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Deal reached on tobacco firm corrective statements

By MICHAEL FELBERBAUM, AP Tobacco Writer
RICHMOND, Va. (AP) — The nation’s tobacco companies and the federal government have reached an agreement on publishing corrective statements that say the companies lied about the dangers of smoking and requires them to disclose smoking’s health effects, including the death on average of 1,200 people a day.
The agreement filed Friday in U.S. District Court in Washington, D.C., follows a 2012 ruling ordering the industry to pay for corrective statements in various advertisements. The judge in the case ordered the parties to meet to discuss how to implement the statements, including whether they would be put in inserts with cigarette packs and on websites, TV and newspaper ads.
The court must still approve the agreement and the parties are discussing whether retailers will be required to post large displays with the industry’s admissions.
The corrective statements are part of a case the government brought in 1999 under the Racketeer Influenced and Corrupt Organizations. U.S. District Judge Gladys Kessler ruled in that case in 2006 that the nation’s largest cigarette makers concealed the dangers of smoking for decades. The companies involved in the case include Richmond, Va.-based Altria Group Inc., owner of the biggest U.S. tobacco company, Philip Morris USA; No. 2 cigarette maker, R.J. Reynolds Tobacco Co., owned by Winston-Salem, N.C.-based Reynolds American Inc.; and No. 3 cigarette maker Lorillard Inc., based in Greensboro, N.C.
Under the agreement with the Justice Department, each of the companies must publish full-page ads in the Sunday editions of 35 newspapers and on the newspapers’ websites, as well as air prime-time TV spots on CBS, ABC or NBC five times per week for a year. The companies also must publish the statements on their websites and affix them to a certain number of cigarette packs three times per year for two years.
Each corrective ad is to be prefaced by a statement that a federal court has concluded that the defendant tobacco companies “deliberately deceived the American public.” Among the required statements are that smoking kills more people than murder, AIDS, suicide, drugs, car crashes and alcohol combined, and that “secondhand smoke kills over 38,000 Americans a year.”
Tobacco companies had urged Kessler to reject the government’s proposed corrective statements; the companies called them “forced public confessions.” They also said the statements were designed to “shame and humiliate” them. They had argued for statements that include the health effects and addictive qualities of smoking.
A federal appeals court also rejected efforts by the tobacco companies to overrule Kessler’s ruling requiring corrective statements.
Representatives for Altria, R.J. Reynolds and Lorillard each declined to comment.
Several public health groups, including the American Cancer Society, American Heart Association and American Lung Association, intervened in the case. In a statement Friday, the groups said the corrective statements are “necessary reminders that tobacco’s devastating toll over the past 50-plus years is no accident. It stems directly from the tobacco industry’s deceptive and even illegal practices.”
The corrective statements include five categories: adverse health effects of smoking; addictiveness of smoking and nicotine; lack of significant health benefit from smoking cigarettes marked as “low tar,” ”light,” etc.; manipulation of cigarette design and composition to ensure optimum nicotine delivery; and adverse health effects of exposure to secondhand smoke.
Among the statements within those categories:
“Smoking kills, on average, 1,200 Americans. Every day.”
“Philip Morris USA, R.J. Reynolds Tobacco, Lorillard, and Altria intentionally designed cigarettes to make them more addictive.”
“When you smoke, the nicotine actually changes the brain — that’s why quitting is so hard.”
“All cigarettes cause cancer, lung disease, heart attacks, and premature disease, heart attacks, and premature death — lights, low tar, ultra lights, and naturals. There is no safe cigarette.”
“Secondhand smoke causes lung cancer and coronary heart disease in adults who do not smoke.”
“Children exposed to secondhand smoke are at an increased risk for sudden infant death syndrome (SIDS), acute respiratory infections, ear problems, severe asthma, and reduced lung function.”
“There is no safe level of exposure to secondhand smoke.”
http://www.seattlepi.com/news/article/Deal-reached-on-tobacco-firm-corrective-statements-5131393.php

Drugs to Stop Smoking Better Given Together?

