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E-cigarettes sprouting promise and questions

With a preoccupied gaze into the distance, Matt Tlougan inhales from the mouthpiece of a device held in his hand. A battery in its base powers a heating unit that vaporizes a concoction of confectioners’ flavors and nicotine, “juice,” as it’s known.
A few moments later, a gray-white cloud rolls out of his nostrils and mouth.
Is he smoking?
The answer, so far, is as nebulous as the cloud around him. Electronic cigarettes, or e-cigarettes, began appearing in the U.S. as something more than a curiosity around 2005. The market for them is growing at such a rate that Tlougan has opened three Vape It Zone stores since he first tried an e-cigarette himself seven months ago. At his sites in Rochester and St. Cloud, Minn., he said, sales average 20 to 25 units a day. He has similar hopes for the kiosk in The Empire Mall that opened about a month ago, and he is considering opening a fourth Vape It Zone in Brandon.
Articles from Time and the New York Timesthis year note e-cigarette sales have doubled annually since 2008 and are expected to reach $1.7 billion this year.
E-cigarette proponents say the product simulates smoking, and Tlougan said within a day of using one he was able to stop a pack-and-a-half-a-day habit of the real thing. He also gave up chewing a can of smokeless tobacco a day.
Because e-cigarettes don’t incinerate tobacco, they don’t produce the toxic chemicals associated with smoking.
However, “we don’t know what the potential health effects are from vapor, nicotine and other compounds. It kind of goes back to the early days of cigarettes,” said Dr. Daniel Heinemann of Canton, president of the South Dakota State Medical Association.
Vapor could be as bad as smoke.
“Any time you heat chemicals, they change their properties … you get chemical reactions that take place. We don’t know if other chemicals are formed in that process. That could be a problem. It could cause health effects,” Heinemann said. At the very least, e-cigarettes are a potent device for delivering addictive nicotine to the body, he said.
Doctors and public officials are looking to the Food and Drug Administration for guidance on regulating e-cigarettes.
“All of us are waiting to see what happens at the federal level,” Mary Michaels said. She is a healthy community specialist with the Sioux Falls Health Department. Depending on how the FDA approaches e-cigarettes, they might fall under the South Dakota ban on smoking in public places.

Attorneys general press for FDA study

Marty Jackley already has joined 40 other state attorneys general in urging the FDA to move quickly to study and regulate e-cigarettes.
“The nicotine found in e-cigarettes is highly addictive, has immediate biochemical effects on the brain and body at any dosage and is toxic in high doses,” the attorneys general wrote FDA Commissioner Margaret Hamburg on Oct. 23.
“Consumers are led to believe that e-cigarettes are a safe alternative to cigarettes, despite the fact that they are addictive, and there is no regulatory oversight ensuring the safety of the ingredients in e-cigarettes.”
The latter assertion is a fair point. The e-cigarettes Tlougan sells already are manufactured. However, family members, including his mother, a chemist at the Mayo Clinic, make the juice he sells.
“We make each bottle, one by one.” Quality control can be readily achieved, though “you’ve got to be on your toes,” he said. The flavorings come from candy manufacturers, and the nicotine is from an FDA-approved lab. He offers juice with nicotine concentrations ranging from 18 percent to zero, and if you have to take his word for that, well, he points out competitors are selling juice they readily acknowledge was made in China.
FDA scrutiny ultimately could help his business, Tlougan said. He would like to be able to prove he’s selling a product using certified ingredients that is as safe as the nicotine inhalers Mayo Clinic physicians give to patients who are trying to quit smoking. The only substantive difference between those and e-cigarettes, Tlougan said, is that e-cigarettes transport nicotine in vapor and inhalers don’t.
Tlougan won’t sell to minors, and he has no problem with e-cigarettes being included in smoking bans.
“It would not hurt our business if they are banned in bars and public areas. If you ask me, I think it’s a great thing. Nonsmokers shouldn’t have to be around smokers,” he said.
Sioux Falls Mayor Mike Huether is a big supporter of the smoking ban. So far, though, he isn’t making e-cigarettes a priority for inclusion under the ban. They’re flying under his radar.
“I know nothing about those,” Huether said. “I couldn’t even pick one out.”
If his position mirrors many officials’ who have yet to learn about e-cigarettes, it is not universal. Rochester moved pre-emptively as a municipality to ban e-cigarettes everywhere smoking is banned. The City Council a week ago gave final approval to an ordinance, according to Stevan Kvenvold, city administrator.
“It wasn’t subject to much debate,” Kvenvold said. “The council pretty much agreed that e-cigarettes were smoking. There was not too much back and forth about it.”
While the attorneys general want the FDA to extend to e-cigarettes the existing rules prohibiting marketing tobacco to minors, Jackley said state and local governments should decide other issues associated with them, such as taxing them and determining whether they fall under the umbrella of smoking bans.
Heinemann of the state medical association said e-cigarettes should not be sold to minors. However, his group has not yet taken a position on whether they should fall under the smoking ban.

