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

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

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

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

5 Things to Know About E-Cigarettes

By , ABC News

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

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

E-Cigarette Health Row Catches Fire

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

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

What are e-cigarettes?

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

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

How much do they cost?

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

Are e-cigarettes regulated?

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

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

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

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

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

What are the health risks of vaping?

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

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

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

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

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

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

Do e-cigarettes help tobacco smokers quit?

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

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

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

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

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

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

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

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

U.S. Senators call for e-cigarettes advertising ban

​WASHINGTON – Last week U.S. Senator Tom Harkin (D-IA), chairman of the Senate Health, Education, Labor, and Pensions (HELP) Committee, joined Senators Barbara Boxer (D-CA), Dick Durbin (D-IL), Richard Blumenthal (D-CT) and Edward J. Markey (D-MA) in introducing the Protecting Children from Electronic Cigarette Advertising Act, a bill that seeks to prohibit the marketing of e-cigarettes to children and teens.
“When it comes to the marketing of e-cigarettes to children and teens, it’s ‘Joe Camel’ all over again,” said Harkin in a press release. “It is troubling that manufacturers of e-cigarettes — some of whom also make traditional cigarettes — are attempting to establish a new generation of nicotine addicts through aggressive marketing that often uses cartoons and sponsorship of music festivals and sporting events. This bill will take strong action to prohibit the advertising of e-cigarettes directed at young people and ensure that the FTC can take action against those who violate the law. While FDA regulation of these products remains critical, this legislation would complement oversight and regulation by the FDA, and ultimately help prevent e-cigarette manufacturers from targeting our children.”
“Tobacco companies advertising e-cigarettes — with flavors like bubblegum and strawberry — are clearly targeting young people with the intent of creating a new generation of smokers, and those that argue otherwise are being callously disingenuous,” Blumenthal said.
“We’ve made great strides educating young people about the dangers of smoking, and we cannot allow e-cigarettes to snuff out the progress we’ve made preventing nicotine addiction and its deadly consequences,” said Markey.
The senators noted in a press release that e-cigarettes are not subject to federal laws and regulations that apply to traditional cigarettes, including a ban on marketing to youth. The Protecting Children from Electronic Cigarette Advertising Act would permit the Federal Trade Commission (FTC) to determine what constitutes marketing e-cigarettes to children, and would allow the FTC to work with states attorneys general to enforce the ban.
In December, Senators Harkin, Durbin, Boxer, Blumenthal, Markey and Sherrod Brown (D-OH) sent a letter urging the FTC to investigate the marketing practices of e-cigarette manufacturers.
http://www.nacsonline.com/News/Daily/Pages/ND0303141.aspx#.UxSdH0JdXuc

Health Minute: Doctors weigh in on e-cigarettes

(CNN) — Tobacco-less cigarettes called e-cigarettes are gaining popularity in this country.
They can help people quit smoking, but some fear they can get others hooked on nicotine.
Peter Chugaev has been smoking for 45 years and for the past 15 he’s been trying to quit.
“You have a cup of coffee, you go on the deck, you have a cigarette,” Chugaev said.
Now he’s turning to electronic cigarettes to try to quit. Users inhale, but there’s no smoke. Taking a puff triggers a heating coil, which warms up liquid nicotine, in a plastic filter, resulting in nicotine-filled vapor.
But hardcore smokers aren’t the only ones seeking out e-cigarettes.
Young people are as well and this has some health experts concerned because these products are not federally regulated and there is limited research on their safety.
Dr. Sharon Bergquist, with the Emory School of Medicine said, “The greatest concern is that between 2011 and 2012 the rate of use between middle school and high school kids has doubled.”
These products come in flavors that may appeal to young people.
Dr. Thomas Frieden, Director of the Centers for Disease Control says, “Well, there are not a lot of adults who would smoke a cotton candy e-cigarette.”
Health experts worry that once addicted to the nicotine in e-cigarettes, young people may branch out and try tobacco products.
Manufacturers say they don’t market to kids and maintain that electronic cigarettes are a good alternative to conventional cigarettes.
And for Peter, e-cigarettes seem to be helping. He is down from a pack a day of regular cigarettes to about half that and hopes to kick the habit by the end of the year.
http://fox44.com/news/health-minute-doctors-weigh-e-cigarettes

