More U.S. Teens Try E-Cigarettes, Hookahs: Report

By Steven Reinberg, HealthDay Reporter – US News
(HealthDay News) — The rapidly growing use of electronic cigarettes, hookahs and other smoking alternatives by middle school and high school students concerns U.S. health officials.
While use of these devices nearly doubled in some cases between 2011 and 2012, no corresponding decline has been seen in cigarette smoking, the U.S. Centers for Disease Control and Prevention reported Thursday.
“We have seen, between 2011 and 2012, a big increase in the percentage of middle- and high-school students who are using non-conventional tobacco products, particularly electronic cigarettes and hookahs,” said Brian King, a senior scientific adviser in CDC’s office on smoking and health.
These products are marketed in innovative ways on TV and through social media, he said. “So, it’s not surprising that we are seeing this increase among youth,” he added.
E-cigarettes and hookah tobacco come in flavors, which appeals to kids. And since hookahs are often used in groups, they also provide a social experience, which may be adding to their popularity, King said.
Teens may also believe that e-cigarettes are safer than tobacco, said Stanton Glantz, director of the Center for Tobacco Control Research and Education at the University of California, San Francisco. However, nicotine is addictive and can hamper the developing brains of teens.
“This paper shows that the return of nicotine advertising to TV and radio, combined with an aggressive social media presence and use of flavors is promoting rapid uptake of electronic cigarettes by youth,” said Glantz.
The report, based on data from the 2012 National Youth Tobacco Survey, was published in the Nov. 15 issue of the CDC’s Morbidity and Mortality Weekly Report.
King said efforts are needed to curb use of these tobacco products and prevent other teens from ever trying them. “We know that 90 percent of smokers start in their teens, so if we can stop them from using tobacco at this point, we could potentially prevent another generation from being addicted to tobacco,” King noted.
Smoking is the leading cause of preventable death and disease in the United States, killing more than 1,200 people every day.
E-cigarettes simulate the experience of smoking without delivering smoke. They are shaped like cigarettes but users inhale a vaporized, nicotine-based liquid.
“Nicotine is an addictive drug that affects brain development, especially in adolescents, whose brains are still developing,” he said.
According to the report, from 2011 to 2012 use of e-cigarettes among middle-school students rose from 0.6 percent to 1.1 percent. Their use by high school students jumped from 1.5 percent to 2.8 percent.
Over the same period, hookah use among high schoolers jumped from 4.1 percent to 5.4 percent, the researchers found.
Currently, electronic cigarettes, hookah tobacco, cigars and certain other new tobacco products are not regulated by the U.S. Food and Drug Administration.
The FDA has said it intends to classify these products as tobacco products, putting them under the agency’s control.
The popularity of these new products hurts ongoing tobacco-prevention efforts, experts say. “This proliferation of novel tobacco products that are priced and marketed to appeal to kids are slowing our progress in reducing tobacco use among kids,” said Danny McGoldrick, research director for Campaign for Tobacco-Free Kids.
“You have the marketing of electronic cigarettes that are using all the themes and tactics that have been used by cigarette companies for decades to market to kids, like flavors, the use of celebrities, the use of sports and entertainment, as well as glamour, sex and rebellion,” he said.
This is why the FDA needs to assert jurisdiction over all tobacco products, McGoldrick said.
Cigar use is also rising among adolescents. Their use by black high school students rose from about 12 percent to nearly 17 percent from 2011 to 2012, and since 2009 has more than doubled, according to the report.
Cigars and cigarettes were smoked by about the same number of boys in 2012 — more than 16 percent.
Cigars include so-called “little cigars,” which are similar in size, shape and filter to cigarettes, King said. But since they are taxed at lower rates than cigarettes, they are more affordable. “You can buy a single, flavored little cigar for mere pocket change, which could increase their appeal among youth,” he said.
Fruit and candy flavors, which are banned from cigarettes, are added to some of these little cigars, King said.
According to the CDC, about one in three middle- and high-school students who smoke cigars use flavored little cigars.
Every day, more than 2,000 teens and young adults start smoking. Smoking-related diseases cost $96 billion a year in direct health care expenses, according to the CDC.
More information
For more information on stopping smoking, visit the American Cancer Society.
http://health.usnews.com/health-news/news/articles/2013/11/14/more-us-teens-try-e-cigarettes-hookahs-report