By Crystal Phend, Senior Staff Writer, MedPage Today
Reviewed by F. Perry Wilson, MD, MSCE; Instructor of Medicine, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner
Doubling up on tobacco cessation drugs helped smokers quit at first, but didn’t significantly improve longer-term abstinence, a trial showed.
Quit rates at 12 weeks were a relative 36% to 49% better with the addition of sustained-release bupropion (Zyban) to varenicline (Chantix), Jon O. Ebbert, MD, MSc, of the Mayo Clinic in Rochester, Minn., and colleagues found.
One year after the 12-week treatment course, though, abstinence had fallen to where the relative 39% to 40% advantage of combination treatment lost significance, the researchers reported in the Jan. 8 issue of the Journal of the American Medical Association.
“Further research is required to determine the role of combination therapy in smoking cessation,” they concluded.
Bupropion and varenicline both tackle cravings and “rewards” from smoking but through somewhat different routes to nicotinic acetylcholine receptors, leading to hopes for additive or synergistic effects, such as with the combination of bupropion and the nicotine patch, the group noted.
Their study randomized 500 adult smokers desiring to quit to take open-label varenicline along with blinded placebo or sustained-release bupropion for 12 weeks.
For the primary outcome, abstinence rates at week 12 were significantly better with the combination in terms of prolonged cessation with no smoking from 2 weeks after the target quit date (53% versus 43.2%, odds ratio 1.49, P=0.03), although not by point-prevalence of no smoking in the prior 7 days (56.2% versus 48.6%, OR 1.36, P=0.09).
By 26 weeks, prolonged abstinence rates had fallen to 36.6% and 27.6% in the two groups, respectively (OR 1.52, P=0.03), and 7-day point-prevalence abstinence to 38.2% and 31.9% (OR 1.32, P=0.14).
At 52 weeks, neither measure showed a significant difference between groups, although the odds ratios remained roughly the same as before (OR 1.39 and 1.40).
Prolonged abstinence rates at that point were 30.9% with combination therapy and 24.5% with varenicline alone (P=0.11); 7-day point-prevalence abstinence rates were 36.6% and 29.2%, respectively (P=0.08).
However, individuals with high levels of baseline nicotine dependence did achieve a significant impact on both measures of abstinence at 52 weeks with the combination versus monotherapy in a sensitivity analysis.
Combination therapy was associated with more adverse events in terms of both anxiety (7.2% versus 3.1%, P=0.04) and depressive symptoms (3.6% versus 0.8%, P=0.03). No serious adverse events in either group were judged treatment related.
Weight gain was similar between groups through the end of follow-up (4.9 kg [11 lbs], and 6.1 kg [13 lbs], P=0.23).
The researchers cautioned that the study was limited by the 38% rate of dropout and limited generalizability “because patients with serious medical and psychiatric illnesses including those with active substance abuse were excluded.”
http://www.medpagetoday.com/PrimaryCare/Smoking/43680?xid=nl_mpt_DHE_2014-01-08&utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&eun=g436493d0r&userid=436493&email=megan.houn@tfnd.org&mu_id=5533639

