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CNN: E-cigarettes: Helping smokers quit, or fueling a new addiction?

By Meera Senthilingam, for CNN

(CNN) It’s a portable piece of technology providing seemingly bottomless access to a drug craved by more than 1 billion people worldwide — nicotine. That craving is caused by smoking tobacco but is now being increasingly satisfied by e-cigarettes and the trend to “vape” instead of smoke.

The selling point is the clean image e-cigarettes purvey by removing the simultaneous exposure to the tar and thousands of chemicals found in the tobacco smoke of regular cigarettes — removing the cause of lung diseases as well as other tobacco-related conditions.

Tobacco kills almost 6 million people each year, according to the World Health Organization (WHO), and a growing number of people are now “vaping” instead of smoking, resulting in industry worth $2.7 billion worldwide.

Since their introduction in 2006, e-cigarettes have become commonplace among smokers trying to kick their habit, with a third of smokers trying to quit in the United Kingdom turning to e-cigarettes to aid them, according to one study. But some critics argue these electronic nicotine delivery systems (ENDS) are fueling a new addiction to nicotine — particularly among young people experimenting with them.

Allure for adolescents

“While ENDS may have the potential to benefit established adult smokers … [they] should not be used by youth and adult non-tobacco users because of the harmful effects of nicotine and other risk exposures,” says Tim McAfee, director the Office on Smoking and Health at the U.S. Centers for Disease Control and Prevention. “Exposure to nicotine can harm adolescent brain development.”

Studies conducted by the CDC through its Adult and Youth National Tobacco Surveys found increased experimentation by youth trying out e-cigarettes but not conventional cigarettes. The gadgetry and flavors associated with the devices is suggested as a reason behind this, with fears of them acting as a gateway into real tobacco smoking.

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But others in the field of tobacco control disagree, stating that whilst people — including youth — may have tried e-cigarettes, the evidence is lacking for their regular use. “Kids like new technology and just experiment or use it once or twice,” says Jean-Francois Etter, professor of Public Health at the University of Geneva.

Etter has been researching the use of e-cigarettes since 2009 and believes they are much safer than conventional cigarettes. “The most dangerous way of consuming nicotine is to smoke it,” he says. Etter argued this point last week at the World Conference of Tobacco or Health in Abu Dhabi.

Whilst Etter says that use among young people should be monitored, he believes the role of e-cigarettes in reducing global tobacco consumption is more important. “They are a gateway out of smoking,” says Etter. The number of people using a combination of tobacco and e-cigarettes is on the rise, according to Etter, resulting in smokers switching and consuming less tobacco each day. “[They have] the same level of nicotine but people are less exposed to toxins … nicotine is not a health problem,” he says. However, further evidence on the long-term health effects of e-cigarettes or nicotine is needed.

Satisfying the craving

Nicotine is the main substance keeping people addicted to smoking tobacco and consequently exposing them to the tar and toxins found in cigarettes. Whilst many people try to kick the habit cold turkey, nicotine replacement through gums and patches has long been advocated as a helping hand. “Nicotine withdrawal is a very unpleasant process,” says Linda Bauld, professor of Health Policy at the University of Stirling, whose recent report for Public Health England identified an extensive and growing market for e-cigarettes worldwide.

“The vast number of people using e-cigarettes are using them to stop smoking; [they’re] about 60% more effective than going cold turkey or buying nicotine replacement therapy over the counter.”

Bauld’s research hasn’t identified a dependence on nicotine with e-cigarettes in the same way as the addiction resulting from regular cigarettes. “E-cigarettes are not the best nicotine delivery devices,” she says referring to the fact nicotine is not seen to enter the bloodstream as readily when using e-cigarettes. That’s backed up by Etter’s research as well as a recent study by researchers at Penn State College of Medicine, in which e-cigarettes were found to be less addictive than tobacco cigarettes.

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They do, however, provide nicotine more effectively than aids such as patches or gums, according to Bauld.

“Patches and gums are a very small market,” says Etter about the quitting devices which first came onto the market 40 years ago. He fears too much restriction on e-cigarettes will limit their impact in achieving a world free of tobacco.

Both Bauld and Etter recognize the need to monitor the consumption of nicotine among teenagers but feel the value of e-cigarettes among adult smokers and their potential to save lives by reducing tobacco consumption should not be underestimated — a sentiment recognized by the World Health Organization.

