Cigars Loaded With Harmful Toxins, Study Shows

(HealthDay News) — Some cigar smokers may believe they face less health risk than if they were smoking cigarettes, but a new study casts doubt on that notion.
Researchers say that cigar smokers are exposed to high levels of cancer-causing agents and other toxic substances, which suggests that the habit is as risky as smoking cigarettes.
None of this came as much surprise to lung experts.
“In spite of the fact that cigar smokers don’t inhale, more attention needs to be paid to the damages of secondhand smoke, and to acknowledge that no smoking is safe,” said Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City.
“It is well known that secondhand smoking causes asthma, as well as a possible increase in the risk for lung cancer. The cloud around a cigar smoker’s respiratory system is tantamount to this phenomenon,” Horovitz said.
Cigar use in the United States more than doubled from 2000 to 2011, according to the U.S. Centers for Disease Control and Prevention.
The findings are reported Nov. 7 in the journal Cancer Epidemiology, Biomarkers & Prevention.
In the new study, researchers analyzed the presence of five chemical signals of tobacco exposure in tests conducted on more than 25,500 Americans.
Two of the biomarkers — cotinine and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) — are specific to tobacco. The other biomarkers — lead, cadmium and arsenic — are not tobacco-specific and can come from other sources.
The study found that cigar smokers — whether or not they also smoked cigarettes — carried higher levels of cotinine, NNAL, cadmium and lead than people who did not use tobacco. Cigar smokers with a history of cigarette use had much higher levels of cotinine and NNAL than cigar smokers who did not smoke cigarettes.
Also, levels of NNAL in daily cigar smokers were similar to those of daily cigarette smokers, according to the study.
“Cigar smoking exposes users to similar types of harmful and cancer-causing agents as cigarette smoking,” lead author Dr. Jiping Chen, an epidemiologist at the U.S. Food and Drug Administration’s Office of Science, Center for Tobacco Products, said in a journal news release.
“Once differences are accounted for in frequency of use, the levels of NNAL, a strong carcinogen, are comparable in cigar and cigarette smokers,” Chen said.
Another expert in respiratory health agreed that cigars are probably no better than cigarettes when it comes to health.
“This is especially significant because, although youth cigarette smoking has decreased, high school students in the U.S. are twice as likely as adults to smoke cigars,” noted Patrician Folan, director of the Center for Tobacco Control at North Shore-LIJ Health System in Great Neck, NY.
“Frequently, cigars are cheaper and are available in a wide variety of flavors that appeal to adolescents and young adults,” she said. “This combination of factors makes cigar smoking more attractive to young people, who may have the perception that cigar smoking is less harmful, especially due to flavors like chocolate, grape, strawberry and peach.”
More information
The American Cancer Society has more about cigar smoking.

SOURCES: Len Horovitz, M.D., pulmonary specialist, Lenox Hill Hospital, New York City; Patricia Folan, RN, director, Center for Tobacco Control, North Shore-LIJ Health System, Great Neck, N.Y.;Cancer Epidemiology, Biomarkers & Prevention, news release, Nov. 7, 2014

5 Important Lessons From The Biggest E-Cigarette Study

 | by  Anna Almendrala

Those colorfully lit e-cigarettes are giving off way more than just “harmless water vapor,” according to a comprehensive new study review by UC San Francisco’s Center for Tobacco Control Research and Education. Users could also be inhaling and exhaling low levels of chemicals such as formaldehyde, propylene glycol and acetaldehyde (to name a few), and this secondhand vapor could be a potentially toxic source of indoor air pollution.

While the levels of the toxins were still much lower compared to conventional cigarette emissions, the findings fly in the face of the e-cigarette industries’ claims that the handheld devices are just as safe as any other smoking cessation tool.

E-cigarettes as we know them today were invented by a Chinese pharmacist, Hon Lik in the early 2000s as a smoking cessation aid. They are handheld nicotine vaporizers that deliver an aerosol made up of nicotine, flavorings and other chemicals to users. It’s the chemicals in those vapors that are moving municipalities like Los Angeles, New York City, Washington D.C., Chicago and Boston to restrict “vaping” in some way.