Smoking Rates Still High Among the Mentally Ill

By John Gever, Deputy Managing Editor, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner
Smoking rates among Americans with mental illnesses didn’t budge from 2004 to 2011, a period during which rates in the rest of the population fell 14%, researchers said.
Data from the federal Medical Expenditure Panel Survey (MEPS) found that, among respondents with mental illnesses, 25.3% reported current smoking in 2004-2005 (95% CI 24.2%-26.3%), versus 24.9% in 2010-2011 (95% CI 23.8%-26.0%, P=0.50) after adjustments for other predictors of smoking such as income and education, according to Benjamin Le Cook, PhD, MPH, of Harvard Medical School in Cambridge, Mass., and colleagues.
Over the same interval, adjusted smoking rates in other MEPS respondents declined from 19.2% (95% CI 18.7%-19.7%) to 16.5% (95% CI 16.0%-17.0%, P<0.001), the researchers reported in the Jan. 8 issue of the Journal of the American Medical Association.
On the other hand, individuals with mental illnesses who were undergoing treatment showed somewhat greater quit rates than those who were untreated (37.2% versus 33.1%, P=0.005), Cook and colleagues found from a different data set, the 2009-2011 National Survey of Drug Use and Health (NSDUH).
“The mechanisms that support persistently higher rates of smoking among individuals with mental illness are complex and remain understudied,” they wrote. “Patients with mental illness may attribute greater benefits and reward value to smoking compared with patients without psychiatric disorders or may experience more difficult life circumstances, higher negative affect, or a relative lack of alternative rewards.”
Other experts contacted by MedPage Today offered differing views on the high smoking rates among the mentally ill.
John Spangler, MD, MPH, of Wake Forest Baptist Medical Center in Winston-Salem, N.C., said in an email that the nicotine in cigarettes “is very effective at relieving stress and improving mood. You can ask any smoker about that. It also can increase concentration in those with ADHD, and it improves memory as well.”
But Joseph McClernon, PhD, of Duke University, told MedPage Today that smoking as self-medication is not very effective. “Among dependent smokers, much of the relief or improvement in cognitive performance they experience from smoking likely has as much to do with reversing the effects of withdrawal,” he said in an email, which appears to be more severe in patients with some mental illnesses.
A similar viewpoint was expressed by Glen Getz, PhD, of Allegheny Health Network in Pittsburgh. The positive subjective effect of smoking “is only briefly effective and ultimately has counterproductive effects on mood, anxiety, and other emotional problems,” he said.
There was general agreement, however, that it may be more difficult for the mentally ill to quit smoking.
Among the factors cited by Cook and colleagues is a “smoking culture” that has long pervaded the mental health community, including clinicians as well as patients.
They noted that psychiatric inpatients historically were allowed and even encouraged to smoke “to decrease agitation and encourage patient adherence.” Even today, they suggested, many mental health professionals shy away from encouraging their patients to quit smoking for a variety of reasons, ranging from concern that it may distract from other therapeutic efforts to “lack of confidence” that patients can succeed in quitting.
But although such a culture did exist in the past, that’s changing, Douglas Ziedonis, MD, MPH, of the University of Massachusetts Medical School in Worcester, told MedPage Today.
“Nowadays we’re much more focused on wellness in recovery and also looking at the physical health of individuals who have mental illnesses,” he said in an email. “Mental health treatment providers are now realizing that they need to better address tobacco and wellness issues in mental health treatment.”
Said Martin Mahoney, MD, of Roswell Park Cancer Institute in Buffalo, N.Y., and director of New York state’s smoking quitline, “I don’t think there’s anything more important than helping a patients who is addicted to nicotine to get off of that addiction.”
For the current study, Cook and colleagues analyzed data on more than 32,000 MEPS respondents with mental illnesses and some 133,000 without. Participants were considered to have mental illness if they met any of several criteria: having a healthcare visit linked to a psychiatric ICD-9 code, receiving psychotherapy or mental health counseling, filling a prescription for a behavioral health disorder, or having scores on neuropsychiatric tests indicating severe psychological distress or at least moderate depression.
The data on quit rates associated with mental health treatments covered some 14,000 participants in the NSDUH from 2009 to 2011 whose responses indicated at least mild mental illness according to criteria established by the Substance Use and Mental Health Administration.
Differences in smoking prevalence in the MEPS data between those with and without mental illnesses were most pronounced among respondents with apparent depression or distress, for whom the gap was consistently around 15 percentage points through the 8-year study period.
Cook and colleagues acknowledged that the ascertainment of mental illness in both surveys could be faulty because they didn’t use structured diagnostic interviews. Also, as in most federal surveys, persons in institutional settings (including psychiatric inpatients) were excluded.
Another limitation was that the NSDUH did not include data on the timing of smoking cessation versus provision of mental health treatment, leaving open the possibility that some respondents may have quit smoking before receiving treatment. The researchers cautioned that “reverse causality” could therefore have occurred: patients may be more likely to seek mental health treatment after they quit smoking.
Primary source: Journal of the American Medical Association
Source reference: Cook B, et al “Trends in smoking among adults with mental illness and association between mental health treatment and smoking cessation” JAMA 2014; 311: 172-182.
http://www.medpagetoday.com/PrimaryCare/Smoking/43690?xid=nl_mpt_DHE_2014-01-08&utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&eun=g436493d0r&userid=436493&email=megan.houn@tfnd.org&mu_id=5533639

