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Selling a Poison by the Barrel: Liquid Nicotine for E-Cigarettes

By , New York Times

A dangerous new form of a powerful stimulant is hitting markets nationwide, for sale by the vial, the gallon and even the barrel.

The drug is nicotine, in its potent, liquid form — extracted from tobacco and tinctured with a cocktail of flavorings, colorings and assorted chemicals to feed the fast-growing electronic cigarette industry.

These “e-liquids,” the key ingredients in e-cigarettes, are powerful neurotoxins. Tiny amounts, whether ingested or absorbed through the skin, can cause vomiting and seizures and even be lethal. A teaspoon of even highly diluted e-liquid can kill a small child.

But, like e-cigarettes, e-liquids are not regulated by federal authorities. They are mixed on factory floors and in the back rooms of shops, and sold legally in stores and online in small bottles that are kept casually around the house for regular refilling of e-cigarettes.

Evidence of the potential dangers is already emerging. Toxicologists warn that e-liquids pose a significant risk to public health, particularly to children, who may be drawn to their bright colors and fragrant flavorings like cherry, chocolate and bubble gum.

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The liquid stimulant used in e-cigarettes, when ingested or absorbed through the skin, can cause vomiting, seizures or death. CreditFrank Franklin II/Associated Press

“It’s not a matter of if a child will be seriously poisoned or killed,” said Lee Cantrell, director of the San Diego division of the California Poison Control System and a professor of pharmacy at the University of California, San Francisco. “It’s a matter of when.”

Reports of accidental poisonings, notably among children, are soaring. Since 2011, there appears to have been one death in the United States, a suicide by an adult who injected nicotine. But less serious cases have led to a surge in calls to poison control centers. Nationwide, the number of cases linked to e-liquids jumped to 1,351 in 2013, a 300 percent increase from 2012, and the number is on pace to double this year, according to information from the National Poison Data System. Of the cases in 2013, 365 were referred to hospitals, triple the previous year’s number.

Examples come from across the country. Last month, a 2-year-old girl in Oklahoma City drank a small bottle of a parent’s nicotine liquid, started vomiting and was rushed to an emergency room.

That case and age group is considered typical. Of the 74 e-cigarette and nicotine poisoning cases called into Minnesota poison control in 2013, 29 involved children age 2 and under. In Oklahoma, all but two of the 25 cases in the first two months of this year involved children age 4 and under.

In terms of the immediate poison risk, e-liquids are far more dangerous than tobacco, because the liquid is absorbed more quickly, even in diluted concentrations.

“This is one of the most potent naturally occurring toxins we have,” Mr. Cantrell said of nicotine. But e-liquids are now available almost everywhere. “It is sold all over the place. It is ubiquitous in society.”

The surge in poisonings reflects not only the growth of e-cigarettes but also a shift in technology. Initially, many e-cigarettes were disposable devices that looked like conventional cigarettes. Increasingly, however, they are larger, reusable gadgets that can be refilled with liquid, generally a combination of nicotine, flavorings and solvents. In Kentucky, where about 40 percent of cases involved adults, one woman was admitted to the hospital with cardiac problems after her e-cigarette broke in her bed, spilling the e-liquid, which was then absorbed through her skin.

The problems with adults, like those with children, owe to carelessness and lack of understanding of the risks. In the cases of exposure in children, “a lot of parents didn’t realize it was toxic until the kid started vomiting,” said Ashley Webb, director of the Kentucky Regional Poison Control Center at Kosair Children’s Hospital.

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Nicotine solutions at Volt Vapes in Boise, Idaho. The “e-liquid” comes in colors and flavors that experts say may entice children. CreditKatherine Jones/The Idaho Statesman, via Associated Press

The increased use of liquid nicotine has, in effect, created a new kind of recreational drug category, and a controversial one. For advocates of e-cigarettes, liquid nicotine represents the fuel of a technology that might prompt people to quit smoking, and there is anecdotal evidence that is happening. But there are no long-term studies about whether e-cigarettes will be better than nicotine gum or patches at helping people quit. Nor are there studies about the long-term effects of inhaling vaporized nicotine.

 Unlike nicotine gums and patches, e-cigarettes and their ingredients are not regulated. The Food and Drug Administration has said it plans to regulate e-cigarettes but has not disclosed how it will approach the issue. Many e-cigarette companies hope there will be limited regulation.

“It’s the wild, wild west right now,” said Chip Paul, chief executive officer of Palm Beach Vapors, a company based in Tulsa, Okla., that operates 13 e-cigarette franchises nationwide and plans to open 50 more this year. “Everybody fears F.D.A. regulation, but honestly, we kind of welcome some kind of rules and regulations around this liquid.”