ND smoking ban: 1 year later; Support increases, businesses see no change

By Katherine Grandstrand, The Dickinson Press
Support has only increased in the year since North Dakota voters decided to end smoking in bars, the group that lobbied to implement the law said.
North Dakotans got the measure on last November’s general election ballot and it passed with a supermajority of 67 percent. Three months later, Tobacco Free North Dakota polled a statistical cross section of the state to find that approval had increased to 72 percent.
“This was actually the people who voted this law in,” said Jeanne Prom, executive director of the North Dakota Center for Tobacco Prevention and Control Policy. “This was not a government mandate. This was a mandate by the voters.”
North Dakota voters took up the issue because the Legislature did not, said Erin Hill-Oban, executive director of Tobacco Free North Dakota.
“When the Legislature doesn’t act for so many years on something and they only meet every other year the way it is, to get things accomplished, the public really stepped up,” Hill-Oban said. “It’s a difficult and expensive way to get something done. But, in my opinion, when the public speaks, their voices should be heard.”
Banning smoking from bars and smoke shops — the last non-residential indoor place people could smoke — was about protecting non-smoking patrons and employees from second-hand smoke, Prom said.
“People still had to be exposed to a known human carcinogen at their place of work,” Prom said. “No one should have to choose between a healthy place to work and an unhealthy place to work. A place to work should be healthy.
“This is really about clearing the air in all workplaces and also all public places.”
In Dickinson, local bars haven’t seen much of a change in business over the past year since the ban.
“It’s a lot less stinky,” said Milissa Bauer, general manager of Army’s West Sports Bar. “As far as business goes, I don’t think it’s changed a whole lot.”
Because the ban went into effect in winter, there was a bit of a dip in business right away at The Rock bar in downtown Dickinson, but people have gotten used to it, said manager Traci Barnum.
“It actually shocks us that it’s only been a year,” Barnum said. “It feels like it’s been a lot longer than that. Everybody pretty much got right on board and nobody really complains about it anymore.”
This is the norm, Hill-Oban said.
“There have been many studies done that show that it does not have an economic impact on business,” Hill-Oban said. “People get adjusted to it and they go back to their regular routine and going back to places they frequented.”
Enforcement has been smooth, Bauer said.
“It’s clearly posted on the front door as you come in,” Bauer said. “There were few incidents where we’d have someone light one up at the very beginning, but not much of a problem.”
Some businesses were upset that they were required to cover the cost of posting smoke-free signs, but the 2013 North Dakota Legislature made a provision that allows the North Dakota Center for Tobacco Prevention and Control to provide signs and templates for businesses, Prom said.
“On request, we do provide signage as well as templates online,” Prom said. “If any businesses need signs, we provide that free of charge. There is no excuse for not having a smoke-free sign in a business or public place.”
State law still allows for smoking in outdoor public areas and in multi-family housing. However, anti-smoking groups are working with municipalities to add these places to the smoke-free list.
“Our local public health units are working with their parks and recreation departments and their city officials to make parks and recreation facilities — which, of course, include outdoor facilities — smoke free as well as tobacco free,” Prom said.
Apartments, townhouses and condos share ventilation systems, so if a neighbor is smoking, second-hand smoke can make its way into the rest of the building.
“It’s mostly just how it affects people who aren’t users,” Hill-Oban said.
Removing smoking from public takes it out of normal social behavior, Prom said.
“It creates a very healthy social norm for youth and young adults,” Prom said. “When they see that there is no smoking in public or in workplaces, the norm is that if you’re going to be out in public and if you’re going to work, it’s going to be a healthy environment and there won’t be smoking there.”
http://www.thedickinsonpress.com/content/nd-smoking-ban-1-year-later-support-increases-businesses-see-no-change?fb_action_ids=10153494288605599&fb_action_types=og.recommends&fb_source=other_multiline&action_object_map=%7B%2210153494288605599%22%3A179267778943604%7D&action_type_map=%7B%2210153494288605599%22%3A%22og.recommends%22%7D&action_ref_map=%5B%5D

Gov. Branstad ‘Absolutely Interested’ in Regulating E-Cigarette

By James Lynch, Reporter

DES MOINES, Iowa –
Gov. Terry Branstad, who made Terrace Hill and the governor’s office smoke-free the day he took office, is open to regulating electronic cigarettes in much the same way as the traditional variety.
Iowa law prohibits smoking in workplaces other than on casino floors, but electronic cigarettes – e-cigarettes – are not covered by the five-year-old Iowa Smoke-free Air Act.
Branstad wouldn’t commit to any specific regulation of e-cigarettes, which are battery-operated products that heat liquid nicotine derived from tobacco plants into a vapor that the user inhales. However, during a visit to Timberline Manufacturing in Marion Tuesday, he said he is “absolutely interested” in looking at proposals by Attorney General Tom Miller to regulate e-cigarettes.
Last week, Miller called on state lawmakers to ban sales of e-cigarettes to minors, add e-cigarettes to products covered by the state’s Smoke-free Air Act and tax them more than the standard state sales tax rate.
In addition to looking at Miller’s proposal, Branstad wants to look at what other states have done before deciding the appropriate course of action.
“My wife and I have been strong supporters of smoke-free workplaces,” Branstad said. “We think this is an important part of our goal to the healthiest state.”
He compared e-cigarettes to synthetic drugs created to circumvent state and federal drug laws.
“They just keep coming up with different things just like we have to deal with all these synthetic drugs,” Branstad said.
According to Miller, Iowa’s smoke-free air act does not address the new technology. He said officials in Arkansas, New Jersey, North Dakota and Utah have included e-cigarettes in their indoor smoking bans and Minnesota changed its definition of tobacco products to include e-cigarettes and subject them to the tobacco taxes.
He called on the Legislature to define e-cigarettes and recommended they be subject to the state cigarette tax — $1.36 on a pack of 20 traditional cigarettes.
Miller didn’t have Iowa numbers, but in a letter to the Food and Drug Administration, he said sales of e-cigarettes, which doubled every year since 2008, now are accelerating even faster and are projected to reach $1.7 billion.
At the same time, the cost has fallen, making them more affordable and more attractive to young people.
http://www.kcrg.com/news/local/Gov-Branstad-Absolutely-Interested-in-Regulating-E-Cigarette-231681781.html

Controversy, concerns heat up over e-cigarettes and vaping trend

SAN DIEGO – All the cool kids are doing it. Should you?
The use of electronic cigarettes or e-cigarettes, also referred to as “vaping,” is suddenly a smoking hot trend, fueled by the recent visibility of numerous celebrities including Katy Perry, Lady Gaga, Johnny Depp, Leonardo DiCaprio, and Ryan Seacrest among others. Actress Katherine Heigl even convinced talk show host David Letterman to give her rig a try on a recent appearance on “Late Night.”
For those unfamiliar, electronic cigarettes are battery-powered devices that heat a liquid-filled cartridge, allowing the user to inhale the aerosol vapor. The components of the blend vary. They typically include nicotine, propylene glycol or glycerol to produce the aerosol, and various flavorings, which range from mint to fruits to even chocolate.

A standard e-cigarette.