Formaldehyde, for instance, is a carcinogen that also irritates the eyes, nose and throat. Propylene glycol can also cause eye and respiratory irritation, and prolonged exposure can affect the nervous system and the spleen. Acetaldehyde, also known as the “hangover chemical,” is also a possible carcinogen.

The secondhand vapor finding is just one of several that UCSF researchers highlighted in the broadest review to date of peer-reviewed e-cigarette studies. The findings, which were published Monday in the American Heart Association’s journal Circulation, include:

1. Some youth have their first taste of nicotine via e-cigarettes. Twenty percent of middle schoolers and 7.2 percent of high schooler e-cigarette users in the U.S. report never smoking cigarettes.

2. Nicotine absorption varies too much between brands. Early 2010 studies found that users got much lower levels of nicotine from e-cigarettes than from conventional cigarettes, but more recent studies show that experienced e-cigarette users can draw levels of nicotine from an e-cigarette that are similar to conventional cigarettes. Yet another study noted that the chosen e-cigarettes for the research malfunctioned for a third of participants. UCSF researchers say this indicates the need for stronger product standards and regulations.

3. Just because particulate matter from e-cigarettes isn’t well studied, doesn’t mean it’s safe. To deliver nicotine, e-cigarettes create a spray of very fine particles that have yet to be studied in depth. “It is not clear whether the ultra-fine particles delivered by e-cigarettes have health effects and toxicity similar to the ambient fine particles generated by conventional cigarette smoke or secondhand smoke,” wrote the researchers. But we do know that fine particulate matter from cigarettes and from air pollution are associated with an increased risk of cardiovascular and respiratory disease. And some research has found that the size and spray of fine particulate matter from e-cigarettes is just as great or greater than conventional cigarettes.

4. So far, e-cigarette use is not associated with the successful quitting of conventional cigarettes. One clinical trial found that e-cigarettes was no more effective than the nicotine patch at helping people quit, and both cessation methods “produced very modest quit rates without counseling.”

5. Major tobacco companies have acquired or produced their own e-cigarette products. They’re promoting the products as “harm reduction” for smokers, which allows them to protect their cigarette market while promoting a new product. Companies also using “grassroots” tactics to form seemingly independent smokers’ rights groups, just like they did for cigarettes in the 1980s.

Based on the weight of the combined research, UCSF researchers end with several policy recommendations, which include banning e-cigarettes wherever cigarettes are banned, subjecting e-cigarettes to the same advertising restrictions that constrict cigarette marketing and banning fruit, candy and alcohol flavors, which are attractive to younger customers.