Homeless North Texans being weaned from tobacco

ARLINGTON, Texas (AP) — When he was sent to Vietnam in 1970, Travis Dorsey quickly picked up a smoking habit.
As the stress of being in a war zone took its toll, Dorsey found comfort in cigarettes.
“They started giving them to us with our meals, they called them C-rations, and the next thing you know I was buying them,” Dorsey told the Fort Worth Star-Telegram (http://bit.ly/1cXO5HL). “I didn’t drink. I didn’t do drugs. The cigarette helped me deal with the stress during the day.”
Life hasn’t been easy for Dorsey since returning, and through it all he has continued to smoke.
Sixteen years ago, he was diagnosed with post-traumatic stress disorder and lost his job as an aircraft mechanic. Two years ago, his wife died from breast cancer, triggering a downward spiral.
“I tried to commit suicide here about three months ago,” Dorsey said. “I ran off the cliff and tore up my truck. I was in the hospital about 2½ months.”
Dorsey, 62, who is now staying at the Arlington Life Shelter, says he’s beginning to turn his life around. He’s resumed taking insulin for his diabetes, received counseling to cope with his wife’s loss and found a church in Arlington where he feels at home.
And he’s now looking at quitting smoking through a program started in November by Tarrant County Public Health at the Arlington Life Shelter.
“I know it’s easier to quit now because I’m not under the stress I’ve been under the last two years,” Dorsey said. “I’m laying down at night and I’m not afraid.”
The county health department plans to eventually expand the program to other homeless shelters across Tarrant County, including the Patriot House, a shelter for homeless veterans.
“I wanted to reach an audience that wasn’t already being reached,” said Vanessa Ayala, a community health worker with the department. “We try to help them manage the stress from quitting smoking and understand the effects of nicotine withdrawal and dealing with weight gain.”
Michael Businelle, an assistant professor at the University of Texas School of Public Health in Dallas, said more should be done to encourage those who are homeless to quit smoking.
Tobacco-related deaths in the U.S. are about 440,000 annually, which include deaths from secondhand smoke, according to the federal Centers for Disease Control and Prevention.
“These tobacco cessation services are generally not offered at homeless shelters while substance abuse programs are generally ubiquitous,” Businelle said. “Smokers don’t go and rob their neighbors or sell their VCRs for cigarettes like someone would do for crack, but smoking is responsible for way more deaths than drugs and alcohol combined.”
Businelle helped conduct a study with several other researchers for publication in the American Journal of Public Health, comparing homeless smokers with economically disadvantaged smokers who have a home. The study, conducted from August 2011 to November 2012, found that the homeless smoking rate of 70 percent was twice that of those living in poverty (34.7 percent).
One of the challenges Businelle found was that homeless people were exposed to as many 40 smokers a day compared with three or four among those who are not homeless.
Those who run area shelters agree that efforts to curb smoking among homeless people are needed.
“The majority of the homeless population does smoke,” said Toby Owen, executive director of the Presbyterian Night Shelter. “Offering programs would certainly be most beneficial but it’s going to have to provide more than just going cold turkey.”
In Businelle’s study, 10 participants received small incentives — gift cards — and their carbon monoxide levels were tested to see whether they had actually quit. A larger group of 58 homeless people did not receive gift cards.
The quit rate four weeks after stopping smoking was 30 percent among the group that got gift cards versus 1.7 percent among those who didn’t receive gift cards.
“The findings of this pilot study are important because smoking cessation interventions that have worked in the general population are not as effective in homeless smokers,” Businelle said. “Offering small financial incentives for smoking cessation may be a novel way to have an impact on smoking in this vulnerable population.”
Businelle has applied for a National Institutes of Health grant that would pay for a five-year study and is still waiting to see whether it gets approved. The most recent study didn’t cover enough time to draw definitive conclusions. But Businelle said it is worth exploring because of the extensive costs associated with tobacco-related illnesses.
“The study is so small you can’t really make any broad generalizations,” Businelle said. “It is a pilot study that shows there is potential.”
The Bridge homeless recovery center in Dallas has been offering smoking cessation classes and modified its courtyard this summer to include a nonsmoking area for those who want to quit. With a day shelter that brings in as many as 1,200 people daily, along with a transitional shelter and an emergency shelter, the Bridge is trying to find ways to reach as many people as possible, President and CEO Jay Dunn said.
“We’re learning about the need for smoking cessation medication and brainstorming about how to make that more accessible,” Dunn said.
At the Arlington Life Shelter, Dorsey can get nicotine replacement medication through the Veterans Administration Hospital in Dallas.
Another shelter resident, Dennis Bell, said he can get a prescription through the JPS Connection Program if he needs one.
“I don’t know that I’ll need the medication,” Bell said. “I think I can do it with just the knowledge I’ve learned in the classes. That’s my goal. Now if my body says otherwise, that’s another thing.”
Bell, 45, ended up at the Arlington Life Shelter after his home was foreclosed on and he went through a difficult divorce.
But he said he was receptive to quitting smoking after Ayala pointed out how much money it would save him.
“I knew some of the health issues but the cost of smoking wasn’t something I had really thought about,” Bell said. “It was good information.”
Bell started smoking at 19 to fit in with his friends.
“To be honest with you, it was peer pressure,” Bell said. “I guess I wanted to be in the cool crowd.”
Karen Caston, director of shelter operations at the Arlington Life Shelter, said the classes can have an impact.
“They come here to become self-sufficient,” Caston said. “Anything that helps their health, their mental state and their financial state, can’t help but be a good thing.”
http://www.fosters.com/apps/pbcs.dll/article?AID=/20131216/GJLIFESTYLES/131209301/-1/SANNEWS

