Reuters Health: Adolescent e-cigarette use tied to breathing problems

Adolescents who reported using e-cigarettes were about 30 percent more likely to report respiratory symptoms than those who never used e-cigarettes, in a study from China.
The increased risk of breathing problems – like a cough or phlegm – varied depending on whether or not the adolescents also smoked traditional cigarettes.
“Among never smoking adolescents, e-cigarette users are twice as likely to report respiratory symptoms than non-users,” study author Dr. Daniel Ho, of the University of Hong Kong School of Public Health.
“E-cigarettes are certainly not harmless and serious health problems of long-term use will probably emerge with time,” Ho added in an email to Reuters Health.
E-cigarettes deliver nicotine through a vapor, which contains propylene glycol and flavoring chemicals known to be bothersome to the respiratory system, the researchers write in JAMA Pediatrics.
While past research found some short-term respiratory effects in adults after e-cigarette use, the researchers say no study had looked for these effects in adolescents.
The new findings are drawn from data collected between 2012 and 2013 from over 45,000 schoolchildren in Hong Kong with an average age of about 15.
Overall, 1.1 percent of students reported smoking e-cigarettes within the past 30 days, and about 19 percent of all students reported respiratory symptoms.
Students who smoked e-cigarettes were 30 percent more likely to report breathing problems, compared to those who didn’t use the devices.
The difference in breathing problems was most pronounced among students who said they never smoked traditional cigarettes. These students were over twice as likely to report breathing problems as those who didn’t use e-cigarettes.
Students who reported using e-cigarettes and also smoking traditional cigarettes at some point in their lives were at a 40 percent increased risk of breathing problems, compared to those who didn’t use the devices.
While the study can’t prove the devices caused breathing problems among children, the researchers say the findings support the World Health Organization’s recommendation to regulate e-cigarette use among children.
“Other studies have also shown that adolescent e-cigarette users are more likely to initiate cigarette smoking than non-users,” Ho said. “One in two smokers will be killed by tobacco; two in three if started from a young age.”
Parents, he said, can prevent e-cigarette and traditional cigarette use among their children by not using the devices or tobacco, not exposing their children to secondhand smoke and setting strict smoke-free rules at home.
“E-cigarette use is a controversial topic,” Ho said. “While supporters are optimistic about the potential for harm reduction in the minority of established cigarette smokers, (for) which convincing evidence is lacking, this does not seem to justify the potential harm of re-normalizing cigarette smoking, delaying smoking cessation, and escalating to real cigarette smoking, especially among the majority non-smoking young people.”

KX News: Less Students Smoking Cigarettes, More Students Smoking E-Cigarettes

By Alicia Ewen
North Dakota kids smoke cigarettes less than they used to…far less.
But they are dabbling in some other risky behaviors.
The state asked high school students across the state about their habits. It found that fewer kids smoke.
In fact, 80% of kids said they hadn’t smoked or used smokeless tobacco in the previous month.
Only 3% of high school students say they smoke cigarettes daily.
For the first time though electronic cigarette use was surveyed.
22% of students surveyed say they tried an e-cigarette in the month before they took the survey…
“That’s another misconception, that kids think they are safer than traditional smoking but really there are still chemicals in these vaping products that will harm your body. There hasn’t been as much research done on them as we should have so I’ll be really excited to see what comes out in the next couple of years about these vaping products,” says Hannah Rexine, CHS student and member of the tobacco policy board.
Rexine is the only youth member on the state tobacco policy board. She’s a senior at Century High School in Bismarck.