Some e-cigarettes mimic the look of the real thing, with a tip that glows when the user inhales. Others have a futuristic high tech look, something like a miniature light saber from “Star Wars.” They come in enough colors and various bling options to turn them into a fashion accessory.
The devices were first introduced into the general market about 10 years ago, but improved second generation devices produced by the tobacco companies who’ve seen the writing on the wall as well as the vapor in the air have jumpstarted vaping’s popularity. Lorillard, which manufactures several brands of cigarettes including Kent, Newport and True, controls about half the vaping market in the U.S., thanks in part to its aggressive advertising featuring Jenny McCarthy. E-cigarettes now account for four percent of its total revenue. Reynolds American and Altria also have a significant presence in the vaping marketplace.
Starter vaping kits run under $100, but high end vaping pens can cost as much as $1,000. Some users collect them and have different models they select day to day just as they choose a pair of shoes to go with the rest of their attire.

Bring on the vape bling: E-cigarettes are becoming fashion accessories. Photo: Courtesy VapeGirl.com

Vaping has been big in Southern California for several years, and the trend is now spreading, fueled by the visibility of famous faces puffing away.
The Tobacco Vapor Electronic Cigarette Association estimates that four million Americans now use the battery-powered cigarettes. Sales of the devices are expected to exceed $1 billion by the end of this year. It’s the best news for Big Tobacco in a long time.
The use of e-cigarettes has spawned its own culture including dedicated retail vape shops and even vaping bars, similar to hookah bars in some regions where patrons can freely indulge in their e-cigarettes in a social setting.
Fans of e-cigarettes say they are an effective way to stop smoking traditional tobacco cigarettes. Users can taper off their intake of nicotine to a fraction of what they were previously consuming, without ingesting the tars and other dangerous additives in cigarettes. Some say they’ve tried patches, gum, and counseling without success before finally kicking their habit with e-cigarettes.
Critics say e-cigarettes encourage minors to smoke, and point out they are far from nicotine free. They believe the devices will eventually lead many young users to try tobacco cigarettes and develop a nicotine habit they wouldn’t have pursued otherwise. Harold P. Wimmer, president and CEO of the American Lung Association, said the organization is “very concerned that e-cigarettes with flavors like cotton candy and bubble gum are being marketed to kids, which could result in a lifelong addiction to nicotine.”
The Center for Disease Control’s 2012 National Youth Tobacco Survey found that 10 percent of high school students have tried vaping at some point, 1.78 million people. This is double the previous year. One-third of these users are regular users. What alarms the CDC is that regular tobacco use nearly doubled during this time period as well. How much is attributable to the “starter” factor created by e-cigarettes is unclear.
There is currently no regulation of e-cigarettes by the Food and Drug Administration as there is over tobacco products. It is illegal to sell e-cigarettes devices to minors. It is legal in most states including California to use an e-cigarette indoors, but users say they are careful where they choose to indulge their new habit. Many school districts and local governments are extending current smoking bans to e-cigarettes.
Public health officials and governments say they don’t know what they don’t know about e-cigarettes, saying that more research is needed and regulation may be needed similar to existing tobacco use laws. School districts are putting specific bans on e-cigarettes in place, and local governments are beginning to restrict their use in ways similar to traditional cigarettes.
The European Parliament recently refused to classify and regulate e-cigarettes like other nicotine delivery systems including patches, to the dismay of the companies which manufacture them andt he delight of e-cigarette users in Europe who voiced strong opposition to the regulations.
One truth must be acknowledged: In a 2010 CDC survey, over two thirds of all traditional cigarette smokers said they wanted to quit. Fifty-two percent said they had tried to quit. But just 6.2 percent of smokers who have tried to quit were eventually successful, less than one out of ten. Smokers who used e-cigarettes to quit smoking tobacco reported a 96 percent success rate. If this is anywhere close to being accurate, e-cigarettes could be the tool health experts and society have desperately sought to try and lower the number of deaths attributed to cigarette smoking in the U.S. and worldwide.
 

Can vaping help cigarette smokers kick their habit with greater success? Survey data is promising.

Professor John Britton of the Royal College of Physicians in Great Britain says “If all the smokers in Britain stopped smoking cigarettes and started smoking e-cigarettes we would save five million deaths in people who are alive today.”
This should not signal the relaxation of laws protecting nonsmokers from being subjected to unwelcome vapors in the atmosphere. A vaping bar can look like the fog just rolled in off San Francisco Bay. But the cost to society from cigarette smoking demands that the potential of e-cigarettes be fully explored.
Let’s bear in mind also at a time when our economy isn’t all that healthy that Big Tobacco generates a tremendous amount of revenue, jobs, and taxes. Finding an alternative marketplace that allows these companies to stay in business selling a product that might cut down on cigarette production nothing but positive.
The CDC and FDA both say they will continue to explore ways to increase monitoring and research on e-cigarettes, with particular attention to developing strategies to prevent the use of e-cigarettes among minors.
Gayle Lynn Falkenthal, APR, is President/Owner of the Falcon Valley Group in San Diego, California. Read her regular columns Media Migraine and Ringside Seat in Communities at The Washington Times. Follow Gayle on Facebook and on Twitter @PRProSanDiego. Gayle can be reached via Google +
Please credit “Gayle Falkenthal for Communities Digital News at WashingtonTimes.com” when quoting from or linking to this story.   
http://communities.washingtontimes.com/neighborhood/communities-health-and-science-today/2013/nov/11/controversy-concerns-heat-over-e-cigarettes-and-va/
 

E-cigarette ads model big tobacco ads of old

Jolie Lee, USA TODAY Network
Correction: An earlier version of this story included a quote that suggested the Food and Drug Administration regulated alcohol. The FDA does not have jurisdiction over alcoholic beverages.
Some e-cigarette companies are following in the marketing footsteps of tobacco companies: celebrity appeals and flavors that could attract kids. The Food and Drug Administration restricts how regular cigarettes are advertised, but e-cigarettes fall into a loophole for federal regulation.
The head of the Centers for Disease Control and Prevention said these new kinds of cigarettes threaten the next generation and some members of Congress are urging the FDA to regulate e-cigarette ads as well.
About 4 million Americans now use e-cigarettes and sales have grown dramatically since 2010, according to the Tobacco Vapor Electronic Cigarette Association. E-cigarette manufacturers have cited their product’s potential to get smokers to give up tobacco cigarettes.
But critics of e-cigarettes have raised concerns that the industry is targeting non-smokers, including young people. The CDC says 10% of middle and high students have tried e-cigarettes, a rate that doubled from 2011 to 2012.
Here’s a look at how e-cigarette ads compare to tobacco marketing strategies, many of which targeted young people.
Ads in front of kids
Vype e-cigarettes were advertised in a children’s iPad game last month.

