Posts

EDITORIAL: Raise Colorado's minimum age for buying cigarettes to 21

By The Denver Post Editorial Board
Teen smoking is not a right, it is a horrible choice that is addictive and incredibly damaging to the young brain.
The federal government has left it up to local and state governments to raise the legal age to buy cigarettes, and Colorado is looking to do just that.
Sen. Steve King, R-Grand Junction, is pushing a bill that will be introduced soon to increase the cigarette-buying age from 18 to 21 — a move he says would add consistency to vice laws that set a 21 age limit to buy recreational marijuana, gamble and buy alcohol.
New York City last year raised the tobacco buying age to 21 and so did Utah— dismissing the argument that 18-year-olds who are old enough to fight in wars and vote should be allowed to buy cigarettes.
That is a bad position when you are talking about the supremely addictive substance of nicotine and what it does to teens.
Research shows adolescent smokers are more likely to become heavy smokers, are much less likely to quit smoking later in life, and are more likely to die from smoking-related illnesses.
Additionally, nicotine has more deleterious effects on developing brain of an 18-year-old than a 21-year-old.
Though the numbers of teen smokers have declined, research shows virtually all new users of tobacco products are under 18.
History also shows raising age limits works. It did with alcohol.
In the 1970s, states lowered the legal age to buy alcohol to 18, a major mistake that resulted in more drunken-driving deaths.
In the 1980s, Congress passed the Uniform Minimum Drinking Age Act, giving states a financial incentive to raise the drinking age to 21. States began reporting fewer drunken-driving deaths, and youth usage and binge drinking fell by a third.
In 2005, the town of Needham, Mass., raised the age to buy cigarettes to 21. The result has been a dramatic local decline in smoking.
Society has said teens can’t smoke recreational pot; we should be consistent with tobacco.
http://www.denverpost.com/editorials/ci_25054723/raise-colorados-minimum-age-buying-cigarettes-21#ixzz2sOZXWxRI

Nicotine Levels In US Cigarettes Went Up 15% Between 1999 And 2011

By: , Business Insider
Nicotine levels in cigarettes went up 15% between 1999 and 2011, according to a study published this week in the journal Nicotine and Tobacco Research.
The data were collected from the annual report filed with Massachusetts Department of Public Health by four major manufacturers of cigarettes from 1997 to 2012.
“Young people could have an easier time becoming addicted to cigarettes the first few times they do smoke,” lead author Thomas Land, director of the Office of Health Information Policy and Informatics at the State Health Department, told Deborah Kotz of The Boston Globe.
From The Globe:
Each day, 3800 American teens try their first cigarette and 1000 become hooked, according to a 2012 Surgeon General’s report. Those who are unable to quit as adults will die, on average, 13 years earlier than their peers.
This is not the first study to find rising nicotine levels in cigarettes. In 2007, a Harvard study found nicotine levels had gone up by nearly 11% between 1997 and 2005, the Globe noted. Industry executives disputed the findings and attributed the increase to agricultural and rainfall variations that led to more concentrated levels of nicotine in tobacco crops.
But Land told The Globe that if that were the case, “we would have seen a similar trend of increased nicotine yield for all cigarette makers since they tend to buy their tobacco from the same regions. We did not.”
The study concludes that nicotine levels “are controllable features of cigarettes, and should be monitored and regulated by government agencies.”
While federal law lets the FDA set new regulations to lower nicotine content, according to Kotz, he noted that the agency has not set new limits on the amount of nicotine allowed in each cigarette.
http://www.businessinsider.com/nicotine-levels-up-15-since-1990-2014-1#ixzz2qh357qlT

