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E-Cigarettes: Separating Fiction From Fact

By Serena Gordon
HealthDay Reporter
It’s the new year, a time when a smokers’ thoughts often turn to quitting.
Some people may use that promise of a fresh start to trade their tobacco cigarettes for an electronic cigarette, a device that attempts to mimic the look and feel of a cigarette and often contains nicotine.
Here’s what you need to know about e-cigarettes:
What is an e-cigarette?
The U.S. Food and Drug Administration (FDA) describes an e-cigarette as a battery-operated device that turns nicotine, flavorings and other chemicals into a vapor that can be inhaled. The ones that contain nicotine offer varying concentrations of nicotine. Most are designed to look like a tobacco cigarette, but some look like everyday objects, such as pens or USB drives, according to the FDA.
How does an e-cigarette work?
“Nicotine or flavorings are dissolved into propylene glycol usually, though it’s hard to know for sure because they’re not regulated,” explained smoking cessation expert Dr. Gordon Strauss, founder of QuitGroups and a psychiatrist at Lenox Hill Hospital in New York City. “Then, when heated, you can inhale the vapor.”
The process of using an e-cigarette is called “vaping” rather than smoking, according to Hilary Tindle, an assistant professor of medicine and director of the tobacco treatment service at the University of Pittsburgh Medical Center. She said that people who use electronic cigarettes are called “vapers” rather than smokers.
Although many e-cigarettes are designed to look like regular cigarettes, both Tindle and Strauss said they don’t exactly replicate the smoking experience, particularly when it comes to the nicotine delivery. Most of the nicotine in e-cigarettes gets into the bloodstream through the soft tissue of your cheeks (buccal mucosa) instead of through your lungs, like it does with a tobacco cigarette.
“Nicotine from a regular cigarette gets to the brain much quicker, which may make them more addictive and satisfying,” Strauss said.
Where can e-cigarettes be used?
“People want to use e-cigarettes anywhere they can’t smoke,” Strauss said. “I sat next to someone on a plane who was using an e-cigarette. He was using it to get nicotine during the flight.” But he noted that just where it’s OK to use an e-cigarette — indoors, for instance? — remains unclear.
Wherever they’re used, though, he said it’s unlikely that anyone would get more than a miniscule amount of nicotine secondhand from an e-cigarette.
Can an e-cigarette help people quit smoking?
That, too, seems to be an unanswered question. Tindle said that “it’s too early to tell definitively that e-cigarettes can help people quit.”
A study published in The Lancet in September was the first moderately sized, randomized and controlled trial of the use of e-cigarettes to quit smoking, she said. It compared nicotine-containing e-cigarettes to nicotine patches and to e-cigarettes that simply contained flavorings. The researchers found essentially no differences in the quit rates for the products after six months of use.
“E-cigarettes didn’t do worse than the patch, and there were no differences in the adverse events,” she said. “I would be happy if it turned out to be a safe and effective alternative for quitting, but we need a few more large trials for safety and efficacy.”
Strauss noted that “although we can’t say with certainty that e-cigarettes are an effective way to quit, people are using them” for that purpose. “Some people have told me that e-cigarettes are like a godsend,” he said.
Former smoker Elizabeth Phillips would agree. She’s been smoke-free since July 2012 with the help of e-cigarettes, which she used for about eight months after giving up tobacco cigarettes.
“E-cigarettes allowed me to gradually quit smoking without completely removing myself from the physical actions and social experience associated with smoking,” Phillips said. “I consider my e-cigarette experience as a baby step that changed my life.”
Are e-cigarettes approved or regulated by the government?
E-cigarettes are not currently regulated in a specific way by the FDA. The agency would like to change this, however, and last April filed a request for the authority to regulate e-cigarettes as a tobacco product.
The attorneys general of 40 states agree that electronic cigarettes should be regulated and sent a letter to the FDA in September requesting oversight of the products. They contend that e-cigarettes are being marketed to children; some brands have fruit and candy flavors or are advertising with cartoon characters. And, they note that the health effects of e-cigarettes have not been well-studied, especially in children.
Are e-cigarettes dangerous?
“It’s not the nicotine in cigarettes that kills you, and the nicotine in e-cigarettes probably won’t really hurt you either, but again, it hasn’t been studied,” Strauss said. “Is smoking something out of a metal and plastic container safer than a cigarette? Cigarettes are already so bad for you it’s hard to imagine anything worse. But, it’s a risk/benefit analysis. For a parent trying to quit, we know that secondhand smoke is a huge risk to kids, so if an electronic cigarette keeps you from smoking, maybe you’d be helping kids with asthma or saving babies.”
But on the flip side, he said, in former smokers, using an e-cigarette could trigger the urge to smoke again.
The other big concern is children using e-cigarettes.
“More and more middle and high school kids are using e-cigarettes,” Tindle said. “Some are smoking conventional cigarettes, too. The latest data from the CDC found the rate of teens reporting ever having used an e-cigarette doubled in just a year. We could be creating new nicotine addicts. We don’t know what the addictive properties of e-cigarettes are,” she added.
“It’s shocking that they’ve been allowed to sell to minors,” Tindle said.
More information
The U.S. Food and Drug Administration has more about electronic cigarettes.
http://health.usnews.com/health-news/news/articles/2014/01/03/e-cigarettes-separating-fiction-from-fact