“[E-cigarettes] could be a way to help people quit but we need more evidence and regulation,” says Armand Peruga, program manager for the WHO’s Tobacco Free Initiative, which has celebrated 10 years of its Framework for Tobacco Control whilst at the conference in Abu Dhabi.

Legislate and regulate

The greatest impact to date in reducing the number of smokers worldwide has been the taxation and legislation restricting tobacco advertising and increasing prices. “For every 10% increase in tax you have 4% reduction in tobacco consumption,” says Peruga.

The growing fear is the increasing domination of big tobacco in the e-cigarette market, which was once seen as a competitor. Their ownerships of popular e-cigarette brands could push out smaller companies in the field, reminiscent of the original tobacco epidemic.

“The intent of big tobacco is to sell their product,” concludes Peruga. “[They may] expand their market to other customers who didn’t use cigarettes but might consider nicotine use.”

But as it seems e-cigarettes are here to stay, most calls are for informed regulation rather than prohibition. “The majority of e-cigarettes — especially when they are well regulated — are likely to be less toxic than cigarettes — and that for smokers is an advantage,” says Peruga.

http://www.cnn.com/2015/03/23/health/e-cigarettes-smoking-addiction-nicotine/

North Dakota ranks poorly in smokeless tobacco use

By Robin Huebner Forum News Service
FARGO — Chris Carlson’s nicotine habit started with chewing tobacco and his college fraternity brothers.
He really got hooked in the mid ’80s as an exchange student in Sweden, where he says everyone – including his female classmates – chewed the smokeless tobacco known as “snus.”
“I’ve got warm, sweet memories of the time,” said Carlson, 51, Fargo, who teaches college public speaking courses and is an adjunct instructor of Norwegian and Scandinavian studies at Concordia College.
While Carlson fondly recalls the rituals and relaxed feelings he said went along with using smokeless tobacco, his memory of that 24-year period is selective.
“You don’t remember all the times it made you nauseous,” he said.
Carlson also smoked cigarettes, but at the urging of his children, gave up both vices about eight years ago with the help of nicotine gum.
He fully understands the difficulty in quitting a substance that is highly addicting and deeply rooted in culture.
At a time when anti-smoking laws have carved out a strong foothold in North Dakota, the state is at the other end of the spectrum with smokeless tobacco.
Statistics from the U.S. Centers for Disease Control and Prevention show that North Dakota is in the middle of the pack for cigarette smoking, but is third worst – behind Wyoming and Mississippi – in the percentage of adults who use chewing tobacco or snuff.
The ranking lists all 50 states and the District of Columbia.
North Dakota was ranked 49th with 7.6 percent of its adults using smokeless tobacco in 2011 – the most recent year for which numbers are available.
South Dakota ranked 43rd with 6.8 percent, and Minnesota was 32nd with 4.8 percent of adults using smokeless tobacco.
The highest percentage of smokeless tobacco users in North Dakota by race are American Indians, who double up on the number of Caucasians using it.
A tribal tradition
Neil Charvat is a former smoker and smokeless tobacco user whose career now focuses on preventing people from picking up the habit.
Charvat, 44, works closely with the state’s Indian reservations as director of the tobacco prevention and control program for the North Dakota Department of Health in Bismarck.
While the state’s smoke-free laws don’t apply to reservations because of their sovereign nation status, the state does fund tribal tobacco prevention programs.
Charvat said it can be tricky educating American Indians about tobacco because the traditional form of it is often central to their religious beliefs.
“If we say, ‘Tobacco is bad,’ that’s a direct insult to their religion,” he said.
So when tribal educators go into schools on the reservation, they make an important distinction from the very start.
“We teach from the viewpoint of it being commercial vs. traditional tobacco,” said Jackie Giron, tobacco prevention coordinator for the Turtle Mountain Band of Chippewa.
Charvat said traditional tobacco grown by tribes doesn’t contain the additives and chemicals that commercial tobacco contains.
In addition, it’s meant for ceremonial use only – not recreation.
In some cases, addictions took hold after tribes began using commercial tobacco for those ceremonies when they weren’t able to obtain traditional tobacco, Charvat said.
As years went on, some commercial tobacco companies even sponsored powwows.
“They portrayed it as something sacred and not harmful to you, which it is,” Giron said.
She said she sees both adults and children chewing tobacco at Turtle Mountain. It means the education process needs to start early, in kids as young as 3 and 4 – and continue through high school and college, she said.
“All you can do is take baby steps sometimes,” Giron said.
Just as dangerous
One challenge in keeping people from starting with smokeless tobacco and helping them quit involves a common, but mistaken belief.
“Some of that has to do with the misconception that if you don’t inhale, it might be somewhat safer,” said Holly Scott, a tobacco prevention coordinator at Fargo Cass Public Health.
In fact, it’s equally as risky.
“When chewing, they’re actually getting more nicotine than in cigarettes, increasing their nicotine addiction,” said Melissa Markegard, who is also a tobacco prevention coordinator at Fargo Cass Public Health.
The incidence of many types of cancer and other diseases can be attributed to smoking and/or chewing tobacco, but combining the products makes it even worse.
“It greatly increases (the risk of lung cancer) if they use both together,” Markegard said.
While there are fewer opportunities than ever to smoke in North Dakota, the same restrictions don’t apply to chewing tobacco because it’s easier to hide.
Charvat said as a teen, he used to smoke a cigarette outside of his school, and then tuck a chew into his mouth before going to class.
Youth at risk
A survey of more than 10,500 North Dakota high school students in 2013 found 13.8 percent of them had used chewing tobacco, snuff or dip during the past 30 days.
It also found chewing tobacco is more often used in smaller towns than in urban centers – 15.1 percent to 11.2 percent, respectively.
“In Western and rural cultures, it’s more commonplace and accepted,” Charvat said.
According to the survey, the Williston area had the highest incidence of chewing tobacco use in high school students, while the Grand Forks area had the lowest.
The Youth Risk Behavior Survey, a collaboration of federal, state and local health education agencies, will be conducted again this spring.
Scott said her overall goal is to “de-normalize” all tobacco use because it’s the state’s No. 1 cause of preventable disease and death.
Charvat is optimistic North Dakota will show up better the next time rankings are compiled because the people he’s working with are motivated.
“They all know someone who’s died from tobacco- related cancer,” he said.
http://bismarcktribune.com/news/state-and-regional/north-dakota-ranks-poorly-in-smokeless-tobacco-use/article_86fa27cb-e925-5210-9ee7-2456e943dbde.html