Smoking Rates Still High Among the Mentally Ill

By John Gever, Deputy Managing Editor, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner
Smoking rates among Americans with mental illnesses didn’t budge from 2004 to 2011, a period during which rates in the rest of the population fell 14%, researchers said.
Data from the federal Medical Expenditure Panel Survey (MEPS) found that, among respondents with mental illnesses, 25.3% reported current smoking in 2004-2005 (95% CI 24.2%-26.3%), versus 24.9% in 2010-2011 (95% CI 23.8%-26.0%, P=0.50) after adjustments for other predictors of smoking such as income and education, according to Benjamin Le Cook, PhD, MPH, of Harvard Medical School in Cambridge, Mass., and colleagues.
Over the same interval, adjusted smoking rates in other MEPS respondents declined from 19.2% (95% CI 18.7%-19.7%) to 16.5% (95% CI 16.0%-17.0%, P<0.001), the researchers reported in the Jan. 8 issue of the Journal of the American Medical Association.
On the other hand, individuals with mental illnesses who were undergoing treatment showed somewhat greater quit rates than those who were untreated (37.2% versus 33.1%, P=0.005), Cook and colleagues found from a different data set, the 2009-2011 National Survey of Drug Use and Health (NSDUH).
“The mechanisms that support persistently higher rates of smoking among individuals with mental illness are complex and remain understudied,” they wrote. “Patients with mental illness may attribute greater benefits and reward value to smoking compared with patients without psychiatric disorders or may experience more difficult life circumstances, higher negative affect, or a relative lack of alternative rewards.”
Other experts contacted by MedPage Today offered differing views on the high smoking rates among the mentally ill.
John Spangler, MD, MPH, of Wake Forest Baptist Medical Center in Winston-Salem, N.C., said in an email that the nicotine in cigarettes “is very effective at relieving stress and improving mood. You can ask any smoker about that. It also can increase concentration in those with ADHD, and it improves memory as well.”
But Joseph McClernon, PhD, of Duke University, told MedPage Today that smoking as self-medication is not very effective. “Among dependent smokers, much of the relief or improvement in cognitive performance they experience from smoking likely has as much to do with reversing the effects of withdrawal,” he said in an email, which appears to be more severe in patients with some mental illnesses.
A similar viewpoint was expressed by Glen Getz, PhD, of Allegheny Health Network in Pittsburgh. The positive subjective effect of smoking “is only briefly effective and ultimately has counterproductive effects on mood, anxiety, and other emotional problems,” he said.
There was general agreement, however, that it may be more difficult for the mentally ill to quit smoking.
Among the factors cited by Cook and colleagues is a “smoking culture” that has long pervaded the mental health community, including clinicians as well as patients.
They noted that psychiatric inpatients historically were allowed and even encouraged to smoke “to decrease agitation and encourage patient adherence.” Even today, they suggested, many mental health professionals shy away from encouraging their patients to quit smoking for a variety of reasons, ranging from concern that it may distract from other therapeutic efforts to “lack of confidence” that patients can succeed in quitting.
But although such a culture did exist in the past, that’s changing, Douglas Ziedonis, MD, MPH, of the University of Massachusetts Medical School in Worcester, told MedPage Today.
“Nowadays we’re much more focused on wellness in recovery and also looking at the physical health of individuals who have mental illnesses,” he said in an email. “Mental health treatment providers are now realizing that they need to better address tobacco and wellness issues in mental health treatment.”
Said Martin Mahoney, MD, of Roswell Park Cancer Institute in Buffalo, N.Y., and director of New York state’s smoking quitline, “I don’t think there’s anything more important than helping a patients who is addicted to nicotine to get off of that addiction.”
For the current study, Cook and colleagues analyzed data on more than 32,000 MEPS respondents with mental illnesses and some 133,000 without. Participants were considered to have mental illness if they met any of several criteria: having a healthcare visit linked to a psychiatric ICD-9 code, receiving psychotherapy or mental health counseling, filling a prescription for a behavioral health disorder, or having scores on neuropsychiatric tests indicating severe psychological distress or at least moderate depression.
The data on quit rates associated with mental health treatments covered some 14,000 participants in the NSDUH from 2009 to 2011 whose responses indicated at least mild mental illness according to criteria established by the Substance Use and Mental Health Administration.
Differences in smoking prevalence in the MEPS data between those with and without mental illnesses were most pronounced among respondents with apparent depression or distress, for whom the gap was consistently around 15 percentage points through the 8-year study period.
Cook and colleagues acknowledged that the ascertainment of mental illness in both surveys could be faulty because they didn’t use structured diagnostic interviews. Also, as in most federal surveys, persons in institutional settings (including psychiatric inpatients) were excluded.
Another limitation was that the NSDUH did not include data on the timing of smoking cessation versus provision of mental health treatment, leaving open the possibility that some respondents may have quit smoking before receiving treatment. The researchers cautioned that “reverse causality” could therefore have occurred: patients may be more likely to seek mental health treatment after they quit smoking.
Primary source: Journal of the American Medical Association
Source reference: Cook B, et al “Trends in smoking among adults with mental illness and association between mental health treatment and smoking cessation” JAMA 2014; 311: 172-182.
http://www.medpagetoday.com/PrimaryCare/Smoking/43690?xid=nl_mpt_DHE_2014-01-08&utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&eun=g436493d0r&userid=436493&email=megan.houn@tfnd.org&mu_id=5533639

Are e-cigarettes dangerous?

