CHART OF THE DAY: How Cigarettes Became Bigger Than Spitting Tobacco 100 Years Ago

, Business Insider
These days, you can’t talk about tobacco without talking about the rise of e-cigarettes.
“By year-end 2013, the e-cigarette category is expected to have doubled to over $1B from $500MM in 2012, according to various industry sources,” noted RBC Capital analyst Nik Modi.
Still, e-cigarettes represent a very tiny fraction of the tobacco business.  Tobacco giant Lorillard recently said that e-cigarettes may have taken 1% of the U.S. cigarette volume.
However, there was once a time when the cigarette wasn’t the dominant product in the tobacco business.
“We point out that it took 45 years for tobacco consumers to transition from smokeless to cigarettes during the late 1800s and early 1900s,” added Modi. “The cigarette’s popularity among tobacco consumers as we know it today was helped by two key catalysts: 1) spitting tobacco was declared unsanitary and disease spreading, leading to spittoons being removed from public places in 1915; and 2) during the Second World War, soldiers were given cigarettes as part of their rations.”
The removal of spittoons a hundred years ago isn’t unlike the bans on smoking we see today.
Who knows where we’ll be 45 years from now?

cotd tobaccoRBC Capital Markets

http://www.businessinsider.com/historical-share-of-tobacco-2013-12#ixzz2nekV5FUw

E-cigarettes: a burning question for U.S. regulators

Marina Lopes, Reuters
NEW YORK (Reuters) – At the Henley Vaporium, one of a growing number of e-cigarette lounges sprouting up in New York and other U.S. cities, patrons can indulge in their choice of more than 90 flavors of nicotine-infused vapor, ranging from bacon to bubble gum.
The lounge, located in Manhattan’s trendy Lower East Side, features plush seating, blaring rock music, and fresh juice and coffee. A sprawling sign on one wall lists all the carcinogens that e-cigarette users avoid by kicking their smoking habits and using the e-devices instead.
But the growing popularity of e-cigarettes has not escaped the notice of the industry’s critics, who have stepped up calls for new regulations, including bans on their use in public places, even though the scientific evidence about exposure to their vapors remains inconclusive.
Selling for about $30 to $50 each, e-cigarettes are slim, reusable, metal tubes containing nicotine-laced liquids that come in exotic flavors. When users puff on the device, the nicotine is heated and releases a vapor that, unlike cigarette smoke, contains no tar, which causes cancer and other diseases.
The product, introduced in China in 2006, has become a worldwide trend at least in part because it may help smokers of regular cigarettes break the habit.
“It’s an addiction – not everyone can quit cold turkey,” said Nick Edwards, 34, a Henley employee who says he kicked a 15-year cigarette habit the day he tried his first e-cigarette. “E-cigarettes give you a harm-reduction option.”
That’s one reason why the market for e-cigarettes is expected to surge, reaching $2 billion by the end of 2013 and $10 billion by 2017, according to Bonnie Herzog, an analyst at Wells Fargo Bank in New York.
Herzog said the U.S. market alone could top $1 billion this year. She predicts that by 2017 e-cigarettes sales will overtake sales of regular cigarettes. That estimate does not take into account the impact of potential government regulations on sales.
E-cigarettes may help smokers save money too. Edwards, for one, says he cut his $60 monthly cigarette bill in half when he switched. On top of the cost of the device, the smoking liquids cost around $10 per refill.
Despite the perceived benefits, critics worry that the addictive nicotine found in e-cigarettes could lure more people into smoking and discourage others from quitting all together.
“Essentially e-cigarette companies are selling nicotine addiction,” said Dr. Neil Schluger, chief scientific officer for the World Lung Foundation, which advocates for tobacco control.
“Once you have them addicted to nicotine, you can sell them all sorts of things, including conventional cigarettes,” he said. “This is a giant Trojan horse.”
In the United States, such concerns have led to calls for increased government regulation.
The U.S. Food and Drug Administration currently has no regulations on e-cigarettes, but it is expected to release rules this month that would extend its “tobacco product” authority over the devices. New FDA rules could follow.
“Further research is needed to assess the potential public health benefits and risks of electronic cigarettes and other novel tobacco products,” said Jenny Haliski, an FDA spokeswoman.