Teen tobacco users likely to use it in multiple forms

By Reuters Media

A national survey of U.S. middle and high school students finds that those who use tobacco or nicotine products are likely to also use more than one type of product.

About 15 percent of the adolescents reported smoking cigarettes, cigars, pipes, bidis, hookahs or water pipes, using dissolvable forms of tobacco or “vaping” e-cigarettes. And twice as many in that group used two or more of these product types compared to those who said they used only one.

“Our study really shows that kids are using more than one of these products at the same time,” said Youn Ok Lee of RTI International in Research Triangle Park, North Carolina, the report’s lead author.

Lee said there are many varieties of tobacco products available. And each type of product also has a diverse range of options, such as flavors.

“So we don’t really know a lot about how this range of products might affect kids’ use of tobacco,” she told Reuters Health.

Using data from a 2012 national survey of nearly 25,000 U.S. students, researchers found that about 7 percent reported using one tobacco product in the past 30 days. About 4 percent said they used two tobacco products in that time. Another 4 percent said they used three or more products.

“I was a little bit surprised by just how many kids were using more than one product,” Lee said. “Even more surprising was that using three or more products is more popular than using cigarettes alone.”

Overall, about 3 percent of kids exclusively used cigarettes and about 2 percent exclusively used cigars. Those products were the most popular and their use increased with age.

The study team also found that almost 1 percent of students reported exclusively using e-cigarettes, which contain no tobacco but deliver a vapor laced with nicotine, the addictive substance in tobacco.

That’s more than the 0.4 percent who reported using e-cigarettes in combination with traditional cigarettes.

The increasing popularity of e-cigarettes is a concern for U.S. health officials as use has tripled between 2013 and 2014.

Lee noted that the results don’t tell why young people are using more than one form of tobacco, or how often the survey participants had used the products.

The researchers did find that being a boy, using flavored products, being dependent on nicotine, being receptive to advertising and having friends who used any tobacco products were all factors linked to an increased risk of using more than one product.

Policymakers and researchers should look at how these products affect tobacco use among middle and high school students, said Lee, because little is known about the influence of non-cigarette products.

Moreover, these products may create a public health issue by introducing people who would never have smoked cigarettes to nicotine, she said.