New thing for some, quitting for others

Tlougan said his customers fall into two camps: Those who are eager to try a new experience and those who hope to use e-cigarettes to wean themselves off smoking, and he cites his own spectacular success in being able to quit a savage tobacco habit using e-cigarettes.
But Heinemann said e-cigarettes are not an ideal tool to quit smoking.
If a patient came to him asking about using an e-cigarette to quit smoking, “I would tell them there are other things we can use over time to taper you off nicotine,” such as nicotine gum and patches. He said e-cigarettes re-enforce the ritual and oral fixation that is a part of smoking. For someone trying to give up smoking, “in my mind, replacing one oral device with another, I’m not sure that gets them headed in the right direction.”
For Tlougan, though, the fact he can hold it and it has a mouthpiece hardly are coincidental. They are attractive aspects of his e-cigarette.
While he still needs nicotine, he said almost half his customers buy juice without it. “They just want the flavor.” It begs the question: How dangerous is it to inhale vaporized cinnamon, blueberry or chocolate flavoring?
“We need to study them,” Heinemann said. “For anybody to say they’re not harmful, we don’t know that yet.
“In terms of what it means to the body to inhale this, we don’t know. We need more research.
“Until we have that, the minimum should be to keep these out of the hands of children.”
http://www.argusleader.com/article/DF/20131125/NEWS/311250014/E-cigarettes-sprouting-promise-questions?nclick_check=1