E-cigs may deliver more toxins than smoke, researchers say

By Andy Soltis
Don’t make that nicotine switch just yet.
E-cigarette users may be getting higher concentrations of toxins than regular smokers because they inhale deeper and more frequently when they puff, NYU researchers say.
Although they are often touted as a safer alternative, e-cigs, introduced in the States in 2007, haven’t been in use long enough to determine their health effects, said Dr. Deepak Saxena, of NYU’s College of Dentistry.
“We have no scientific data to show that nicotine at this concentration is safe,” said Saxena, an associate professor of basic science and craniofacial biology.
Each e-cig nicotine cartridge provides 200 to 400 puffs, equal to two to three packs of regular cigarettes.
Saxena says e-cigs, which deliver nicotine in a vapor form, must be studied as their popularity grows.
“They are designed for new smokers, to bring up a new generation,” he said.
The City Council is now weighing a proposal to place e-cigs under the same restrictions as regular cigs. Former tobacco smokers oppose it, saying e-cigs helped them kick regular puffing.
“People are saying, ‘Now I am smoking and happy with my addiction,’ ” Saxena said.
“But the problem is that if you want to get out of the addiction, you may become more addicted.”
http://nypost.com/2013/12/14/e-cigs-may-deliver-more-toxins-than-smoke-researchers-say/

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

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

E-cigs: Just how safe are they?