To the Editor: Curbs on E-Cigarettes

To the Editor:

Re “Hot Debate Over E-Cigarettes as Path to Tobacco, or From It” (“The New Smoke” series, front page, Feb. 23):

As you note, the health effects of e-cigarette use remain unknown, and their use may actually be leading to greater smoking of traditional cigarettes, especially among children.

In fact, a recent study of 76,000 South Korean teenagers indicates that users of e-cigarettes were less likely to succeed in quitting smoking and were more likely to be heavy smokers.

The availability of e-cigarette flavored vapors (mango and watermelon) enhances the attraction. The troubling increase in the use of e-cigarettes among American teenagers found in the survey by the Centers for Disease Control and Prevention, also reported in the article, suggests that e-cigarettes are a gateway to tobacco addiction.

The American Thoracic Society, as a member of the Forum of International Respiratory Societies, supports an age restriction and government regulation of the sale of e-cigarettes, which in many states do not exist. Until more research is done, it is dangerous to promote their widespread use.

PATRICIA FINN
Chicago, Feb. 24, 2014

The writer is president of the American Thoracic Society and chairwoman of the department of medicine at the University of Illinois Chicago.

http://www.nytimes.com/2014/02/28/opinion/curbs-on-e-cigarettes.html?_r=0

A Hot Debate Over E-Cigarettes as a Path to Tobacco, or From It

By , The New York Times

Dr. Michael Siegel, a hard-charging public health researcher at Boston University, argues that e-cigarettes could be the beginning of the end of smoking in America. He sees them as a disruptive innovation that could make cigarettes obsolete, like the computer did to the typewriter.

But his former teacher and mentor, Stanton A. Glantz, a professor of medicine at the University of California, San Francisco, is convinced that e-cigarettes may erase the hard-won progress achieved over the last half-century in reducing smoking. He predicts that the modern gadgetry will be a glittering gateway to the deadly, old-fashioned habit for children, and that adult smokers will stay hooked longer now that they can get a nicotine fix at their desks.

These experts represent the two camps now at war over the public health implications of e-cigarettes. The devices, intended to feed nicotine addiction without the toxic tar of conventional cigarettes, have divided a normally sedate public health community that had long been united in the fight against smoking and Big Tobacco.

The essence of their disagreement comes down to a simple question: Will e-cigarettes cause more or fewer people to smoke? The answer matters. Cigarette smoking is still the single largest cause of preventable death in the United States, killing about 480,000 people a year.

Dr. Siegel, whose graduate school manuscripts Dr. Glantz used to read, says e-cigarette pessimists are stuck on the idea that anything that looks like smoking is bad. “They are so blinded by this ideology that they are not able to see e-cigarettes objectively,” he said. Dr. Glantz disagrees. “E-cigarettes seem like a good idea,” he said, “but they aren’t.”

Science that might resolve questions about e-cigarettes is still developing, and many experts agree that the evidence so far is too skimpy to draw definitive conclusions about the long-term effects of the devices on the broader population.

“The popularity is outpacing the knowledge,” said Dr. Michael B. Steinberg, associate professor of medicine at the Robert Wood Johnson Medical School at Rutgers University. “We’ll have a better idea in another year or two of how safe these products are, but the question is, will the horse be out of the barn by then?”

This high-stakes debate over what e-cigarettes mean for the nation’s 42 million smokers comes at a crucial moment. Soon, the Food and Drug Administration is expected to issue regulations that would give the agency control over the devices, which have had explosive growth virtually free of any federal oversight. (Some cities, like Boston and New York, and states, like New Jersey and Utah, have already weighed in, enacting bans in public places.)