To be sure, no one is expecting the federal government to go as far as Brazil, Norway and Singapore, where the devices are banned outright.
In the United States, Utah, North Dakota, Arkansas and New Jersey have already passed legislation outlawing e-cigarettes wherever smoking is prohibited.
Other jurisdictions are considering new rules of their own. New York City could decide as early as next week whether to prohibit e-cigarette use in public places.
Under Mayor Michael Bloomberg, who leaves office January 1, New York was one of the first cities to ban cigarette smoking in public places, and its decision could influence Chicago and other cities that are considering a similar controls.
The outcome is crucial for tobacco companies, which are banking on the devices to make up for a sharp decline in sales of regular cigarettes in the United States. Smoking among U.S. adults dropped to 18 percent in 2012 from 24.7 percent in 1997, according to the Centers for Disease Control and Prevention.
Reynolds American Inc, which makes Camel cigarettes, began selling its Vuse vapor cigarettes in Colorado retail stores in July and plans on expanding nationwide by mid-2014.
Other companies have also dipped into the e-cigarette business, too. Last year Lorillard Inc, maker of Newport cigarettes, acquired the best-selling blu eCigs brand, while Altria Group Inc, best known for the Marlboro brand, followed suit in August with the launch of MarkTen e-cigarettes.
“As society is transforming, so must the tobacco industry,” said Reynolds spokesman Richard Smith. “It’s just good business sense.”
The arrival of Big Tobacco could mean fierce competition for small e-cigarette companies that do not have the resources or experience to deal with tight government regulation.
But many e-cigarette companies say Big Tobacco is late to the game and has a lot to catch up on. “They are going to need to boost up their game if they want to compete,” said Christina Lopez, a saleswoman at Smokeless Image, an e-cigarette shop that sells smaller brands in Hoboken, New Jersey.
HEALTH RISKS UNCERTAIN
To be sure, there is still a dearth of scientific evidence about the safety of e-cigarettes and their effectiveness in helping smokers quit. For regulators, the big question is, are e-cigarettes a treatment for would-be quitters or “gateway” products to nicotine addiction?
Supporters say some e-cigarettes allow users to slowly reduce their nicotine intake and wean themselves off nicotine completely. A study published in the September issue in Lancet, the British medical journal, said the e-cigarettes are as effective as nicotine patches for smokers trying to quit.
Worldwide, conventional cigarette addictions kill 6 million people a year, in part because of the 250 harmful chemicals found in tobacco smoke, which can cause cancer, heart disease and stroke, says the Centers for Disease Control and Prevention.
But e-cigarettes may not be harmless, either. Nicotine addictions, fed by smoking, chewing tobacco or e-cigarettes, can cause high blood pressure, disrupt heart rhythms and lead to obesity and diabetes.
Electronic devices that feature fruit and candy flavors are even more worrying, critics say, because they could introduce children to smoking.
E-cigarette vendors say the sweet flavors make the process of quitting smoking less painful.
“By taking a sort of ‘Willy Wonka,’ fun approach to a serious matter, it breaks down people’s perceptions of e-cigarettes,” said Talia Eisenberg, owner of the Henley Vaporium, referring to the fictional candy maker.
The Centers for Disease Control and Prevention said 10 percent of high school students surveyed reported using e-cigarettes in 2012, up from 4.7 percent in 2011.
About 60 percent of current users are over 35 years old, and 43 percent are college-educated, according to Reynolds American.
Twelve states, including New York, have passed laws preventing e-cigarette sales to minors.
At a hearing on the proposed New York City ban on e-cigarette use in public places, Health Commissioner Thomas Farley said allowing it could glamorize all types of smoking and encourage teenagers and children to take up the cigarette habit.
“While more research is needed on electronic cigarettes, waiting to act could jeopardize the progress we have made over the last few years,” he said.
(Reporting By Marina Lopes; Editing by Jilian Mincer and Tim Dobbyn)
http://www.chicagotribune.com/news/sns-rt-us-usa-ecigarettes-20131211,0,720952.story?page=2