Bismarck Tribune: E-cigarettes more popular than tobacco among teens, survey finds

Although tobacco use is down among North Dakota’s teenagers, nearly double the number of youngsters are using e-cigarettes, according to a survey of students.
The 2015 Youth Risk Behavior Survey shows that 12 percent of high school students statewide reported smoking at least once in the month before the survey. That’s down from 22 percent in 2005.
Meanwhile, 22 percent of students report having used an e-cigarette in the past month.
The statistics come from a survey overseen by the U.S. Centers for Disease Control and Prevention given to middle school and high school students in every state. In North Dakota, the Department of Public Instruction and the Department of Health administer it to 10,000 high school students.
The prevalence of e-cigarettes marks an area of concern for school and health officials who spoke Monday at a news conference at the state Capitol in Bismarck. E-cigarettes convert nicotine liquid into aerosols that are inhaled, said Jeanne Prom, director of the North Dakota Center for Tobacco Prevention and Control Policy.
Hannah Rexine, a senior at Century High School, said she and her friends became aware of the vaping devices two or three years ago when they began to grow in popularity.
“E-cigarettes are becoming more popular because kids think they are more safe than an actual cigarette,” she said.
Rexine, who sits on the board of directors for the tobacco prevention center, said not enough research has been done to verify that claim.
Prom said using nicotine at a young age causes lasting harm to the brain.
“Nicotine is one of the most highly addictive drugs,” she said. “A curious experiment with an e-cigarette could lead kids into an addiction into any form of nicotine.”
Teens often buy e-cigarettes off the Internet or from friends and don’t know the nicotine content, Rexine said.
E-cigarettes come in a variety of flavors. Some believe the product can help them quit smoking.
“It’s all these rumors going around,” Rexine said.
The Students Against Destructive Decisions group at Century has educated freshmen during orientation each of the past two years about the risks associated with e-cigarettes.
The state and local governments have also jumped on board to combat the popularity of the vaping devices.
Prom said the 2015 North Dakota Legislature passed a bill prohibiting youth from using e-cigarettes and vendors from selling them to minors. Bismarck also approved an ordinance that requires stores selling the products to have a tobacco license and place the items behind the counter.
Though the percentage of teens smoking traditional cigarettes has dropped, Prom said there’s still work to do.
She said 42 percent of the state’s K-12 students attend a school that has a comprehensive policy banning tobacco. She aims to bring that number up to 100 percent by working with county public health units and school districts. Money from North Dakota’s settlement with tobacco companies in the 1990s is funding that effort.
In addition to cigarette use, the survey asks about a number of issues affecting teens, including suicide, drinking, drug use and diet.
State Superintendent Kirsten Baesler outlined efforts to address mental health issues.
The percentage of North Dakota high school students who report having attempted suicide in the past year is 9 percent. The number of students who felt sad or hopeless daily for two or more weeks in the past year is climbing from 20 percent in 2005 to 27 percent this year, according to the survey.
“We need to work to change those numbers,” Baesler said.
She said DPI is preparing training for teachers to identify early signs of mental health issues. She said the 2015 Legislature passed a bill requiring such training annually for high school and middle school administrators, teachers and instructional staff.
She said another new law requires that new teachers receive mental health training before they receive their teaching license.

WebMD: E-Cigarette Use Highest Among Young Adults: Report

Almost 4 percent of all adult Americans use them, new survey shows

WebMD News from HealthDay

By Alan Mozes, HealthDay Reporter

WEDNESDAY, Oct. 28, 2015 (HealthDay News) — In a first-of-its-kind look at electronic cigarettes, a new U.S. government study reports that nearly 13 percent of American adults have tried e-cigarettes at least once and almost 4 percent use them.

According to the 2014 National Health Interview Survey by the U.S. Centers for Disease Control and Prevention, the popularity of e-cigarettes rose slightly among men (about 14 percent) and dipped among women (about 11 percent).

But the most dramatic usage differences break along age lines, the poll of nearly 37,000 adults found. Almost 22 percent of Americans between the ages of 18 and 24 said they had tried the battery-powered aerosol nicotine-delivery device, while usage among those 65 and older was less than 4 percent.

Current users also tend to be younger, the report noted, with more than 5 percent of those 18 to 24 saying they now use e-cigarettes, compared with just over 1 percent of those 65 and older.