Local doctor’s view e-cigarettes

By Diane Miller, High Plains Reader, Fargo
Sales of electronic cigarettes are expected to reach $1.7 billion this year. Many smokers are turning to this odor-free, vapor-releasing instrument as a safer alternative to cigarettes, but many health experts are skeptical.
HPR turned to local e-cig expert Dr. Brody Maack from Family HealthCare to answer a few questions this new product.
HPR: Why are the FDA and health experts so concerned about a product that seems like a much safer alternative to cigarettes?
Dr. Brody Maack: The main concern revolves around the fact that e-cigarettes currently have no manufacturing standards and are unregulated. This means that there have been no well done, long term safety studies in which the products are tested to see if there are any harmful effects.
Also, as far back as 2009, the FDA did laboratory analysis of some e-cigarettes, which showed that they contained carcinogens (cancer-causing chemicals) as well as diethylene glycol (which is found in anti-freeze).
The FDA also found that quality control in manufacturing the e-cigarettes is either poor or non-existent in laboratory studies.
It is also unknown as to the risks of inhaling the “vapor” which is let off by the products, and we don’t know if there is a risk for second-hand exposure to the vapor. Because e-cigarettes all contain different amounts of their ingredients, including nicotine, in addition to these other safety concerns, we cannot say that they are “safer” than cigarettes.
Another concern is that we are seeing a rapid increase in the use of e-cigarettes in our youth, due to various flavors which are attractive to a younger crowd, and intensive marketing of the products. Also, there is no restriction to e-cigarette sales to minors in North Dakota. Minnesota, however, does prohibit the sale and possession of e-cigarettes to minors.
HPR: What would be your response to this statement made by Craig Youngblood, president of the InLife e-cigarette company:
In our product you have nicotine or no nicotine, PEG, and some flavoring. In cigarettes you have nicotine, PEG, and 4,000 chemicals and 43 carcinogens. There are 45 to 50 million people already addicted to nicotine.
Should they have the choice to satisfy their addiction by other means? … I am a proponent of harm reduction. People have rights and choices and should be allowed to make them.
BM: Mr. Youngblood states that his product contains various ingredients (i.e. “nicotine or no nicotine”), also admitting that his product includes “some flavoring.” As I stated before, there are no e-cigarette manufacturers that are currently being held to any manufacturing standards or regulations, so the InLife product, like other e-cigarette products, may contain various amounts of its stated ingredients.
Also, the fact that InLife is promoting its product as containing flavoring may be increasing exposure of this product with unknown safety to our youth. This is why the FDA has banned flavoring in cigarettes. The CDC released data in October of this year which showed that 40 percent of middle and high schoolers who smoke, smoke flavored tobacco products.
I agree with Mr. Youngblood when he states that “people have rights and choices and should be allowed to make them,” but I believe that people’s decisions should therefore be well-informed, and not subject them, or their children, to potential health risk. Also, the issue of “harm reduction” is typically promoted by tobacco product supporters, however it is felt by most of the tobacco cessation expert community that complete abstinence from tobacco is the only way to reduce the number of people who will die in the next 100 years from tobacco related disease, which is expected to be 1 billion!
HPR: Many community citizens are upset that the city of Fargo banned the use of e-cigs in indoor public places. Do you foresee this rule changing and why?
BM: The banning of e-cigarettes in Fargo is actually a statewide law, which went into effect December 6, 2012. I don’t see this changing, simply because of concerns we have discussed—lack of manufacturing standards, lack of safety proof, potentially harmful ingredients and concerns for turning our youth on to tobacco products. Considering that e-cigarettes look similar to regular cigarettes, prohibiting their use indoors also eliminates any confusion about what’s acceptable under the statewide law.
HPR: In your opinion, what is the best method to quitting smoking?
BM: The best method of quitting smoking has been proven countless times to be a method which includes behavioral counseling along with medications, such as the nicotine patches, gum or lozenges. This method is recommended by the US Public Health Service, and is available in many communities through doctors’ offices, pharmacies and through state telephone quitline services, such as ND Quits (1-800-QUIT-NOW) or internet quit services. Many of these programs are free!
HPR: Anything you’d like to add?
BM: As of right now, e-cigarettes are too much of an “unknown” with regards to safety and whether or not they help people to quit smoking, and with concerns for the products being a gateway to youth tobacco use, they simply cannot be recommended for use. There have been no respectable studies showing that e-cigarettes are better, or safer, than any of our seven FDA-approved medications for quitting smoking.
We have a large amount of safety data and data to show that the FDA-approved options work very well to help people quit tobacco. These options include three over-the-counter options (nicotine patches, gum and lozenges), and four prescription products (Chantix, Zyban, nicotine inhaler and nicotine nasal spray). In fact, the nicotine inhaler is a proven, safe option for people who want to quit in a similar way as e-cigarettes, without the unknown risks of “vapor” exposure and other potentially harmful ingredients.
Also, the nicotine inhaler, along with the other FDA-approved options, is legal to use in any indoor space in North Dakota. I personally recommend this option for patients of mine who show interest in e-cigarette products as a safe alternative to e-cigarettes.
Brody Maack, PharmD, CTTS, is a clinical pharmacist who provides medication management services, including tobacco cessation, at Family HealthCare in Fargo. He also serves as Assistant Professor of Pharmacy Practice at the NDSU College of Pharmacy, Nursing and Allied Sciences, where he teaches the subjects of heart and lung diseases, which includes tobacco related disease, prevention and cessation.