By Harold P. Wimmer
Editor’s note: Harold P. Wimmer is the president and CEO of the American Lung Association.
(CNN) — For the makers of electronic cigarettes, today we are living in the Wild West — a lawless frontier where they can say or do whatever they want, no matter what the consequences. They are free to make unsubstantiated therapeutic claims and include myriad chemicals and additives in e-cigarettes.
Big Tobacco desperately needs new nicotine addicts and is up to its old tricks to make sure it gets them. E-cigarettes are being aggressively marketed to children with flavors like Bazooka Bubble Gum, Cap’n Crunch and Cotton Candy. Joe Camel was killed in the 1990s, but cartoon characters are back promoting e-cigarettes.
Many e-cigarettes look like Marlboro or Camel cigarettes. Like their old-Hollywood counterparts, glamorous and attractive celebrities are appearing on TV promoting specific e-cigarette brands. Free samples are even being handed out on street corners.

A report from the Centers for Disease Control and Prevention shows the promotion of e-cigarettes is reaching our children with alarming success. In just one year, e-cigarette use doubled among high school and middle school students, and 1 in 10 high school students have used an e-cigarette. Altogether, 1.78 million middle and high school students nationwide use e-cigarettes.

The three largest cigarette companies are all selling e-cigarettes. Because tobacco use kills more than 400,000 people each year and thousands more successfully quit, the industry needs to attract and addict thousands of children each day, as well as keep adults dependent to maintain its huge profits.
Nicotine is a highly addictive substance, whether delivered in a conventional cigarette or their electronic counterparts. The potential harm from exposure to secondhand emissions from e-cigarettes is unknown. Two initial studies have found formaldehyde, benzene and tobacco-specific nitrosamines (a well-known carcinogen) coming from those secondhand emissions. We commend New York City recently for banning the use of e-cigarettes indoors.
No e-cigarette has been approved by the FDA as a safe and effective product to help people quit smoking. Yet many companies are making claims that e-cigarettes help smokers quit. When smokers are ready to quit, they should call 1-800-QUIT NOW or talk with their doctors about using one of the seven FDA-approved medications proven to be safe and effective in helping smokers quit.
According to one study, there are 250 different e-cigarette brands for sale in the U.S. today. With so many brands, there is likely to be wide variation in the chemicals — intended and unintended — that each contain.
In 2009, lab tests conducted by the FDA found detectable levels of toxic cancer-causing chemicals — including an ingredient used in anti-freeze — in two leading brands of e-cigarettes and 18 various e-cigarette cartridges.
There is no safe form of tobacco. Right now, the public health and medical community or consumers have no way of knowing what chemicals are contained in an e-cigarette or what the short and long term health implications might be.
Commonsense regulation of e-cigarettes by the U.S. Food and Drug Administration is urgently needed. In the absence of meaningful oversight, the tobacco industry has free rein to promote their products as “safe” without any proof.
A proposal to regulate e-cigarettes and other tobacco products has been under review at the White House Office of Management and Budget since October 1, 2013. The Obama administration must move forward with these rules to protect the health of everyone, especially our children.
The opinions expressed in this commentary are solely those of Harold P. Wimmer.
http://www.cnn.com/2014/01/06/opinion/wimmer-ecigarette-danger/

Nicotine Poisoning Blamed on E-cigs

BY 
Threats of nicotine poisoning are now serving as the catalyst of new protests against electronic cigarettes, prompting some countries to consider regulating or banning the e-cigs.  The European Union is currently considering either bans or regulation, and some places such as Spain have already banned the e-cigs.
Some cities in the US are also considering bans or stronger regulations on the products.   New York, Chicago, and Oklahoma City are also seeking regulation with some cities choosing to treat the e-cigs as tobacco products, even though they do not contain any tobacco.  New York just recently passed a ban on e-cig product usage in public places.
E-cigs are electronic cigarettes that feature a heating element.  They contain propylene glycol which produces a vapor when heated and also have a flavoring liquid.  The liquids come in a variety of flavors and contain different levels of nicotine.
The e-cigs are used by people who are trying to quit smoking tobacco, and many people see them as a safer alternative to regular cigarettes which contain several carcinogenic compounds.
The liquids used for e-cigs contain concentrated amounts of nicotine and are being blamed for poisoning children who accidently drink the fluid.  In May 2013, an Israeli 2 year old reportedly died after drinking the fluid and ingesting a lethal dose of nicotine.
In Sweden, 29 cases of nicotine poisoning were attributed to e-cigs last year.  Due to less strict requirements, e-cig users are able to use in more places, which may be leading to accidental overdoses as users are not required to wait for a smoking break.
Nicotine poisoning can exhibit many side effects such as nausea and vomiting, abdominal cramps, agitation and weakness.  Severe cases can lead to coma and respiratory failure.
Nicotine has an average lethal dosage of 0.5 to 1 milligram per kilogram in body weight for humans.  It is easily absorbed through the skin.  It has a half life of approximately two hours.
Most overdoses happen with simultaneous use of nicotine products, such as smoking and use of a patch at the same time.
Emergency treatment of nicotine poisoning includes administering activated charcoal and gastric lavage.
Nicotine has been used and valued for centuries due to its positive effects.  It can relieve depression, suppress appetites and can help with mental focus.  Nicotine is widely believed to be highly addictive, although some theories suggest that pure nicotine is not addictive, but it is only addictive when used in tobacco form.
No matter what the true reason, tobacco usage is highly addictive and has been attributed to several health problems, such as strokes and lung cancer.  The e-cigs are seen as a safer alternative by many users and some health officials have even come out in favor of e-cigs over regular tobacco.
Other officials claim that e-cigs are unregulated and have not been fully researched for potential side effects.  Authorities claim that the health hazards from inhaling the propylene glycol mist are unknown.
Some cities that are considering bans on e-cigs are concerned that they may be used by teenagers as a gateway into cigarette smoking. According to a youth survey by the US Center for Disease Control, 10 percent of high school students have tried using e-cigs.  CDC official called the results troubling.  Opponents blamed the increase in teenage usage on advertising featuring popular celebrities such as Jenny McCarthy and Courtney Love touting the benefits of the e-cigs.
Proponents of the e-cigs point out that the products are safer than the traditional cigarettes and say that many people have been able to stop using traditional tobacco thanks to the use of e-cigs.  Many satisfied customers point that the e-cigs have been their only alternative as nicotine patches are costly, and smoking cessation pills such as Chantix can have severe side effects such as suicidal thoughts.
http://www.newschanneldaily.com/nicotine-poisoning-blamed-e-cigs/2316/kb-hallmark/