Lee emphasized that it’s important to look at all tobacco products together – not individually.

SOURCE: http://bit.ly/1za0ykL Pediatrics, online February 2, 2015.

http://www.inforum.com/news/3671610-teen-tobacco-users-likely-use-it-multiple-forms

What to Know About the Science of E-Cigarettes

 
Eliza Gray & Alexandra Sifferlin | TIME Magazine

A guide to understanding conflicting and ongoing research

Two Columbia University professors warned in a new study Thursday that the health fears over electronic cigarettes are hindering research. The very same day, another new study showed that smoking e-cigs, or “vaping,” can produce cancer-causing formaldehyde.
Clearly there’s some disagreement among scientists about the risks and benefits of a product that’s growing in popularity. Here’s what you need to know about the latest science.
What’s with the latest disagreement?
Columbia public health professors Amy Fairchild and Ronald Bayer argue in Science magazine that the staunchest opponents of electronic cigarettes are so concerned about the potential downsides that they advocate for an anti-e-cigarette regulatory and research approach that may be bad for public health. This approach of “deep precaution,” they argue, “has served as a kind of trump argument, hostile to the notion of trade-offs, seeing in them perilous compromise. Such a posture does not serve either science or policy well.”
It “may be years before the disagreements over the evidence” about the effects of electronic cigarettes can be resolved, Fairchild and Bayer wrote. On the one hand, electronic cigarettes may serve as gateway drugs for young people to start smoking cigarettes, and “dual” use of electronic cigarettes with tobacco cigarettes may stop some smokers from quitting. Electronic cigarettes may also carry unknown health consequences of their own. On the other hand, they may provide harm reduction for people who have been unable to quit any other way.
Given these two competing possibilities, the authors argued that the best formula for public health is to acknowledge the possibility for costs and benefits and to push for a regulatory scheme that is flexible enough to account for both outcomes. It is better to make public policy and execute scientific research under the assumption that e-cigarettes could bring good as well as bad.
But also on Thursday, the New England Journal of Medicine published a new study reporting that chemicals inside e-cigarettes—like propylene glycol and glycerol—can produce a type of the cancer-causing chemical called formaldehyde when heated during the vaping process. The researchers report that when testing samples of the aerosol from vaped e-cigs, they found that the e-cigs can contain formaldehyde-releasing agents slightly different from regular formaldehyde, and that the levels are especially high when a user vapes at high voltages. Scientists don’t yet know if formaldehyde-releasing agents carry the same risk as pure formaldehyde, but the researchers said in their report that if they assume the substances do carry the same risks, then long-term vaping could be associated with a significantly higher risk for cancer compared to long-term smoking. The researchers said formaldehyde-releasing agents may actually burrow into the respiratory tract more efficiently than regular formaldehyde, though the observation wasn’t confirmed.
Are there other reasons experts are concerned?

There’s also debate over the safety of the liquid nicotine inside e-cigarettes. In April 2014, the Centers for Disease Control and Prevention (CDC) released a report showing what they called a “dramatic” rise in e-cigarette-related calls to U.S. poison centers. Calls went from one a month in September 2010 to 215 calls a month in February 2014, and more than half of the calls involved children age five and under. Forty-two percent involved people age 20 and older. Symptoms of liquid nicotine ingestion are known to be vomiting, nausea and eye irritation.

Researchers are also wary of the long term effects of inhaling propylene glycol, one of the main ingredients in e-cigarettes. The jury is still out, but some physicians are concerned. “As for long-term effects, we don’t know what happens when you breathe the vapor into the lungs regularly,” Thomas Glynn, the director of science and trends at the American Cancer Society, told ABC News. “No one knows the answer to that.”

Are they really attracting young people?

Several recent—but fairly small—studies say yes. A December 2o14 study in the journal Pediatrics surveyed 1,941 Hawaii high school students and found that about 17% of the high schoolers smoked e-cigarettes only, 12% smoked both e-cigarettes and conventional cigarettes, and only 3% smoked conventional cigarettes. The findings suggested that kids who smoked e-cigarettes scored lower on outside risk factors to pick up a conventional smoking habit. “The fact that e-cigarette only users were intermediate in risk status between nonusers and dual users raises the possibility that e-cigarettes are recruiting medium-risk adolescents, who otherwise would be less susceptible to tobacco product use,” the authors wrote. Numbers released in 2013 from the National Youth Tobacco Survey showedthat the percentage of middle school and high school students who have tried e-cigarettes doubled from 3.3% in 2011 to 6.8% in 2012.