And among never-smokers, the usage was also highest among the 18-to-24 age group.

The report found that e-cigarette popularity is greatest among white and Native American adults, with nearly 5 and 11 percent, respectively, now using them. Only about 2 percent of blacks and Hispanics use them.

E-cigs also seem to curry much more favor among those who now smoke traditional cigarettes, or those who only recently kicked the habit: About 48 percent of current smokers have tried an e-cigarette and one in six currently use them. About 55 percent of those who stopped smoking just in the last year have tried them, and 22 percent said they currently use them.

By contrast, only about 3 percent of never-smoking adults said they’ve tried an e-cigarette, and less than half of 1 percent said they use them now. Among young (aged 18 to 24) never-smokers, however, almost 10 percent said they’ve tried one out.

So what’s driving the numbers?

“We really can’t answer that question,” said study co-author Charlotte Schoenborn, a statistician with the U.S. National Center for Health Statistics in the CDC’s division of health interview statistics. “This was the first year that the NCHS has even asked these questions. So we can only speculate as to why, as we watch to see how the trends unfold over time.”

Schoenborn and her colleague Renee Gindi outline their findings in the CDC’s October NCHS report released Oct. 28.
Erika Sward, assistant vice president for national advocacy with the American Lung Association, suggested that the CDC data will end up becoming a “very useful and much needed benchmark” for monitoring e-cigarettes.
“Electronic cigarettes are really the wild, wild West,” Sward said. “There’s absolutely no federal oversight of e-cigarettes, even though the FDA [U.S. Food and Drug Administration] has not found any e-cig to be safe or effective in helping smokers quit. And to our knowledge, no e-cigarette company has even applied to the FDA for approval as a smoking cessation product.”
But many manufacturers market the devices that way anyway, she said.
“So the real take-away message is that the people who are most likely to use e-cigs are our most vulnerable adults: the young, current smokers, and those who have recently quit or are trying to quit,” she said.
Sward added, “So just as we’re seeing traditional cigarette use decline — after years of FDA regulation and state smoke-free policies and taxation — we’re now seeing the tobacco industry continue its narrative of aggressively marketing e-cigarettes to younger people in the hopes of developing a whole new lifelong user.
“And until we act,” she said, “troubling studies like this one suggest that we’re on a path to a real public health crisis that will undo much of the progress that has been made to reduce tobacco use in the U.S.”
The report comes on the heels of a recommendation by the nation’s leading pediatricians group to raise the minimum age for purchasing tobacco products and e-cigarettes to 21 across the United States.
The new policy recommendation by the American Academy of Pediatrics, released Oct. 26, also called for the FDA to regulate e-cigarettes the same way it regulates other tobacco products.

USA Today: DOT bans e-cigarettes in checked luggage

Harriet Baskas, Special for USA TODAY
Under a new federal rule announced Monday by the Department of Transportation, airline passengers and crewmembers will no longer be able to pack battery-powered portable electronic smoking devices such as e-cigarettes, e-cigars, e-pipes, personal vaporizers and any sort of electronic nicotine delivery system, in checked luggage.
“We know from recent incidents that e-cigarettes in checked bags can catch fire during transport,” Transportation Secretary Anthony Foxx said in statement announcing the new federal rule. “Fire hazards in flight are particularly dangerous. Banning e-cigarettes from checked bags is a prudent safety measure.”
The DOT cites a U.S. Fire Administration report listing more than two dozen e-cigarette-related explosions and fires that have taken place since 2009, including some that involved e-cigarettes that were in checked luggage on airplanes.
According to the DOT, on Aug. 9, 2014, at Boston’s Logan Airport, an e-cigarette that was in a passenger’s checked bag in the cargo hold of a passenger plane caused a fire that forced the evacuation of the aircraft. And on Jan. 4, 2015, at Los Angeles International Airport, a checked bag that arrived late and missed its connecting flight caught on fire when an e-cigarette inside the bag overheated.
Under the new rule, passengers may continue to put e-cigarettes in their carry-on bags (or in their pockets), but they cannot use the e-cigs or charge them during a flight.
Although the DOT has said in the past that its rule banning the smoking of tobacco products on passenger flights extends to electronic cigarettes, the DOT is now also proposing to amend the rule to name e-cigarettes in the ruling.
According to the Associated Press, the ruling banning e-cigarettes from checked luggage should go into effect within two weeks.
Harriet Baskas is a Seattle-based airports and aviation writer and USA TODAY Travel’s “At the Airport” columnist. She occasionally contributes to Ben Mutzabaugh’s Today in the Sky blog. Follow her at