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

Study: Teens' E-Cigarette Use Promotes Heavy Tobacco Use

By: Jessica Berman
WASHINGTON — According to the first-ever study on the use of electronic cigarettes, or e-cigarettes, by young people, researchers have found that the devices, marketed as an alternative to real cigarettes, appear to fuel heavy smoking among youth.
E-cigarettes are battery-powered devices that look like cigarettes and deliver a smokeless aerosol of nicotine, flavorings and other chemicals. They are promoted as a safer alternative to cigarettes and an aid to stopping smoking.
However, a new study looking at the use of electronic cigarettes in nearly 76,000 Korean teenagers found they are less likely to have succeeded in kicking the habit and that electronic cigarettes made them heavier smokers.
Stan Glantz directs the Center for Tobacco Control Research and Education at the University of California, San Francisco.  He is also the senior author of the study.
Glantz said that while there is evidence electronic cigarettes help a small percentage of adult smokers stop, the same is not true for adolescents, who he says are being bombarded with appealing ads.
“They are being marketed with flavors, with images of sex and independence, and also marketed with the claim they will help you quit smoking and, in fact, the kids who are trying to quit smoking were more likely to be using e-cigarettes. But, as I said before, [they are] much less likely to actually quit,” said Glantz.
Glantz said that the nicotine in e-cigarettes makes them addictive even though users do not inhale as many toxic chemicals. He also claimed that tobacco companies, which manufacture the devices, take advantage of the lack of regulation of e-cigarettes to try to hook new smokers.
“We have the kind of Wild West marketing that we did in the bad old days for cigarettes. And the kids are clearly responding to that, and youth use of e-cigarettes in Korea is going up very rapidly just as it did here in the United States,” said Glantz.
U.S. regulators report the number of middle and high school students who use e-cigarettes doubled from 2011 to 2012, to a total of 1.7 million students.
Regulations to ban the smokeless devices are being proposed in Chicago, which may become the first U.S. city to restrict the sale of electronic cigarettes.
The article on e-cigarette use among Korean teens is published in the Journal of Adolescent Health.
http://www.voanews.com/content/study-teens-e-cigarette-promotes-heavy-tobacco-use/1798525.html

E-cigarettes: Do benefits outweigh risks?

by Natalie Brand / KTVK
More and more tobacco companies are jumping into the “e-cigarette” market, considered the “wild, wild west,” since it’s without FDA regulations.
From celebrity commercials to candy flavors, some health officials worry who e-cigarette manufacturers may be targeting.
“You see all the commercials that cigarettes are so bad, which is true, then they say, it’s a new, safe alternative,” said Matt Majd who admitted e-cigarettes were popular at his high school.
“People think it’s cool to do it in class and try not to let teachers see,” said Majd who has also tried e-cigarettes himself.  “Just gives you somewhat of a buzz, somewhat of a head rush, kinda similar to the effect of cigarettes.”
“It’s still troubling to see some actors in the industry real actively trying to recruit kids to their product,” said Arizona Department of Health Services Director Will Humble.
Humble says the jury’s still out as to whether e-cigarettes will serve their purpose as a safer alternative for smokers, or inadvertently get a new generation hooked.
“What I don’t know yet is where electronic cigarettes lie on the scale; are there more benefits than risks?”
A recent CDC study found e-cigarette experimentation and use among middle and high school students doubled last year.  It’s too early to know if that will eventually lead them to smoking tobacco cigarettes.
“Once you’ve got a kid addicted to nicotine, now you’ve got an active potential smoker for the rest of their lives, because their brains get hardwired when they start smoking,” said Humble.
Craig Weiss, President and CEO of Scottsdale based NJOY says his company goes out of its way to play by the rules from verifying age to advertising to smokers and smokers only.
Former Surgeon General Richard Carmona of Tucson sits on NJOY’s Board of Directors.
“We’re not interested in people who are underage,” said Weiss.  He said his target is the public health epidemic of smoking.
“We feel we’re helping people,” said Weiss.  “Smokers are already addicted to nicotine, and that’s the only customer I’m interested in.”
Weiss said his end game is a place with no tobacco.
“We want there to be reasonable regulation by the FDA, so everyone is playing by the same rules,” said Weiss.
When asked if he fears e-cigarette commercials are glamorizing smokers:
“I think of it as advertising,” said Weiss.  “It’s important for us to communicate to our smokers that they have an alternative.”
But health leaders worry what could happen if this now billion dollar business is left unregulated.
“The potential is there for these products to really do a lot of good, I honestly believe that,” said Will Humble.  “But not if they’re going to go after kids, not if they’re going to go after people who don’t smoke.”
http://www.kvue.com/news/232829891.html