The new federal rules will have broad implications for public health. If they are too tough, experts say, they risk snuffing out small e-cigarette companies in favor of Big Tobacco, which has recently entered the e-cigarette business. If they are too lax, sloppy manufacturing could lead to devices that do not work properly or even harm people.

And many scientists say e-cigarettes will be truly effective in reducing the death toll from smoking only with the right kind of federal regulation — for example, rules that make ordinary cigarettes more expensive than e-cigarettes, or that reduce the amount of nicotine in ordinary cigarettes so smokers turn to e-cigarettes for their nicotine.

“E-cigarettes are not a miracle cure,” said David B. Abrams, executive director of the Schroeder National Institute for Tobacco Research and Policy Studies at the Legacy Foundation, an antismoking research group. “They need a little help to eclipse cigarettes, which are still the most satisfying and deadly product ever made.”

Smoking is already undergoing a rapid evolution. Nicotine, the powerful stimulant that makes traditional cigarettes addictive, is the crucial ingredient in e-cigarettes, whose current incarnation was developed by a Chinese pharmacist whose father died of lung cancer. With e-cigarettes, nicotine is inhaled through a liquid that is heated into vapor. New research suggests that e-cigarettes deliver nicotine faster than gum or lozenges, two therapies that have never quite taken off.

Sales of e-cigarettes more than doubled last year from 2012, to $1.7 billion, according to Bonnie Herzog, an analyst at Wells Fargo Securities. Ms. Herzog said that in the next decade, consumption of e-cigarettes could outstrip that of conventional cigarettes. The number of stores that sell them has quadrupled in just the last year, according to the Smoke Free Alternatives Trade Association, an e-cigarette industry trade group.

“E-cigarette users sure seem to be speaking with their pocketbooks,” said Mitchell Zeller, director of the F.D.A.’s Center for Tobacco Products.

Public health experts like to say that people smoke for the nicotine but die from the tar. And the reason e-cigarettes have caused such a stir is that they take the deadly tar out of the equation while offering the nicotine fix and the sensation of smoking. For all that is unknown about the new devices — they have been on the American market for only seven years — most researchers agree that puffing on one is far less harmful than smoking a traditional cigarette.

But then their views diverge.

Pessimists like Dr. Glantz say that while e-cigarettes might be good in theory, they are bad in practice. The vast majority of people who smoke them now also smoke conventional cigarettes, he said, and there is little evidence that much switching is happening. E-cigarettes may even prolong the habit, he said, by offering a dose of nicotine at times when getting one from a traditional cigarette is inconvenient or illegal.

What is more, critics say, they make smoking look alluring again, with images on billboards and television ads for the first time in decades. Dr. Glantz says that only about half the people alive today have ever seen a broadcast ad for cigarettes. “I feel like I’ve gotten into a time machine and gone back to the 1980s,” he said.

Researchers also worry that e-cigarettes could be a gateway to traditional cigarettes for young people. The devices are sold on the Internet. The liquids that make their vapor come in flavors like mango and watermelon. Celebrities smoke them: Julia Louis-Dreyfus and Leonardo DiCaprio puffed on them at the Golden Globe Awards.

A survey from the Centers for Disease Control and Prevention found that in 2012, about 10 percent of high school students said they had tried an e-cigarette, up from 5 percent in 2011. But 7 percent of those who had tried e-cigarettes said they had never smoked a traditional cigarette, prompting concern that e-cigarettes were, in fact, becoming a gateway.

“I think the precautionary principle — better safe than sorry — rules here,” said Dr. Thomas Frieden, director of the C.D.C.

E-cigarette skeptics have also raised concerns about nicotine addiction. But many researchers say that the nicotine by itself is not a serious health hazard. Nicotine-replacement therapies like lozenges and patches have been used for years. Some even argue that nicotine is a lot like caffeine: an addictive substance that stimulates the mind.

“Nicotine may have some adverse health effects, but they are relatively minor,” said Dr. Neal L. Benowitz, a professor of medicine at the University of California, San Francisco, who has spent his career studying the pharmacology of nicotine.