E-cigs may deliver more toxins than smoke, researchers say

By Andy Soltis
Don’t make that nicotine switch just yet.
E-cigarette users may be getting higher concentrations of toxins than regular smokers because they inhale deeper and more frequently when they puff, NYU researchers say.
Although they are often touted as a safer alternative, e-cigs, introduced in the States in 2007, haven’t been in use long enough to determine their health effects, said Dr. Deepak Saxena, of NYU’s College of Dentistry.
“We have no scientific data to show that nicotine at this concentration is safe,” said Saxena, an associate professor of basic science and craniofacial biology.
Each e-cig nicotine cartridge provides 200 to 400 puffs, equal to two to three packs of regular cigarettes.
Saxena says e-cigs, which deliver nicotine in a vapor form, must be studied as their popularity grows.
“They are designed for new smokers, to bring up a new generation,” he said.
The City Council is now weighing a proposal to place e-cigs under the same restrictions as regular cigs. Former tobacco smokers oppose it, saying e-cigs helped them kick regular puffing.
“People are saying, ‘Now I am smoking and happy with my addiction,’ ” Saxena said.
“But the problem is that if you want to get out of the addiction, you may become more addicted.”
http://nypost.com/2013/12/14/e-cigs-may-deliver-more-toxins-than-smoke-researchers-say/

