigarettes.

Marketers of e-hookahs and hookah pens say they are not trying to reach young people. But they do say that they want to reach an audience that wants no part of e-cigarettes and that their customers prefer the association with traditional hookahs, or water pipes.

“The technology and hardware is the same,” said Adam Querbach, head of sales and marketing for Romman Inc. of Austin, Tex., which operates several websites that sell hookahs as well as e-cigarettes and e-hookahs. “A lot of the difference is branding.”

Sales of e-hookahs have grown “exponentially” in the last 18 months, Mr. Querbach said.

Public health authorities worry that people are being drawn to products that intentionally avoid the term “e-cigarette.” Of particular concern is use among teenagers, many of whom appear to view e-cigarettes and e-hookahs as entirely different products when, for all practical purposes, they are often indistinguishable.

Indeed, public health officials warn that they may be misjudging the use of such products — whatever they are called — partly because of semantics. A survey by the Centers for Disease Control and Prevention found that 10 percent of high school students nationwide said that they had tried e-cigarettes in 2012, double the year before. But the C.D.C. conceded it might have asked the wrong question: Many young people say they have not and will not use an e-cigarette but do say they have tried hookah pens, e-hookahs or vaping pens.

The C.D.C. is sending a tobacco-use survey to 20,000 students nationwide that asks about e-cigarette experimentation but does not identify the devices by other names. The state of California, through a nonprofit partner called WestEd, is asking virtually the same question of 400,000 students.

Brian King, senior adviser to the Office on Smoking and Health at the C.D.C., said the agency was aware of the language problem. “The use of hookah pens could lead us to underestimate overall use of nicotine-delivery devices,” he said. A similar problem occurred when certain smokeless tobacco products were marketed as snus.

Other health officials are more blunt.

“Asking about e-cigarettes is a waste of time. Twelve months ago, that was the question to be asking,” said Janine Saunders, head of tobacco use prevention education in Alameda County in Northern California.

In October, Ms. Saunders convened a student advisory board to discuss how to approach “e-cigs.” “They said: ‘What’s an e-cig?’ “ Ms. Saunders recalled, and she showed what she meant. “They said: ‘That’s a vape pen.’ “

Health officials worry that such views will lead to increased nicotine use and, possibly, prompt some people to graduate to cigarettes. The Food and Drug Administration is preparing to issue regulations that would give the agency control over e-cigarettes, which have grown explosively virtually free of any federal oversight. Sales of e-cigarettes more than doubled last year from 2012, to $1.7 billion, according to Wells Fargo Securities, and in the next decade, consumption of e-cigarettes could outstrip that of conventional cigarettes. The number of stores that sell them has quadrupled in just the last year, according to the Smoke Free Alternatives Trade Association, an e-cigarette industry trade group.

The emergence of hookah pens and other products and nicknames seems to suggest the market is growing well beyond smokers. Ms. Zacks was among more than 300 Bay Area high school students who attended a conference focused on health issues last month on the campus of the University of California, Berkeley. Many students talked about wide use of e-hookahs or vaping pens — saying as many as half of their classmates had tried one — but said that there was little use of e-cigarettes.

Ms. Zacks said the devices were popular at her high school here. “E-cigarettes are for people trying to quit smoking,” she said, explaining her understanding of the distinction. “Hookah pens are for people doing tricks, like blowing smoke rings.”

James Hennessey, a sophomore at Drake High School in San Anselmo, Calif., who has tried a hookah pen several times, said e-hookahs were less dangerous than e-cigarettes. He and several Drake students estimated that 60 percent of their classmates had tried the devices, that they could be purchased easily in local stores, and that they often were present at parties or when people were hanging out.

“E-cigarettes have nicotine and hookah pens just have water vapor and flavor,” said Andrew Hamilton, a senior from Drake.

Actually, it is possible for e-cigarettes or e-hookah devices to vary in nicotine content, and even to have no nicotine. Mr. Querbach at Romman said that 75 percent of the demand initially was for liquids with no nicotine, but that makers of the liquids were expanding their nicotine offerings. Often, nicotine is precisely the point, along with flavor.

Take, for example, the offerings of a store in San Francisco called King Kush Clothing Plus, where high school students say they sometimes buy their electronic inhalers. On a counter near the back, where tobacco products are sold, are several racks of flavored liquids that can be used to refill e-cigarettes or hookah pens. The flavors include cinnamon apple, banana nut bread, vanilla cupcake, chocolate candy bar and coconut bomb. They range in nicotine concentration from zero to 24 milligrams — about as much as a pack of 20 ordinary cigarettes — but most of the products have some nicotine. To use the refills, it is necessary to buy a hookah pen, which vary widely in price — around $20 and upward.

It is also possible to buy disposable versions, whether e-cigarettes or hookah pens, that vary in nicotine content and flavor. At King Kush, the Atmos ice lemonade-flavored disposable electronic portable hookah promises 0.6 percent nicotine and 600 puffs before it expires.

Emily Anne McDonald, an anthropologist at the University of California, San Francisco who is studying e-cigarette use among young people, said the lack of public education about the breadth of nicotine-vapor products was creating a vacuum “so that young adults are getting information from marketing and from each other.”

“We need to understand what people are calling these before we send out large surveys,” Dr. McDonald said. Otherwise the responses do not reflect reality, “and then you’re back to the beginning.”