Another ingredient, propylene glycol, the vapor that e-cigarettes emit — whose main alternative use is as fake smoke on concert and theater stages — is a lung irritant, and the effects of inhaling it over time are a concern, Dr. Benowitz said.

But Dr. Siegel and others contend that some public health experts, after a single-minded battle against smoking that has run for decades, are too inflexible about e-cigarettes. The strategy should be to reduce harm from conventional cigarettes, and e-cigarettes offer a way to do that, he said, much in the way that giving clean needles to intravenous drug users reduces their odds of getting infected with the virus that causes AIDS.

Solid evidence about e-cigarettes is limited. A clinical trial in New Zealand, which many researchers regard as the most reliable study to date, found that after six months about 7 percent of people given e-cigarettes had quit smoking, a slightly better rate than those with patches.

“The findings were intriguing but nothing to write home about yet,” said Thomas J. Glynn, a researcher at the American Cancer Society.

In Britain, where the regulatory process is more developed than in the United States, researchers say that smoking trends are heading in the right direction.

“Motivation to quit is up, success of quit attempts are up, and prevalence is coming down faster than it has for the last six or seven years,” said Robert West, director of tobacco studies at University College London. It is impossible to know whether e-cigarettes drove the changes, he said, but “we can certainly say they are not undermining quitting.”

The scientific uncertainties have intensified the public health fight, with each side seizing on scraps of new data to bolster its position. One recent study in Germany on secondhand vapor from e-cigarettes prompted Dr. Glantz to write on his blog, “More evidence that e-cigs cause substantial air pollution.” Dr. Siegel highlighted the same study, concluding that it showed “no evidence of a significant public health hazard.”

That Big Tobacco is now selling e-cigarettes has contributed to skepticism among experts and advocates.

Cigarettes went into broad use in the 1920s — and by the 1940s, lung cancer rates had exploded. More Americans have died from smoking than in all the wars the United States has fought. Smoking rates have declined sharply since the 1960s, when about half of all men and a third of women smoked. But progress has slowed, with a smoking rate now of around 18 percent.

“Part of the furniture for us is that the tobacco industry is evil and everything they do has to be opposed,” said John Britton, a professor of epidemiology at the University of Nottingham in England, and the director for the U.K. Center for Tobacco and Alcohol Studies. “But one doesn’t want that to get in the way of public health.”

Carefully devised federal regulations might channel the marketing might of major tobacco companies into e-cigarettes, cannibalizing sales of traditional cigarettes, Dr. Abrams of the Schroeder Institute said. “We need a jujitsu move to take their own weight and use it against them,” he said.

Dr. Benowitz said he could see a situation under which the F.D.A. would gradually reduce the nicotine levels allowable in traditional cigarettes, pushing smokers to e-cigarettes.

“If we make it too hard for this experiment to continue, we’ve wasted an opportunity that could eventually save millions of lives,” Dr. Siegel said.

Dr. Glantz disagreed.

“I frankly think the fault line will be gone in another year,” he said. “The evidence will show their true colors.”

http://www.nytimes.com/2014/02/23/health/a-hot-debate-over-e-cigarettes-as-a-path-to-tobacco-or-from-it.html?_r=0

