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The Weird Link Between E-Cigarettes and Mental Health Disorders

Dan Kedmey, TIME

A new study finds elevated rates of depression, anxiety and other mental disorders among users of e-cigarettes

A new study has found that people suffering from depression, anxiety and other mental disorders are more than twice as likely to spark up an e-cigarette and three times as likely to “vape” regularly than those without a history of mental issues.

Researchers at the University of California, San Diego drew their findings from an extensive survey of American smoking habits. Among 10,041 respondents, 14.8% of individuals suffering from mental health disorders said they had tried an e-cigarette, compared with 6.6% of individuals who had no self-reported history of mental disorders.

The e-smokers’ elevated rates of mental disorders reflected the elevated rates of mental illness among smokers in general. The authors note that by some estimates, people suffering from mental disorders buy upwards of 50 percent of cigarettes sold in the U.S. annually.

Many respondents said they switched to e-cigarettes as a gateway to quitting. The FDA has not yet approved e-cigarettes as a quitting aide.

“People with mental health conditions have largely been forgotten in the war on smoking,” study author Sharon Cummins said in a university press release. “But because they are high consumers of cigarettes, they have the most to gain or lose from the e-cigarette phenomenon.”

The study will run in the May 13 issue of Tobacco Control.

http://time.com/97414/the-weird-link-between-e-cigarettes-and-mental-health-disorders/

