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Medical News Today: E-cigarettes impair immune responses more than tobacco

Written by Yvette Brazier

As evidence emerges that e-cigarettes are not as safe as advertisers claim, a new study shows that flavorings classed as “Generally Recognized as Safe” by the US Food and Drug Administration are best avoided in smoking. The findings are presented at the American Association for the Advancement of Science annual meeting in Washington, DC.

Cigarettes kill more than 480,000 people annually in the US. Since e-cigarettes appeared on the scene, many assume them to be a safer alternative, because smokers are not inhaling known carcinogens.

But as researchers analyze the contents of e-cigarettes, they are finding that some of them could be as risky as tobacco.

Ilona Jaspers, PhD, professor of pediatrics and director of the curriculum in toxicology at the University of North Carolina (UNC) School of Medicine has been researching new and emerging tobacco products, including e-cigarettes.

Having already found that cigarette smoking significantly impairs the immune responses of mucosal cells in the respiratory system, Jaspers’ lab is now looking at how e-cigarette chemicals affect immune responses in smokers’ airways.

E-cigarette flavorings not ‘recognized as safe’ for inhalation

But people do not consume e-cigarette flavorings orally, they inhale them. And the potential for toxic effects of inhalation have not been assessed, in most cases.While the Food and Drug Administration (FDA) may class e-cigarette flavorings “Generally Recognized as Safe,” Jaspers points out that this classification means they are safe for oral consumption.

Jaspers, who is also deputy director of the UNC Center for Environmental Medicine, Asthma and Lung Biology, explains:

“The digestive systems and respiratory systems are very different. Our stomachs are full of acids and enzymes that break down food and deal with chemicals; this environment is very different than our respiratory systems. We simply don’t know what effects, if any, e-cigarettes have on our lungs.”

Researchers studied the effects on smokers of cinnamon-flavored e-liquids and cinnamaldehyde, the chemical that gives cinnamon flavor to an e-cigarette.

Results showed that the cinnamaldehyde e-liquids had a significant negative impact on epithelial cells that could set off a chain of cellular mechanisms potentially leading to impaired immune responses in the lung.

Jaspers elaborates: “The chemicals compromise the immune function of key respiratory immune cells, such as macrophages, natural killer cells and neutrophils.”

Negative effect of e-cigarettes on respiratory immune system

The team also obtained tissue samples from the epithelial layer inside the nasal cavities of smokers, non-smokers and e-cigarette users, to analyze changes in the expressions of nearly 600 genes involved in immune responses.

They then tested nasal lavage fluid, urine and blood samples obtained from participants to detect changes in genetic and proteomic markers of tobacco and nicotine exposure and other markers of inflammation or immune responses.

In conventional cigarette smokers, they observed signs that a number of key immune genes in the nasal mucosa were suppressed.

In e-cigarette users, they found the same genetic changes, as well as suppression of additional immune genes. The findings imply that e-cigarettes have an even broader effect on the respiratory mucosal immune response system than conventional cigarettes.

The next step will involve in-vitro and in-vivo studies into the effects of chemicals on long-term e-cigarette smokers. Research will focus on immune suppression in the respiratory mucosa, with particular focus on cinnamon-flavored e-liquids.

Further evidence that e-cigarette smoking weakens the immune system was published recently in Medical News Today.

http://www.medicalnewstoday.com/articles/306444.php

USA Today Network: Study suggests link between flavor in e-cigarettes and lung disease