E-cigarettes: a burning question for U.S. regulators

Marina Lopes, Reuters
NEW YORK (Reuters) – At the Henley Vaporium, one of a growing number of e-cigarette lounges sprouting up in New York and other U.S. cities, patrons can indulge in their choice of more than 90 flavors of nicotine-infused vapor, ranging from bacon to bubble gum.
The lounge, located in Manhattan’s trendy Lower East Side, features plush seating, blaring rock music, and fresh juice and coffee. A sprawling sign on one wall lists all the carcinogens that e-cigarette users avoid by kicking their smoking habits and using the e-devices instead.
But the growing popularity of e-cigarettes has not escaped the notice of the industry’s critics, who have stepped up calls for new regulations, including bans on their use in public places, even though the scientific evidence about exposure to their vapors remains inconclusive.
Selling for about $30 to $50 each, e-cigarettes are slim, reusable, metal tubes containing nicotine-laced liquids that come in exotic flavors. When users puff on the device, the nicotine is heated and releases a vapor that, unlike cigarette smoke, contains no tar, which causes cancer and other diseases.
The product, introduced in China in 2006, has become a worldwide trend at least in part because it may help smokers of regular cigarettes break the habit.
“It’s an addiction – not everyone can quit cold turkey,” said Nick Edwards, 34, a Henley employee who says he kicked a 15-year cigarette habit the day he tried his first e-cigarette. “E-cigarettes give you a harm-reduction option.”
That’s one reason why the market for e-cigarettes is expected to surge, reaching $2 billion by the end of 2013 and $10 billion by 2017, according to Bonnie Herzog, an analyst at Wells Fargo Bank in New York.
Herzog said the U.S. market alone could top $1 billion this year. She predicts that by 2017 e-cigarettes sales will overtake sales of regular cigarettes. That estimate does not take into account the impact of potential government regulations on sales.
E-cigarettes may help smokers save money too. Edwards, for one, says he cut his $60 monthly cigarette bill in half when he switched. On top of the cost of the device, the smoking liquids cost around $10 per refill.
Despite the perceived benefits, critics worry that the addictive nicotine found in e-cigarettes could lure more people into smoking and discourage others from quitting all together.
“Essentially e-cigarette companies are selling nicotine addiction,” said Dr. Neil Schluger, chief scientific officer for the World Lung Foundation, which advocates for tobacco control.
“Once you have them addicted to nicotine, you can sell them all sorts of things, including conventional cigarettes,” he said. “This is a giant Trojan horse.”
In the United States, such concerns have led to calls for increased government regulation.
The U.S. Food and Drug Administration currently has no regulations on e-cigarettes, but it is expected to release rules this month that would extend its “tobacco product” authority over the devices. New FDA rules could follow.
“Further research is needed to assess the potential public health benefits and risks of electronic cigarettes and other novel tobacco products,” said Jenny Haliski, an FDA spokeswoman.
To be sure, no one is expecting the federal government to go as far as Brazil, Norway and Singapore, where the devices are banned outright.
In the United States, Utah, North Dakota, Arkansas and New Jersey have already passed legislation outlawing e-cigarettes wherever smoking is prohibited.
Other jurisdictions are considering new rules of their own. New York City could decide as early as next week whether to prohibit e-cigarette use in public places.
Under Mayor Michael Bloomberg, who leaves office January 1, New York was one of the first cities to ban cigarette smoking in public places, and its decision could influence Chicago and other cities that are considering a similar controls.
The outcome is crucial for tobacco companies, which are banking on the devices to make up for a sharp decline in sales of regular cigarettes in the United States. Smoking among U.S. adults dropped to 18 percent in 2012 from 24.7 percent in 1997, according to the Centers for Disease Control and Prevention.
Reynolds American Inc, which makes Camel cigarettes, began selling its Vuse vapor cigarettes in Colorado retail stores in July and plans on expanding nationwide by mid-2014.
Other companies have also dipped into the e-cigarette business, too. Last year Lorillard Inc, maker of Newport cigarettes, acquired the best-selling blu eCigs brand, while Altria Group Inc, best known for the Marlboro brand, followed suit in August with the launch of MarkTen e-cigarettes.
“As society is transforming, so must the tobacco industry,” said Reynolds spokesman Richard Smith. “It’s just good business sense.”
The arrival of Big Tobacco could mean fierce competition for small e-cigarette companies that do not have the resources or experience to deal with tight government regulation.
But many e-cigarette companies say Big Tobacco is late to the game and has a lot to catch up on. “They are going to need to boost up their game if they want to compete,” said Christina Lopez, a saleswoman at Smokeless Image, an e-cigarette shop that sells smaller brands in Hoboken, New Jersey.
HEALTH RISKS UNCERTAIN
To be sure, there is still a dearth of scientific evidence about the safety of e-cigarettes and their effectiveness in helping smokers quit. For regulators, the big question is, are e-cigarettes a treatment for would-be quitters or “gateway” products to nicotine addiction?
Supporters say some e-cigarettes allow users to slowly reduce their nicotine intake and wean themselves off nicotine completely. A study published in the September issue in Lancet, the British medical journal, said the e-cigarettes are as effective as nicotine patches for smokers trying to quit.
Worldwide, conventional cigarette addictions kill 6 million people a year, in part because of the 250 harmful chemicals found in tobacco smoke, which can cause cancer, heart disease and stroke, says the Centers for Disease Control and Prevention.
But e-cigarettes may not be harmless, either. Nicotine addictions, fed by smoking, chewing tobacco or e-cigarettes, can cause high blood pressure, disrupt heart rhythms and lead to obesity and diabetes.
Electronic devices that feature fruit and candy flavors are even more worrying, critics say, because they could introduce children to smoking.
E-cigarette vendors say the sweet flavors make the process of quitting smoking less painful.
“By taking a sort of ‘Willy Wonka,’ fun approach to a serious matter, it breaks down people’s perceptions of e-cigarettes,” said Talia Eisenberg, owner of the Henley Vaporium, referring to the fictional candy maker.
The Centers for Disease Control and Prevention said 10 percent of high school students surveyed reported using e-cigarettes in 2012, up from 4.7 percent in 2011.
About 60 percent of current users are over 35 years old, and 43 percent are college-educated, according to Reynolds American.
Twelve states, including New York, have passed laws preventing e-cigarette sales to minors.
At a hearing on the proposed New York City ban on e-cigarette use in public places, Health Commissioner Thomas Farley said allowing it could glamorize all types of smoking and encourage teenagers and children to take up the cigarette habit.
“While more research is needed on electronic cigarettes, waiting to act could jeopardize the progress we have made over the last few years,” he said.
(Reporting By Marina Lopes; Editing by Jilian Mincer and Tim Dobbyn)
http://www.chicagotribune.com/news/sns-rt-us-usa-ecigarettes-20131211,0,720952.story?page=2

E-cigs: Just how safe are they?