British Tobacco Company, the owner of Vype, apologized for the ad placement, citing a “breach of protocols by third party used by ad agency,” according to a company tweet.

Decades earlier — before they were pushing vitamins, the Flintstones were lighting up Winstons in a 1960 commercial.
“Cigarette ads have always tried to exploit kids’ aspirations that they want to be glamorous, rugged, rebellious,” said Vince Willmore, spokesman for the Campaign for Tobacco-Free Kids. “Now e-cigarettes are appealing to those same aspirations.”
The FDA is considering expanding regulations to the e-cigarette industry, including how products are advertised. TVECA’s position is that e-cigarettes should be regulated like tobacco, co-founder Tom Kiklas said, noting the possibility that localities could impose strict regulations on the use of e-cigarettes unless the FDA provides guidelines for their sale.
Cartoon mascots
E-cigarette company eJuiceMonkeys has a smiling, smoking monkey as its mascot.
Camel started using the cartoon Joe Camel in its advertising campaigns starting in 1988. Joe Camel retired in 1997 — the same year big tobacco reached a $365 billion settlement, which included an end to marketing to kids.
Fun flavors
E-cigarettes come in a variety of flavors, including chocolate, gummy bears and evenwaffles topped with maple syrup and butter. To get in the fall spirit, V2 Cigs offers a pumpkin spice e-cigarette

The Food and Drug Administration banned flavors for regular cigarettes in 2009, saying cigarettes characterizing fruit, candy and cloves “have special appeal for children.”
Kiklas, though, disputes the need to extend these regulations to e-cigarettes. He cited the FDA’s approval of cherry-flavored nicotine lozenges. “Is that marketing to kids?” he said.
“We support any flavor that assists in a smoker’s transition to e-cigarettes,” he said.

Before the FDA ban on flavored cigarettes, Camel was offering tropical flavors such as “Kauai Kolada” with a hint of pineapple and coconut, as well as “Twista Lime.”
Kids in ads
The British e-cigarette company E-Lites features a baby dancing Gangnam-style. The U.K.’s Advertising Standards Authority banned the ad on TV and radio.
This Marlboro ad from the 1950s shows another family-friendly scene — a little boy sailing a paper boat with his dad while he’s smoking a cigarette.
Credit: From the collection of Stanford University (tobacco.stanford.edu)
E-cigarette company Bull Smoke tweets, “Everybody is doing it!” with pictures of celebrities, including movie stars Katherine Heigl and Dennis Quaid, reality TV star JWoww and actor Kevin Connolly.

The tobacco industry enacted a self-imposed ban on ads featuring entertainers, athletes and personalities in 1964. Before then, tobacco companies used A-list stars to sell their product.

10 Things E-Cigarettes Won't Tell You

By JEN WIECZNER
The cigarettes of the future could be safer, cheaper and less taboo than the smokes of the past. But they also threaten to upend decades of antismoking efforts.
1 “We’re Big Tobacco in disguise.”
When electronic cigarettes made their debut in the U.S. about five years ago, they seemed like a threat to the traditional cigarette industry.
The battery-powered devices, which turn nicotine-laced liquid into vapor, promised a less harmful and more socially acceptable alternative to combustible paper-and-tar cigarettes—and they were cheaper, not being subject to hefty tobacco taxes.
Already, the underdog industry is on track to hit nearly $2 billion in sales for 2013, tripling its 2012 figures, says Wells Fargo WFC -0.77% tobacco analyst Bonnie Herzog. And although the market for traditional cigarettes is still far bigger—topping $80 billion—Ms. Herzog predicts that e-cigarettes could surpass old-fashioned smokes in popularity within a decade.
But Big Tobacco brooks no challenge. The Big Three— Altria Group, MO -0.09%Reynolds American RAI +0.26% and Lorillard—have all made forays into e-cigarettes in the past two years.