The Truth About The Safety Of E-Cigarettes

By Christopher Wanjek, Columnist
At first, electronic cigarettes were a novelty — something a braggart in a bar might puff to challenge the established no-smoking policy, marveling bystanders with the fact that the smoke released from the device was merely harmless vapor.
Now, e-cigarettes are poised to be a billion-dollar industry, claimed as the solution to bring in smokers from out of the cold, both figuratively and literally, as e-cigarettes promise to lift the stigma of smoking and are increasingly permitted at indoor facilities where smoking is banned.
So, are e-cigarettes safe? Well, they’re not great for you, doctors say. What’s being debated is the degree to which they are less dangerous than traditional cigarettes.
1940 revisited
E-cigarettes are battery-powered devices, often shaped like traditional cigarettes, with a heating element that vaporizes a liquid nicotine solution, which must be replaced every few hundred puffs. Nicotine is inhaled into the lungs, and a largely odorless water vapor comes out of the device. Puffing an e-cigarette is called vaping.
Yet the industry’s duplicity is clear to medical experts: E-cigarettes are marketed to smokers as a means to wean them off of tobacco (although studies show they don’t help much); yet the same devices, some with fruity flavors, are marketed to young people who don’t smoke, which could get them hooked.
Hooked? Yes, e-cigarettes are a nicotine-delivery system, highly addictive and ultimately harmful because of their nicotine.
Cancer and respiratory experts see the same ploy being played out today with e-cigarettes as was done in the 1940s with cigarettes, when America started smoking en masse. They often are distributed for free and pitched by celebrities and even doctors as cool, liberating and safe.
In an ad for a product called blu eCigs, celebrity Jenny McCarthy, infamous for encouraging parents not to vaccinate their children, encourages young adults to vape, enlisting words such as “freedom” and the promise of sex. In another ad, for V2 Cigs, a medical doctor named Matthew Huebner — who is presented without affiliation but is associated with a Cleveland Clinic facility in Weston, Fla. — implies that vaping is as harmless as boiling water.
As for the notion of e-cigs as liberating, the cost of a year’s worth of e-cigarette nicotine cartridges is about $600, compared with $1,000 yearly for a half-pack a day of regular cigarettes.
As for whether they’re safe, it’s a matter of comparing the advantages of one addiction over another.
E-cigarettes not a patch
One would think that vaping has to be safer than smoking real cigarettes. Experts say they are probably safer, but safer doesn’t mean safe.
“Cigarettes have their risk profile,” said Dr. Frank Leone, a pulmonary expert at the University of Pennsylvania Medical Center in Philadelphia. And just about everyone who breathes understands the risks: circulatory disease and myriad cancers, for starters. “E-cigarettes might be better off compared to that profile. But that doesn’t mean they don’t have their own risk profile.”
A top concern is the nicotine delivery rate, Leone said. With nicotine patches and gum, the nicotine delivery is regulated, with small amounts of nicotine released slowly into the bloodstream. But with traditional cigarettes and now e-cigarettes, heat creates a freebase form of nicotine that is more addictive — or what smokers would call more satisfying. The nicotine goes right into the lungs, where it is quickly channeled into the heart and then pumped into the brain.
Once addicted, the body will crave nicotine. And although nicotine isn’t the most dangerous toxin in tobacco’s arsenal, this chemical nevertheless is a cancer-promoting agent, and is associated with birth defects and developmental disorders.
A study published in 2006 in the journal Obstetrics and Gynecology, for example, found that women who chewed nicotine gum during pregnancy had a higher risk of birth defects compared to other nonsmokers.
Great unknowns
This great unknown of possible negative health effects, along with the lack of regulation of e-cigarettes, scares experts like Leone. The products come bereft of health warnings. How many pregnant women will vape following McCarthy’s promotion?
As for their merits in smoking cessation, e-cigarettes don’t appear very helpful. A study published last month in the journal Addictive Behaviors found that most smokers who used them while they tried to quit either became hooked on vaping, or reverted back to smoking cigarettes. A study published Nov. 16 in the journal The Lancet found no statistically significant difference in the merits of the e-cigarette over the nicotine patch in terms of helping people quit.
Leone said that e-cigarettes might not help people quit smoking because the device keeps addicts in a state of ambivalence — the illusion of doing something positive to mitigate the guilt that comes from smoking, but all the while maintaining the ritual of smoking.
The Jenny McCarthy blu eCigs ad hints at this notion, with such phrases as “smarter alternative to cigarettes,” “without the guilt” and “now that I switched…I feel better about myself.”
Editors of The Lancet called promotion of e-cigarettes “a moral quandary” because of this potential to replace harmful cigarettes with something slightly less harmful yet just as addictive. Other researchers agree that e-cigarettes might help some people quit, but at a population level, converting millions of smokers into vapers still addicted to nicotine might not lead to the cleaner, greener, healthier world implied by e-cigarette manufacturers.
And then there’s the issue of not knowing what’s in the e-cigarette nicotine cartridge.
“It’s an amazing thing to watch a new product like that just kind of appear; there’s no quality control,” said Dr. Richard Hurt, director of the Mayo Clinic’s Nicotine Dependence Center in Rochester, Minn. “Many of them are manufactured in China under no control conditions, so the story is yet to be completely told.”
The authors of The Lancet study, all based in New Zealand, called for countries to regulate the manufacturing and sale of e-cigarettes. The U.S. Food and Drug Administration, which does not approve any e-cigarettes for therapeutic purpose, said it plans to propose a regulation to extend the definition of “tobacco product” under the Tobacco Control Act to gain more authority to regulate products such as e-cigarettes.
http://www.huffingtonpost.com/2013/11/22/ecigarettes-safety-health-risks-electronic-cigarettes_n_4323231.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