NPR: Poll: Most Americans Support FDA Regulation Of E-Cigarettes

Poll: "Do you believe e-cigarettes should be regulated by the FDA like tobacco products?"
A majority of Americans say electronic cigarettes should be regulated by the Food and Drug Administration the same way the agency handles cigarettes containing tobacco, according to results from the latest NPR-Truven Health Analytics Health Poll.
Overall, 57 percent of people said the FDA should regulate e-cigarettes like tobacco products. The proportion of people in favor of regulation rose with age and education. Nearly, two-thirds of people with college degrees or graduate degrees supported regulation compared with 48 percent with high school diplomas or less.
The Food and Drug Administration proposed regulations for e-cigarettes in April 2014. Since then the agency has collected comments and held workshops on the public health issues raised by the products.
The agency sent its e-cigarette regulations to the White House on Oct. 19 for a required review, agency spokesman Michael Felberbaum tells Shots. The Office of Management and Budget has to pore over major regulations before they can be into effect.
Some of the key parts of the proposal included a ban on the sale of e-cigarettes to minors, a requirement that the products carry warnings they contain nicotine and disclosure of ingredients by manufacturers.
How much the FDA may have changed the regulations since they were first proposed isn’t clear because the agency doesn’t publicly release what it sends to the White House for sign-off. The White House can further tweak the rules, too.
We may find out fairly soon, though. There is a 90-day timetable for OMB review. The White House can extend the review to allow for more back and forth on the rules.
In the meantime, plenty of Americans have tried e-cigarettes. The NPR-Truven Health poll found that a quarter of respondents had vaped at least once. About a quarter of the respondents said they are current tobacco users.
E-Cigarette Use vs. Tobacco Use
What’s drawing people to e-cigarettes? The most common reasons given from those who have tried them were: to help stop smoking cigarettes (27 percent), as a healthier alternative to tobacco (26 percent) and curiosity (24 percent).
Among people who have tried e-cigarettes, half continue to use them. But 40 percent of current vapers said they have concerns about the health effects.
What was your primary reason for trying e-cigarettes?
“Electronic cigarettes have exploded in popularity in just a few short years, but we still know very little about the health risks associated with the technology,” said Dr. Michael Taylor, chief medical officer at Truven Health Analytics. “With our data showing a 50 percent adoption rate among those who have tried e-cigarettes, it’s reasonable to expect that usage will continue to grow, even as traditional cigarette smoking declines. This is clearly an area that will require a great deal more research.”
More than 3,000 people were surveyed about e-cigarettes during the first half of August. The responses came from households contacted by cellphone, land line and the Internet. The margin of error is plus or minus 1.8 percentage points.
You can find the questions and full results of the latest poll here. For previous polls, click here.