CHUCK NORRIS EXTINGUISHES THE E-CIGARETTE CRAZE

Question to Norris:  Chuck, my son joined the train of those who are smoking e-cigarettes. He claims they are better for him than regular smoking and that’s why he does it. Do you have any thoughts on this latest fad? – “Eliminate the E-Cigs, Too,” in Elko, Nev.
Answer:  E-cigarettes have become more than just one of the latest crazes among our culture. Vaping, which is the process of “smoking” or inhaling e-cigs, is a billion-dollar business in the U.S. and has its own subculture. Rather than devices that merely look like cigarettes, whole new breeds of smokeless apparatuses to help users get their next nicotine fix have been spawned by vaping.
Technically speaking, vaping isn’t smoking, at least according to its veteran users. Nevertheless, a user is viewed as inhaling and exhaling vapor that is generally mimicking smoke.
For the record, according to the Macmillan English Dictionary, “E-cigarettes are battery-powered devices that provide inhaled doses of nicotine through a vaporized solution.” They generally utilize a heating element to vaporize that nicotine cocktail.
E-liquid, aka e-juice, is normally composed of four or five ingredients, according to Project:Vape:
1) Vegetable glycerin and/or propylene glycol makes up 80-90 percent. These are touted as “generally considered safe for consumption” because they are “widely used as food additives in a variety of commercially available products.”
2) Flavor makes up 10-20 percent. These are generally food-grade flavorings intended for baking or candy making.
3) Nicotine makes up 0-2.4 percent, depending upon potency. But according to The New York Times, “Most range between 1.8 percent and 2.4 percent, concentrations that can cause sickness, but rarely death, in children. But higher concentrations, like 10 percent or even 7.2 percent, are widely available on the Internet.” (I will speak later about the potential hazards of such high dosages.)
4) Potency prompts some manufacturers to use distilled water to dilute the chemicals.
The pitch of e-cigarettes is that they are a safer alternative to smoking. Supporters say e-juice is much less harmful than tobacco, which contains tar and other chemicals that cause cancer. Some even use e-cigarettes as a way to cut down on and quit smoking.
There is selective research that says vaping may be as effective as nicotine patches in terms of quitting smoking, but a new study documented in JAMA Internal Medicine showed that those who vaped were no likelier to quit or even smoke less than tobacco smokers. (It should be noted, however, that those who smoked e-cigarettes represented only 10 percent of those in the study.)
The Boston Globe reported: “Researchers followed nearly 1,000 smokers for a year and found that those who used e-cigarettes were no more likely to quit smoking or reduce their dependence on tobacco cigarettes than those who weren’t using the products at the beginning of the study. About 14 percent of those who didn’t use e-cigarettes quit smoking compared to 10 percent of those (who) used the products.”
I have two primary concerns about e-cigarettes. The first is that there is a significant increase of use among minors. Despite the fact that e-juice’s chemicals are less harmful than tobacco, nicotine is still an addictive drug. And in liquid form, potency and ingestion (let alone unregulated chemical mixing) clearly pose greater risks among youths.
Neal L. Benowitz, a professor and specialist in nicotine research at the University of California, San Francisco, explained: “There’s no risk to a barista no matter how much caffeine they spill on themselves. Nicotine is different.”
The health risks were explained in a recent New York Times article, “Selling a Poison by the Barrel: Liquid Nicotine for E-Cigarettes.”
It noted, “Toxicologists warn that e-liquids pose a significant risk to public health, particularly to children, who may be drawn to their bright colors and fragrant flavorings like cherry, chocolate and bubble gum.”
Some even look similar to a 5-hour Energy drink, which is why many teens are mixing these vials of nicotine with energy drinks for a quick high, according to Fox News.
But e-juices can deliver far more than benign buzzes. The Times continued: “These ‘e-liquids,’ the key ingredients in e-cigarettes, are powerful neurotoxins. Tiny amounts, whether ingested or absorbed through the skin, can cause vomiting and seizures and even be lethal. A teaspoon of even highly diluted e-liquid can kill a small child.”
I mentioned earlier that higher concentrations are widely available on the Internet. The Times went on to discuss how a lethal dose at such levels could be “less than a tablespoon,” according to Dr. Lee Cantrell, director of the San Diego division of the California Poison Control System and a professor of pharmacy at the University of California, San Francisco. “Not just a kid. One tablespoon could kill an adult,” he said.
The Times further reported on increased poisonings: “Nationwide, the number of cases linked to e-liquids jumped to 1,351 in 2013, a 300 percent increase from 2012, and the number is on pace to double this year, according to information from the National Poison Data System. Of the cases in 2013, 365 were referred to hospitals, triple the previous year’s number.”
This is particularly alarming when one realizes, as the Los Angeles Times recently documented from a Centers for Disease Control and Prevention report, that e-cigarette use among minors has increased significantly. Case in point, the percentage of high-school students who have tried vaping has gone up significantly in recent years, from 4.7 percent in 2011 to 10 percent in 2012. One can only imagine how that percentage has increased in the past two years.
It’s no surprise, the LA Times continued, that “health advocacy groups, including the American Heart Assn., Tobacco-Free Kids and the American Cancer Society Cancer Action Network, have expressed concern that any delay on additional regulations would allow the fast-growing industry, which already counts billions of dollars of sales, to target more children.”
That is why even some of e-cigarettes’ biggest supporters are advocating some regulation. Chip Paul – CEO of Palm Beach Vapors, which operates 13 nationwide e-cigarette franchises and plans to open 50 more in 2014 – says: “It’s the wild, wild west right now. Everybody fears FDA regulation, but honestly, we kind of welcome some kind of rules and regulations around this liquid.”
Besides the health risks, my biggest problem with e-cigarettes remains that I’m just not a believer that introducing another popular addictive vice in society is going to help young, old or America. Instead of perpetuating a this-is-better-than-that drug consumerism – as many do with the marijuana vs. tobacco smoking debate – maybe we should simply start making healthier decisions by eliminating any and all potential health risks in our lives.
I’ve said it before: Justifying eating a plain doughnut over a glazed doughnut because it’s healthier doesn’t mean one is making a healthy decision that will empower the person for optimal human performance and longevity.
Write to Chuck Norris with your questions about health and fitness. Follow Chuck Norris through his official social media sites, on Twitter @chucknorris and Facebook’s “Official Chuck Norris Page.” He blogs at ChuckNorrisNews.blogspot.com.
Read more at http://www.wnd.com/2014/05/chuck-norris-extinguishes-the-e-cigarette-craze/#yATcDVs6ZQMUKGBU.99

E-Cigarette Makers Going After Youth, Report Finds

BY MAGGIE FOX, NBC News

E-cigarette makers may say they welcome regulation and don’t want to sell to teenage nonsmokers, but their advertising dollars paint a very different picture, according to a report released Thursday.