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

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

Nicotine Levels In US Cigarettes Went Up 15% Between 1999 And 2011

By: , Business Insider
Nicotine levels in cigarettes went up 15% between 1999 and 2011, according to a study published this week in the journal Nicotine and Tobacco Research.
The data were collected from the annual report filed with Massachusetts Department of Public Health by four major manufacturers of cigarettes from 1997 to 2012.
“Young people could have an easier time becoming addicted to cigarettes the first few times they do smoke,” lead author Thomas Land, director of the Office of Health Information Policy and Informatics at the State Health Department, told Deborah Kotz of The Boston Globe.
From The Globe:
Each day, 3800 American teens try their first cigarette and 1000 become hooked, according to a 2012 Surgeon General’s report. Those who are unable to quit as adults will die, on average, 13 years earlier than their peers.
This is not the first study to find rising nicotine levels in cigarettes. In 2007, a Harvard study found nicotine levels had gone up by nearly 11% between 1997 and 2005, the Globe noted. Industry executives disputed the findings and attributed the increase to agricultural and rainfall variations that led to more concentrated levels of nicotine in tobacco crops.
But Land told The Globe that if that were the case, “we would have seen a similar trend of increased nicotine yield for all cigarette makers since they tend to buy their tobacco from the same regions. We did not.”
The study concludes that nicotine levels “are controllable features of cigarettes, and should be monitored and regulated by government agencies.”
While federal law lets the FDA set new regulations to lower nicotine content, according to Kotz, he noted that the agency has not set new limits on the amount of nicotine allowed in each cigarette.
http://www.businessinsider.com/nicotine-levels-up-15-since-1990-2014-1#ixzz2qh357qlT

Surgeon General Sets Tobacco End-Game as Smoking Persists

By Anna Edney, Bloomberg News
A half century after linking smoking to lung cancer, the U.S. is confronting stalled progress in kicking the habit of 42 million Americans with new evidence that many common ailments such as diabetes, arthritis and impotence can be tied to tobacco use.
Acting Surgeon General Boris Lushniak in a report today criticized the “fraudulent campaigns” by cigarette companies, weaknesses in regulation and a rebound in smoking depicted in Hollywood films. He said he’s considering greater restrictions on sales to achieve “a society free of tobacco-related death and disease.”
While a landmark 1964 report on smoking and lung cancer helped cut cigarette use by more than half to 18 percent of U.S. adults, the decline has slowed. Smoking remains the leading preventable cause of death, killing 480,000 people each year, and the U.S. may miss a 2020 goal of limiting to 12 percent the share of smoking adults, today’s report shows.
“Enough is enough,” Lushniak said repeatedly at a press conference in Washington where he presented the more than 900-page report. “It’s astonishing that so many years later we’re still making these findings.”
The report shows the U.S. must be more aggressive in promoting tobacco control than regulators have been, he said.
“What we really need to do is say ‘Now is the time,’” Len Lichtenfeld, deputy chief medical officer at the Atlanta-based American Cancer Society, said in a telephone interview.

Further Stalling

Maintaining the status quo on tobacco control will lead to further stalling in the declining rate of smoking, said Lushniak, whose job serves as the nation’s main public-health advocate. He placed part of the blame on tobacco companies.
“The tobacco epidemic was initiated and has been sustained by the aggressive strategies of the tobacco industry, which has deliberately misled the public on the risk of smoking cigarettes,” he said in the report.
Earlier this week, Altria Group Inc. (MO:US), Reynolds American Inc. (RAI:US)and other tobacco companies agreed with the U.S. on how they will publicize admissions that they deceived the American public on the dangers of smoking. Altria is the largest tobacco company in the U.S. and its Philip Morris unit makes the popular Marlboro brand of smokes.

Overwhelming Evidence

“Philip Morris USA agrees with the overwhelming medical and scientific consensus that cigarette smoking causes lung cancer, heart disease, emphysema and other serious diseases in smokers,” David Sutton, a spokesman for parent company Altria Group Inc., said in an e-mail.“ Smokers are far more likely to develop serious diseases, like lung cancer, than non-smokers. There is no safe cigarette.”
The report lists smoking as a cause of liver cancer and colorectal cancer, which is responsible for the second-largest number of cancer deaths each year. Cigarette use may cause breast cancer and women smokers’ chances of dying from lung cancer have caught up to men, the surgeon general said. Even secondhand smoke can now be linked to a higher risk of stroke, Lushniak said.
The first surgeon general report on tobacco’s ill effects was made in January 1964, when at least half of all men in the U.S. and almost 40 percent of women smoked. Congress later adopted an act that required warning labels about the health consequences of smoking and in 1970 it prohibited cigarette advertising on television and radio.