City leaders regulate e-cigarettes

By: WDAY Staff Reports , WDAY
Fargo, ND (WDAY TV) – City leaders have decided to include E-cigs in the Fargo tobacco ordinance.
That means it will be illegal to give or sell electronic cigarettes to minors.
The electronic smoking devices claim to be a safer alternative to traditional cigarettes because they give off a vapor instead of smoke.
State law does prohibit smoking in any public places, which includes e-cigarettes.
http://www.wday.com/event/article/id/91782/publisher_ID/29/

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

Will your children buy candy, gum or little cigars?

By Dr. Tom Frieden, Special to CNN
Editor’s note: Dr. Tom Frieden is director of the Centers for Disease Control and Prevention.
(CNN) — They’re on display at cash registers all across America: Candy bars, packs of gum — and little cigars.
In some cases, those cigars aren’t tucked away behind the counter where only the attendant can get to them but right in front for anyone to pick up.
Traditional fat cigars are a small part of today’s cigar industry. Newer types of cancer sticks include cigarette-sized cigars, or little cigars, designed to look like a typical cigarette but which evade cigarette taxes and regulations.
Flavored little cigars can be sold virtually anywhere, and kids are a prime target of these new products.
Unlike cigarettes, many are sold singly or in small, low-priced packs, at a fraction of the cost of a cigarette in most states.
These little cigars have names like “Da Bomb Blueberry” and “Swagberry.” The flavors themselves — chocolate mint, watermelon, wild cherry and more — can mask the harsh taste of tobacco and are clearly attractive to children.
The Food and Drug Administration banned candy and fruit flavors in cigarettes so young people would not be enticed. But cigars weren’t covered.
The tobacco industry claims that its marketing efforts are solely aimed at adults. It has long argued that its marketing doesn’t increase demand or cause young people to smoke but instead is intended to increase brand appeal and market share among existing adult smokers.
How many grown-ups do you know who smoke grape-flavored cigars?
Little cigars have become more popular in recent years. Flavored brands have almost 80% of the market share.
In 2011, among middle school and high school students who currently smoke cigars, more than one in three reported using flavored little cigars.
Six states — Florida, Georgia, Maryland, Massachusetts, Rhode Island and Wisconsin — have youth cigar smoking rates the same as or higher than those of youth cigarette smoking.
Despite industry statements to the contrary, the link between marketing and youth tobacco use is clear.
Some legislative and regulatory actions that tackle elements of tax discrepancies, youth appeal and marketing are in place or under consideration.
New York and Providence, Rhode Island, have enacted city-wide ordinances prohibiting the sale of flavored tobacco products, including flavored little cigars. Both ordinances have been challenged and upheld in U.S. District Court.
In April, the Tobacco Tax and Enforcement Reform Act was introduced in the Senate. This bill aims to eliminate tax disparities between different tobacco products, reduce illegal tobacco trade and increase the federal excise tax on tobacco products.
Based on decades of evidence, the 2012 surgeon general’s reporton tobacco use among youth and young adults concluded that tobacco industry marketing causes youths to smoke, and nicotine addiction keeps them smoking.
This sobering fact holds true in spite of bans on advertising and promotions that target children and youths, and restrictions on certain other marketing activities.
Nearly 90% of smokers started before they were 18 years old, and almost no one starts smoking after age 25.
To prevent the needless death, disability and illness caused by smoking, we must stop young people from even starting to smoke.
A key part of prevention efforts must be action that will eliminate loopholes in restrictions on tobacco marketing, pricing and products that encourage children and youth to smoke.
I don’t think it’s too much to expect of our society that we protect our kids so they can reach adulthood without an addiction that can harm or kill them.
– – – –
The opinions expressed are solely those of Dr. Tom Frieden.
http://www.cnn.com/2013/12/11/health/frieden-little-cigars/