E-cigarette makers spent $39 million on ads from June through November 2013, much of it on programming targeting youth, the anti-tobacco organization Legacy found.

“Overall, these research findings indicate that, despite their publicly stated intentions, some e-cigarette companies are reaching youth with their advertising,” Legacy says in its report.

“Moreover, the only national brand owned by a major tobacco company, blu, is reaching a significant portion of young Americans with its advertising. The effects of this are apparent, with nearly all young people aware of these products and use among young people rising rapidly.”

Health officials from several major U.S. cities say that’s why federal regulators need to act. They can restrict sales and limit where people may smoke or “vape,” but they cannot restrict national ads.

“There are some areas where our hands are tied and that particularly is in marketing,” said New York City health commissioner Dr. Mary Travis Bassett.

“They need to do more to protect kids from the effects of TV,” added Los Angeles County health commissioner Dr. Jonathan Fielding.

The fear is a whole new generation of people will become addicted to nicotine before federal regulations can be written, let alone take hold, the health commissioners told a news conference. New York, Chicago, Boston and Los Angeles County are among the big city areas that have restricted sales and use of e-cigarettes.

Even some public health experts say e-cigarettes may be a useful alternative to burned tobacco cigarettes for smokers. But they also agree that it would be bad to encourage or even allow non-smoking children to become addicted to the nicotine in e-cigarettes.

Legacy was set up in 1999 as part of the Master Settlement Agreement when major tobacco companies agreed to pay more than $200 billion to states and territories. The states wanted some of the money to be used for an organization dedicated to studying and providing public education about the impact of tobacco.

Just last week, the U.S. Food and Drug Administration said it would seek to regulate e-cigarettes, because they contain nicotine, the addictive substance in tobacco. Most e-cigarette makers said they’d welcome some regulation.

Legacy did two studies looking at the marketing of e-cigarettes, and asking teens and young adults what they knew about them. It found e-cigarette TV ads reached 29.3 million teens and young adults from January through November 2013, including 58 percent of 12- to 17-year-olds.

Taken together, the two reports show e-cigarette makers using tactics that have long been banned for regular cigarettes, the report says.

E-cigarette makers dispute this. “The products are being advertised to adults,” said Cynthia Cabrera, executive director of the Smoke Free Alternatives Trade Association. “If children are watching during that time, it’s possible, but they are being marketed to adult consumers, to adult smokers.”

Public health experts say 90 percent of smokers start by the age of 20. They worry that e-cigarettes sold in flavors such as bubble gum and Gummi bear are targeted mainly to younger teens.

“While cigarette advertising is prohibited on television, it is currently fair game to use television to promote electronic cigarettes. Using broadcast and online advertising has allowed the e-cigarette industry to promote its products in a way that has broad reach and is largely unregulated,” Legacy says.

“Every day that industry is growing very, very rapidly,” LA’s Fielding said. “And you can be sure that big tobacco is going to wind up in the driver’s seat with respect to marketing. Don’t let them undo decades of efforts to de-glamorize smoking.”

http://www.nbcnews.com/health/kids-health/e-cigarette-makers-going-after-youth-report-finds-n94166

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

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

Forum editorial: The ‘no’ applies to e-cigs

Forum editorials represent the opinion of Forum management and the newspaper’s Editorial Board.