, USA TODAY Network
Flavored e-cigarettes may seem like an alternative to smoking, but researchers warn that flavored e-cigarettes may not be worth the unknown long-term risks.
Researchers at the Harvard University T.H. Chan School of Public Health tested 51 types of flavored e-cigarettes and flavor canisters for diacetyl, acetoin, and 2,3-pentanedione; three chemicals known to cause respiratory problems in factory workers.
The study tested popular e-cigarette flavors like bubble gum, cotton candy and tutti frutti, and found, at least one of the three chemicals were present in 47 of the 51 products they tested.
With around 7,000 e-cigarette flavors on the market, consumers are essentially at the mercy of the manufacturers, with little hope of knowing what chemicals are used in the products, according to Taylor Hays, director of Mayo Clinic Nicotine Dependence Center.
“There are no FDA regulations on these products. It’s the Wild West of e-cigarettes,” Hays told USA TODAY Network.
He says the popularity of e-cigarettes continues to grow among adults that think the products will wean them off of regular cigarettes and among younger users. The percentage of teens using e-cigarettes tripled from 2013 to 2014, according to an April report from the Centers for Disease Control and Prevention (CDC).
The study was published Wednesday in the journal Environmental Health Prospectives.
Diacetyl has been directly linked to “bronchiolitis obliterans,” which in serious cases can require lung transplants, according to Robert Kotloff, chair of pulmonary medicine at Cleveland Clinic.
The disease, also known as “popcorn lung,” got its name from workers who developed the disease after inhaling diacetyl while working in popcorn factories, according to Kotloff.
While the study doesn’t provide a concrete link between flavored e-cigarette use and lung disease, it does further the debate over the unknown long-term consequences of e-cigarettes use.
“[The study] is an intermediary step showing the presence of a compound which could potentially predispose individuals to develop bronchiolitis obliterans,” Kotloff told USA TODAY Network.
http://www.usatoday.com/story/news/nation-now/2015/12/09/chemical-flavor-e-cigarettes-lung-disease-harvard-study/77043340/

Wahpeton Daily News: Study: More nicotine found in smokeless tobacco

By Carrie McDermott • Daily News

Users of smokeless tobacco are exposed to equal or higher levels of nicotine and NNK, a cancer-causing chemical in tobacco products, than cigarette smokers, according to a study from the federal government.
Researchers from the Food and Drug Administration and the Centers for Disease Control and Prevention say more data is needed on the toxic components of smokeless tobacco products and the health of those who use them.
In the study, researchers analyzed information from more than 23,000 participants in national health surveys between 1999 and 2012. They looked for markers used to measure the addictive stimulant nicotine and cancer-causing NNK from blood and urine samples. They found the level of cotinine, the marker for nicotine exposure, to be .043 nanograms/milliliter in nonsmokers compared to 180 ng/ml among smokeless tobacco users, about 131 ng/ml in cigarette users and 184 ng/ml among people who used both smokeless tobacco and cigarettes.

Jason McCoy, tobacco prevention coordinator at PartnerSHIP 4 Health in Moorhead, Minnesota, said he’s eager to get this surprising information out to the public.
“We know that in rural parts of the state, one in 10 young white men, basically high school boys, are using Snus and chewing tobacco, thinking it’s less dangerous than smoking,” he said.
He said the only difference is when they use chewing tobacco, they aren’t affecting others with secondhand smoke.
“The individual is potentially damaging themselves more,” he said. “It’s surprising.”
And many young smokeless tobacco users are choosing flavored products, which make it more attractive.
“This ties into other research we have that shows flavored tobacco is viewed, in self reports by teens, as less addictive than regular tobacco,” McCoy said. “On the other end, we know the flavoring makes it more addictive. The part of the brain that ties into the flavor of the product, similar to why you may like Coke over Pepsi, it’s the same triggering mechanism that happens. The flavor gets assigned in your brain along with the nicotine.”
McCoy works with four counties — Becker, Clay, Otter Tail and Wilkin — and gets reports showing that often high school athletes know they don’t want to smoke because of the smell, so they choose smokeless tobacco, also thinking it won’t affect their athletic performance.
“We know that short term, it’s going to cause gum disease and tooth decay, long term, possible mouth, throat and stomach cancers,” he said. “It’s every bit as dangerous as cigarettes.”
He said he’s been told by teachers that students are taking the Ice Breakers mints and filling those containers with Snus, so they can surreptitiously carry the smokeless tobacco around with them.
“When they open it up, it just looks like they’re getting a mint,” he said.
About 3.6 percent of Minnesotans regularly use smokeless tobacco, according to the latest Minnesota Adult Tobacco survey.
For those wanting to quit their nicotine use, the state of Minnesota offers QUITPLAN which provides proven methods of quitting successfully. The program offers phone counseling and nicotine replacement tools at no cost. To find out more, visit www.quitplan.com or call 1-888-354-7526.
http://www.wahpetondailynews.com/news/study-more-nicotine-found-in-smokeless-tobacco/article_a81d5b36-9a9f-11e5-9849-3facbacf33f9.html