A case against e-cigarettes

By MANDY JORDAN, Bismarck
Today we celebrate the Great American Smokeout. It is a national campaign that brings awareness to the dangers of tobacco and secondhand smoke, and encourages people who smoke to quit.
According to statistics from BreatheND, this year in North Dakota 19.4 percent of high school students will smoke and will purchase 1.9 million packs of cigarettes. In our community, 42,000 kids are exposed to secondhand smoke on a daily basis.
Last year, Century SADD testified in front of legislators regarding the new threat to our young people’s health called e-cigarettes. These are electronic devices that deliver nicotine to the body through vapor. Not only can these be candy-flavored, you can now buy cartoon wraps for them to make them visually pleasing. They are not regulated by the Food and Drug Administration and contain carcinogens and toxic chemicals such as diethylene glycol, which is found in antifreeze.
Although the carton says that you need to be 18 to purchase these, we have seen our peers who are under 18 using this product. They are now being sold at a kiosk in a local mall, which is cleverly located by stores where young people shop.
The tobacco industry is trying to say that this is a “harms reduction” product that is intended to help people quit smoking. It is even trying to get North Dakota taxpayers to pay for research that benefits the industry. (Keep in mind that tobacco companies own this product.) It is our strong belief that “harms reduction” is a lie and that e-cigs are a gateway drug that will ultimately create long-term addiction versus reduction. Please join us in our effort to put an end to not only tobacco use, but the new threat of e-cigarettes.
(This letter was signed by Mandy Jordan and members of Century High School SADD. Laurie Foerderer is the adviser.)
http://bismarcktribune.com/news/opinion/mailbag/a-case-against-e-cigarettes/article_fe0eb3b8-522c-11e3-827c-0019bb2963f4.html