Article by: JEREMY OLSON , Star Tribune
One of the great unanswered questions for smokers who are trying to quit — and for the advocacy groups trying to help them — is whether electronic cigarettes are friends or foes.
University of Minnesota researchers aim to address that dilemma with a study examining exactly what smokers inhale when they breathe e-cigarette vapors and how “vaping” affects the body. Researchers will collect blood, urine and saliva samples from at least 25 smokers who use only e-cigarettes and at least 25 who use them with traditional cigarettes.
“The first step is to say, ‘Well, how toxic are these products? What is actually in them?’ ” said Dorothy Hatsukami, associate director for cancer prevention and control in the U’s Masonic Cancer Center.
E-cigarettes, rechargeable devices that heat liquid nicotine or other flavored substances into a vapor that the user inhales, have been marketed as a safer alternative to tobacco. Yet a lack of regulation on their manufacture and contents makes it hard to know if they’re safer than traditional cigarettes and whether they can be used to safely help wean people off tobacco, Hatsukami said.
“It’s like a Wild West out there,” she said.
Some e-cigarettes that are promoted as nicotine-free, for example, have been found to contain the addictive substance, while others contain little or no nicotine despite claims to the contrary.
Some previous studies have chemically analyzed the contents of e-cigarettes. The Minnesota study aims to go a step further by examining how the contents of different kinds of e-cigarettes affect the body.
The market for e-cigarettes has grown rapidly — sales have doubled annually since 2008 and are expected to reach $1.6 billion this year. About 6 percent of adults have tried them, and the share of high school students who have tried them hit 10 percent last year, according to the U.S. Centers for Disease Control and Prevention.
Heidi Scholtz, 20, a German and theater student at Hamline University, tried her first one two years ago because she was tired of going outside in the snow and cold to smoke. Before long, she said, she was using only e-cigarettes and was surprised at what happened when the weather warmed up and she tried a cigarette.
“It tasted disgusting,” she said.
Now Scholtz uses only e-cigarettes, and has kicked a cigarette habit that started when she was 15. A close friend tried them at her urging, but now uses both.
Help smokers quit?
Studies nationally have produced mixed results about whether e-cigarettes help people quit or reduce smoking — or simply supplement real tobacco. Clearway Minnesota, a nonprofit quit-smoking group, has taken a noncommittal stance on them.
Spokesman Mike Sheldon said it’s great if they help some people quit. But, he added, the lack of science about their contents makes it hard to endorse them over proven stop-smoking strategies of counseling combined with such well-studied supplements as nicotine patches or gum.
The recent increase in youth use of e-cigarettes also is troubling, Sheldon said. “We just don’t know enough about these,” he said.
The Minnesota Clean Indoor Air Act does not apply to e-cigarettes, which can be smoked indoors unless banned by local laws or individual establishments. The city of Duluth banned them from public indoor locations because so little is known about their effect on people who inhale the vapors secondarily.
Clearway would support extending the state ban to e-cigarettes, Sheldon said. However, a group of former cigarette smokers have formed the Minnesota Vapers Advocacy Group to fight the idea.
The group’s president, Matt Black, said his first e-cigarette meant his last real cigarette. A device that physically mimicked his smoking mannerisms was key to to quitting.
“For 17 years, I was constantly hand to mouth (with a cigarette),” Black said. “I was blowing out smoke. I was breathing differently. All of those things play a role in that addiction. We found a way to maintain those habits in a way that’s not going to kill us.”
Black said he hopes the U study will ultimately find e-cigarettes safe, so more people would use them to quit real cigarettes.
Hatsukami said a key aspect of the study is looking at the different types of e-cigarettes to see if some are more harmful than others. (To enroll, call 612-624-4568.)
“Although the majority of the products don’t contain toxicants that are cancer-causing, there are a few that do,” she said. “There is a lot of variability out there.”
http://www.startribune.com/lifestyle/health/235430591.html?page=2&c=y