Mr. Paul estimated that this year in the United States there will be sales of one million to two million liters of liquid used to refill e-cigarettes, and it is widely available on the Internet. Liquid Nicotine Wholesalers, based in Peoria, Ariz., charges $110 for a liter with 10 percent nicotine concentration. The company says on its website that it also offers a 55 gallon size. Vaporworld.biz sells a gallon at 10 percent concentrations for $195.

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The website of Liquid Nicotine Wholesalers. The Food and Drug Administration has yet to impose rules on e-liquids’ sale.

Mr. Paul said he was worried that some manufacturers outside the United States — China is a major center of e-cigarette production — were not always delivering the concentrations and purity of nicotine they promise. Some retailers, Mr. Paul said, “are selling liquid and they don’t have a clue what is in it.”

 Cynthia Cabrera, executive director of Smoke Free Alternatives Trade Association, said she would also favor regulations, including those that would include childproof bottles and warning labels, and also manufacturing standards. But she said many companies already were doing that voluntarily, and that parents also needed to take some responsibility.

“You wouldn’t leave a bottle of Ajax out,” she said. Advocates of e-cigarettes sometimes draw comparisons between nicotine and caffeine, characterizing both as recreational stimulants that carry few risks. But that argument is not established by science, and many health advocates take issue with the comparison.

“There’s no risk to a barista no matter how much caffeine they spill on themselves,” said Dr. Neal L. Benowitz, a professor at the University of California, San Francisco, who specializes in nicotine research. “Nicotine is different.”

Without proper precautions, like wearing gloves while mixing e-liquids, these products “represents a serious workplace hazard,” he said.

The nicotine levels in e-liquids varies. Most range between 1.8 percent and 2.4 percent, concentrations that can cause sickness, but rarely death, in children. But higher concentrations, like 10 percent or even 7.2 percent, are widely available on the Internet. A lethal dose at such levels would take “less than a tablespoon,” according to Dr. Cantrell, from the poison control system in California. “Not just a kid. One tablespoon could kill an adult,” he said.

http://www.nytimes.com/2014/03/24/business/selling-a-poison-by-the-barrel-liquid-nicotine-for-e-cigarettes.html?_r=0

Teenage E-Cigarette Use Likely Gateway to Smoking

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

Enticing Product

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

No Tar

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

Nicotine Effects

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

Pivotal Year

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

Bans Criticized

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

5 Things to Know About E-Cigarettes

By , ABC News

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

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

E-Cigarette Health Row Catches Fire

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

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

What are e-cigarettes?

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

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

How much do they cost?

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

Are e-cigarettes regulated?

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

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

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

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

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

What are the health risks of vaping?

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

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

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

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

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

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

Do e-cigarettes help tobacco smokers quit?

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

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

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

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

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

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

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

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

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

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

Senators look for e-cigarette marketing limits

By MICHAEL FELBERBAUM AP Tobacco Writer
RICHMOND, Va.—Several U.S. senators on Wednesday introduced a bill that would curb electronic cigarette marketing while the fast-growing industry awaits regulation by the Food and Drug Administration.
The bill is co-sponsored by California Sen. Barbara Boxer, Iowa Sen. Tom Harkin, both Democrats, and others. It would ban marketing to children based on standards set by the Federal Trade Commission and allow the agency to work with state attorneys general to enforce the ban on advertising. The battery-powered devices heat a liquid nicotine solution and create vapor that’s inhaled.
Companies vying for a stake in the electronic cigarette business are reviving the decades-old marketing tactics the tobacco industry used to hook generations of Americans on regular smokes. Those tactics, such as running TV commercials and sponsoring race cars and other events, are raising worries that e-cigarette makers could tempt young people to take up something that could prove addictive.
While the FDA plans to set marketing and product regulations for electronic cigarettes in the near future, for now, almost anything goes.
And Harkin said e-cigarette makers are attempting to create “a new generation of nicotine addicts.”
“When it comes to the marketing of e-cigarettes to children and teens, it’s ‘Joe Camel’ all over again,” Harkin said in a statement.
A 2009 law gave the FDA the power to regulate a number of aspects of tobacco marketing and manufacturing, though it cannot ban nicotine or cigarettes outright.
The agency first said it planned to assert authority over e-cigarettes in 2011 but hasn’t yet. The proposed FDA regulation was submitted to the Office of Management and Budget for review in October.
While FDA regulation of these products remains critical, Harkin said the legislation would complement the agency’s oversight.
http://www.twincities.com/nation/ci_25233292/senators-look-e-cigarette-marketing-limits