Will your children buy candy, gum or little cigars?

By Dr. Tom Frieden, Special to CNN
Editor’s note: Dr. Tom Frieden is director of the Centers for Disease Control and Prevention.
(CNN) — They’re on display at cash registers all across America: Candy bars, packs of gum — and little cigars.
In some cases, those cigars aren’t tucked away behind the counter where only the attendant can get to them but right in front for anyone to pick up.
Traditional fat cigars are a small part of today’s cigar industry. Newer types of cancer sticks include cigarette-sized cigars, or little cigars, designed to look like a typical cigarette but which evade cigarette taxes and regulations.
Flavored little cigars can be sold virtually anywhere, and kids are a prime target of these new products.
Unlike cigarettes, many are sold singly or in small, low-priced packs, at a fraction of the cost of a cigarette in most states.
These little cigars have names like “Da Bomb Blueberry” and “Swagberry.” The flavors themselves — chocolate mint, watermelon, wild cherry and more — can mask the harsh taste of tobacco and are clearly attractive to children.
The Food and Drug Administration banned candy and fruit flavors in cigarettes so young people would not be enticed. But cigars weren’t covered.
The tobacco industry claims that its marketing efforts are solely aimed at adults. It has long argued that its marketing doesn’t increase demand or cause young people to smoke but instead is intended to increase brand appeal and market share among existing adult smokers.
How many grown-ups do you know who smoke grape-flavored cigars?
Little cigars have become more popular in recent years. Flavored brands have almost 80% of the market share.
In 2011, among middle school and high school students who currently smoke cigars, more than one in three reported using flavored little cigars.
Six states — Florida, Georgia, Maryland, Massachusetts, Rhode Island and Wisconsin — have youth cigar smoking rates the same as or higher than those of youth cigarette smoking.
Despite industry statements to the contrary, the link between marketing and youth tobacco use is clear.
Some legislative and regulatory actions that tackle elements of tax discrepancies, youth appeal and marketing are in place or under consideration.
New York and Providence, Rhode Island, have enacted city-wide ordinances prohibiting the sale of flavored tobacco products, including flavored little cigars. Both ordinances have been challenged and upheld in U.S. District Court.
In April, the Tobacco Tax and Enforcement Reform Act was introduced in the Senate. This bill aims to eliminate tax disparities between different tobacco products, reduce illegal tobacco trade and increase the federal excise tax on tobacco products.
Based on decades of evidence, the 2012 surgeon general’s reporton tobacco use among youth and young adults concluded that tobacco industry marketing causes youths to smoke, and nicotine addiction keeps them smoking.
This sobering fact holds true in spite of bans on advertising and promotions that target children and youths, and restrictions on certain other marketing activities.
Nearly 90% of smokers started before they were 18 years old, and almost no one starts smoking after age 25.
To prevent the needless death, disability and illness caused by smoking, we must stop young people from even starting to smoke.
A key part of prevention efforts must be action that will eliminate loopholes in restrictions on tobacco marketing, pricing and products that encourage children and youth to smoke.
I don’t think it’s too much to expect of our society that we protect our kids so they can reach adulthood without an addiction that can harm or kill them.
– – – –
The opinions expressed are solely those of Dr. Tom Frieden.
http://www.cnn.com/2013/12/11/health/frieden-little-cigars/

E-cigs: Just how safe are they?

Article by: JEREMY OLSON , Star Tribune
One of the great unanswered questions for smokers who are trying to quit — and for the advocacy groups trying to help them — is whether electronic cigarettes are friends or foes.
University of Minnesota researchers aim to address that dilemma with a study examining exactly what smokers inhale when they breathe e-cigarette vapors and how “vaping” affects the body. Researchers will collect blood, urine and saliva samples from at least 25 smokers who use only e-cigarettes and at least 25 who use them with traditional cigarettes.
“The first step is to say, ‘Well, how toxic are these products? What is actually in them?’ ” said Dorothy Hatsukami, associate director for cancer prevention and control in the U’s Masonic Cancer Center.
E-cigarettes, rechargeable devices that heat liquid nicotine or other flavored substances into a vapor that the user inhales, have been marketed as a safer alternative to tobacco. Yet a lack of regulation on their manufacture and contents makes it hard to know if they’re safer than traditional cigarettes and whether they can be used to safely help wean people off tobacco, Hatsukami said.
“It’s like a Wild West out there,” she said.
Some e-cigarettes that are promoted as nicotine-free, for example, have been found to contain the addictive substance, while others contain little or no nicotine despite claims to the contrary.
Some previous studies have chemically analyzed the contents of e-cigarettes. The Minnesota study aims to go a step further by examining how the contents of different kinds of e-cigarettes affect the body.
The market for e-cigarettes has grown rapidly — sales have doubled annually since 2008 and are expected to reach $1.6 billion this year. About 6 percent of adults have tried them, and the share of high school students who have tried them hit 10 percent last year, according to the U.S. Centers for Disease Control and Prevention.
Heidi Scholtz, 20, a German and theater student at Hamline University, tried her first one two years ago because she was tired of going outside in the snow and cold to smoke. Before long, she said, she was using only e-cigarettes and was surprised at what happened when the weather warmed up and she tried a cigarette.
“It tasted disgusting,” she said.
Now Scholtz uses only e-cigarettes, and has kicked a cigarette habit that started when she was 15. A close friend tried them at her urging, but now uses both.
Help smokers quit?
Studies nationally have produced mixed results about whether e-cigarettes help people quit or reduce smoking — or simply supplement real tobacco. Clearway Minnesota, a nonprofit quit-smoking group, has taken a noncommittal stance on them.
Spokesman Mike Sheldon said it’s great if they help some people quit. But, he added, the lack of science about their contents makes it hard to endorse them over proven stop-smoking strategies of counseling combined with such well-studied supplements as nicotine patches or gum.
The recent increase in youth use of e-cigarettes also is troubling, Sheldon said. “We just don’t know enough about these,” he said.
The Minnesota Clean Indoor Air Act does not apply to e-cigarettes, which can be smoked indoors unless banned by local laws or individual establishments. The city of Duluth banned them from public indoor locations because so little is known about their effect on people who inhale the vapors secondarily.
Clearway would support extending the state ban to e-cigarettes, Sheldon said. However, a group of former cigarette smokers have formed the Minnesota Vapers Advocacy Group to fight the idea.
The group’s president, Matt Black, said his first e-cigarette meant his last real cigarette. A device that physically mimicked his smoking mannerisms was key to to quitting.
“For 17 years, I was constantly hand to mouth (with a cigarette),” Black said. “I was blowing out smoke. I was breathing differently. All of those things play a role in that addiction. We found a way to maintain those habits in a way that’s not going to kill us.”
Black said he hopes the U study will ultimately find e-cigarettes safe, so more people would use them to quit real cigarettes.
Hatsukami said a key aspect of the study is looking at the different types of e-cigarettes to see if some are more harmful than others. (To enroll, call 612-624-4568.)
“Although the majority of the products don’t contain toxicants that are cancer-causing, there are a few that do,” she said. “There is a lot of variability out there.”
http://www.startribune.com/lifestyle/health/235430591.html?page=2&c=y