LA Times: First-time tobacco users lured by flavorings, report says

Melissa HealyContact Reporter
A majority of adolescents who are puffing, vaping or chewing a tobacco product for the first time prefer one with flavor, suggesting that fruity, tangy, spicy or minty flavorings add a powerful allure to the uninitiated.
In a nationwide survey of U.S. children ages 12 to 17, the Food and Drug Administration’s Center for Tobacco Products has found that among those trying a hookah, electronic cigarette, cigar or regular cigarette for the first time, 89%, 81%, 65% and 50%, respectively, chose to try their tobacco product with an added flavoring.
In the United States, the marketing of flavored cigarettes — with the exception of menthol — is prohibited. But a wide range of flavorings is used in tobacco that is vaped, smoked in hookahs, chewed or dissolved in the mouth.
When adolescents were asked about their use of a tobacco product over the last 30 days, large majorities underscored that flavorings continued to play a role in their enjoyment of tobacco products. Asked about their tobacco use in the preceding month, 89% among hookah users said they had used flavored tobacco, compared with 85% of e-cigarette users, 72% of  users of any cigar type, and 60% of cigarette smokers.
The results were published Monday in the Journal of the American Medical Assn.
The study offers new insights into what factors pave the way for an estimated 3,200 American kids each day to try tobacco for the first time. A lifetime tobacco habit is overwhelmingly started in the teen and young adult years, and federal regulators have been keen to blunt smoking’s appeal to first-time users.
Since 2009, the FDA has had sweeping powers to regulate tobacco products in the interest of the public’s health. New evidence that flavorings play a key role in easing a would-be tobacco user’s introduction to the product is sure to spark renewed debate over outlawing flavorings.
“Consistent with national school-based estimates, this study confirms widespread appeal of flavored products among youth tobacco users,” the authors write. “In addition to continued proven tobacco control and prevention strategies, efforts to decrease use of flavored tobacco products among youth should be considered.”

The Hill: FDA sends e-cigarette regs to White House for review

By Lydia Wheeler
The Food and Drug Administration (FDA) has sent its final rule to regulate additional tobacco products, including electronic cigarettes and cigars, for White House review.
The rule, which was first proposed more than a year ago, was sent to the White House Office of Management and Budget’s Office of Information and Regulatory Affairs on Monday, but it could be weeks before the rule is actually released.
FDA spokesman Michael Felberbaum said the Office of Management and Budget is required to review all significant regulatory actions and has 90 calendar days to do so.
“However, this timeframe can be extended to allow for additional interagency discussion,” he said. “At this time, the FDA cannot provide any further comment until the final rule is published.”
The American Lung Association is hoping for an expedited review.
“We remain deeply troubled that it’s taken 18 months from the time the proposal was released to now,” said Erika Sward, the group’s assistant vice president of national advocacy. “We need to move forward in protecting kids and public heath.”
Sward said the lung association is hoping the final rule will give FDA the authority to truly regulate all tobacco products. Under the proposed rule, she said, there was a loophole for certain “premium” cigars.
“There’s no such thing as a safe tobacco product and certainly not a safe cigar,” she said. “FDA needs to have the basic authority over all tobacco products to make sure kids aren’t buying them and warning labels are required.”