FDA issues first orders to stop sale, distribution of tobacco products

FDA NEWS RELEASE

For Immediate Release: Feb. 21, 2014 

The U.S. Food and Drug Administration issued orders today to stop the further sale and distribution of four tobacco products currently on the market. The action marks the first time the FDA has used its authority under the Family Smoking Prevention and Tobacco Control Act to order a manufacturer of currently available tobacco products to stop selling and distributing them.
The products – Sutra Bidis Red, Sutra Bidis Menthol, Sutra Bidis Red Cone, and Sutra Bidis Menthol Cone – were found to be not substantially equivalent to tobacco products commercially marketed as of February 15, 2007, also known as predicate products. This means they can no longer be sold or distributed in interstate commerce or imported into the United States.
Bidis are thin, hand-rolled cigarettes filled with tobacco and wrapped in leaves from a tendu tree that are tied with string. The manufacturer, Jash International, did not meet the requirements of the Tobacco Control Act to be able to continue selling these products.
“Historically, tobacco companies controlled which products came on and off the market without any oversight,” said Mitch Zeller, J.D., director of the FDA’s Center for Tobacco Products. “But the Tobacco Control Act gave the FDA, a science-based regulatory agency, the authority to review applications and determine which new tobacco products may be sold and distributed under the law in order to protect public health.”
Under the Tobacco Control Act, regulated products were allowed to stay on the market if companies submitted an application to the FDA by March 22, 2011. The law requires the FDA to review product applications so the agency can decide whether the products are substantially equivalent (SE) to valid predicate products. If a company fails to provide the necessary information to show that their product is SE to a predicate product, the FDA has the authority to declare a product not substantially equivalent, which means that it can no longer be sold or distributed in interstate commerce.
In this case, Jash International did not identify eligible predicate tobacco products as required for the FDA to perform an SE review. Also, the company did not provide information necessary to determine whether the new products had the same characteristics as a predicate product, or had different characteristics but did not raise different questions of public health, the basis used by the FDA to review SE applications for tobacco products.
“Companies have an obligation to comply with the law – in this case, by providing evidence to support an SE application,” said Zeller. “Because the company failed to meet the requirement of the Tobacco Control Act, the FDA’s decision means that, regardless of when the products were manufactured, these four products can no longer be legally imported or sold or distributed through interstate commerce in the United States.”
Existing inventory may be subject to enforcement action, including seizure, without further notice. Companies that continue to sell and distribute these products in the United States may be subject to enforcement actions by the FDA.
With regard to retailers, FDA does not intend to take enforcement action for 30 days on previously purchased products that a retailer has in its inventory.  This policy does not apply to inventory purchased by retailers after the date of the order. FDA has issued draft guidance containing more information on the agency’s enforcement policy for certain tobacco products that the FDA finds not substantially equivalent. It will be open for public comment for 60 days, beginning Tuesday, February 25.
The FDA encourages retailers to contact their supplier or the manufacturer to discuss possible options for the misbranded and adulterated product or products that the retailers have in current inventory.
Consumers and other interested parties can report a potential tobacco-related violation of the Food, Drug & Cosmetic Act, including NSE products that continue to be sold or distributed in the United States, by using the FDA’s Potential Tobacco Product Violation Reporting Form.

For more information:

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

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http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm386707.htm

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

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

FDA launching $115M multimedia education campaign showing at-risk youth 'real cost' of smoking