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-cig boom leads to taxation, regulation questions

WOODBURY, Minn. (AP) — Stores that sell increasingly popular e-cigarettes are popping up around the Twin Cities, highlighting the lack of regulation or taxation of the tobacco alternative.
E-cigarettes are battery powered and produce a nicotine vapor. Owners of stores that sell the devices told the St. Paul Pioneer Press that demand skyrocketed in July when a state tax increase sent cigarette prices up to about $7.50 a pack.
“Sales were insane,” said Angie Griffith, who owns several Smokeless Smoking stores and kiosks.
The surging sales have left regulators scrambling to react. The federal Food and Drug Administration is expected to release regulations on e-cigarettes soon, but for now there are very few state or federal rules applying to the devices.
That’s raised concern that some varieties could serve as an introduction to nicotine for youths. Some come in flavors including root beer, and cookies and cream.
But some former traditional smokers said e-cigarettes helped them kick a tobacco habit. A new Smokeless Smoking store in Woodbury, which opened Nov. 18, has already become a social hub for e-puffers, with its dimly lit lounge with sofas, TVs, games and books.
Griffith said the ability to form friendships and impromptu support groups with fellow e-cigarette smokers is important in helping customers kick tobacco.
“Smoking” an e-cigarette involves pushing a button on the small metal cylinder, examining its tiny computer screen, applying drops of flavoring and keeping an eye on the battery, then inhaling and exhaling the vapor. The vaporized liquids come in standard varieties but can be custom-made. Flavors mimic brands of cigarettes including Marlboro and Camel.
Gus Menth, a White Bear Lake truck driver, smoked cigarettes for 15 years. He tried to quit with nicotine patches but got so frustrated he once popped one in his mouth and chewed it. He can still remember the exact date he successfully switched to e-cigs: Jan. 15, 2011.
“I was tired of smelling bad,” Menth said. “And the cost savings is incredible.”
The metal e-cigarette costs from $30 to about $200, but is reusable. Menth and his wife, who also smokes e-cigs, estimate they are saving about $170 a month since their switch.
Menth said his breathing has improved. “I can run and play with my kid now,” he said.
___
Information from: St. Paul Pioneer Press
http://minnesota.publicradio.org/display/web/2013/11/30/health/ecigarettes-twin-cities