STAT: E-cigarettes widely seen as harmful in STAT-Harvard poll

By DAVID NATHER And SHEILA KAPLAN
WASHINGTON — Most Americans believe electronic cigarettes are harmful to people’s health, according to a new national poll — even though scientists have not reached a consensus on the risks of the increasingly popular products.
The results of the poll, by STAT and the Harvard T.H. Chan School of Public Health, could bolster the Food and Drug Administration as it moves to regulate e-cigarettes for the first time. There is solid support for a broad range of government restrictions among both Democrats and Republicans, with virtually no partisan differences to be found.
E-cigarettes have been around only since 2004 — too little time for researchers to have completed definitive studies on their health effects — but already they are more popular among teenagers than conventional cigarettes.
Manufacturers market the products as safer than tobacco cigarettes and as an effective way to help people stop smoking. The poll results, however, suggest that the public isn’t buying this pitch.

Read the full poll results here

E-cigarette users don’t inhale cancer-causing tobacco smoke. Instead, the devices produce a vapor from heated liquid nicotine. For many public health experts, though, the concern is that they still contain nicotine — which is addictive — and may expose users to various toxic chemicals.
Americans do think they’re less dangerous than tobacco cigarettes, but that doesn’t mean they think the products are safe. The survey found that 65 percent of adults believe e-cigarettes are harmful to the people who use them. That’s less than the 96 percent who say tobacco cigarettes are harmful, but more than the 58 percent who say the same thing about marijuana.
Those results appear to be the main reason the public is ready to embrace regulations that would treat e-cigarettes largely like tobacco cigarettes, including rules that go beyond what are actively being considered at the federal level.
“They believe it’s less harmful than tobacco, but they do think it is harmful, and that sets off all the other answers,” said Robert Blendon, a professor of health policy and political analysis at Harvard who directed the poll.