FDA’s anti-smoking campaign to target teens

By 

Early next year, half a century after the U.S. surgeon general first proclaimed the deadly effects of smoking, the Food and Drug Administration will launch a public health campaign unlike any the federal government has ever attempted.
Slick, data-driven and well-funded, the effort could cost up to $600 million over the next five years, all of it paid for by the tobacco industry under a 2009 law.
It will feature carefully crafted anti-smoking messages targeting specific types of teenagers, from rural kids who watch “Duck Dynasty” and drive pickups to gay and lesbian teens who prefer the nightclub scene.
In contracting with top-flight advertising firms, conducting intense demographic research and micro-targeting subsets of the 12-to-17-year-old crowd, the FDA is hoping to take a page from the marketing playbook of corporate America.
“It’s the federal government going to ad firms of the quality and ability that the tobacco industry has always used,” said Matthew Myers, president of the Campaign for Tobacco-Free Kids, a national advocacy group. “They’re ensuring that the media designed to educate and reach at-risk young people is of the same quality that the tobacco industry has used to attract them.”
The federal government can scarcely compete with the tobacco industry, whichspent more than $8 billion on advertising and promotions during 2011, according to the most recent data available from the Federal Trade Commission.
But Mitch Zeller, head of the FDA’s Center for Tobacco Products, said he hopes that in undertaking the first federally funded anti-smoking campaign aimed exclusively at young people, the government can put a dent in the number of teenagers who smoke their first cigarette each day — now roughly 3,300, with an estimated 700 to 800 becoming addicted.
“Once they become regular smokers or regular tobacco users, then it’s the progression to addiction, disease and premature death,” Zeller said. “We have a responsibility . . . to reduce the death and disease toll from tobacco use. That includes educating kids about the harms of tobacco use in an effective way, in a way that will reach them.”
Previous government-backed anti-smoking initiatives have not been on this scale. Some individual states have run campaigns designed to discourage youth smoking — efforts largely financed by a 1998 settlement under which tobacco companies paid states billions of dollars to settle Medicaid claims for tobacco-related health-care costs.
Last year, the Centers for Disease Control and Prevention launched the first federally funded national anti-smoking campaign, but that was geared toward getting existing smokers to stop, not toward teen prevention.
For the new campaign, the FDA is turning to people such as Jeff Jordan, 29. The agency has given him $152 million and a mission: Find a way to cut through the cluttered modern media landscape and persuade teenagers to steer clear of tobacco. And not just any teenagers, but those particularly at risk for becoming smokers, such as Hispanics, Asian Americans, African Americans, gays and lesbians.
Jordan’s San Diego-based firm, Rescue Social Change Group, has spent years developing anti-smoking campaigns that target slivers of youth culture, from teens in Northern Virginia’s alternative rock scene to gay, lesbian, bisexual and transgender teens in Las Vegas. He said he believes that to have any chance of reaching those and other at-risk populations, the government must break free of generic messages aimed at reaching all teens.
“If half the population likes blue, and the other half likes yellow, a government agency will make their campaign green,” Jordan told an audience in Finland in 2012. “But they need to realize that being everything to everyone doesn’t work in marketing. They need to segment their audience and tailor their campaigns to be effective.”
The FDA has committed $300 million to the anti-smoking ad blitz in 2014 and 2015, with the possibility of doubling that in coming years. While a chunk of the money will initially be used to target teens who have never smoked or are intermittent tobacco users, most will be aimed at young people with higher risks of becoming addicted to tobacco.
Kathy Crosby, an FDA official and advertising industry veteran overseeing the campaigns, said the agency hopes to replicate the ways in which corporate America focuses on certain demographic groups, including notoriously hard-to-reach teenagers.
“Brands are masters at understanding the marketplace, understanding the dynamics of the marketplace and carving out a way to reach their target audiences,” Crosby said. “That’s what we’re trying to do.”
Neither the FDA nor the firms it has hired have offered specifics about the campaigns, saying they are a work in progress. But Jordan said the first and most important step is researching which teens to target, then crafting messages that ring true to that group.
“No public health effort before has truly fit into a youth culture, the way they see their culture,” said Jordan, whose small firm has doubled in size to nearly 60 employees and opened a Washington office since starting to work on the FDA project. “The most important part is to be authentic and credible. . . . If we can make a campaign that’s specifically designed for a group, that looks like them, sounds like them, identified with them, we can help them see that people like them are deciding smoking is unhealthy.”
He calls the approach “creating bull’s-eyes” at the fringes of youth culture. “If it actually works,” he said, “we’re talking about reducing [smoking] rates among the groups that are most resistant to a generally targeted message.”
Previous anti-smoking campaigns created by the various firms hired by the FDA offer hints about what to expect. The ads tend to be more edgy than people might expect from a government-backed campaign and often feature young people talking in blunt terms to peers about the consequences of tobacco use.
The firms involved also are adept at getting messages out in ways beyond traditional television and radio advertising, such as creating specialized Web sites and blogs, using Twitter and Facebook, hosting events at bars and staging concerts headlined by bands popular among target audiences.
Better World Advertising, a firm that the FDA has hired to target Native American teens, created a campaign in New York to encourage doctors to talk more with patients about the risks of tobacco, and another in California reminding parents of the dangers of secondhand smoke. The slogan for the latter: “When you smoke, they smoke.”
Another firm working with the FDA, Draftfcb, recently helped the government revamp the image of Smokey Bear.
Zeller, the FDA’s top tobacco official, knows a thing or two about the potential benefits of an aggressive anti-smoking campaign. In the early 2000s, he spent time as an executive at the nonprofit American Legacy Foundation, where he oversaw the “Truth Campaign.”
Funded by a massive tobacco-industry settlement in 1998, the campaign was characterized by in-your-face ads meant to educate teens about the tobacco industry’s misleading marketing practices.
“I know how to do this, and I know what works,” Zeller said in an interview with The Washington Post earlier this year. “And what works is, get really smart people from the outside, do it under contract, do the right research, develop the right messages, have a laser beam focus on who your target is and then buy your media correctly. And then spend money. Because it’s a dose response. Once you’ve done those first three or four things, the more you invest, the more impact you will have.”
Studies have concluded that the “truth” campaign had a tangible effect, discouraging some young people from starting to smoke and prompting others to think twice about their habit.
Another recent study estimated that 1.6 million Americans tried to quit smoking after last year’s CDC campaign, which featured stark images and pleas from adult ex-smokers suffering from a variety of ailments, including amputated limbs and throat cancer.
Whatever shape the FDA’s anti-smoking ads take, Jordan said he’s encouraged to see the government trying to reach teenagers in new and creative ways, in part by taking a chance on firms like his, which aren’t exactly mainstream.
“From the perspective of a federal agency, we’re by no means a quiet company,” he said. “Our work is risque and really in your face, and it’s meant to really cause change. I’m thankful they were willing to take the risk.”
http://www.washingtonpost.com/national/health-science/fdas-anti-smoking-campaign-to-target-teens/2013/12/09/5b24030a-4d73-11e3-be6b-d3d28122e6d4_story.html