Extend Lifespans

Measures, such as city and state bans on smoking in workplaces, restaurants and bars, also have helped to prevent 8 million early deaths and extended lifespans by two decades. About 5.3 million men and 2.7 million women live longer thanks to tobacco control, according to one of six studies on the topic published last week in the Journal of the American Medical Association.
Advertising and promotional activities entice younger smokers and nicotine addiction keeps people smoking as they grow older. Portrayals of tobacco use in U.S. films rebounded in the past two years and the use of multiple tobacco products may increase initiation rates among teens and young adults, according to the report.
While the share of teens and young adults who smoke is down, the number of them who start to smoke has increased since 2002. In addition, the prevalence of U.S. students in middle and high school who used electronic cigarettes doubled in 2012, the Centers for Disease Control and Prevention said in a September report.
“There are a substantial number of diseases, not just cancer, but certain cardiovascular disease, stroke, respiratory disease, whether it’s chronic lung disease or asthma, the list goes on and on about how tobacco impacts this country,” Lichtenfeld said.

Erectile Dysfunction

Smokers also have as much as a 40 percent higher risk of developing Type 2 diabetes and the habit is attributable to erectile dysfunction and deadly ectopic pregnancies where the embryo implants in the Fallopian tube or elsewhere outside the uterus, according to the report. People exposed to second-hand smoke are as much as 30 percent more likely to have a stroke.
Women smokers were 2.7 times more likely to develop lung cancer in 1959, a number that jumped to 25.7 percent by 2010. Male smokers were 12.2 times more likely to get lung cancer in 1959 and now smokers of both genders carry almost an equal chance of being diagnosed with the disease.
In the last 50 years almost 25 trillion cigarettes have been consumed in the U.S. costing at least $130 billion a year for direct medical care and $150 billion annually in lost productivity from premature death, according to the surgeon general.

Kicking the Habit

The surgeon general recommended helping people kick the habit with more national media campaigns like the federally funded graphic advertisements that featured former smokers with missing limbs and holes in their throats. He also advocated consideration of additional cigarette taxes and legislation to extend smoke-free indoor protections.
Banning smoking “is a bigger societal issue,” Lushniak said at the press conference. “We need to have that discussion.”
The tobacco companies and the Justice Department resolved this week that “corrective statements” will appear in the print and online editions of newspapers and on television as well as on the companies’ websites. Expanded information on the adverse health effects of smoking will appear on cigarette packages, according to the agreement filed Jan. 10 in federal court in Washington.

Altria Support

“Moving forward, we believe FDA regulation, particularly as it applies to product innovation, has the potential to substantially reduce the harm caused by smoking,” Altria’s Sutton said. “We support extending its regulatory authority over all tobacco products, including those containing tobacco-derived nicotine such as e-cigarettes.”
The FDA regulates cigarettes and is poised to extend its oversight to their electronic counterparts.
While smoking substitutes such as e-cigarettes may help reduce tobacco use, more needs to be known about their health effects and how much they may help, the report said.
“However, the promotion of electronic cigarettes and other innovative tobacco products is much more likely to be beneficial in an environment where the appeal, accessibility, promotion, and use of cigarettes are being rapidly reduced,” Lushniak said.
http://www.businessweek.com/news/2014-01-17/surgeon-general-sets-tobacco-end-game-as-smoking-decline-stalls

Jury is out on health effects of e-cigarettes

By Monte Morin, Los Angeles Times
Electronic cigarettes are either a potent weapon in the war against tobacco, or they are an insidious menace that threatens to get kids hooked on nicotine and make smoking socially acceptable again.