Roughly 9 out of 10 Americans support banning the sale of e-cigarettes to minors under age 18 — a law already passed in most states. A similar number favor requiring warning labels stating that e-cigarettes contain nicotine.
About 7 out of 10 say people shouldn’t be allowed to use e-cigarettes indoors in public places like restaurants and workplaces, and 6 out of 10 say the government should ban e-cigarette ads on TV, just as it bans ads for tobacco cigarettes.
Even the biggest partisan differences are slight. The warning labels on e-cigarette packages are supported by 98 percent of Democrats and 87 percent of Republicans.
And on taxes — a subject that usually sets off food fights in Washington — there is solid support from both parties: 63 percent of Republicans and 72 percent of Democrats say they support taxing e-cigarettes in the same way that tobacco cigarettes are taxed.
The results suggest that Americans have largely made up their minds on how e-cigarettes should be treated, and that they’re using tobacco cigarettes as their frame of reference — even as scientists are still trying to determine what the health consequences of e-cigarettes are.
“For a new product … you wouldn’t have expected that people would have reached as firm a judgment about this as they have,” said Blendon. On the proposed policies the poll asked about, he added, “their responses are nearly identical to what you find asking about tobacco cigarettes.”
That’s how Anna Glasscock, a Republican retiree who lives near Springfield, Ill., decided her views on e-cigarettes. She’s a former smoker who knows the health risks of tobacco and said e-cigarettes “shouldn’t even exist” because “any addictions are not good.”
Glasscock, one of the people in the poll who agreed to a follow-up interview, said e-cigarettes should be regulated and taxed — she considers it a “sin tax.” Even though e-cigarettes are different from tobacco cigarettes, she said, “I don’t see that replacing one with the other makes any difference.”
Gregory Conley, president of the American Vaping Association, the main advocacy group for e-cigarette makers, blamed the poll results on “unethical propaganda campaigns” against e-cigarettes that have led to “a confused populace.”
“This poll is not measuring public opinion, but the effectiveness of a well-funded corporate strategy to destroy a category that is eroding a cash cow for Big Pharma,” he said.
But Vince Willmore, a spokesman for the Campaign for Tobacco-Free Kids, said it was “not surprising that the public wants to apply common-sense regulations to e-cigarettes” and urged the Obama administration to issue the FDA’s e-cigarette regulations as soon as possible.
The one issue the public is split on is whether to ban the sale of flavored nicotine cartridges — an issue that doesn’t have any parallel with tobacco cigarettes. Fewer than half of Americans think that’s a good idea.
Supporters argue that flavored cartridges attract young people to start using e-cigarettes, and that they will later move on to tobacco cigarettes.
The telephone poll of 1,014 adults was conducted Oct. 7-11 and has a margin of error of 3.7 percentage points.
John Dunn of Garland, Texas, a suburb of Dallas, said he has used e-cigarettes to quit smoking tobacco cigarettes. But a friend who tried the same thing got hooked on e-cigarettes.
“I think they’re pretty different, but also I’ve seen people get on the vapors and not be able to stop,” said Dunn, 33, a Democrat. He’s in favor of some regulation, including warning labels: “They should know they might get addicted.”
E-cigarette makers say that e-cigarettes help smokers quit, and there is some evidence from a small number of studies that they do — although scientists say more research is needed. The survey found that 38 percent of Americans believe e-cigarettes can help people quit smoking, but that 47 percent don’t think they’re effective.
At the same time, public health advocates — and government regulators such as the FDA and the Centers for Disease Control and Prevention — have strong concerns that e-cigarettes serve as a “gateway” for non-smokers to start using tobacco products. More than half of Americans — 56 percent — believe e-cigarettes make teenagers more likely to try tobacco cigarettes, according to the poll.
At a panel discussion on e-cigarettes last month, CDC Director Tom Frieden declared that e-cigarettes are “highly addictive” and that the goal should be to “keep kids away from all forms of nicotine.” The CDC reported earlier this year that e-cigarette use tripled among high-school and middle-school students from 2013 to 2014.
The FDA is preparing to issue a final version of a rule that would extend the agency’s authority to regulate e-cigarettes. The proposal, recently submitted to the White House Office of Management and Budget for final revisions, would likely require pre-market reviews of e-cigarettes — a process that is used to prove whether potentially risky products are safe. The FDA is also expected to ban e-cigarette sales to minors under age 18 and require warning labels stating that the products contain nicotine. The regulation drew 135,000 comments from the public when the original proposal was published.
The agency is also considering a separate proposal that could require broader warnings about the dangers of nicotine — especially accidental exposure to infants and children — and possibly require child-resistant packages for e-liquids, which are liquid nicotine combined with colorings and flavorings.
Some in Congress, however, are trying to prevent the FDA from taking action that might damage the industry. A House spending bill includes a provision by Representative Robert Aderholt (R-Ala.) that would keep the FDA from requiring premarket review for e-cigarettes that are already being sold in stores. Aderholt’s office did not respond to requests for comment.
Even if much of the public is ready to regulate e-cigarettes, Aderholt will find at least some support from those who don’t think they are dangerous enough to need new rules.
“They’re not a cigarette. The only thing you’re inhaling is vapor,” said Chris Grieser, a Republican from Cheyenne, Wyo. who participated in the survey. “That’s no different from standing over a pot of boiling water.”
Researchers aren’t so sure about that, though. One study earlier this year found that e-cigarette vapor can contain cancer-causing formaldehyde at levels far higher than those found in tobacco cigarettes.
The original e-cigarettes were manufactured by small companies, but when it became clear that they were catching on, the more established tobacco companies such as RJ Reynolds and British American Tobacco bought out or partnered with some of these smaller businesses, or launched their own divisions. This has given more clout to industry groups such as the American Vaping Association.
This is the first of a series of monthly polls being conducted by STAT and the Harvard T.H. Chan School of Public Health.
http://www.statnews.com/2015/11/09/e-cigarettes-widely-seen-as-harmful-in-stat-harvard-poll/

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

Melissa Healy, Contact 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.”
http://www.latimes.com/science/sciencenow/la-sci-sn-first-time-tobacco-flavorings-20151026-story.html

MINNPOST: Proposed Minneapolis tobacco licensing changes will help curb youth smoking

By Jan Malcolm | 06/19/15

Imagine a future when tobacco is no longer the leading cause of preventable death and disease. To make this vision a reality, we must prevent more young people from getting hooked by deadly tobacco products. The Minneapolis City Council is poised to do just that by considering changes to the licensing ordinance to restrict the sale of all flavored tobacco (other than menthol) to adult-only tobacco stores and set minimum price limits for cigars. These measures strike at the heart of the tobacco industry’s strategy to sell their products to kids: flavoring and price.