Regulation push catching up with electronic cigarettes

By John Keilman and Mitch Smith, Chicago Tribune reporters
Jay Altman smoked cigarettes for 25 years before deciding a few months ago that for the sake of his wallet and his health, a change was in order.
But Altman didn’t quit — he switched.
The North Side insurance worker swapped his daily pack and a half of smokes for the vanilla-flavored nicotine aerosol of an electronic cigarette. He feels better these days, he said, and not just because he’s saving more than $100 a week.
“My friends have noticed a difference,” Altman said while sampling assorted flavors at Smoque Vapours, an e-cigarette shop in the Loop. “They’ll say, ‘You smell good,’ instead of, ‘You stink.'”
The fast-growing e-cigarette industry has hitched its future to such testimonials, pitching its product as a safer and cheaper alternative to tobacco cigarettes. So far the business has escaped the reach of regulators, but from Washington, D.C., to the Chicago suburbs, that is changing quickly.
The U.S. Food and Drug Administration appears poised to label e-cigarettes a “tobacco product,” a distinction that would give the agency power over their marketing, manufacture and sale. North suburban Mundelein just passed an ordinance banning the sale of e-cigarettes to anyone younger than 18, and on Jan. 1 a similar law will take effect statewide.
Evanston, meanwhile, has gone even further, banning the use of e-cigarettes anywhere smoking is prohibited.
“There hasn’t been a whole lot of long-term research on this, but we really wanted to make sure we were on the front end to protect our residents,” said Carl Caneva, assistant director of Evanston’s health department.
The lack of regulation has turned e-cigarettes into a commercial Wild West, where basement chemists and giant corporations alike concoct mixtures that taste like everything from peach schnapps to Mountain Dew. The novel flavors concern anti-smoking advocates, who note that teen e-cigarette use recently doubled within a single year.
“I don’t think that there’s any question that flavors appeal to young people,” said Danny McGoldrick of the Campaign for Tobacco-Free Kids. “It’s just another way to help introduce them to the habit.”
Researchers aren’t sure of all the chemicals released by the products, but some say there’s ample reason for worry.
The American Lung Association, which favors strict regulation, cites a recent study that found chemicals such as formaldehyde and acetone in exhaled e-cigarette vapor.
“We’re very concerned because we don’t know what’s in e-cigarettes or what the health consequences of them might be,” said Erika Sward, the lung association’s assistant vice president for national advocacy. “Frankly, until the FDA begins its oversight of these products, I think everyone needs to proceed very cautiously.”
E-cigarettes use tiny atomizers to turn nicotine-infused liquids into an aerosol, which is inhaled by the user. They’ve been sold in the United States since the mid-2000s, but the Electronic Cigarette Industry Group says sales have boomed in recent years, turning the gadgets into a $2 billion-a-year business.
The group’s president, Eric Criss, said e-cigarettes are intended to be a safer alternative for people who already smoke.
“We feel very strongly that we not be taxed and regulated as a tobacco product because our goal as an industry is to distinguish ourselves from traditional tobacco cigarettes,” he said. “We believe there’s a ladder of harm. Cigarettes are at the top of that, and our goal is to get people to move down that ladder.”
The science behind that claim is far from settled. The industry points to research — some of it funded by e-cigarette interests — that shows the products to be less risky to users, sometimes called “vapers,” and bystanders alike. Robert West, a health psychology professor at University College London, maintains that a global switch from tobacco cigarettes to atomized nicotine would save millions of lives a year.
Stanton Glantz, director of the Center for Tobacco Control Research & Education at the University of California at San Francisco, agreed that e-cigarettes appear to be less harmful than tobacco but said they’re hardly risk-free.
He said most smokers don’t give up tobacco cigarettes entirely when they use electronic ones, so their health doesn’t improve much. And while bystanders aren’t exposed to secondhand smoke, he said, initial research shows that they’re still inhaling nicotine, an addictive substance, along with toxic chemicals and ultrafine particles that can cause heart problems.
“Just because someone chooses to service their (nicotine) addiction by using an e-cigarette, that still doesn’t create a right for them to poison people in the neighborhood,” Glantz said.
The FDA says a federal appeals court has given it the power to regulate e-cigarettes as though they are tobacco products. The agency has a proposed regulation in the works, and while officials won’t say what it contains, public health advocates and industry representatives expect the FDA to assert its authority over e-cigarettes.
Many states are waiting for that to happen before deciding whether to incorporate e-cigarettes into smoking bans, but Glantz argues that new rules could take years to finalize and aren’t necessary for states to tighten their clean air laws.
Three states — North Dakota, New Jersey and Utah — already include e-cigarettes in their smoking bans, and about 100 cities and counties nationwide have taken similar steps, according to the American Nonsmokers’ Rights Foundation.
But Melaney Arnold, spokeswoman for the Illinois Department of Public Health, said the research on e-cigarettes’ secondhand effects is still too preliminary to act upon.
“It’s still evolving, and it will still (take) time until we know the total health effects,” she said.
Chicago Ald. Edward Burke, who often takes up health issues, has a proposed ordinance before the City Council to ban the sale of e-cigarettes to minors. He said he might try to amend it to make e-cigarettes subject to the city’s smoking ban.
“I think we certainly should apply the same regulations to e-cigarettes that we apply to regular cigarettes,” the 14th Ward alderman said.
For now, though, the devices exist in a mishmash of vague and confusing regulations. They’re not allowed to be used on airplanes, though the U.S. Department of Transportation doesn’t explicitly ban them. They’re not allowed in Chicago’s airports, though city ordinances are silent on the point.
“As a practical matter, airport staff does not determine if a cigarette that is being smoked is a tobacco cigarette or an e-cigarette,” said Karen Pride, spokeswoman for the Chicago Department of Aviation. “As such, the use of electronic cigarettes, as with tobacco cigarettes, is prohibited in the airports.”
While the city allows bar patrons to partake of e-cigarettes, taverns make their own rules. Declan’s Irish Pub in Old Town and Lange’s Lounge in Lakeview have no problems with the devices, but Joe’s Bar, a Goose Island establishment, says no.
“We don’t allow it inside because it promotes other people to take out their cigarettes and smoke them,” general manager Bob Casey said.
Despite the lack of clarity over e-cigarette use, several boutique shops selling the devices have sprung up in the city. Jared Yucht, owner of Smoque Vapours, said he started creating “e-liquids” in his basement when he stopped smoking. He opened his first store and lounge in Lakeview last spring and added a second location in the Loop this month.
He said he is proud of his safety precautions, carefully monitoring the nicotine levels of his products and refusing to sell to minors, though neither step is yet required by law.
“I don’t know anyone who owns another store who serves underage,” he said. “I have children and I wouldn’t want them taking stimulants at a young age. It’s an unwritten rule in the community that this is an adult activity for adults.”
http://www.chicagotribune.com/news/local/ct-met-electronic-cigarettes-20131115,0,5010760.story?page=1