A case against e-cigarettes

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

Letter: Harm-reduction not best public policy for tobacco

There has been a good deal of talk about “harm-reduction” strategies (promoting alternative tobacco products, such as chewing tobacco or e-cigarettes, as safer alternatives to smoking cigarettes) as being good options for tobacco users to reduce the risk of using tobacco while maintaining the addiction to nicotine.
Reducing-harm strategies can be an option for an individual who wants to try to reduce his or her own risk of harm while maintaining an addiction. However, when it comes to tobacco use, harm-reduction strategies are not the best public policy to use to address the population-based well-being that public health strategies must address.
• How would it be if the public health professionals advocated for food handlers to wash their hands most of the time after using the bathroom rather than every time? After all, it would reduce the chances of contracting disease from someone who never washed his/her hands. One could say it is better than never washing one’s hands. The public policy must continue to be the best method of preventing disease transmission, that is: wash one’s hands every time, not just sometimes.
• I hear a lot about smokeless tobacco being a good alternative for adult smokers who don’t want to quit using tobacco. Consider this: It is not just adults who use chew. The sweeteners added and new products that have come on the market make it an easy way to addict our next generation to tobacco. North Dakota’s youth consume smokeless tobacco at a rate almost twice the national average (N.D., 13.6 percent, U.S., 7.7 percent). In addition, smokeless tobacco is not without its health hazards.
• E-cigarettes are often touted as a good alternative to tobacco use. We are told by some that the vapor is harmless. This is not true. It has not been regulated or studied enough to know how dangerous it is, but it is not harmless. There is another issue to consider. Have you ever noticed how candy cigarettes and now e-cigarettes mimic the activity a smoker would do with a cigarette? It models the smoking behavior and should not be discounted as harmless.
One of the core functions of public health is to promote strategies that protect the health and safety of the community. Public health providers are accountable to the community to provide up-to-date information and advocate for tried-and-true strategies to improve or maintain a community’s health status.
As a public health nurse, I cannot support harm-reduction policies that supports maintaining one’s addiction to tobacco. Harm- reduction policy is not sound public health policy.
The rationale that was brought up recently in a letter to the editor, that the tobacco user who is not willing or able to quit should have chewing tobacco or e-cigarettes researched and funded with tobacco prevention dollars in the state of North Dakota, falls short. The evidence is readily available regarding what works and how to gain access to help. The options are available, and they are FDA-approved and researched for safety and effectiveness. They are called nicotine replacement therapy and NDQuits at (800)-QUIT-NOW.
Knox, RN, is master of public health and certified tobacco treatment specialist with the Grand Forks Public Health Department Tobacco Prevention Program.