The Truth About The Safety Of E-Cigarettes

By Christopher Wanjek, Columnist
At first, electronic cigarettes were a novelty — something a braggart in a bar might puff to challenge the established no-smoking policy, marveling bystanders with the fact that the smoke released from the device was merely harmless vapor.
Now, e-cigarettes are poised to be a billion-dollar industry, claimed as the solution to bring in smokers from out of the cold, both figuratively and literally, as e-cigarettes promise to lift the stigma of smoking and are increasingly permitted at indoor facilities where smoking is banned.
So, are e-cigarettes safe? Well, they’re not great for you, doctors say. What’s being debated is the degree to which they are less dangerous than traditional cigarettes.
1940 revisited
E-cigarettes are battery-powered devices, often shaped like traditional cigarettes, with a heating element that vaporizes a liquid nicotine solution, which must be replaced every few hundred puffs. Nicotine is inhaled into the lungs, and a largely odorless water vapor comes out of the device. Puffing an e-cigarette is called vaping.
Yet the industry’s duplicity is clear to medical experts: E-cigarettes are marketed to smokers as a means to wean them off of tobacco (although studies show they don’t help much); yet the same devices, some with fruity flavors, are marketed to young people who don’t smoke, which could get them hooked.
Hooked? Yes, e-cigarettes are a nicotine-delivery system, highly addictive and ultimately harmful because of their nicotine.
Cancer and respiratory experts see the same ploy being played out today with e-cigarettes as was done in the 1940s with cigarettes, when America started smoking en masse. They often are distributed for free and pitched by celebrities and even doctors as cool, liberating and safe.
In an ad for a product called blu eCigs, celebrity Jenny McCarthy, infamous for encouraging parents not to vaccinate their children, encourages young adults to vape, enlisting words such as “freedom” and the promise of sex. In another ad, for V2 Cigs, a medical doctor named Matthew Huebner — who is presented without affiliation but is associated with a Cleveland Clinic facility in Weston, Fla. — implies that vaping is as harmless as boiling water.
As for the notion of e-cigs as liberating, the cost of a year’s worth of e-cigarette nicotine cartridges is about $600, compared with $1,000 yearly for a half-pack a day of regular cigarettes.
As for whether they’re safe, it’s a matter of comparing the advantages of one addiction over another.
E-cigarettes not a patch
One would think that vaping has to be safer than smoking real cigarettes. Experts say they are probably safer, but safer doesn’t mean safe.
“Cigarettes have their risk profile,” said Dr. Frank Leone, a pulmonary expert at the University of Pennsylvania Medical Center in Philadelphia. And just about everyone who breathes understands the risks: circulatory disease and myriad cancers, for starters. “E-cigarettes might be better off compared to that profile. But that doesn’t mean they don’t have their own risk profile.”
A top concern is the nicotine delivery rate, Leone said. With nicotine patches and gum, the nicotine delivery is regulated, with small amounts of nicotine released slowly into the bloodstream. But with traditional cigarettes and now e-cigarettes, heat creates a freebase form of nicotine that is more addictive — or what smokers would call more satisfying. The nicotine goes right into the lungs, where it is quickly channeled into the heart and then pumped into the brain.
Once addicted, the body will crave nicotine. And although nicotine isn’t the most dangerous toxin in tobacco’s arsenal, this chemical nevertheless is a cancer-promoting agent, and is associated with birth defects and developmental disorders.
A study published in 2006 in the journal Obstetrics and Gynecology, for example, found that women who chewed nicotine gum during pregnancy had a higher risk of birth defects compared to other nonsmokers.
Great unknowns
This great unknown of possible negative health effects, along with the lack of regulation of e-cigarettes, scares experts like Leone. The products come bereft of health warnings. How many pregnant women will vape following McCarthy’s promotion?
As for their merits in smoking cessation, e-cigarettes don’t appear very helpful. A study published last month in the journal Addictive Behaviors found that most smokers who used them while they tried to quit either became hooked on vaping, or reverted back to smoking cigarettes. A study published Nov. 16 in the journal The Lancet found no statistically significant difference in the merits of the e-cigarette over the nicotine patch in terms of helping people quit.
Leone said that e-cigarettes might not help people quit smoking because the device keeps addicts in a state of ambivalence — the illusion of doing something positive to mitigate the guilt that comes from smoking, but all the while maintaining the ritual of smoking.
The Jenny McCarthy blu eCigs ad hints at this notion, with such phrases as “smarter alternative to cigarettes,” “without the guilt” and “now that I switched…I feel better about myself.”
Editors of The Lancet called promotion of e-cigarettes “a moral quandary” because of this potential to replace harmful cigarettes with something slightly less harmful yet just as addictive. Other researchers agree that e-cigarettes might help some people quit, but at a population level, converting millions of smokers into vapers still addicted to nicotine might not lead to the cleaner, greener, healthier world implied by e-cigarette manufacturers.
And then there’s the issue of not knowing what’s in the e-cigarette nicotine cartridge.
“It’s an amazing thing to watch a new product like that just kind of appear; there’s no quality control,” said Dr. Richard Hurt, director of the Mayo Clinic’s Nicotine Dependence Center in Rochester, Minn. “Many of them are manufactured in China under no control conditions, so the story is yet to be completely told.”
The authors of The Lancet study, all based in New Zealand, called for countries to regulate the manufacturing and sale of e-cigarettes. The U.S. Food and Drug Administration, which does not approve any e-cigarettes for therapeutic purpose, said it plans to propose a regulation to extend the definition of “tobacco product” under the Tobacco Control Act to gain more authority to regulate products such as e-cigarettes.
http://www.huffingtonpost.com/2013/11/22/ecigarettes-safety-health-risks-electronic-cigarettes_n_4323231.html
 