What’s the argument in favor of e-cigarettes?

Some smokers use e-cigarettes to help them curb their traditional cigarette habit, or even quit. An August 2014 study that surveyed over 20,000 Americans showed that among adults who used a product to help them quit smoking, 57% chose e-cigarettes. That’s compared to the 39% who used prescription drugs like Chantix and the 39% who used other over-the-counter methods like patches or nicotine gum. Another study from July 2014, which reviewed 80 studies on e-cigarettes’ safety and their effects on users, revealed that not only can e-cigarettes help smokers quit, but they are less harmful to smokers and bystanders’ health compared to regular cigarettes.

What’s the FDA doing about it?

The U.S. Food and Drug Administration (FDA) only regulates e-cigarettes that are marketed for therapeutic purposes, though the agency has proposed a rule that would give it more regulatory power over e-cigarettes but that has not yet been implemented. The FDA has suggested a ban on sale of e-cigarettes to minors, and admits that there is a lot consumers don’t know about the product like whether they attract kids and teens or just how much nicotine is inhaled when a person vapes.

http://time.com/3678402/electronic-cigarettes-ecigs-health-science-research/
 

Salt Lake County health study reveals big problem with inaccurate e-liquid labeling

By , Deseret News
SALT LAKE CITY — An increase in emergency room visits and calls to the local poison control hotline has Salt Lake County Health Department officials concerned about e-liquid used in battery-operated electronic cigarettes.
“You really have to treat it as a drug because it is fatal to a small child,” said Kathy Garrett, tobacco prevention and cessation manager for the Salt Lake County Health Department.
The health department, Garrett said, is encouraging users to put e-cigarettes and the “enticing candy-flavored cartridges” out of the reach of young people.
It is also seeking to pass new regulations to keep manufacturers in check.
“E-liquid is a serious poisoning threat to children,” Garrett said, adding that the United States Food and Drug Administration does not regulate e-liquid manufacturing at all. “If they drink enough of it, it can be fatal to small children.”
The Salt Lake County Health Department recently concluded its own study, where undercover workers visited all 14 vape shops and 16 of the 80 tobacco specialty stores in the county to purchase a variety of e-liquid cartridges for testing at the Center for Human Toxicology at the University of Utah.
Health officials found that 61 percent of the e-liquid cartridges collected strayed at least 10 percent from what was indicated on the labels, with either more or less nicotine content than expected.
Garrett said even the samples that listed no nicotine content had trace amounts, and at least one variety had 7.35 miligrams per milliliter.
1467294“Both specialty stores and vape shops are inconsistent with their labeling,” she said. “These findings support the need for local policy that requires licensing for the manufacturing of e-liquid, and also we’d like to regulate the sale of e-cigarettes to ensure safety standards that include accurate labeling and ingredients with nicotine levels.”
The Utah Legislature has yet to pass legislation that would govern any part of the surging electronic cigarette industry in the state, and the federal government is just beginning to assess the issues surrounding production and sales.
Last year, the number of adults using e-cigarettes topped 40 million nationwide, an increase of more than 620 percent over the previous year. The number of children and teens who use them is on the rise as well, health officials said.
The Utah Department of Health reports that 4.8 percent of adults and 5.8 percent of teens routinely use the nicotine vapor product, according to 2013 data, the latest available. The rate of regular e-cigarette use in Utah more than doubled from 2012 to 2013, and it tripled among Utah students from 2011 to 2013.
Without state or federal laws to govern e-cigarette and e-liquid production and sales, local jurisdictions have taken it upon themselves to protect Utahns, and Garrett said Salt Lake County will be the next to enact a policy.
She expects the board to vote on something as early as next month. If a policy is adopted, the health department would be responsible for enforcing it through random inspections and monitoring of local manufacturing activity.
Garrett said there are several manufacturers in the valley that the health department would love to keep its eye on to make sure they’re following the rules.
“Inaccurate labeling is alarming because consumers don’t know exactly what they’re taking into their bodies or at what level,” she said. “It’s also a real concern for poison control and emergency room staff, who don’t know if the labeled amount of nicotine in a bottle a child has ingested is accurate.”
Nicotine in e-liquids was to blame for 131 calls to theUtah Poison Control Center in 2014, according to the health department.
Health officials also reviewed the availability of child-proof lids for e-liquid cartridges and found that more than a quarter of the samples containing a listed amount of nicotine did not have safety caps.
There are 12 local health departments in the state, and at least Davis, Weber and Utah counties have adopted regulations, while Summit County has an ordinance, but Garrett said most if not all departments would be on board for statewide legislation, which may be presented in the upcoming session of the Utah Legislature.
In the meantime, Garrett said, “if you have e-cigarettes of e-juice lying around, lock it up where a child can’t get into it. Just like any medication, you should lock it up and keep it out of reach.”
http://www.deseretnews.com/article/865619211/Salt-Lake-County-health-study-reveals-big-problem-with-inaccurate-e-liquid-labeling.html?pg=all