2 “We can’t promise this won’t kill you.”
Antismoking advocates and public-health officials at the Centers for Disease Control and Prevention alike concede that e-cigarettes have fewer toxins than regular cigarettes and none of the tar.
But that’s no guarantee e-cigs won’t give you cancer or kill you the way tobacco-burning cigarettes are known to do.
The e-cigarette industry will go only so far as to say the products are “less harmful” than traditional smokes: “It’s better than a cigarette,” says Eric Criss, president of the Electronic Cigarette Industry Group, adding that the organization doesn’t want nonsmokers to start using the product.
3 “This probably isn’t the best way to quit smoking.”
E-cigarettes aren’t approved by the Food and Drug Administration as a smoking-cessation product, but users and advocates say that’s one of the devices’ biggest selling points. A Gallup survey of former smokers in July found that 3% credited electronic cigarettes with helping them quit, compared with 2% who cited prescription drugs and 1% who used nicotine gum.(The rest cited everything from will power to hypnosis.)
Still, health experts worry that smokers will just switch to e-cigarettes, or use them additionally, instead of quitting cold turkey.
4 “We’re advertising like it’s 1960—while we still can.”
You won’t see a Surgeon General’s warning on e-cig packages. And you will see them advertised on TV, from which ads for traditional cigarettes have been banned since 1971. And you’ll see them promoted by celebrities—another no-no for cigarette marketers.
Indeed, there are now an estimated 250 brands of e-cigarettes sold in stores and online, and virtually no federal regulations on them.
The FDA plans to issue new rules soon, however, and state lawmakers have tried to improvise a few of their own. E-cigarette industry representatives, for their part, say they are just as eager for regulation, “especially to keep electronic cigarettes out of the hands of children,” Mr. Criss says.
5 “We defy categorization.”
The e-cigarette industry says it welcomes regulation, but it’s also shown some ambivalence: On the one hand, it doesn’t want to be grouped with cigarettes, not only because it has staked its success on being an alternative to those products, but because being lumped in with them would put restrictions on who can buy e-cigs and how they’re advertised.
On the other hand, it doesn’t want to see its product shelved. To be categorized as safe and therapeutic, the industry would have to go through years of trials and FDA approval as a drug or drug-delivery device, effectively taking e-cigs off the market entirely, Mr. Criss says.
The lack of categorization probably won’t last much longer, however. The FDA is expected to issue long-awaited rules regulating e-cigs as a tobacco product this fall.
6 “We’re cheaper than cigarettes because we aren’t taxed like cigarettes.”
E-cigarettes’ biggest advantage over traditional cigarettes is their price, market analysts say. Regular cigarettes carry excise taxes of up to about 50% of the retail price; e-cigarettes, for the most part, are subject only to sales tax, says Ms. Herzog.
Regulation, however, and accompanying taxes are likely to increase prices. Ms. Herzog predicts that e-cigarettes will be taxed 5% next year, 10% by 2015 and 20% by 2019.
7 “Kids love us.”
If there’s one thing that the e-cigarette industry and the public-health community agree on, it’s that e-cigarettes aren’t for children. Many kids, on the other hand, seem to disagree.
The proportion of middle- and high-school kids who have used e-cigarettes doubled to nearly 7%, or almost 2 million students, between 2011 and 2012, according to a recent report by the CDC.
What’s more, “there’s a substantial concern that e-cigarettes will serve as a gateway product to nicotine addiction for a new generation of young people,” says Michael Fiore, a physician and director of the University of Wisconsin’s Center for Tobacco Research and Intervention.
8 “We’re bringing smoking back indoors…”
As cigarette smokers have been pushed ever farther out into the cold—often as far as 25 feet from the entrance of restaurants, bars and even outdoor spaces like parks and beaches—e-cigarette smokers have moved indoors.
The devices, which emit vapor that is less noticeable and odorous than smoke, and don’t involve flames or smoldering butts that pose a fire hazard, have largely been tolerated if not fully welcomed in places where smoking is banned, including workplaces.
Some policy makers have recently stomped out e-cigarettes, applying smoke-free laws to e-cigs, too. The University of California, where researchers recently found that “many of the elements” in e-cig vapor “are known to cause respiratory distress and disease,” has banned e-cigs at all of its campuses.
9 “…and back into aircraft.”
Lately, airlines have had to chastise not just passengers, but their own flight attendants for smoking—er, “vaping”—e-cigarettes on planes. The Department of Transportation doesn’t explicitly prohibit e-cigs but plans to issue new rules prohibiting them by mid-2014. And many airlines have explicitly banned them.
10 “E-joints and e-crackpipes are the new e-cig.”
The season premiere of Saturday Night Live in September included a mock commercial for “e-meth,” devices like e-cigarettes supposedly containing the illegal drug crystal meth. The spoof was funny because it seemed outrageous, but e-cigarette experts say that using the devices to vaporize illegal drugs isn’t so far-fetched.
Some users say e-cigarettes can easily vaporize a liquid form of marijuana, and Dr. Fiore cites reports that e-cigs could be used to consume crack cocaine. “It sure concerns me that there are new methods to deliver illegal substances, particularly to young people,” he says.
http://online.wsj.com/news/articles/SB10001424052702304448204579184052293918312

Quitters are winners: The benefits of kicking the tobacco habit

By Richard A. Claiborne

We all know the bad news about smoking, including health risks, expense and even criticism from non-smokers. But, for many people, scare tactics are not helpful when it comes to quitting. To put a positive spin on smoking cessation, let’s look at the benefits of living tobacco-free and how to go about quitting.
The greatest benefit to kicking the habit is dramatically improving your health. According to a report from the Surgeon General, as soon as you take that last puff, your body is busy repairing itself. Just one day after stopping, the heart rate and blood pressure drop and the carbon monoxide level drops to normal. By nine months, coughing and shortness of breath decrease; lungs start to regain normal function, increasing the ability to handle mucus, clean the lungs and reduce the risk of infection. At one year, the risk of coronary heart disease is half that of a smoker, and by five years, the report says the risks of cancer of the mouth, throat, esophagus and bladder are cut in half. After 15 years of living smoke-free, the risk of coronary heart disease and many cancers is that of a non-smoker.
Other benefits of living nicotine-free include:
•  Feeling in charge of your actions.
•  Knowing you are not bothering others with your smoke.
•  Saving money (not to mention time looking for a place to smoke).
•  Smelling better! Your hair, clothes, breath, care, home and kids won’t smell like smoke.
•  Enjoying an increased sense of smell.
•  Having fewer worries – about health, money, having to make sure you have a cigarette supply.
•  Looking and feeling better! Your skin will look healthier.
•  Having more energy.

How to quit

Those most successful at quitting are those who make a firm commitment, have a plan and work hand in hand with their physician to tailor a program to meet their unique needs. So:
•  Make a commitment and pick a “quit day.” Mark it on your calendar, tell friends and family and seek out support systems so you will feel accountable to achieve your goal.
•  Prepare your surroundings. Get rid of cigarettes and remove smoking triggers, including inviting smoking areas.
•  Stock up on suckers and gum to satisfy oral cravings.
•  Create distractions and have plans for how you will stay busy. Make a list of friends to call.
•  Make an appointment with your doctor. Your doctor can help you decide if you would benefit from anti-smoking medication or a support group.