Regulation push catching up with electronic cigarettes

By John Keilman and Mitch Smith, Chicago Tribune reporters
Jay Altman smoked cigarettes for 25 years before deciding a few months ago that for the sake of his wallet and his health, a change was in order.
But Altman didn’t quit — he switched.
The North Side insurance worker swapped his daily pack and a half of smokes for the vanilla-flavored nicotine aerosol of an electronic cigarette. He feels better these days, he said, and not just because he’s saving more than $100 a week.
“My friends have noticed a difference,” Altman said while sampling assorted flavors at Smoque Vapours, an e-cigarette shop in the Loop. “They’ll say, ‘You smell good,’ instead of, ‘You stink.'”
The fast-growing e-cigarette industry has hitched its future to such testimonials, pitching its product as a safer and cheaper alternative to tobacco cigarettes. So far the business has escaped the reach of regulators, but from Washington, D.C., to the Chicago suburbs, that is changing quickly.
The U.S. Food and Drug Administration appears poised to label e-cigarettes a “tobacco product,” a distinction that would give the agency power over their marketing, manufacture and sale. North suburban Mundelein just passed an ordinance banning the sale of e-cigarettes to anyone younger than 18, and on Jan. 1 a similar law will take effect statewide.
Evanston, meanwhile, has gone even further, banning the use of e-cigarettes anywhere smoking is prohibited.
“There hasn’t been a whole lot of long-term research on this, but we really wanted to make sure we were on the front end to protect our residents,” said Carl Caneva, assistant director of Evanston’s health department.
The lack of regulation has turned e-cigarettes into a commercial Wild West, where basement chemists and giant corporations alike concoct mixtures that taste like everything from peach schnapps to Mountain Dew. The novel flavors concern anti-smoking advocates, who note that teen e-cigarette use recently doubled within a single year.
“I don’t think that there’s any question that flavors appeal to young people,” said Danny McGoldrick of the Campaign for Tobacco-Free Kids. “It’s just another way to help introduce them to the habit.”
Researchers aren’t sure of all the chemicals released by the products, but some say there’s ample reason for worry.
The American Lung Association, which favors strict regulation, cites a recent study that found chemicals such as formaldehyde and acetone in exhaled e-cigarette vapor.
“We’re very concerned because we don’t know what’s in e-cigarettes or what the health consequences of them might be,” said Erika Sward, the lung association’s assistant vice president for national advocacy. “Frankly, until the FDA begins its oversight of these products, I think everyone needs to proceed very cautiously.”
E-cigarettes use tiny atomizers to turn nicotine-infused liquids into an aerosol, which is inhaled by the user. They’ve been sold in the United States since the mid-2000s, but the Electronic Cigarette Industry Group says sales have boomed in recent years, turning the gadgets into a $2 billion-a-year business.
The group’s president, Eric Criss, said e-cigarettes are intended to be a safer alternative for people who already smoke.
“We feel very strongly that we not be taxed and regulated as a tobacco product because our goal as an industry is to distinguish ourselves from traditional tobacco cigarettes,” he said. “We believe there’s a ladder of harm. Cigarettes are at the top of that, and our goal is to get people to move down that ladder.”
The science behind that claim is far from settled. The industry points to research — some of it funded by e-cigarette interests — that shows the products to be less risky to users, sometimes called “vapers,” and bystanders alike. Robert West, a health psychology professor at University College London, maintains that a global switch from tobacco cigarettes to atomized nicotine would save millions of lives a year.