Under the smoke-free law approved by North Dakota voters in 2012 the use of
so-called electronic cigarettes is prohibited in all places where smoking tobacco is not allowed. It’s that simple. The law, which won voter support in every county in the state, is unequivocal. No spinning by the tobacco lobby and its lackeys can make North Dakota’s e-cig prohibition less clear.
One argument for treating e-cigs differently than tobacco cigarettes is the devices do not generate secondhand smoke, and that they help smokers who want to quit tobacco. Therefore, e-cig advocates contend they should not be in the same banned-nearly-everywhere classification as other tobacco-based smoking products.
It’s all smoke and mirrors promulgated by Big Tobacco and others who know e-cigs can be (and early research shows they are) gateways for young people to start smoking tobacco.
First, the claim the vapors produced by e-cigs are harmless has no good science behind it. Rather, the substances generated include humectants used in fog and smoke machines, and vaporized nicotine and artificial flavors. Manufacturers have been cited for contaminants, including nickel, arsenic and chromium. There is no FDA oversight, no product-specific taxes and no restrictions on age of buyers.
No matter how dressed up they are, e-cigs are simply a nicotine-delivery device. The dangers of nicotine, a poisonous water-soluble alkaloid, are known. Furthermore, e-cigs are being marketed by emphasizing their candy-like flavors and seemingly benign brand names. Young people are responding as expected. A recent Youth Tobacco Survey showed a spike in e-cig use by youth, doubling to 10 percent in one year.
Also, the claim that e-cigs help cigarette smokers quit, and therefore should be unregulated, is a phony argument. There is nothing in law that prevents smokers from using e-cigs, as long as used in compliance with North Dakota’s smoke-free laws.
E-cigarettes represent the latest attempt by tobacco companies and their allies to hook more young smokers, and thus ensure a nicotine-addicted customer base into the future. The effort to characterize the devices as a way to help smokers quit is cynical and predicated on a falsehood. That effort has wormed its way into legislatures, including the North Dakota Legislature, where a handful of lawmakers have bought into the lie.
Voters overwhelming said “no” to cigarettes in 2012. That “no” included e-cigarettes. Legislators who don’t get it might want to find other work.
http://www.inforum.com/event/article/id/432045/group/Opinion/

ERIC JOHNSON: E-cigs’ risks are real while benefits are scant

By Eric Johnson, Op-Ed, Grand Forks Herald
GRAND FORKS — According to the Centers for Disease Control and the U.S. Surgeon General, tobacco kills about 480,000 persons every year in the United States.
In 1964, about 41 percent of adults were cigarette smokers. Today, that rate is down to a little more than 18 percent. Significant strides have been made over the past five decades to reduce smoking and the tremendous health and financial burden it puts on our society.
In North Dakota alone, tobacco use still contributes to about $250 million in health care expenditures.
Encouraging people to quit tobacco remains a high priority with regard to the health of Americans, yet only two states in the nation — Alaska and North Dakota — fund anti-tobacco programs at levels recommended by the CDC.
In North Dakota, our efforts continue to be supported by the public. Public sentiment, expressed at the ballot box and in polling, shows that reducing tobacco use remains a high priority for North Dakotans. In 2008, voters approved Measure 3 to support funding of anti-tobacco programs; and in 2012, the statewide smoke-free law — passed as a ballot measure — got 67 percent of the vote, winning support from a majority of voters in every legislative district.
Some 89 percent of North Dakotans polled in 2013 think the funds designated for tobacco control should stay there.
What works to help people quit tobacco? The U.S. Preventive Task Force and the Surgeon General endorse medications that have proven effectiveness with a known, Food and Drug Administration-approved, safety and side-effect profile.
These include nicotine replacement products such as gum, patches or lozenges, as well as prescription medications such as Chantix (Varenicline) or Wellbutrin (Buproprion).
Proven counseling programs, such as NDQuits (available free to all North Dakotans who use tobacco), also are very effective, particularly when combined with an FDA-approved medication.
Electronic cigarettes (e-cigs) are increasingly popular products that fall into the unproven category. First invented in the 1960s, their popularity has continued to increase as large tobacco companies buy small “mom-and-pop” manufacturers. With more than 250 brands on the market, (“Blu,” “NJOY” and “Vuse” popular in America), e-cigs are battery-powered (some disposable, some rechargeable) with a vaporizer and mouthpiece attached.
When used, commonly referred to as “vaping,” the vaporizer boils the liquid inside, which most frequently contains three major ingredients — humectants (propylene glycol/glycerin, used in fog and smoke machines and antifreeze), nicotine (at varying levels) and flavoring (fruit flavors, bubble gum, cotton candy, bacon and coffee, to name a few).
Unlike other medications that are used to promote quitting tobacco, e-cigs are largely unregulated by the Food and Drug Administration; and to date, we have no real data to show that they are effective as a cessation product nor any data to show that they are safe.
Furthermore, some of these manufacturers have been cited for contaminants in their products, including nickel, arsenic and chromium.
Without FDA oversight, these products aren’t taxed, they can be sold to anyone of any age, and there are no restrictions on advertising, which is why we see and hear ads on TV, in magazines and on the radio.
Though the industry denies it, it’s apparent that these products are being marketed to children (unless we’re supposed to believe that “Hello Kitty” e-cigs are popular among adult users).
E-cig manufacturers, rather than relying on science, really are trying to “normalize” smoking again for the next generation. The recent national Youth Tobacco Survey showed a spike in use of e-cigs by youth, doubling to more than 10 percent in just one year.
In addition, many who use e-cigs become dual users, continuing to use other tobacco products at the same time.
Last but not least, the industry is playing on the desperate idea that anything else would be better than smoking traditional cigarettes. If that’s true, ask yourself why these same companies are so resistant to producing the data to back up their claims.
It’s disappointing that e-cigs have been marketed for more than 35 years and have yet to collect or publish any significant data to show they are safe for users or that they actually help people quit.
Considering these products increasingly are manufactured and marketed by Big Tobacco, I’m not anticipating we’ll see such data any time soon.
The FDA has made it very clear that e-cigs cannot be marketed as smoking cessation products as a result.
As a health care provider, I would love a good, new and novel option to help people quit smoking. Like other conditions I treat as a physician, I want to provide the best possible treatment for my patients, and that means practicing strategies and using medications that have scientific proof that they work and have an established safety profile.
To date, when it comes to quitting tobacco, that answer is not found in electronic cigarettes.
Dr. Johnson is a family physician at Altru Health System in Grand Forks.
http://www.grandforksherald.com/content/eric-johnson-e-cigs-risks-are-real-while-benefits-are-scant