Cigarette Addiction Affects Men, Women's Brains Differently; Brain Scans Reveal Need For Tailored Treatment

By Samantha Olson, Medical Daily

Smoking is addictive and bad for the body in a laundry list of ways, but it hooks men and women differently. Researchers at Yale University studied the brains of men and women using positron emission tomography (PET) scans. Their intention was to measure the changing levels of dopamine, which control the brain’s pleasure and reward pathways, in men and women’s brains, and published their findings in the Journal of Neuroscience earlier this month.

Dopamine levels increase when addictive substances, such as the nicotine found in cigarettes, enter the body and flood the brain. For the first time, researchers have developed a way to watch the dopamine levels change while a person smokes. Researchers observed the dopamine levels of 16 addicted cigarettes smokers — eight men and eight women — with at least 17 years of smoking behind them.

Each participant was told to smoke one or two cigarettes whenever they wanted while under observation, and they weren’t allowed to use any nicotine patches or medications during the study. The study’s lead researcher Kelly Cosgrove, a radiology professor from Yale University, scanned each of their brains, and pieced each of the images together in order to create a sequence of brain movements.

Dopamine struck women harder and faster in one section of the brain called the dorsal putamen, while men had moderate to low activation in the same area. Men, on the other hand, had much faster and consistent activity in the ventral striatum, while women were only mildly affected. But what did all this mean?

“I think it confirms that strategies that focus on drug reward are likely to work better for men –- these would include the nicotine replacement strategies [like the patch],” Cosgrove, told the Huffington Post. “And for women it highlights that we need different and new medications — ones that target the reasons why women smoke, such as to relieve stress and manage mood.”

Women were more affected by the sensation of smoking, such as its taste and the smell of smoke, while men were more affected by the nicotine itself. Men are much more likely to use chewing tobacco because they don’t care about the cigarette or the activities smoking brings with it; they just want that nicotine. Women, on the other hand, may do better smoking a low-nicotine cigarette, so long as they have a cigarette in hand to take a drag and blow smoke from.

“If [women] are smoking more for the taste and sensory effects, then low-nicotine cigarettes might be an effective way to wean themselves off the regular cigarettes, whereas men might have more nicotine withdrawal and not really get much out of those [low-nicotine] cigarettes,” Kenneth Perkins, a psychiatric professor at the University of Pittsburgh who was not involved in the study, told HuffPost. “The possibility is that they might be a more effective way for women to quit than men, but that’s purely speculative at this point.”

Source: Cosgrove K. Journal of Neuroscience. 2014.

http://www.medicaldaily.com/cigarette-addiction-affects-men-womens-brains-differently-brain-scans-reveal-need-315628

First Child's Death From Liquid Nicotine Reported as 'Vaping' Gains Popularity

By GILLIAN MOHNEY, ABC News

A toddler from upstate New York could be the first child to die from liquid nicotine, the substance used in e-cigarettes, poisoning in the U.S., concerning health officials as e-cigarettes continue to rise in popularity.

Police reported that the 1-year-old child died after ingesting liquid nicotine at a home in Fort Plain, New York, on Tuesday. The child was found unresponsive and rushed to a hospital where he was later pronounced dead.

Fort Plain police released a statement saying the death is believed to be a “tragic accident.” They declined to say whether the liquid nicotine was associated with an e-cigarette.

But health officials are concerned if steps aren’t taken to protect children, they could see more fatal accidents similar to this one.

The rise of e-cigarettes and “vaping” in recent years has also meant a rise in the purchase of liquid nicotine. Coming in flavors like cotton candy or gummy bear, health officials say that the brightly colored liquid could appeal to young children.