Stanton Glantz, director of the Center for Tobacco Control Research & Education at the University of California at San Francisco, agreed that e-cigarettes appear to be less harmful than tobacco but said they’re hardly risk-free.
He said most smokers don’t give up tobacco cigarettes entirely when they use electronic ones, so their health doesn’t improve much. And while bystanders aren’t exposed to secondhand smoke, he said, initial research shows that they’re still inhaling nicotine, an addictive substance, along with toxic chemicals and ultrafine particles that can cause heart problems.
“Just because someone chooses to service their (nicotine) addiction by using an e-cigarette, that still doesn’t create a right for them to poison people in the neighborhood,” Glantz said.
The FDA says a federal appeals court has given it the power to regulate e-cigarettes as though they are tobacco products. The agency has a proposed regulation in the works, and while officials won’t say what it contains, public health advocates and industry representatives expect the FDA to assert its authority over e-cigarettes.
Many states are waiting for that to happen before deciding whether to incorporate e-cigarettes into smoking bans, but Glantz argues that new rules could take years to finalize and aren’t necessary for states to tighten their clean air laws.
Three states — North Dakota, New Jersey and Utah — already include e-cigarettes in their smoking bans, and about 100 cities and counties nationwide have taken similar steps, according to the American Nonsmokers’ Rights Foundation.
But Melaney Arnold, spokeswoman for the Illinois Department of Public Health, said the research on e-cigarettes’ secondhand effects is still too preliminary to act upon.
“It’s still evolving, and it will still (take) time until we know the total health effects,” she said.
Chicago Ald. Edward Burke, who often takes up health issues, has a proposed ordinance before the City Council to ban the sale of e-cigarettes to minors. He said he might try to amend it to make e-cigarettes subject to the city’s smoking ban.
“I think we certainly should apply the same regulations to e-cigarettes that we apply to regular cigarettes,” the 14th Ward alderman said.
For now, though, the devices exist in a mishmash of vague and confusing regulations. They’re not allowed to be used on airplanes, though the U.S. Department of Transportation doesn’t explicitly ban them. They’re not allowed in Chicago’s airports, though city ordinances are silent on the point.
“As a practical matter, airport staff does not determine if a cigarette that is being smoked is a tobacco cigarette or an e-cigarette,” said Karen Pride, spokeswoman for the Chicago Department of Aviation. “As such, the use of electronic cigarettes, as with tobacco cigarettes, is prohibited in the airports.”
While the city allows bar patrons to partake of e-cigarettes, taverns make their own rules. Declan’s Irish Pub in Old Town and Lange’s Lounge in Lakeview have no problems with the devices, but Joe’s Bar, a Goose Island establishment, says no.
“We don’t allow it inside because it promotes other people to take out their cigarettes and smoke them,” general manager Bob Casey said.
Despite the lack of clarity over e-cigarette use, several boutique shops selling the devices have sprung up in the city. Jared Yucht, owner of Smoque Vapours, said he started creating “e-liquids” in his basement when he stopped smoking. He opened his first store and lounge in Lakeview last spring and added a second location in the Loop this month.
He said he is proud of his safety precautions, carefully monitoring the nicotine levels of his products and refusing to sell to minors, though neither step is yet required by law.
“I don’t know anyone who owns another store who serves underage,” he said. “I have children and I wouldn’t want them taking stimulants at a young age. It’s an unwritten rule in the community that this is an adult activity for adults.”
http://www.chicagotribune.com/news/local/ct-met-electronic-cigarettes-20131115,0,5010760.story?page=1