CDC: More teens smoking e-cigarettes, hookah

By RYAN JASLOW / CBS NEWS
More middle and high school students are smoking electronic cigarettes, hookahs and cigars, according to a new government report form the Centers for Disease Control and Prevention.
While rates for those tobacco products have increased, overall youth smoking rates haven’t declined at all, a concerning figure for health officials.
“We need effective action to protect our kids from addiction to nicotine,” Dr. Tom Frieden, director of the CDC, said in an agency press release.
For the new report, researchers combed data from the 2012 National Youth Tobacco Survey, a nationally-representative poll of about 25,000 students in grades six through 12 on their tobacco use habits and attitudes towards smoking.
They found recent e-cigarette use among high school students rose to 2.8 percent in 2012, up from 1.5 percent the year before. About 1.1 percent of middle school students reported using the products, up from 0.6 percent in 2011.

E-cigarette use among youths surges

In September, the CDC released a report that found the number of middle and high school students who ever used an e-cigarette doubled, from 1.4 percent and 4.7 percent of surveyed students in 2011 to 2.7 percent and 10 percent by 2012, respectively.
Hookah use was also looked at in the new report. The CDC finding smoking rates increased from 4.1 percent of high schoolers in 2011 to 5.4 percent by 2012.
Cigar use rose “dramatically” among black high school students, with 16.7 percent reporting using them, up from 11.7 percent in 2011 and a doubling of rates since 2009.
Included in cigars were flavored little cigars or cigarillos, which contain fruit or candy flavorings and tend to look similar to cigarettes. They are often cheaper because they are taxed at lower rates and can be sold individually.
Last month, the CDC also released a report on youth smoking rates for flavored little cigars, finding six percent of surveyed middle and high students said they had tried them.
E-cigarettes, hookahs, cigars and other “new” tobacco products are not regulated by the Food and Drug Administration, the CDC points out. Increases in the marketing and availability of these products — along with a misconception they’re safer than cigarettes — may be fueling these increases in kids.
“This report raises a red flag about newer tobacco products,” said Frieden. “Cigars and hookah tobacco are smoked tobacco — addictive and deadly.”
Overall, about 7 percent of middle school students reported smoking any tobacco product along with 23 percent of high school students, rates unchanged from 2011.
The new report was published Nov. 14 in the CDC’s journal Morbidity and Mortality Weekly Report.
The FDA intends to propose a rule to tighten regulation of non-cigarette nicotine products like e-cigarettes. The authors also called for more tobacco-control measures implemented to these newer products, including increasing the price of them, using media campaigns aimed at curbing smoking, increasing access to services that help people quit and enforcing restrictions on advertising and promotion.
Under the Affordable Care Act, more Americans will qualify to coverage for tobacco cessation services, the CDC added.
http://www.cbsnews.com/8301-204_162-57612410/cdc-more-teens-smoking-e-cigarettes-hookah/

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

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

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

By James Lynch, Reporter

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

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

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

A standard e-cigarette.

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

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

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

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

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

E-cigarette ads model big tobacco ads of old

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

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

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

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

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

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