E-cigarettes cause alarming increase in calls to poison control center

Kentucky Regional Poison Control Center sees 333-percent increase

LOUISVILLE, Ky. — As the debate about electronic cigarette regulation continues with the U.S. Food and Drug Administration (FDA) and device manufacturers, data from one state poses concerns that should be part of the conversation.
E-cigarettes consist of a rechargeable lithium battery, a liquid cartridge and an LED light at one end that simulates the burning effect of a regular cigarette. When the user inhales, or “vapes,” a heating element converts the liquid in the cartridge into a vapor. Cartridges typically contain nicotine, propylene glycol or glycerol, flavoring and other additives.
E-cigarettes consist of a rechargeable lithium battery, a liquid cartridge and an LED light at one end that simulates the burning effect of a regular cigarette. When the user inhales, or “vapes,” a heating element converts the liquid in the cartridge into a vapor. Cartridges typically contain nicotine, propylene glycol or glycerol, flavoring and other additives.
The Kentucky Regional Poison Control Center of Kosair Children’s Hospital has received 39 calls about e-cigarettes so far this year, a 333-percent increase from nine calls received in 2012. Nationally, poison control centers have seen a 161 percent increase in calls from people with concerns about these devices. With sales of e-cigarettes doubling to $1.5 billion in the past year, the calls are likely to increase.
E-cigarettes consist of a rechargeable lithium battery, a liquid cartridge and an LED light at one end that simulates the burning effect of a regular cigarette. When the user inhales, or “vapes,” a heating element converts the liquid in the cartridge into a vapor. Cartridges typically contain nicotine, propylene glycol or glycerol, flavoring and other additives.
“More than half of the calls we have received were concerning children,” said Ashley Webb, Pharm.D., board-certified toxicologist and director of the Kentucky Regional Poison Control Center of Kosair Children’s Hospital.
“Kids are picking up the liquid cartridge when cartridges are left accessible or when an adult is changing the cartridge,” she said. “They’re also getting a hold of the e-cigarette and taking it apart to expose the liquid. They then either ingest the liquid or get it onto their skin. Even on the skin, the nicotine is absorbed and can create adverse side effects.”
These exposures raise a concern because of the concentrated nature of the cartridge fluid.
“The amount of nicotine in the cartridges is not regulated, but many contain more than 14 milligrams of nicotine,” said Dr. George Rodgers, associate medical director, Kentucky Regional Poison Control Center and professor and division chief of pediatric pharmacology and toxicology at the University of Louisville School of Medicine. “Severe cases of toxicity requiring hospitalization have been reported with children consuming 1.4 milligrams per kilogram of weight — equivalent to an average 2-year-old consuming the amount found in a cartridge,” he said. “And since children are not used to consuming nicotine, their symptoms may be more severe at lower levels.”
“Accidental exposure by children to e-cigarettes is a public health concern that we need to take seriously,” said Dr. LaQuandra Nesbitt, director of the Louisville Metro Department of Public Health and Wellness in Louisville, Ky. “Parents need to be aware of the potential dangers to their children.”
Symptoms of severe nicotine exposure include a pale appearance, flushing, sweating, headache, dizziness, hyperactivity or restlessness, vomiting, diarrhea, rapid heart rate, increased blood pressure, salivation and teary eyes. In very severe cases, the heart rate and blood pressure begin to drop to dangerously low levels and the patient can lapse into a coma, followed by difficulty breathing and even death.
When on the skin, nicotine in liquid form is easily absorbed. Even small amounts can cause irritation and a burning sensation.
“Only a few of the calls we have received have been from children inhaling nicotine from the e-cigarette,” Webb said. “And so far only two of the calls involved symptoms severe enough to require emergency care. But it’s only a matter of time before a child experiences a severe reaction.”
“Parents need to consider these devices as a potential harm to children and, like other poisons, keep them out of reach,” said Dr. Stephen P. Wright, pediatrician and medical director of Kosair Children’s Hospital. “Since e-cigarettes are also unregulated, we don’t know what other toxins may be in them.”
An analysis done by the FDA in 2009 showed that e-cigarettes contain carcinogens and other hazardous chemicals, including diethylene glycol, an ingredient used in antifreeze. Researchers from the University of Athens in Greece found that e-cigarettes, thought by some to be a safer alternative to tobacco smoking, do have a harmful effect on the lungs, as reported in Medical News Today.
“Since the industry is still so new, we don’t yet know all of the long-term health effects of e-cigarettes to the user, in addition to any effects of secondhand vapor,” said Wright, who is also a professor of pediatrics at the University of Louisville School of Medicine. “While they are touted as a healthier alternative to cigarettes, the jury is still out. We do know that not smoking anything — especially around children — is always the best bet.”
About the Kentucky Regional Poison Control Center of Kosair Children’s Hospital
The primary mission of the Kentucky Regional Poison Control Center is to reduce illness and death from poisoning in Kentucky. The center provides 24/7 free and confidential access to specially trained nurses, physicians and pharmacists who are certified in toxicology. They are specialists in communicating advice to health care professionals, first responders, patients, parents, family members, the general public and the media. Some of the more common calls received involve medications, household cleaning products, plants and personal care items.
Calls also are answered about work-related exposures in farming and industry, food poisoning, insect and snakebites and a variety of other potential hazards. On average, the poison control center’s hotline at (800) 222-1222 receives a call every 7 minutes, 24 hours a day, 365 days a year — more than 72,000 calls annually — from all of Kentucky’s 120 counties. Three of every four patients from those calls are successfully managed safely and inexpensively at home, reducing unnecessary emergency room visits and/or shortening hospital stays. For additional information, visit KosairChildrensHospital.com/PoisonControl.
http://www.lanereport.com/27431/2013/12/e-cigarettes-cause-increase-in-calls-to-poison-control-center/?fb_action_ids=10151744182160059&fb_action_types=og.likes&fb_source=other_multiline&action_object_map=%5B267785540038122%5D&action_type_map=%5B%22og.likes%22%5D&action_ref_map=%5B%5D