By MICHAEL FELBERBAUM  AP Tobacco Writer
WASHINGTON — The Food and Drug Administration is using ads depicting wrinkled skin on youthful faces and teenagers paying for cigarettes with their teeth in a campaign to show the nation’s young people the costs associated with smoking.
The federal agency said Tuesday it is launching a $115 million multimedia education campaign called “The Real Cost” that’s aimed at stopping teenagers from smoking and encouraging them to quit.
Advertisements will run in more than 200 markets throughout the U.S. for at least one year beginning Feb. 11. The campaign will include ads on TV stations such as MTV and print spots in magazines like Teen Vogue. It also will use social media.
“Our kids are the replacement customers for the addicted adult smokers who die or quit each day,” said Mitch Zeller, the director of the FDA’s Center for Tobacco Products. “And that’s why we think it’s so important to reach out to them — not to lecture them, not to throw statistics at them — but to reach them in a way that will get them to rethink their relationship with tobacco use.”
Zeller, who oversaw the anti-tobacco “Truth” campaign while working at the nonprofit American Legacy Foundation in the early 2000s, called the new campaign a “compelling, provocative and somewhat graphic way” of grabbing the attention of more than 10 million young people ages 12 to 17 who are open to, or are already experimenting with, cigarettes.
According to the FDA, nearly 90 percent of adult smokers started using cigarettes by age 18 and more than 700 kids under 18 become daily smokers each day. The agency aims to reduce the number of youth cigarette smokers by at least 300,000 within three years.
“While most teens understand the serious health risks associated with tobacco use, they often don’t believe the long-term consequences will ever apply to them,” said FDA Commissioner Margaret Hamburg. “We’ll highlight some of the real costs and health consequences associated with tobacco use by focusing on some of the things that really matter to teens — their outward appearance and having control and independence over their lives.”
Two of the TV ads show teens walking into a corner store to buy cigarettes. When the cashier tells them it’s going to cost them more than they have, the teens proceed to tear off a piece of their skin and use pliers to pull out a tooth in order to pay for their cigarettes. Other ads portray cigarettes as a man dressed in a dirty white shirt and khaki pants bullying teens and another shows teeth being destroyed by a ray gun shooting cigarettes.
The FDA is evaluating the impact of the campaign by following 8,000 people between the ages of 11 and 16 for two years to assess changes in tobacco-related knowledge, attitudes and behaviors.
The campaign announced Tuesday is the first in a series of campaigns to educate the public about the dangers of tobacco use.
In 2011, the FDA said it planned to spend up to $600 million over five years on the campaigns aimed at reducing death and disease caused by tobacco, which is responsible for about 480,000 deaths a year in the U.S. Future campaigns will target minority youth, lesbian, gay, bisexual and transgender youth and youth in rural areas.
Tobacco companies are footing the bill for the campaigns through fees charged by the FDA under a 2009 law that gave the agency authority over the tobacco industry.
 http://www.therepublic.com/view/story/e2170c9ad67b4bc08ab8228b121857ea/US–FDA-Tobacco-Campaign

E-Cigarette Makers Give Public the Finger

Rob Waters, Contributor, Forbes
With Sarah Mittermaier and Lily Swartz
In 1964, smoking was everywhere: on television, on airplanes, in workplaces and movie theatres, college campuses, doctors’ offices, restaurants and bars. In the 50 years since the first Surgeon General’s report on smoking and health was released, smoking has gradually faded to the margins of public life. TheMarlboro man was bounced from the airwaves, comprehensive smoking bans were passed in hundreds of cities and 28 states, and smoking rates were cut almost in half. The struggle to protect the public’s health is far from over—and shocking disparities in tobacco use and exposure to tobacco marketing remain—but we’re now reaping some rewards, with eight million lives saved over the past half-century.
But now a new threat is emerging. The use of e-cigarettes is rising rapidly, with teenagers a key target of marketing efforts. “Vaping” is making smoking acceptable—even cool—once again as the tobacco industry returns to its old ways, putting e-cigarette commercials back on the airwaves for the first time since the 1970s.

Right now, e-cigarettes exist in what tobacco control researcher Stanton Glanz calls a regulatory “Wild West,” with no federal regulation of the manufacturing, marketing and sales of these products. This regulatory vacuum threatens to undo the hard-won victories of the past 50 years in tobacco control.
E-cigarette companies are taking a page right out of Big Tobacco’s old-school playbook: marketing their products with sex appeal, celebrity endorsements, even cartoons. The companies argue that “vaping” is safer than traditional smoking and that may or may not be true—there are far too few studies to back up that claim or refute it. But it’s also a smokescreen.
The tobacco industry is out to hook kids, and it’s working. E-cigarettes come in an array of kid-friendly flavors, from“Cherry Crush” to “Coca Cola.” And unlike conventional cigarettes, e-cigarettes can legally be sold to kids in most US states. Data released last year by the Centers for Disease Control and Prevention showed that e-cigarette use more than doubled among middle and high school students in the previous year. For 20 percent of the middle schoolers, e-cigarettes were their first experience with smoking, raising concerns that e-cigarettes may act as a gateway to the use of other tobacco products.
E-cigarettes also threaten to reintroduce smoking to workplaces, restaurants, bars and other public spaces where hard-fought public health campaigns have succeeded in banning cigarettes. These policies have changed our communities from the ground up, creating new expectations and norms around smoking. The science is still out on whether e-cigarettes threaten non-smokers with toxic exposure, but their use in public legitimizes their use, making them seem acceptable, even Golden Globes-glamorous. We can’t let e-cigarettes undo the hard work tobacco control advocates have achieved over the past 50 years.
Some cities and states are pushing back against e-cigarettes, taking steps to regulate the sale and public use of e-cigarettes. Over the past few months, New York and Chicago city councils voted to regulate e-cigarettes as tobacco products, extending existing smoking bans to cover vaping. The Los Angeles City Council voted unanimously to regulate the sales of e-cigarettes. Boston has banned e-cigarette smoking in workplaces. States such as Utah, New Jersey, and North Dakota ban the use of e-cigarettes in indoor public spaces.
These local and state efforts should be followed—and strengthened—by federal action. Attorneys general from 40 states have called on the Food and Drug Administration to regulate e-cigarettes as tobacco products, a move that would give the FDA the power to impose age restrictions and limit marketing of e-cigarettes. Proposed rules drafted by the agency have not yet been released publicly.
We can’t wait years for scientists to conduct new studies on the health risks of vaping before we take action. We know better than to trust the tobacco industry’s health claims about their products—or to trust the industry with our children’s future. The time for action is now. To paraphrase one anti-cigarette commercial in California: “Some people will say anything to sell (e-) cigarettes.”
http://www.forbes.com/sites/robwaters/2014/01/27/e-cigarette-makers-give-public-the-finger/