Nicotine replacement therapy

Nicotine replacement therapy involves replacing cigarettes with other nicotine substitutes. Therapies work by delivering small and steady doses of nicotine into the body to relieve some of the withdrawal symptoms without the tars and poisonous gases found in cigarettes. This helps smokers focus on breaking their psychological addiction and learn new behaviors and coping skills.
The U.S. Food and Drug Administration has approved five types of nicotine replacement therapies: gum, lozenges and patches, which can be purchased over the counter; and nasal sprays and inhalers, which require a prescription. These products can be very helpful in the initial stages of quitting and withdrawal. However, nicotine is addictive and a person can transfer their dependence from cigarettes to the other therapy, particularly the fast delivery of nasal spray. Use only as prescribed by your doctor.

Prescription medications

These oral medications help you stop smoking by reducing cravings and withdrawal symptoms without the use of nicotine. Some can be used along with nicotine replacement therapies, and some must be started before your planned quit day.
Varenicline (Chantix) is a prescription medicine developed to help people stop smoking by interfering with nicotine receptors in the brain. It has a duel effect: It reduces the pleasure a person gets from smoking, and reduces the symptoms of nicotine withdrawal. It is typically started before your quit date. Bupropion (Zyban) is another effective prescription smoking cessation medicine. Several studies have shown taking medication can more than double the chances of quitting compared to taking no medicines at all. Medications are most effective when used as part of a comprehensive cessation program monitored by your physician.

Alternative therapies

•  Hypnosis – Places you in a deeply relaxed state where you are open to suggestions that strengthen your resolve to quit smoking.
•  Behavioral therapy – Nicotine addiction is related to the habitual behaviors involved in smoking. Behavior therapy focuses on learning new coping skills and breaking those habits.
•  Counseling – Participating in individual or group counseling can be beneficial in the educational and motivational aspects of smoking cessation. According to the Centers for Disease Control and Prevention, the combination of medication and counseling is more effective for smoking cessation than either medication or counseling alone.
Kicking the habit is hard work but it can be done. With a plan tailored to your needs, you can break the addiction, manage your cravings and join the millions of people who have quit smoking for good. If you are ready to quit, talk to your physician.

Richard A. Claiborne practices in pulmonary medicine at Via Christi Clinic, 3311 E. Murdock. He may be reached at 316-689-9325.

http://www.kansas.com/2013/11/09/3106682/quitters-are-winners-the-benefits.html

Crutch or cure: issues surround use of e-cigarettes

By Stephen Rickerl/Fremont Tribune
The meteoric rise in popularity of e-cigarettes has some people scratching their heads as to whether the tobacco-less devices are a new tool in smoking cessation or a Trojan horse that could undo decades of anti-smoking campaigns.
Electronic cigarettes are devices that primarily consist of a battery, heating coil, wick and tank or cartridge that holds flavored liquid and nicotine. As a user puffs on the e-cigarette, the battery heats the coil and the liquid is turned essentially into a vapor that is inhaled like a traditional cigarette.
But e-cigarette users don’t consider themselves smokers, they’re “vapers,” and they don’t smoke – they “vape.” Many of the devices look more like a lightsaber than a Lucky Strike.
Even though the products do not contain tobacco, and do not use combustion to deliver nicotine to the user, there are a number of issues, questions and criticisms surrounding the use of e-cigarettes.
Among the unknowns are whether e-cigarettes are a solution or part of the problem, the answer to which would likely depend on who you ask.
The Fremont Area Medical Center does not support the use of the products as a tool to quit smoking because they are not FDA approved.
Dr. James Sullivan of Fremont Family Care, a clinic associated with FAMC, said smoking is a great health hazard and doctors like it when people are thinking of ways to quit. But he, as a member of the medical community, has a couple of issues with the devices.
First, he said, the devices are unregulated, and outside of strict FDA oversight and testing, there is no way to be certain how much nicotine is being delivered to the user. Another issue Sullivan has with the devices is that the liquid nicotine, the addictive part of smoking, can have harmful health effects – especially in young people and in high doses.
In traditional smoking cessation programs, nicotine in gum or patches slowly weans the user off the drug.
“The e-cigarettes design is basically the same thing, ‘let’s replace the toxic nature of smoking and inhaling that and give you back the nicotine while you quit,’” Sullivan said. “The problem is you don’t know what dose of nicotine you’re getting by inhaling it.
“We need to know a reliable dose that is getting in. For that reason we are reticent to use it,” he added. “I don’t know if a lot of people are quitting, because nicotine is the addictive part. So people are just now using e-cigarettes instead of regular cigarettes, so they’re not using it as a tool to quit, just as a replacement.”
Other criticisms of the devices have included the fact that there are no laws in place banning the sale of the products to minors, and the e-juice — the liquid containing the nicotine — comes in a range of flavors from traditional tobacco to gummy bears, caramel and root beer.
In 2010 the FDA, based on limited studies of samples, issued warning letters to electronic cigarette distributors for various violations of the Federal Food, Drug and Cosmetic Act including “violations of good manufacturing practices, making unsubstantiated drug claims and using the devices as delivery mechanisms for active pharmaceutical ingredients.”
In reporting its results of those limited studies “FDA found significant quality issues that indicate that quality control processes used to manufacture these products are substandard or non-existent. FDA found that cartridges labeled as containing no nicotine contained nicotine and that three different electronic cigarette cartridges with the same label emitted a markedly different amount of nicotine with each puff.”
The American Lung Association in a public health statement said there are 250 different brands of e-cigarettes for sale in the U.S., and those brands are likely to have a wide variation of chemicals that each contain. The lung association said an FDA study in 2009 found detectable levels of toxic cancer-causing chemicals, including an ingredient used in anti-freeze.
Because of potential unknown risks, many school districts and public bodies are enacting policies to treat e-cigarettes like traditional cigarettes.
The Fremont Board of Education at its October meeting voted to approve the first reading of a policy that would treat e-cigarettes the same as traditional, or “burn” cigarettes – effectively banning their use on school grounds. The new policy is expected to pass a second and final reading at the board’s November meeting.
“I think from a school district’s perspective the reason we included them is we felt like they could be a distraction from the learning taking place in the classroom and also in the school,” said Mark Shepard, executive director of business and support services at Fremont Public Schools. “Our concern in adding it to the policy is it’s basically modeling a behavior that students should not be engaged in.”
Chad Burns, owner and CEO of American Vapor — a new e-cigarette store in Fremont — agrees that minors shouldn’t use the product and will not sell to minors, but disagrees with the findings of the incomplete FDA study.
“Right now our state doesn’t regulate (sales to minors). We can sell to anyone legally, morally we do not,” Burns said. “We self-regulate. If you’re not able to buy cigarettes, you’re not able to buy this. It’s 18 and older period. That’s self-imposed, but morally it’s the right thing to do.”
Burns said his business also self-regulates when it comes to the quality and consistency of e-juice.
“Everything we purchase is made here in the U.S. and we know where it is coming from. Most of them are local producers and we know what they’re doing,” Burns said. “Everything that we purchase, we purchase at zero nicotine and then we are right there when they add the nicotine, and it’s all computerized. You punch in how big of a bottle you’re putting the nicotine into and how many milligrams of nicotine you want in that bottle. The computer puts in the exact amount – to the drop.”
Burns said he would welcome FDA regulation of the industry.
“It would be a good idea because there are some shops out there that aren’t following the same standards,” he said. “Personally I want to know what I’m vaping, I don’t order anything offline – even for my personal use. We don’t like the companies that aren’t regulating because they’re giving us a bad name. And as this industry progresses, the weak will be weeded out of the herd.”
Shane Ekdahl, owner and business manager of American Vapor, said the store has been open two weeks and in that time business has been steady.
“People are just bringing their friends in by the droves,” he said. “It’s unreal.”
Ekdahl said about 20 percent of their customers are experienced vapers, but the other 80 percent are traditional smokers new to vaping.
Matt and Brandy Tulak said they smoked 14 and 17 years respectively. Neither has picked up a cigarette since they began vaping a week ago.
Matt Tulak said he was always the smoker who talked about quitting but never did. In vaping he sees the opportunity to satisfy his nicotine cravings without taking in additional chemicals associated with traditional smoking.
“You’re not getting all the nasty chemicals you’re getting from the cigarette,” he said. “I was getting to the point where I was wheezing at night going to bed. Now I don’t wake up in the morning and have that heavy chest,”
Brandy Tulak said they vape now because they like it better than smoking. They don’t smell like cigarettes and their sense of taste and smell are improving. She said she also likes that she can customize her device.
“You can customize your vapers to make them pretty, to speak to what you like,” she said. “With a cigarette you get stench, yellow teeth, wrinkles all that nasty stuff – and it’s not pretty.”
http://fremonttribune.com/news/local/crutch-or-cure-issues-surround-use-of-e-cigarettes/article_0c7c6547-458a-5d2f-8b3c-515f2c1f1c9b.html