19th Annual Kick Butts Day used to promote a tobacco-free lifestyle

By Sun Staff , Jamestown Sun
The 19th annual Kick Butts Day, a national day when youths are encouraged to stand up and speak out against tobacco companies, is Wednesday.
Central Valley Health District and the North Dakota Center for Tobacco Prevention and Control Policy are using this occasion to educate youth about the dangers of tobacco.
Research shows that 600 North Dakota youths under the age of 18 become new daily smokers every year, and 14,000 youths will die prematurely from smoking. In addition, 1.9 million packs of cigarettes are bought or smoked each year by youth younger than 18.
Tobacco companies are spending millions in North Dakota each year to get the youth smoking rates up, according to Jeanne Prom, executive director for the Center. Prom said that some of the tactics tobacco companies use to attract youth are candy- and fruit-flavored tobacco products, providing discounts and sales that make their products affordable and paying retailers to prominently display tobacco products in high-traffic areas.
Julie Hoeckle with Central Valley Health District said that Kick Butts Day is a great way to educate youths in the community on the importance of remaining tobacco-free and to inform everyone about the harmful marketing schemes tobacco companies are using to trap youths into using tobacco.
“It’s essential that we continue to educate our youth about tobacco marketing practices so they can identify those tactics and avoid being lured into tobacco use,” Hoeckle said. “Education is key in tobacco prevention.”
Another effective way to reduce youth smoking rates is to increase the cost of tobacco, Hoeckle said. Research supported by the Centers for Disease Control and Prevention and the American Lung Association shows that increasing North Dakota’s tobacco tax from 44 cents to $2 would reduce youth smoking rates by 25 percent.
“By making tobacco less affordable, kids are less likely to try using tobacco,” Prom said. “North Dakota projections show us that a $2 cigarette tax has the potential to prevent nearly 8,000 kids from ever starting to use tobacco and can save millions of dollars in health care costs.”
To learn about tobacco prevention, contact Hoeckle or Nancy Neary at 252-8130 or visit www.breathend.com.
http://www.jamestownsun.com/content/19th-annual-kick-butts-day-used-promote-tobacco-free-lifestyle

Players find tobacco habit hard to shake

By Peter Abraham |  BOSTON GLOBE

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

Teenage E-Cigarette Use Likely Gateway to Smoking

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

Enticing Product

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

No Tar

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

Nicotine Effects

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

Pivotal Year

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

Bans Criticized

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

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

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