There are health experts who back each point of view. But they do agree that the empirical evidence that will tell them who is right will not be in for several years.
“There are a few studies out there right now, but scientists like to have a gazillion,” said Stanton Glantz, a professor of medicine and director of the Center for Tobacco Control at UC San Francisco.
Among the most pressing questions for researchers: What are the long-term health effects of e-cigarettes on users and people around them? Do e-cigarettes help people kick the smoking habit, or do they actually make it harder? If kids start smoking e-cigarettes, are they likely to graduate to regular cigarettes?
“My big question with e-cigarettes is whether it puts youth on a pathway to smoking,” said acting Surgeon General Boris Lushniak, who will join other U.S. health officials Friday at the White House to commemorate the 50th anniversary of the surgeon general’s first report on the hazards of smoking.
When that landmark report was released in 1964, the proportion of U.S. adults who smoked was at an all-time high of 43%. By 2012, that figure had dropped to 18%. But without a renewed focus on the campaign against tobacco, the U.S. will miss its goal of reducing the national smoking rate to 12% by the end of the decade.
E-cigarettes are uniquely positioned to undo recent public health gains, Lushniak and others fear.
The battery-operated devices heat nicotine, propylene glycol and glycerin into a vapor, which is inhaled by the user. Unlike conventional tobacco-burning cigarettes, e-cigarettes do not deliver poisonous tars or carbon monoxide.
Currently, the devices are regulated only by a smattering of local governments who have passed laws concerning their sale and use. The Food and Drug Administration has the legal authority to regulate e-cigarettes as a tobacco product, but has not yet done so. In the meantime, e-cigarettes have grown to become a $2-billion industry with no federal oversight.
Though the FDA says propylene glycol and glycerin food additives are “generally regarded as safe,” the long-term effects of inhaling the substances are unknown. The FDA’s Center for Tobacco Products has begun collecting reports of adverse effects from e-cigarettes, and those complaints include claims of eye irritation, headaches and coughing.
E-cigarette backers say the health effects of the key component — nicotine — are well established and minimal for most everyone except pregnant mothers. They note that nicotine gum and patches have been used as smoking cessation tools for many years.
“It’s not the nicotine that’s the real enemy; it’s the way it’s burned and delivered in cigarettes,” said psychologist David Abrams, executive director of the American Legacy Foundation’s Schroeder Institute for Tobacco Research and Policy Studies in Washington. “In reasonable doses, and assuming good quality control, nicotine might raise your heart rate two or three beats per minute, but it really has few adverse effects.”
Yet that might not be true for teens. A surgeon general’s report released Friday says evidence now suggests that nicotine exposure during adolescence “may have lasting adverse consequences for brain development.”
And then there are the potential health effects on bystanders, who are also exposed to nicotine and propylene glycol emitted by the e-cigarette and its user.
Studies performed on e-cigarette vapor have detected heavy metals and volatile compounds such as formaldehyde, but the concentration and threat they pose has been hotly debated.
In a review of studies that examined e-cigarette mist, Drexel University environmental and occupational health expert Igor Burstyn concluded that “while these compounds are present, they have been detected at problematic levels only in a few studies that apparently were based on unrealistic levels of heating.”
Abrams took heart in that assessment, though he acknowledged that the vapor was not benign. Even so, the bystander effects are “almost immeasurable compared to the toxins in secondhand cigarette smoke,” he said.
That assessment may change when several studies examining fine particulate matter from e-cigarette vapor and their effects on the cardiovascular system are completed, Glantz said.
The burning question for most experts is whether e-cigarettes actually help people to quit smoking.
Researchers have conducted surveys that give them a “snapshot” of smoker behavior at a particular moment, but not over an extended period. Some results suggest e-cigarette users are continuing to smoke conventional cigarettes and relying on the electronic substitutes to satisfy nicotine cravings in the workplace, restaurants and other places where cigarettes are forbidden.
Another study published in the journal Lancet compared the effectiveness of e-cigarettes to nicotine patches and gum. Researchers said they expected e-cigarettes to be the clear winner, but it was a tie.
Now experts are looking toward long-term behavioral studies that will reveal how smokers actually use e-cigarettes. One such analysis by the FDA is set to begin field work this year, and will track about 60,000 smokers and nonsmokers for two years.
“It should tell us if people are using them for cessation, or as a gateway to traditional tobacco use,” said Brian King, an epidemiologist at the Centers for Disease Control and Prevention.

http://www.latimes.com/science/la-sci-e-cigarettes-science-20140117,0,7562029.story#ixzz2qh59hXu7