Tobacco Myths Persist 50 Years After US Surgeon General Warned Americans of Smoking Dangers

Tobacco misconceptions prevail in the United States despite the dramatic drop in smoking rates since the release of the first Surgeon General’s Report on smoking and health in January 1964. Experts at The University of Texas MD Anderson Cancer Center dispel common myths and share new educational resources to address this persistent challenge.
“Since 1964, smoking rates have dropped by more than half as a result of successful education, legislative and smoking cessation efforts,” said Lewis Foxhall, M.D., vice president for health policy at MD Anderson. “Still, lung cancer remains the number one cancer killer and the leading preventable cause of death in the United States.”
With the approaching 50th anniversary of the Surgeon General’s Report, Foxhall and other MD Anderson experts urge the public to take a proactive stance against this pervasive health issue by gaining insight on current tobacco issues including information that disproves the following myths.
Tobacco Myth #1: Almost no one smokes any more.
Fact: About 43.8 million people still smoke. That’s almost one in five people in the United States.
“The current percentage of smokers is 19%. That’s significantly lower than the 42% in 1965,” Foxhall said. “However, the actual number of people smoking today is close to the same.” About 50 million people smoked in 1965. “Because our population is much larger, it just seems like we have a lot fewer smokers,” Foxhall explained.
“We have a lot of work ahead to prevent new smokers and help existing smokers quit,” said Ellen R. Gritz, Ph.D., professor and chair of behavioral science at MD Anderson. “Thanks to programs like the American Legacy Foundation’s truth national anti-smoking campaign, we have been able to achieve fewer youths smoking,” Gritz said, a previous vice chair on the Legacy board. “But funding for these campaigns is limited and unable to compete with the exorbitant and seemingly unlimited advertising dollars spent by tobacco companies.”
Tobacco Myth #2: e-Cigarettes, cigars and hookahs are safe alternatives.
Fact: All tobacco products, including e-cigarettes and hookahs, have nicotine. And it’s nicotine’s highly addictive properties that make these products harmful.
In 2008, the five largest cigarette companies spent $9.94 billion dollars on advertising and marketing products like e-cigarettes, flavored cigars, cigarillos and hookahs.
“The tobacco industry comes up with these new products to recruit new, younger smokers,” said Alexander Prokhorov, M.D., Ph.D., director of the Tobacco Outreach Education Program at MD Anderson. “And, they advertise them as less harmful than conventional cigarettes. But once a young person gets acquainted with nicotine, it’s more likely he or she will try other tobacco products.”
“While e-cigarettes may contain less harmful substances than combustible tobacco, they’re presently unregulated so quality control over the nicotine content and other components is left to the manufacturer,” said Paul Cinciripini, Ph.D., professor and deputy chair of behavioral science and director of the Tobacco Treatment Program at MD Anderson.
“At this time, it’s far too early to tell whether or not e-cigarettes can be used effectively as a smoking cessation device,” Cinciripini said.
Tobacco Myth #3: Infrequent, social smoking is harmless.
Fact: Any smoking, even social smoking, is dangerous.
“Science has not identified a safe level of smoking, and even a few cigarettes here and there can maintain addiction,” said David Wetter, Ph.D., chair of health disparities research at MD Anderson. “If you are a former smoker, data suggests that having just a single puff can send you back to smoking.”
Tobacco Myth #4: Smoking outside eliminates the dangers of secondhand smoke.
Fact: There is no risk-free level of exposure to secondhand smoke. Even brief secondhand smoke exposure can cause harm. Exposure to secondhand smoke at home or work increases a person’s risk of heart disease by 25 to 30% and lung cancer by 20 to 30%. That’s because the amount of cancer-causing chemicals is higher in secondhand smoke than in the smoke inhaled by smokers. Families that prohibit smoking in and around the home are on the right path, said Wetter.
Stay informed and take action
“Being educated and sharing this knowledge with others are ways to action,” said Ernest Hawk, M.D., vice president of cancer prevention and population sciences at MD Anderson. “For smokers, it’s never too late to quit smoking and reap health benefits.”
As part of MD Anderson’s Moon Shot program to end cancer, Hawk and other experts have developed a comprehensive plan that addresses the burden of tobacco use in institutions, communities, states and nations.
“The End Tobacco plan recommends more than 100 actions in the areas of policy, education and community-based services that MD Anderson can lead to end tobacco at the institutional, local, regional, state national and international levels,” Hawk said. “As a leader in the field of tobacco research, it’s vital we take a leadership role to confront the use of tobacco in any form.”
More than 200,000 people are diagnosed with lung cancer each year in the United States and about 150,000 people die as a result of this disease. Smoking contributes to almost 90% of lung cancer deaths and 30% of all cancer deaths.
Story Source:
The above story is based on materials provided by University of Texas M. D. Anderson Cancer Center.
Note: Materials may be edited for content and length. For further information, please contact the source cited above.
http://www.sciencedaily.com/releases/2013/11/131107142436.htm