North Dakota No. 1 in protecting kids from tobacco

By: Helmut Schmidt, INFORUM
WASHINGTON – North Dakota is ranked first in the nation in funding programs to prevent kids from smoking and to help smokers quit, according to a report released Monday by a coalition of public health organizations.
The state will spend $9.5 million in fiscal year 2014 on tobacco prevention and cessation programs. That’s 102.3 percent of the amount recommended by the U.S. Centers for Disease Control and Prevention.
Alaska is ranked second, spending $10.1 million, or 94.8 percent of the CDC-recommended amount.
“I think this is something that our state should be hugely proud of,” said Holly Scott, tobacco prevention coordinator for Fargo Cass Public Health.
The high school smoking rate was in the 40 percent range in the late 1990s and early 2000s, Scott said.
By 2011, the percentage of high school students smoking had dropped to 19.4 percent. It was even lower in the Fargo area at 13.1 percent, Scott said.
“That’s enormous in terms of the amount of progress made,” she said.
Other states spending at least half of CDC’s recommended level are:

  • No. 3 Delaware, $8.3 million, 59.9 percent.
  • No. 4 Wyoming, $5.1 million, 56.7 percent.
  • No. 5 Hawaii, $7.9 million, 51.7 percent.
  • No. 6 Oklahoma, $22.7 million, 50.5 percent.