E-cigarette regulation and taxes once again on the front burner at the Capitol

By WAYNE GREENE World Senior Writer
OKLAHOMA CITY – Three lawmakers are renewing the fight over an issue that lit up the state House last year – electronic cigarettes.
Last week, Speaker of the House T.W. Shannon approved so-called “e-cigarette” study proposals by Speaker Pro Tem Mike Jackson, Rep. Mike Turner and Rep. David Derby.
Jackson, R-Enid, is the second-ranking member of the House leadership. Derby, R-Owasso, is chairman of the House Public Health Committee and will oversee the studies.
An e-cigarette is an electronic inhaler that vaporizes a liquid nicotine solution, simulating the act of tobacco smoking. Like cigarettes, users get a nicotine fix. Unlike cigarettes, there is no smoke.
During the final days of the Legislature’s last session, the House rejected a bill backed by Jackson to deal with the same issue on a 66-29 vote after nearly three hours of questioning and debate.
At issue in the interim studies is how the devices are taxed and how their sales are regulated.
Derby’s study would investigate “regulation of vapor and other emerging nicotine products.”
The Jackson-Turner study would look into “taxation, tobacco harm reduction, and youth access to electronic cigarettes.”
Currently, state law doesn’t adequately address sales of e-cigarettes to minors, and “youth access is definitely something we need to address,” Jackson said.
The U.S. Food and Drug Administration is considering classifying the devices as tobacco products, a move that could result in a significant tax burden on people using them, he said.
If FDA action made the devices subject to the state’s tobacco tax, it could make the e-cigarette equivalent of a pack of cigarettes taxed at $8.50 to $9, Jackson said.
“What we don’t want to do is put a higher tax on a less-harmful product,” he said.
Jackson said his brother has used an e-cigarette to gradually reduce his nicotine dependency. He hasn’t used a cigarette in three or four months, Jackson said.
“I have seen first-hand how they can help,” he said.
The American Cancer Society opposed Jackson’s efforts last year and will continue to fight against efforts to reduce taxes on e-cigarettes, said James Gray, director of government relations for the Cancer Action Network.
There is no scientific evidence to back claims that e-cigarettes are an effective means of weening smokers from their habit.
No other state has taken the actions Jackson has proposed for Oklahoma, Gray said.
“I think this is a new direction of Big Tobacco, and (legislators are) really cautious about doing anything that provides a new market to Big Tobacco,” he said.
Doug Matheny of said the claim that an FDA regulation could lead to a dramatic state tax hike is a “scare tactic.”
“It’s one of those classic examples of the tobacco industry – and I do believe the tobacco industry is behind this – to make legislators feel like they have to do something – they have to act,” Matheny said. “And actually they don’t need to at all in Oklahoma.”
A simple bill to restrict youth access to e-cigarettes should take less than one page, but the design here is about expanding markets for nicotine, not reducing smoking, Matheny said.
“These companies don’t really care what you buy from them as long as you continue to buy from them. They’re selling an addictive product that contains nicotine. As long as you don’t quit altogether, they’re happy.”
Tobacco lobbyists are a powerful force at the state Capitol, Matheny said.
According to Oklahoma Ethics Commission reports, contributions to Oklahoma state legislative campaigns from the Reynolds American Inc. political action committee increased by 70 percent in the 2012 election cycle. Meals purchased by lobbyists on behalf of Reynolds American Inc. increased by more than 50 percent, Matheny said.

Letter: Thoreson did not tell the full story

By: Vicki Voldal Rosenau, Valley City, N.D., INFORUM
The gentleman doth protest too much, methinks. State Rep. Blair Thoreson, R-Fargo, that is.
In last Sunday’s (July 7) Forum, Thoreson oozed indignation over Dr. Eric Johnson’s 2-months-old public debunking of Thoreson’s failed resolution touting the discredited, unproven “tobacco harms reduction” scheme.
Thoreson testily asserted he “never had any affiliations” with the out-of-state “special-interest groups” referenced in Johnson’s May letter, but I think he forgot about ALEC. Disingenuously named, the corporate-funded American Legislative Exchange Council is a corporate bill mill. It connects corporate lobbyists and right-wing politicians behind closed doors where they craft ALEC “model” legislation serving corporate interests over the interests of ordinary Americans. The bills get introduced in statehouses nationwide (after being stripped of their ALEC origin).
Two big tobacco companies on ALEC’s private board, Altria (formerly Philip Morris) and Reynolds American, have long worked through ALEC to push “harm reduction” as their alternative to actually preventing and reducing tobacco use.
Thoreson is public sector chairman of ALEC’s Communications and Technology Committee, and is a former ALEC state chairman for North Dakota.
Small wonder that Mark Twain reportedly loved to proclaim: “No man’s life, liberty or property is safe while the legislature is in session.”