While Big Tobacco is supposed to be prohibited from marketing to kids, it finds many ways around that ban. Tobacco executives know that unless they get to kids before they reach their 20s they’ve lost a customer. Documents released during the tobacco trials of the 1990s reveal how deliberately tobacco companies target young people. On the witness stand, the chairman of the Liggett & Myers Tobacco Co. said, “If you are really and truly not going to sell to children, you are going to be out of business in 30 years.” A Lorillard executive wrote that he wanted to exchange research data with Life Savers to figure out what tastes kids want. And a marketing plan from U.S. Smokeless Tobacco showed a deliberate strategy to start users on sweet flavors, then “graduate” them to plain tobacco.

Candy and fruit flavors

The appeal of flavoring to young people is the reason the FDA banned cigarettes in flavors other than menthol in 2009. Unfortunately, products such as little cigars, cigarillos, chew, e-cigarettes and others are still widely available in candy and fruit flavors such as bubble gum, grape and gummy bear – flavors that clearly appeal to youth. These flavored products are for sale in more than 250 stores throughout Minneapolis alone, and they are easy for children to purchase. One-third of Minneapolis boys under 18 report buying tobacco from a convenience store or gas station.

Research shows that young people mistakenly believe that flavored tobacco products are less dangerous than other tobacco products. In fact, they are just as dangerous, with the same health risks of cancer, heart disease and chronic obstructive pulmonary disease. Candy and fruit flavored tobacco products just mask the harsh taste and feel of tobacco.

Nearly 20 percent of Minnesota high school students have tried a water pipe or hookah, and almost all shisha (hookah tobacco) is flavored. More than 25 percent of Minnesota high school students have used an e-cigarette, and most e-cigarette liquid is flavored. More than 35 percent of Minnesota high school students report that they have tried flavored cigars, cigarillos or little cigars at some point in their lives. In fact, kids are now twice as likely as older people to be cigar smokers. Almost 20 percent of Minneapolis 12th-graders say they smoke cigar products like cigarillos regularly.

Young people known to be price sensitive

Nearly 75 percent of Minneapolis tobacco retailers currently sell cigars and cigarillos, many for less than a dollar. The proposed changes to our city’s tobacco licensing ordinance would set a minimum price of $2.60 for each cigar. Research shows that young people are very sensitive to price increases and are more likely to just quit using a product they can’t afford than adults are.

Flavored tobacco restrictions and price minimum requirements have been successfully implemented in other communities around the country – and right here in Minnesota. No one wants our young people to face a lifetime of addiction and other health problems. We know that policies that restrict access to flavored tobacco and raise tobacco prices keep kids from starting to smoke and help them to quit.

Support the proposed changes to the Minneapolis tobacco licensing ordinance. Stand up for our kids against Big Tobacco.

Jan Malcolm is the vice president of public affairs for Allina Health. She served as Minnesota state health commissioner from 1999 to 2003. Malcolm lives in Minneapolis.

https://www.minnpost.com/community-voices/2015/06/proposed-minneapolis-tobacco-licensing-changes-will-help-curb-youth-smoking

Cases of kids poisoned by e-cigs increasing in Minnesota

By Andy Rathbun / St. Paul Pioneer Press
Minnesota has seen a jump in the number of children poisoned by e-cigarettes and their liquid refillables, the Minnesota Department of Health said Wednesday.
From 2013 to 2014, the number of e-cigarette and e-liquid poisonings among Minnesota children 5 and younger rose 35 percent — the second year the Minnesota Poison Control System has seen a significant increase of nicotine poisonings related to e-cigarette products, the health department said in a news release. Poisonings from these products rose from three in 2012 to 62 in 2014.
E-cigarette products can contain a fatal amount of nicotine for a child, and about half of the cases last year were treated at emergency departments. Children can confuse the products, which are often flavored, with a candy or drink, the department of health said.
In January, a new state law took effect requiring child-resistant packaging for e-liquid products.
“This past year Minnesota took a big step to keep kids from accidently ingesting these potentially fatal e-liquids,” Minnesota Health Commissioner Ed Ehlinger said in a statement. “But parents should still use caution and store the products out of the reach of children.”
The symptoms that can result from nicotine poisoning include nausea, seizures, diarrhea, vomiting and difficulty breathing.
The department of health issued a nicotine heath advisory Wednesday that also warns teens and pregnant women of possible nicotine effects.
The drug can harm brain development during adolescence and harm fetal brain and lung development, the department said.
http://www.inforum.com/news/3763762-cases-kids-poisoned-e-cigs-increasing-minnesota

Star Tribune: Mpls. considers restrictions on flavored tobacco products

By Eric Roper Star Tribune

The sale of flavored cigars in convenience stores could soon come to an end in Minneapolis, where city officials are mulling the state’s first ban on the products at most traditional locations to curb youth tobacco use.