“One teaspoon of liquid nicotine could be lethal to a child, and smaller amounts can cause severe illness, often requiring trips to the emergency department,” the American Association of Poison Control centers in a statement today. “Despite the dangers these products pose to children, there are currently no standards set in place that require child-proof packaging.”

In November the American Association of Poison Control Centers announced that the number of dangerous “exposures” to liquid nicotine has skyrocketed in recent years with 3,638 exposures as of Nov. 30. An exposure means coming into contact with liquid nicotine through ingestion, inhalation or by absorbing the substance through the skin.

The number is more than double the 1,543 exposures reported in 2013 and exponentially higher than in 2011 when 271 exposures were reported.

Before this week, the only confirmed death related to liquid nicotine happened in 2012 when a man injected himself with the substance, according to the American Association of Poison Control Centers.

Dr. Donna Seger, director of the poison control center at Vanderbilt University Medical Center, said her center has started to get more calls about exposure to e-cigarettes or liquid nicotine.

“They’re not that difficult to get into,” Seger said of the vials that contain the nicotine. “The issue is once the exposure occurs, it could be bad.”

Seger said just a small amount of nicotine can cause dangerous symptoms in children, including seizures.

Phil Daman, president of the Smoke-Free Alternatives Trade Association, said he was “saddened to hear the terrible news.”

“[We] want to always be mindful to put safe products on the market,” said Daman, who said the trade association recommends childproofing products to “err on the side of caution.”

Daman questioned if the child could have gotten a hold of a high-grade liquid nicotine that could be a much higher concentration than what is in many common e-cigarette products. Because e-cigarettes are not federally regulated there is a wide-range of liquid that could be purchased to use in e-cigarette products, ranging from potent high grade liquid nicotine to material that has an extremely small amount of nicotine.

In April the U.S. Centers of Disease Control and Prevention warned they were seeing an increase of calls to poison control centers for liquid nicotine exposure and children were becoming sick after ingesting, inhaling or absorbing the chemical through their skin. The most common symptoms were vomiting, nausea or eye irritation.

“Use of these products is skyrocketing and these poisonings will continue,” U.S. Centers for Disease Control and Prevention Director Dr. Tom Frieden said in April. “E-cigarette liquids as currently sold are a threat to small children because they are not required to be childproof, and they come in candy and fruit flavors that are appealing to children.”

To combat these cases of increased exposure some state lawmakers have introduced bills that would require e-cigarette companies to put child-resistant caps on bottles of liquid nicotine.

In New York State, a bill passed earlier in the year that would require child resistant containers for liquid nicotine. Gov. Andrew Cuomo is set to sign the bill in the next few weeks, according to ABC News affiliate WABC-TV.

At least one e-cigarette, Vapor World, changed their packaging this year so that bottles of liquid nicotine are more child resistant.

http://abcnews.go.com/Health/childs-death-liquid-nicotine-reported-vaping-gains-popularity/story?id=27563788

Q: Is hookah or water pipe smoking a safe alternative to cigarettes?

By Sanjay Gupta, MD

A: Absolutely not. In fact, as Daniel Neides, MD, medical director of the Wellness Institute at Cleveland Clinic points out, hookah smoking “may actually be worse than smoking.”

Hookahs are water pipes in which charcoal is used to heat up flavored tobacco. An ancient form of smoking that originated in the Middle East and India, it has become increasingly popular among American adolescents and young adults. Roughly 1 out of 5 U.S. high school seniors had smoked a hookah in the past year, according to recent data.

The hookah’s gaining popularity is largely due to the misconception that it’s not harmful. That’s not the case. “First, the tobacco used in hookah contains the same cancer-causing agents found in cigarettes,” Dr. Neides says. “Secondly, there is charcoal that is used to heat the tobacco, which gives off carbon monoxide and heavy metals as a by-product when it is heated.”

A hookah session usually lasts longer than time spent smoking cigarettes, with hookah smokers puffing more frequently and inhaling more deeply. A 2010 study reported the amount of smoke inhaled during a hookah session can be nearly 200 times the amount inhaled when smoking a cigarette. Earlier this year, researchers at the University of California, San Francisco, found that hookah smoking raised nicotine urine levels as much as 73 times.

Neides adds that because water pipes are usually smoked in specialty hookah shops or bars and shared among friends, users are exposed to greater levels of secondhand smoke and are at a higher risk of contracting viruses or infections.