Leading Health Groups Call for Bold Action to End the Tobacco Epidemic In the United States

Nation Challenged to Cut Smoking Rates to Under 10 Percent in 10 Years and Protect All Americans from Secondhand Smoke within 5 years

 
The seven groups issuing the call to action are the American Academy of Pediatrics, American Cancer Society Cancer Action Network, American Heart Association, American Lung Association, Americans for Nonsmokers’ Rights, Campaign for Tobacco-Free Kids and Legacy®.
WASHINGTON, DC – As the United States marks the 50th anniversary of the first Surgeon General’s Report on Smoking and Health, seven leading public health and medical organizations today called for a new national commitment to end the tobacco epidemic for good.
At a press conference today, the organizations called for bold action by all levels of government to achieve three goals:

  • Reduce smoking rates, currently at about 18 percent, to less than 10 percent within 10 years;
  • Protect all Americans from secondhand smoke within five years; and
  • Ultimately eliminate the death and disease caused by tobacco use.

These seven organizations issued the following joint statement:  American Academy of Pediatrics, American Cancer Society Cancer Action Network, American Heart Association, American Lung Association, Americans for Nonsmokers’ Rights, Campaign for Tobacco Free Kids, and Legacy for Longer Healthier Lives
The first Surgeon General’s Report on Smoking and Health, issued on January 11, 1964, was a historic turning point in the nation’s fight against tobacco use.
Our organizations celebrate the remarkable progress of the past 50 years.  The United States has cut smoking rates by more than half (from 42.4 percent in 1965 to 18 percent today) and per capita consumption of cigarettes by more than 70 percent.  While smoking was allowed almost everywhere in 1964, today nearly half the nation’s population is protected by smoke-free laws that apply to all workplaces, restaurants and bars.  Reductions in smoking have saved millions of lives and are responsible for 30 percent of the increase in the life expectancy of Americans since 1964, according to a study published today in the Journal of the American Medical Association (JAMA).  The fight against tobacco has been a tremendous public health achievement.
However, the battle is far from over.  Tobacco use is still the number one cause of preventable death in the United States.  Smoking kills more than 440,000 Americans each year, sickens millions more and costs the nation $193 billion annually in health care expenditures and lost productivity.  About 44 million adults still smoke, and more than 3,000 kids try their first cigarette each day.  It is unacceptable that tobacco still kills so many Americans, lures so many children, devastates so many families and places such a huge burden on our nation’s health care system.
On the 50th anniversary of the first Surgeon General’s report, it is time for a new national commitment to end the tobacco epidemic for good.  Today our organizations call for bold action by all levels of government to achieve three goals: 1) Reduce smoking rates, currently at about 18 percent, to less than 10 percent within 10 years; 2) protect all Americans from secondhand smoke within five years; and 3) ultimately eliminate the death and disease caused by tobacco.
Over the past 50 years, we have developed proven strategies that can achieve these goals if they are fully and effectively implemented.  These strategies include tobacco tax increases, comprehensive smoke-free workplace laws, hard-hitting mass media campaigns, health insurance coverage to ensure smokers have access to quit-smoking treatments, and well-funded, sustained programs to prevent kids from smoking and help smokers quit.  In 2009, these measures were supplemented with a powerful new tool when the Food and Drug Administration was granted authority to regulate the manufacturing, marketing and sale of tobacco products, for the first time empowering a federal agency to rein in the tobacco industry’s harmful practices.
We have the tools to end the tobacco epidemic for good.  We cannot afford to wait another 50 years.
Related materials: Downloadable charts showing progress since 1964