Study: Teens using e-cigs much more likely to start smoking cigarettes

More bad news for young people who smoke e-cigarettes.
Doing so makes them much more likely to start smoking traditional cigarettes within a year than peers who don’t smoke e-cigarettes, according to a new analysis published online Tuesday and scheduled for the November issue of JAMA Pediatrics.
The latest news about e-cigarettes comes at a time when their use is soaring among youngsters. The number of middle school and high school students using electronic cigarettes tripled from 2013 to 2014, according to government figures released this spring, a startling increase that public health officials fear could reverse decades of efforts combating the scourge of smoking.
The popularity of e-cigarettes among teenagers now eclipses that of traditional cigarettes, the use of which has fallen to the lowest level in years.
In the latest study, researchers analyzed data from a national sample of nearly 700 nonsmokers who were between ages 16 and 26 in 2012, and again in 2013. All of them said “definitely no” when they were asked if they would try a cigarette offered by a friend or believed they would smoke a cigarette within the next year.
Only 16 of the participants used e-cigarettes when they were initially surveyed, but six of them had progressed to cigarette smoking by the next year, or about 38 percent. By contrast, only 10 percent of the youths who were not e-cigarette users  started smoking traditional cigarettes.
The study was conducted by the University of Pittsburgh Center for Research on Media, Technology and Health and the Dartmouth-Hitchcock Norris Cotton Cancer Center.
In the past, few studies looked at whether e-cigarette users who initially did not smoke were at risk for taking up both the use of e-cigarettes and traditional cigarettes, or the exclusive use of cigarettes. Previous studies could not determine whether e-cigarette use preceded cigarette use, researchers said. Those studies also looked at different youngsters over different time periods.
The latest study analyzed the same individuals over time.
“This is the first longitudinal, national study to show that e-cigarette use among youth directly leads to regular cigarette use, even among people who insist at baseline that they never will smoke regular cigarettes,” said lead author Brian Primack, who is assistant vice chancellor for health and society at Pittsburgh’s Schools of the Health Sciences. “It is also the first to include young adults, as opposed to strictly teenagers.”
Researchers said one limitation was the relatively small number in the sample size. The findings need to be replicated with larger samples. Even so, after controlling for well-known risk factors, such as age, sex, socioeconomic status and risk-taking, “we think the effect is real,” said Samir Soneji, an assistant professor at the Dartmouth Institute for Health Policy and Clinical Practice and one of the authors.
E-cigarettes accelerate the progression to traditional cigarette smoking, he said.
The quandary for public health officials is this, he said. “Are they more dangerous for kids than they are helpful for adults who are trying to quit smoking?”

USA Today: Teens find a new use for e-cigarettes: Vaping marijuana

Teenagers have discovered a new way to inhale marijuana — e-cigarette vaporizers, according to a study released Monday.
About 27% of high school students who have used both marijuana and e-cigarettes reported using the devices to vaporize cannabis. Those most likely to vaporize pot with e-cigarettes included males and younger students.
E-cigarettes are designed to vaporize solutions containing nicotine, said co-author Meghan Rabbitt Morean. But, she noted, “teenagers are resourceful, and it was only a matter of time.”
Vaporizers give kids a better way to hide what they’re inhaling.
“It’s so much easier to conceal e-cigarette pot use,” said Morean, an assistant professor at Oberlin College. “Everybody knows that characteristic smell of marijuana, but this vapor is different. It’s possible that teenagers are using pot in a much less detectable way.”
Researchers at Yale University based their findings on answers from a survey sent to nearly 4,000 Connecticut students. The study was published Monday in Pediatrics.
About 28% of students in the study had tried e-cigarettes.
Morean said people should remember to be cautious when interpreting her findings. There haven’t been any other studies showing teens are using e-cigs to vaporize marijuana. She noted that scientists don’t fully understand the health effects of e-cig-vaporized cannabis.
Marijuana use in other forms can cause several health problems such as short-term memory loss, slow learning, decreased sperm count and lung damage, according to the Centers for Disease Control and Prevention.
“We now know it’s happening, but there are more questions about who is using and how damaging it is,” Morean said.
E-cigarette use among youth increased more than 200% from 2011 to 2013, according to a report in the journal Nicotine and Tobacco Research. Those surveyed had not tried regular cigarettes.
“Unfortunately, there is really no end for what can be vaporized in these devices,” said Erika Sward, a spokeswoman for the American Lung Association.
Supporters of e-cigarettes, who describe them as a healthier alternative to regular cigarettes, found fault with the new survey. The study may not accurately reflect what teens across the country are doing because it surveyed students in only one state, said Phil Daman, president of the Smoke-Free Alternatives Trade Association and attorney for Daman & Associates.
His group strongly discourages underage use of vapor products.
“While some teens experiment, it’s vital that parents and guardians talk to their children about not using any age-restricted products including vapor products,” Daman said.
Morean said she and her colleagues plan to conduct additional studies.
She hopes researchers in other states will provide additional data, to provide a clearer picture of national trends.
“This research is so new,” Morean said.