Representative Phyllis Kahn proposes ban on indoor e-cigarettes

By Allison Kronberg
Minnesota could start treating e-cigarettes just like regular cigarettes.
Rep. Phyllis Kahn, DFL-Minneapolis, proposed a bill Friday to include e-cigarettes in the Minnesota Clean Indoor Air Act, which she authored in 1975, that would ban their use indoors.
She said she’s proposing the bill because the health effects of e-cigarettes are unclear, the smokeless alternative can appeal to young people and it would make the law consistent.
“The same controls that apply to smoking regular cigarettes would apply to smoking e-cigarettes,” Kahn said.
This summer’s new tobacco tax raised the price for a pack of cigarettes by $1.60. Since then, e-cigarettes have gained even more popularity with smokers in Minnesota.
Kahn said she’s heard many people support the bill.
“The negatives all come from people who are users of the e-cigarettes and maybe one from a manufacturer,” she said.
Bad for business
In its print ads, e-cigarette company FIN has encouraged its customers to “rewrite the rules.” Its website encourages users to “smoke when you want, where you want.”
University of Minnesota biology, society and environment sophomore Josh Meidl said he’s never smoked regular cigarettes and doesn’t plan to, but he carries his e-cigarette with him every day because he likes the taste.
“I feel like [the bill] just totally defeats the purpose of the e-cig, because one of its main purposes was to bring smokers back indoors,” he said.
While the move inside is a draw for some, businesses and agencies around the state are enforcing their own rules on the product.
Metro Transit spokesman John Siqveland said the public transportation network banned e-cigarettes from its buses, trains and facilities this summer. Hennepin County banned e-cigarettes on county property in July, a move that county administrator David Hough called proactive at the time.
Joe Berg, general manager of the Library Bar and Grill in Dinkytown, said statewide regulation would be beneficial. Now, the Library asks people not to smoke e-cigarettes on the property, and they generally comply, he said.
Kahn said opponents of the bill argue e-cigarettes are beneficial for smokers who are trying to quit.
“And the answer is no, we’re not going to take it away from you,” she said. “You use it exactly where you’d use a regular cigarette.”
Nasario Sepeda, manager at Smokedale Tobacco in Stadium Village, said the store relies “heavily” on e-cigarette sales and doesn’t agree with the ban.
“The only way to see if it has any effect on us is if it passes,” he said.
Health effects unknown
The U.S. Food and Drug Administration doesn’t regulate e-cigarettes, and experts say they’ve been researched little.
A 2009 FDA study found potentially harmful substances in a majority of the e-cigarettes sampled. E-cigarettes often have nicotine and can be addictive.
“One thing is that the FDA is still struggling over the safety,” Kahn said. “We’re looking at if it’s a safe thing for individuals to use.”
Kahn said e-cigarettes could be a gateway to their more dangerous counterparts, especially for young people. University research found young people would experiment with e-cigarettes because they’re often flavored and because the students view them positively.
Ferdinand Schlapper, director and chief health officer at Boynton Health Service, said the smokeless alternative just prolongs addiction, although many use e-cigarettes to help them quit smoking.
“Proven ways to stop smoking are nicotine replacement therapy and the patch, along with a supportive environment,” Boynton senior health advocate Timothy Bell said.
School of Public Health associate professor Deborah Hennrikus said she would support a ban on indoor e-cigarette use because there is still so little known about them.
“There isn’t enough known to the extent to which e-cigarettes can help people stop smoking, or to the extent to which they appeal to adolescents as a gateway to using other tobacco products,” she said.
“They’re new enough that the research hasn’t been done.”
http://www.mndaily.com/news/campus/2013/11/06/representative-phyllis-kahn-proposes-ban-indoor-e-cigarettes