Anti-smoking advocates and small retailers squared off at a packed City Council hearing Monday over a proposal that would restrict sales of flavored tobacco products from more than 300 allowed locations to just under two dozen specialty tobacco shops. Similar bans have been enacted in New York City and Providence, R.I.

A council committee delayed a vote on the proposal, which targets flavored cigars, smokeless tobacco, shisha for hookahs and e-cigarette juice — but excludes menthol flavors. It would also set a minimum price on all cigars at $2.60 — echoing measures passed in Bloomington, St. Paul, Maplewood and Brooklyn Center.

Supporters said low-cost flavored cigars, sold under brands like White Owl and Swisher Sweets, are especially harmful because they entice young people to start smoking. A recent study of 530 underage youth in north Minneapolis found that more than half of the 313 who had used tobacco reported at one point smoking a cigar or cigarillo.

“Luring people to an addictive product with cheap prices and candy flavors before they’re old enough to know better doesn’t … give kids much choice,” testified Latrisha Vetaw of Northpoint Health and Wellness Center. Some of the non-tobacco flavors mentioned in the ordinance include chocolate, honey and vanilla, as well as fruits, herbs and candy.

City records show that 362 businesses are currently authorized to sell tobacco products in Minneapolis, though about a quarter of them are bars that largely sell cigarettes. The proposal would limit flavored tobacco sales to approximately 21 “tobacco products shops,” which generate 90 percent of their revenue from tobacco-related sales. It also clarifies that customers must be 18 to enter those stores.

Convenience store owners at Monday’s hearing challenged the necessity of the change, noting that it is already illegal for them to sell tobacco to minors. City records show that out of more than 350 undercover compliance checks each year, only about 6 to 7 percent result in violations for selling to a minor.

They also said that restricting tobacco sales threatens one of their core revenue streams. “Forty percent of our sales in the convenience store industry comes from tobacco. … That’s the industry average: 40 percent,” said Steve Williams, owner of Bobby and Steve’s Auto World, which has several locations. “So we’re affecting the viability of a lot of convenience stores.”

Ahmad Al-Hawari, who owns four convenience stores around the city, said while flavored cigars account for less than 5 percent of their business, the change could result in lost customers.

“A customer will walk or drive to a smoke shop, buy his flavored tobacco as he wishes … and then he’s going to buy cigarettes and pop from there,” Al-Hawari said. “He’s not going to go back to the convenience store.”

The federal government banned all flavored cigarettes except for menthol in 2009, but did not apply the same restrictions to cigars. Cigars may also be sold individually, versus in packs like cigarettes, making a common price about 99 cents each, according to a city staff report.

Paul Pentel, an internist at Hennepin County Medical Center, said their low cost also makes cigars an appealing option for adults who already smoke.

“In my clinic, I am very alarmed by the number of patients I see who have switched to cheap cigars because of the cost of cigarettes,” Pentel said. “For these patients, cheap cigars are a missed opportunity to quit smoking.”

New York City banned the sale of flavored tobacco products in 2009, except for at a handful of tobacco bars. A ban in Providence, R.I., went into effect in 2013. The state of Maine has also enacted a ban on small, flavored cigars.

Four Minnesota cities have already established minimum cigar prices. The minimum is $2.10 in St. Paul and Brooklyn Center, and $2.60 in Bloomington and Maplewood, city staff said.

Council Member Blong Yang, a cosponsor of the ordinance change, said he was drawn to the issue after seeing in the recent study from Breathe Free North, a program of Northpoint, that children have too much access to flavored tobacco. It also appears to be disproportionately affecting minority communities, he said.

“Every single convenience store that you go to it seems has all this stuff right in front of people, basically,” Yang said. “And it’s screaming for people to buy it because it’s there.”

The council’s health, environment and community engagement committee is expected to vote on the measure in two weeks, with a final vote before the full council possible in July.

http://www.startribune.com/minneapolis-mulls-restrictions-on-flavored-tobacco-products/306572261/

LA Times: California Senate votes to restrict e-cigarettes as tobacco products

By PATRICK MCGREEVY

The state Senate on Tuesday approved a bill that would ban electronic cigarettes from restaurants, theaters and other public places in California where smoking is prohibited to address health concerns.