Letter: Thoreson fronts for Big Tobacco

By: Jay Taylor, Mapleton, N.D., INFORUM
In a recent letter to the editor, Rep. Blair Thoreson, R-Fargo, criticized a Grand Forks physician for not supporting his support for e-cigarettes. Actually, Thoreson’s push was not supported by anyone in the Legislature, but you gotta give him points for keeping at it.
The push today is from those supporting a “Harm Reduction Strategy,” which includes Thoreson. This push kind of sneaks in the door as it’s supported by some of the Big Tobacco folks. Their theory is that we have failed to get everyone in the world to quit using tobacco, so why not try some products that may have less risk. They often recommend the e-cigarette as well as some smokeless tobacco products.
E-cigarettes have not been shown to be safe, and each brand that we look at seems to have different chemicals within. They are not approved by the Food and Drug Administration, and my guess is that they never will have that approval.
What is approved and what does work is three-fold: attitude, education and medicine. First, want to quit! Then learn why you should and use safe, effective medications in the correct dosage to get the job done. Call the Quit Line: 800-QUIT-NOW and get going.

Letter: Use all anti-tobacco strategies

By: Rep. Blair Thoreson, Fargo, N.D., INFORUM
Several weeks ago, a letter from Dr. Eric Johnson appeared in The Forum in which Johnson made inaccurate accusations regarding a resolution I introduced in the 2013 North Dakota Legislature aimed at reducing the risk of death and disease among smokers. By attempting to distort my motives and tie me to special-interest groups with which I have never had any affiliations, the letter’s author distracted from what should be a productive conversation.
Because smoking harms us all, the state ought to pursue an all-of-the-above strategy to reduce cigarette consumption. In addition to conventional anti-smoking measures, like messaging to youths and promoting smoking cessation, one strategy our state should consider is tobacco harm reduction, which seeks to minimize the damage tobacco does to users and society alike.
Tobacco harm reduction is a secondary strategy that could be used when traditional anti-smoking measures fail. It’s not in question that quitting is the single best thing smokers can do for both themselves and society, but despite our efforts to encourage quitting, thousands of smokers remain unable or unwilling to snuff out their addiction. Tobacco harm reduction targets these individuals by accepting that they will continue to use nicotine, and explores ways to reduce the costs and harmful effects of their nicotine usage.
One alternate product current smokers could turn to is the electronic cigarette, which delivers nicotine without the toxic carcinogens and doesn’t produce secondhand smoke. In fact, a study by the Boston University School of Public Health found that electronic cigarettes are significantly safer than conventional ones, with carcinogen levels 1,000 times lower. If smokers who refuse to quit entirely could be persuaded to switch to electronic cigarettes, North Dakota would pay less in smoking-related health costs, and our children would be at less risk of secondhand smoke exposure.
It may seem like an unconventional method of reducing risk, but studies have shown that smokeless tobacco carries significantly lower health risks than cigarettes. No one should mistake smokeless tobacco for a healthy product, but compared to smoking, it may be less deadly and a better choice.
National and state anti-smoking campaigns have been highly effective, as the smoking rate is half of what it was 50 years ago, and smoking among teenagers is at an all-time low. Yet there remains a persistent minority of nicotine users for whom our conventional outreach has failed. In efforts to promote public health, cut health care costs and reduce preventable deaths, we can’t afford to give up on messaging to these smokers.
It’s clear, however, that we need to think outside the box to reach them. Tobacco harm reduction, endorsed by the American Association of Public Health Physicians, won’t eliminate all the health risks created by persistent smokers, but it could lower their death rate and medical expenses, and take secondhand smoke out of the air.
Instead of making false claims, I believe it would be much more productive to work together and address the public health problems created by smoking on as many fronts as possible. The Legislature’s interim Health Services Committee recently launched a study of the overall effectiveness of North Dakota’s tobacco control programs, which gives us the opportunity to expand and improve our outreach. As we move forward with developing the next generation of public health strategies, tobacco harm reduction should at least be part of the conversation.
Thoreson, R-Fargo, is a small-business owner and represents District 44 in the North Dakota House.