Minnesota is 12th in the nation, spending $21.3 million a year, or 36.4 percent of the funds recommended by CDC.
South Dakota follows at 13th, spending $4 million, or 35.4 percent of the CDC-recommended level.
“Right now we know that here in Minnesota, tobacco use is still a problem,” said Keely Ihry, the Partnership for Health tobacco coordinator for Clay County Public Health.
Ihry oversees the program for Clay, Wilkin, Becker and Otter Tail counties.
Ihry said among high school seniors in Clay County, 32 percent of males and 21 percent of females use tobacco.
In Becker County, 38 percent of males and 24 percent of females use tobacco.
In Wilkin County, 50 percent of males and 13 percent of females use tobacco. And in Otter Tail County, 46 percent of males and 26 percent of females use tobacco.
In North Dakota, a 2008 voter-approved initiative requires the state to fund its tobacco prevention and cessation program at the CDC-recommended level.
North Dakota’s program has seen success. From 2009 to 2011, the state reduced smoking among high school students from 22.4 percent to 19.4 percent.
In 2012, North Dakota voters also overwhelmingly approved a smoke-free law that applies to all workplaces, including restaurants and bars.
The annual report on states’ funding of tobacco prevention programs, titled “A Broken Promise to Our Children: The 1998 State Tobacco Settlement 15 Years Later,” was released by the Campaign for Tobacco-Free Kids, American Heart Association, American Cancer Society Cancer Action Network, American Lung Association, the Robert Wood Johnson Foundation and Americans for Nonsmokers’ Rights.
The states will collect $25 billion this year from the tobacco settlement and tobacco taxes, but will spend just 1.9 percent of it – $481.2 million – on tobacco prevention programs. This means the states are spending less than 2 cents of every dollar in tobacco revenue to fight tobacco use, the report said.
http://www.inforum.com/event/article/id/420703/group/News/

E-cigarettes cause alarming increase in calls to poison control center

Kentucky Regional Poison Control Center sees 333-percent increase

LOUISVILLE, Ky. — As the debate about electronic cigarette regulation continues with the U.S. Food and Drug Administration (FDA) and device manufacturers, data from one state poses concerns that should be part of the conversation.
E-cigarettes consist of a rechargeable lithium battery, a liquid cartridge and an LED light at one end that simulates the burning effect of a regular cigarette. When the user inhales, or “vapes,” a heating element converts the liquid in the cartridge into a vapor. Cartridges typically contain nicotine, propylene glycol or glycerol, flavoring and other additives.
E-cigarettes consist of a rechargeable lithium battery, a liquid cartridge and an LED light at one end that simulates the burning effect of a regular cigarette. When the user inhales, or “vapes,” a heating element converts the liquid in the cartridge into a vapor. Cartridges typically contain nicotine, propylene glycol or glycerol, flavoring and other additives.
The Kentucky Regional Poison Control Center of Kosair Children’s Hospital has received 39 calls about e-cigarettes so far this year, a 333-percent increase from nine calls received in 2012. Nationally, poison control centers have seen a 161 percent increase in calls from people with concerns about these devices. With sales of e-cigarettes doubling to $1.5 billion in the past year, the calls are likely to increase.
E-cigarettes consist of a rechargeable lithium battery, a liquid cartridge and an LED light at one end that simulates the burning effect of a regular cigarette. When the user inhales, or “vapes,” a heating element converts the liquid in the cartridge into a vapor. Cartridges typically contain nicotine, propylene glycol or glycerol, flavoring and other additives.
“More than half of the calls we have received were concerning children,” said Ashley Webb, Pharm.D., board-certified toxicologist and director of the Kentucky Regional Poison Control Center of Kosair Children’s Hospital.
“Kids are picking up the liquid cartridge when cartridges are left accessible or when an adult is changing the cartridge,” she said. “They’re also getting a hold of the e-cigarette and taking it apart to expose the liquid. They then either ingest the liquid or get it onto their skin. Even on the skin, the nicotine is absorbed and can create adverse side effects.”
These exposures raise a concern because of the concentrated nature of the cartridge fluid.
“The amount of nicotine in the cartridges is not regulated, but many contain more than 14 milligrams of nicotine,” said Dr. George Rodgers, associate medical director, Kentucky Regional Poison Control Center and professor and division chief of pediatric pharmacology and toxicology at the University of Louisville School of Medicine. “Severe cases of toxicity requiring hospitalization have been reported with children consuming 1.4 milligrams per kilogram of weight — equivalent to an average 2-year-old consuming the amount found in a cartridge,” he said. “And since children are not used to consuming nicotine, their symptoms may be more severe at lower levels.”
“Accidental exposure by children to e-cigarettes is a public health concern that we need to take seriously,” said Dr. LaQuandra Nesbitt, director of the Louisville Metro Department of Public Health and Wellness in Louisville, Ky. “Parents need to be aware of the potential dangers to their children.”
Symptoms of severe nicotine exposure include a pale appearance, flushing, sweating, headache, dizziness, hyperactivity or restlessness, vomiting, diarrhea, rapid heart rate, increased blood pressure, salivation and teary eyes. In very severe cases, the heart rate and blood pressure begin to drop to dangerously low levels and the patient can lapse into a coma, followed by difficulty breathing and even death.
When on the skin, nicotine in liquid form is easily absorbed. Even small amounts can cause irritation and a burning sensation.
“Only a few of the calls we have received have been from children inhaling nicotine from the e-cigarette,” Webb said. “And so far only two of the calls involved symptoms severe enough to require emergency care. But it’s only a matter of time before a child experiences a severe reaction.”
“Parents need to consider these devices as a potential harm to children and, like other poisons, keep them out of reach,” said Dr. Stephen P. Wright, pediatrician and medical director of Kosair Children’s Hospital. “Since e-cigarettes are also unregulated, we don’t know what other toxins may be in them.”
An analysis done by the FDA in 2009 showed that e-cigarettes contain carcinogens and other hazardous chemicals, including diethylene glycol, an ingredient used in antifreeze. Researchers from the University of Athens in Greece found that e-cigarettes, thought by some to be a safer alternative to tobacco smoking, do have a harmful effect on the lungs, as reported in Medical News Today.
“Since the industry is still so new, we don’t yet know all of the long-term health effects of e-cigarettes to the user, in addition to any effects of secondhand vapor,” said Wright, who is also a professor of pediatrics at the University of Louisville School of Medicine. “While they are touted as a healthier alternative to cigarettes, the jury is still out. We do know that not smoking anything — especially around children — is always the best bet.”
About the Kentucky Regional Poison Control Center of Kosair Children’s Hospital
The primary mission of the Kentucky Regional Poison Control Center is to reduce illness and death from poisoning in Kentucky. The center provides 24/7 free and confidential access to specially trained nurses, physicians and pharmacists who are certified in toxicology. They are specialists in communicating advice to health care professionals, first responders, patients, parents, family members, the general public and the media. Some of the more common calls received involve medications, household cleaning products, plants and personal care items.
Calls also are answered about work-related exposures in farming and industry, food poisoning, insect and snakebites and a variety of other potential hazards. On average, the poison control center’s hotline at (800) 222-1222 receives a call every 7 minutes, 24 hours a day, 365 days a year — more than 72,000 calls annually — from all of Kentucky’s 120 counties. Three of every four patients from those calls are successfully managed safely and inexpensively at home, reducing unnecessary emergency room visits and/or shortening hospital stays. For additional information, visit KosairChildrensHospital.com/PoisonControl.
http://www.lanereport.com/27431/2013/12/e-cigarettes-cause-increase-in-calls-to-poison-control-center/?fb_action_ids=10151744182160059&fb_action_types=og.likes&fb_source=other_multiline&action_object_map=%5B267785540038122%5D&action_type_map=%5B%22og.likes%22%5D&action_ref_map=%5B%5D