Study finds cigarette alternatives may not be safer than cigarettes

UC Davis Researchers Examine E-Cigarettes, Cigars, Hookah
Written By CATHERINE MAYO

If you’ve ever been convinced to smoke hookah — or anything else for that matter  — because someone told you it was completely safe, you aren’t alone (but you’ve been lied to).

Are smoking alternatives as safe as people think? UC Davis pulmonary physicians recently published a study concluding these replacements can be addictive gateways to cigarette smoking. The assessment — which focused on cigars, hookah, e-cigarettes and a Swedish smokeless tobacco called snus — provides new insight on why people trying to quit smoking (and those who haven’t started) should avoid all types of tobacco products.

“Everything I included … in some way or another has become popular in America or worldwide… [These products] are the most commonly used, and because [of this], there is a misperception about them,” said Michael Schivo, assistant professor of internal medicine at UC Davis Health System and lead author of the study.

The research team found that because of a lack of regulation and research, e-cigarettes show unclear risks. From 2011-12, e-cigarette use among students in grades six to 12 doubled. Many people trying to quit smoking view e-cigarettes as a safe way to wean themselves off nicotine, but according to the study, Schivo recommended smokeless tobacco before e-cigarettes to better avoid lung cancer and cardiovascular disease. Moreover, for non-smokers trying something new, the nicotine can be dangerously addicting.

Smoking hookah, a technique that employs a special form of tobacco called shisha smoked out of a water pipe, is growing in popularity among college-aged adults and is commonly perceived as a harmless recreational activity, was discovered to be significantly worse than cigarettes. Waterpipe use leads to deeper and longer inhalation of tobacco smoke than other forms of smoking. In fact, the Mayo Clinic says a typical one-hour-long hookah session consists of 200 puffs compared to the cigarette’s average of 20 puffs. Nicotine levels are reduced in waterpipe smoking, but the amounts of arsenic, chromium and lead — chemicals known to be carcinogens — are all significantly higher.

While this information may come as a shock to some, many others know it and choose to ignore it as best they can.

“I’m sure that almost everyone who smokes … has been told countless times that they should stop. It’s not that they don’t know the risks, it’s just a tough habit to quit,” said Brad Howard, a second-year civil engineering major.

The study arrives in the final months of UC Davis’ tolerance for smoking. Beginning in January 2014, the UC Davis Smoke-Free policy takes full effect. The campus will no longer tolerate any forms of smoking, including e-cigarettes and hookah.

Krystal Wong, a second-year human development major and intern at the Student Health and Wellness Center, welcomes the addition of this new policy.

“Davis is trying to promote a healthier environment … Second-hand smoking can cause health hazards for many students,” Wong said.

Schivo is in support of the new rules.

“Public awareness is good however it’s employed,” he said.

Whether you are for or against the policy, we can at least now know not to believe anyone who tries to convince us smoking alternatives are safe. We only have evidence to prove the opposite. Take it as you will, live your life, be smart.

http://www.theaggie.org/2013/10/24/study-finds-cigarette-alternatives-may-not-be-safer-than-cigarettes/