The bottom line, Neides says, is that “hookah smoke should be considered the same as cigarettes and cigars – a very unhealthy habit that leads to chronic disease and death.”

http://www.everydayhealth.com/columns/paging-dr-gupta/is-hookah-or-water-pipe-smoking-a-safe-alternative-to-cigarettes/

Letter to the Editor: Stop glamorizing the role of tobacco in baseball

Chris Hansen, Washington | The Washington Post

Just weeks after the early death of beloved baseball star Tony Gwynn from cancer likely caused by chewing tobacco, and just days after World Series-winning pitcher Curt Schilling told the world he attributes his cancer to years of chewing tobacco, The Post irresponsibly leads an article about the Washington Nationals with the portrayal of chewing tobacco use as a rally-inducing, lucky superstition [“Nationals’ luck runs out against Phillies thanks to stellar performance by Burnett,” Sports, Aug. 27].

To all the young baseball fans who look to The Post each morning to see if their heroes won last night: Tobacco causes those heroes to suffer nicotine addiction, disease and death. Stephen Strasburg recently stated publicly that he is trying to quit using chewing tobacco but that it is very hard to quit. It is time for the team owners and the players association to eliminate tobacco from baseball, and it is time for the media to stop characterizing tobacco as a quaint part of baseball culture.

Instead of inducing winning rallies, tobacco in baseball induces life-shortening defeats — and that is the only coverage it deserves on the sports page of The Post.

The writer is president of the American Cancer Society Cancer Action Network .

http://www.washingtonpost.com/opinions/stop-glamorizing-the-role-of-tobacco-in-baseball/2014/08/31/cdd004dc-2e08-11e4-be9e-60cc44c01e7f_story.html

CDC: E-cigs may be tempting non-smoking youths to smoke

By Reuters Media

CHICAGO – Electronic cigarettes may be more tempting to non-smoking youths than conventional cigarettes, and once young people have tried e-cigarettes they are more inclined to give regular cigarettes a try, U.S. researchers said on Monday. A report, released by a team at the U.S. Centers for Disease Control and Prevention, lends evidence to the argument that electronic cigarettes encourage youth smoking.

The study, based on nationally representative youth surveys, found that more than a quarter-million adolescents and teens who had never smoked used an electronic cigarette in 2013, a threefold increase from 2011.

Youths who had tried e-cigarettes were nearly twice as likely to say they would try a conventional cigarette in the next year compared with those who had never tried an e-cigarette, according to the study in the journal Nicotine and Tobacco Research.

E-cigarettes are slim, reusable, metal-tube devices containing nicotine-laced liquids that come in exotic flavors. When users puff, the nicotine is heated and released as a vapor containing no tar, unlike conventional cigarette smoke.

Health experts have raised concerns that the burgeoning $2 billion e-cigarette industry, which has been virtually unregulated, would reverse gains in the decades-long effort to curb youth smoking in the United States. Just 15.7 percent of U.S. teenagers reported smoking in 2013, the lowest rate on record.

In April, the U.S. Food and Drug Administration proposed rules that would ban the sale of e-cigarettes to anyone under 18 but would not restrict flavored products, online sales or advertising, which public health advocates say attract children.

Earlier this month, attorneys general from 29 states urged the FDA to strengthen those rules to better protect young people from nicotine addiction.

“We are very concerned about nicotine use among our youth, regardless of whether it comes from conventional cigarettes, e-cigarettes or other tobacco products,” Dr. Tim McAfee, director of CDC’s Office on Smoking and Health, said in a statement.

“Not only is nicotine highly addictive, it can harm adolescent brain development.”

In the CDC study, researchers analyzed data from the 2011, 2012, and 2013 National Youth Tobacco Surveys of students in grades 6-12. They found that more than 263,000 who had never smoked a conventional cigarette used e-cigarettes in 2013, up from 79,000 in 2011.

Among non-smoking youth who had tried electronic cigarettes, 43.9 percent said they intended to smoke conventional cigarettes within the next year, compared with 21.5 percent of those who had never used e-cigarettes.

Lorillard Inc leads the U.S. e-cigarette market, while Reynolds American Inc and Altria Group Inc are rolling out their own brands nationwide this summer. A Wells Fargo analyst report in July projected that U.S. sales of e-cigarettes would outpace conventional ones by 2020.

http://www.inforum.com/content/cdc-e-cigs-may-be-tempting-non-smoking-youths-smoke