Bars one year into smoke-free

Tim Chapman – Tribune Editor , Pierce County Tribune
Rugby bars have been smoke free for just over one year now. Three of the city’s bar owners said business hasn’t been hurt because the state ban made for an even playing field.
Lee Ekren has owned Lee’s Bar for 47 years and said the ban didn’t especially bother him or affect his business. He said it wasn’t a bar of many regular smokers anyway, and people haven’t seemed to mind walking outside for a cigarette.
“Doesn’t make any difference to me,” Ekren said. “I’ve been here so long I figured if I’m gonna get (business), I’m gonna get it anyways.
Dan and Tracy Corum own Third Street Station and Tom Nowell owns I.C. Dubbles. Dan Corum and Nowell are opposed to the law, believing the decision should be up to each business, but neither has seen their profits affected much.
“It’s probably helped our food sales a bit, actually,” Dan Corum said. “Outside we have a lot of extra cigarettes to clean up. It’s kind of tough to stay on top of that.”
Said Nowell: “I don’t think it’s really hurt us much. Initially, there were people not happy about it.”
Dan Corum doesn’t mind going outside because he does the same when smoking at his residence. Tracy Corum, who also smokes, is pleased with the way their establishment feels and looks without cigarette smoke.
“It’s way nicer inside,” she said. “You don’t have all that smoke film.”
As of June, North Dakota was still the latest of 28 states to enact statewide bans in enclosed public places.
http://www.thepiercecountytribune.com/page/content.detail/id/508965/Bars-one-year-into-smoke-free.html?nav=5003#sthash.F2s1ZWEE.dpuf