E-cigarettes: Should They Be Regulated as Cigarettes?

., Commissioner, Chicago Department of Public Health

Should e-cigarettes be regulated as cigarettes?
I think so.
E-cigarettes are designed to look like cigarettes. They are labeled and marketed like cigarettes. They contain nicotine like cigarettes. They should be regulated like cigarettes.
The single most important reason a regulation on e-cigarettes is vital at this time is to protect kids from a product that we know is addictive. Electronic cigarettes now come in dozens of flavors like passion fruit, cotton candy, bubble gum, gummy bear, Atomic Fireball, and orange cream soda. These kid-friendly flavors are an enticing “starter” for youth and non-smokers, increasing nicotine addiction and frequently lead to use of combustible cigarettes.
Like other gateway products Big Tobacco has masked to entice its next generation of smokers, e-cigarettes follow suit as its popularity with youth nationwide more than doubledfrom 2011 to 2012. Ten percent of our students have already used these addictive products — and they have only been on the market for a few years. This meteoric rise in popularity among youth is concerning. It is also the main reason Mayor Rahm Emanuel has introduced a new ordinance to regulate e-cigarettes as tobacco products.
Simply put, kids should not have easy access to e-cigarettes any longer. Right now in Chicago, a 14-year-old can walk into a store and purchase an e-cigarette with no question asked. This is unacceptable. Retailers should be required to have a tobacco-retail license in order to sell e-cigarettes, which would place these products behind the counter with the other tobacco products and out of arms reach of our children. The government has a duty to protect children from ever picking up a nicotine habit. The preventive action Mayor Emanuel is taking right now is a long-term investment in the health and well-being of Chicago’s youth.
Some might argue that e-cigarettes should not be regulated because they are safer than regular cigarettes. While it’s true that they may be safer than regular cigarettes, they have not been proven to be safe. The truth is e-cigarette companies have not provided any scientific studies or toxicity analysis to the FDA to show that e-cigarettes pose any reduced health risk over conventional cigarettes, nor have they demonstrated that e-cigarettes are safe. Laboratory tests have found that the so-called “water vapor” from some e-cigarettes can contain nicotine and volatile organic compounds like benzene and toluene; heavy metals like nickel and arsenic; carbon compounds like formaldehyde and acrolein, in addition to tobacco specific nitrosamines.
Moreover, no federal regulations have been imposed on e-cigarettes, which means that there currently are no restrictions on ingredients manufacturers can or cannot use and no restrictions on the kinds of chemicals they can emit into the indoor environment. Until more is known about these products, limiting their use in indoor areas is just good common sense.
I am also concerned that widespread use of e-cigarettes is re-normalizing smoking in our society, which in turn, makes this a very pertinent public health issue. E-cigarettes intentionally were developed to mimic the act of smoking. This distorted reinforcement of smoking as cool and acceptable sends the wrong message to our youth and undermines the existing smoking bans put in place to protect the health of the public.
In Chicago, smoking rates are lower than ever. This progress is a direct result of life-saving policies like the Chicago Clean Indoor Air Act. Health advocates worked tirelessly to ensure we all have the right to breathe clean in-door air. We’re not turning our backs on their hard work to promote clean air.
Our residents expect a healthy environment when they walk into a restaurant, bar or theater. We can’t allow any regression in our progress to change the landscape of public health by reverting back to a culture we’ve worked so hard to change. We need to, and can do, better for the children in our city.
Chicago’s new ordinances are part of an overall comprehensive strategy to reduce the negative consequences tobacco use has on our youth.
With the introduction of these expanded tobacco-control policies, Mayor Emanuel is inspiring cities across the nation to take action to ensure that residents avoid preventable disease and live healthy and productive lives.
http://www.huffingtonpost.com/bechara-choucair-md/e-cigarettes_b_4352410.html