Sen. Mark Leno (D-San Francisco) said his bill would treat e-cigarettes, also known as “vaping” devices, as tobacco products because they often use nicotine and are popular with teenagers.

Youth e-cigarette use rising; heart group calls for regulation

“Of great concern is that the fastest growth segment of new users is among middle and high school students who are now smoking electronic cigarettes,” Leno told his colleagues. “They are advertised on television. They are advertised on billboards.”

The measure, which would also subject e-cigarettes to the same licensing requirements as tobacco, was approved by a 24-12 vote, with Sen. Jeff Stone of Murrietta the only Republican to vote for the bill.

Senate Republican leader Bob Huff of Diamond Bar said e-cigarettes work on vapor that does not spread as much as tobacco smoke, so they should be treated differently in public.

“E-cigs are used by people trying to kick the tobacco habit,” Huff said. He voted against the bill, saying the state should wait until the federal government takes action.

Stone noted that his mother was a former smoker who died of cancer. He said the tobacco and vaping industries are marketing e-cigarettes to young people with flavors including watermelon, tutti frutti and cotton candy while the vapor has nicotine derived from tobacco. He said “vaping” is a gateway to cigarette smoking.

“Now we are exposing a whole new generation of millenials to this fashionable way of smoking tobacco in a way that is going to jeopardize their lives,” Stone said. The measure next goes to the Assembly for consideration.

http://www.latimes.com/local/political/la-me-pc-california-senate-votes-to-restrict-ecigarettes-like-tobacco-products-20150602-story.html

TIME Health|Research: 4 Weird Health Effects of E-Cigarettes

Justin Worland

Banana pudding-flavored ecigs disturbed the lungs, one study found

E-cigarette research is heating up, and scientists are starting to show that using e-cigarettes can have some surprising health effects, according to new findings presented at the meeting of the American Thoracic Society.

“Millions of people around the world that are puffing e-cigs,” says Peter Dicpinigaitis, professor at Albert Einstein College of Medicine and one of the authors of new e-cigarette research, “but when you look at the scientific literature about the effects of e-cigs, there’s nothing out there.”

Here are some of the newest findings:

Using e-cigarettes suppresses your ability to cough

Smoking an e-cigarette makes you less likely to cough, even when coughing would benefit your health, according to research by Dicpinigaitis. Researchers asked 30 nonsmokers to puff an e-cigarette 30 times in a 15-minute period. After puffing, people in the study were less sensitive to capsaicin, a component of chili peppers that induces coughing. You might think stopping a cough would be a positive side effect, but coughing keeps you from choking and removes agents that may cause infection, says Dicpinigaitis. He presumes that those the effects would continue throughout the day for someone who uses an e-cigarette frequently.

E-cigarette temperature may affect how many chemicals you’re exposed to

People tend to think about the effects of cigarette smoke or e-cigarette vapor when they consider how the products harm their health. But the mechanics of e-cigarettes may also contribute to how much smoking harms your health, according to new research from University of Alabama School of Medicine professor Daniel Sullivan. His research found a correlation between coil temperature and the creation of harmful chemicals like acrolein, acetaldehyde and formaldehyde in the e-cigarette. There are no configuration standards for e-cigarettes, and Sullivan’s research suggests that the lack of consistency makes it hard to assess uniformly the health effects of smoking e-cigarettes.

E-cigarette flavors may have different effects

Researchers tested the effects of flavored e-cigarette liquid on calcium in the lungs and found that not all flavors had the same effect. Five of 13 flavors tested caused changes to calcium signaling in the lungs, according to a study by University of North Carolina at Chapel Hill researcher Temperance Rowell. Hot cinnamon candies, banana pudding and menthol tobacco were among the flavors that disturbed the lungs.

Evidence is growing that e-cigarettes probably aren’t an effective way to quit smoking

E-cigarettes are a popular tool people use to stop smoking, but they may not be the best way, suggests one research review. Using e-cigarettes improved the likelihood that a smoker would quit smoking cigarettes for the first month on the new technology, but the effect dissipated at 3 and 6-month followups, according to a meta-analysis of four studies by University of Toronto researcher Riyad al-Lehebi. He recommended that people who want to quit smoking consider “other more well-established options.”

http://time.com/3860166/ecigs-research/?xid=emailshare