Keep E-Cigarettes Away From Teens

Chicago Sun Times Editorial Board
Electronic cigarettes, those hip new cigarettes that blow a thick white vapor rather than smoke, are clearly less harmful than real cigarettes.
But that doesn’t mean e-cigarettes are harmless.
And until we know something different, that’s how we ought to treat them.
Folks who are wary of e-cigarettes — battery-operated nicotine inhalers that do not produce smoke — are going after them on two fronts. This group includes Mayor Rahm Emanuel, New York’s city council, other municipalities and states as well as the U.S. Food and Drug Administration.
The first is a no-brainer: keeping e-cigarettes out of the hands of teens and pre-teens. We cheer on efforts to do that in the city of Chicago and at the national level.
E-cigarettes don’t burn tar or tobacco, removing the risk of exposure to carcinogens in cigarette smoke. But they contain nicotine and the risks there, particularly to young people, are well documented. Nicotine is highly addictive, can impact the development of young brains, raises the heart rate and is one of the elements of smoking associated with heart disease.
E-cigarettes are being marketed aggressively to young people and come in flavors clearly meant to entice, such as bubble gum, pina colada and cherry. It appears to be working: between 2011 and 2012, use among middle and high school students more than doubled, according to the U.S. Centers for Disease Control. The risks of young people getting hooked on e-cigarettes and then switching to the more noxious traditional cigarettes are all too real.
Fortunately, Illinois already has joined about half the states in banning the sale of e-cigarettes to anyone under 18, effective Jan. 1. The FDA appears poised to take action across the country, with the agency noting with “great concern” the rise in youth e-cigarette usage. The wisest course is to ban the sale or marketing to anyone under 18.
The Chicago City Council could take that a step farther under an ordinance introduced last week. The mayor proposed prohibiting the sale of methol and flavored tobacco products, including e-cigarettes, within 500 feet of Chicago schools, up from 100 feet.
The mayor also wants to ban the smoke-less cigarettes anywhere that regular cigarettes are banned, including virtually all of indoor Chicago expect homes and cars, and at least 10 feet from business entrances. This is the second front that critics of e-cigarettes are pursuing. New York City will consider a similar ban this month.
This one is a little trickier but not by much. Without smoke, the risks to non-smokers nearby are clearly diminished. But the risks are not eliminated — there is concern that nicotine and chemicals such as formaldehyde and acetone are present in the e-cigarette vapor as well as other particles that can cause heart problems.
There is only limited and preliminary research on the potential hazards of e-cigarette vapors to others, leaving us in the do-no-harm category.
Until we know the full second hand effects of smoke-less cigarettes, it’s prudent to restrict them in the same way we do regular cigarettes. The City Council can and should be a forerunner in this area.
If and when the science on this questions is settled, a ban could be reconsidered.
Until then, do no harm.
http://www.suntimes.com/opinions/24065452-474/keep-e-cigarettes-away-from-teens.html

E-cig boom leads to taxation, regulation questions

WOODBURY, Minn. (AP) — Stores that sell increasingly popular e-cigarettes are popping up around the Twin Cities, highlighting the lack of regulation or taxation of the tobacco alternative.
E-cigarettes are battery powered and produce a nicotine vapor. Owners of stores that sell the devices told the St. Paul Pioneer Press that demand skyrocketed in July when a state tax increase sent cigarette prices up to about $7.50 a pack.
“Sales were insane,” said Angie Griffith, who owns several Smokeless Smoking stores and kiosks.
The surging sales have left regulators scrambling to react. The federal Food and Drug Administration is expected to release regulations on e-cigarettes soon, but for now there are very few state or federal rules applying to the devices.
That’s raised concern that some varieties could serve as an introduction to nicotine for youths. Some come in flavors including root beer, and cookies and cream.
But some former traditional smokers said e-cigarettes helped them kick a tobacco habit. A new Smokeless Smoking store in Woodbury, which opened Nov. 18, has already become a social hub for e-puffers, with its dimly lit lounge with sofas, TVs, games and books.
Griffith said the ability to form friendships and impromptu support groups with fellow e-cigarette smokers is important in helping customers kick tobacco.
“Smoking” an e-cigarette involves pushing a button on the small metal cylinder, examining its tiny computer screen, applying drops of flavoring and keeping an eye on the battery, then inhaling and exhaling the vapor. The vaporized liquids come in standard varieties but can be custom-made. Flavors mimic brands of cigarettes including Marlboro and Camel.
Gus Menth, a White Bear Lake truck driver, smoked cigarettes for 15 years. He tried to quit with nicotine patches but got so frustrated he once popped one in his mouth and chewed it. He can still remember the exact date he successfully switched to e-cigs: Jan. 15, 2011.
“I was tired of smelling bad,” Menth said. “And the cost savings is incredible.”
The metal e-cigarette costs from $30 to about $200, but is reusable. Menth and his wife, who also smokes e-cigs, estimate they are saving about $170 a month since their switch.
Menth said his breathing has improved. “I can run and play with my kid now,” he said.
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Information from: St. Paul Pioneer Press
http://minnesota.publicradio.org/display/web/2013/11/30/health/ecigarettes-twin-cities