Gov. Branstad ‘Absolutely Interested’ in Regulating E-Cigarette

By James Lynch, Reporter

DES MOINES, Iowa –
Gov. Terry Branstad, who made Terrace Hill and the governor’s office smoke-free the day he took office, is open to regulating electronic cigarettes in much the same way as the traditional variety.
Iowa law prohibits smoking in workplaces other than on casino floors, but electronic cigarettes – e-cigarettes – are not covered by the five-year-old Iowa Smoke-free Air Act.
Branstad wouldn’t commit to any specific regulation of e-cigarettes, which are battery-operated products that heat liquid nicotine derived from tobacco plants into a vapor that the user inhales. However, during a visit to Timberline Manufacturing in Marion Tuesday, he said he is “absolutely interested” in looking at proposals by Attorney General Tom Miller to regulate e-cigarettes.
Last week, Miller called on state lawmakers to ban sales of e-cigarettes to minors, add e-cigarettes to products covered by the state’s Smoke-free Air Act and tax them more than the standard state sales tax rate.
In addition to looking at Miller’s proposal, Branstad wants to look at what other states have done before deciding the appropriate course of action.
“My wife and I have been strong supporters of smoke-free workplaces,” Branstad said. “We think this is an important part of our goal to the healthiest state.”
He compared e-cigarettes to synthetic drugs created to circumvent state and federal drug laws.
“They just keep coming up with different things just like we have to deal with all these synthetic drugs,” Branstad said.
According to Miller, Iowa’s smoke-free air act does not address the new technology. He said officials in Arkansas, New Jersey, North Dakota and Utah have included e-cigarettes in their indoor smoking bans and Minnesota changed its definition of tobacco products to include e-cigarettes and subject them to the tobacco taxes.
He called on the Legislature to define e-cigarettes and recommended they be subject to the state cigarette tax — $1.36 on a pack of 20 traditional cigarettes.
Miller didn’t have Iowa numbers, but in a letter to the Food and Drug Administration, he said sales of e-cigarettes, which doubled every year since 2008, now are accelerating even faster and are projected to reach $1.7 billion.
At the same time, the cost has fallen, making them more affordable and more attractive to young people.
http://www.kcrg.com/news/local/Gov-Branstad-Absolutely-Interested-in-Regulating-E-Cigarette-231681781.html

FDA: cigarette of the future could be non-addictive

By Deborah Kotz |  GLOBE STAFF

The US Food and Drug Administration submitted plans several weeks ago to increase regulation of tobacco products including chewing tobacco, cigars, and likely electronic cigarettes — which produce a nicotine vapor that’s inhaled. While the agency hasn’t announced what those restrictions will be — since they’re being reviewed by the White House budget office — Mitch Zeller, the director for the FDA Center for Tobacco Products, sat down for an interview Monday to discuss efforts to help people stop smoking and to keep kids from starting in the first place.
Here’s a run-down of some of the things on his agenda, with a few wrinkles that still need to be ironed out.
1. Create a non-addictive cigarette. We have the authority given to us by Congress to reduce nicotine in cigarettes down to nearly zero,” Zeller said. Since nicotine is the addictive chemical in cigarettes, teens who start smoking products that are almost nicotine-free could, in theory, never get hooked in the first place. Researchers now have access to 9 million cigarettes with varying amounts of nicotine to start testing whether products with lower amounts will lead to less addiction among new smokers. But don’t expect an ultra-low-nicotine product for at least a few years, Zeller added, since the studies are just beginning.
The wrinkle: Smokers already hooked on nicotine might find the new products seriously lacking, and they might need better nicotine replacement products than those currently on the market to help them overcome their cravings.

2. Run ads to scare teens away from smoking. Teens may think they already know about the dangers of smoking, but that doesn’t prevent 3,000 12- to 17-year-olds every day from lighting up for the first time. The FDA is planning an ad campaign for early next that is intended to make the thought of smoking turn teens’ stomachs. Expect, Zeller hinted, to see an anti-glamour campaign: ugly photos of smokers with rotting yellow teeth, wrinkles, and tar-stained fingernails.

The wrinkle: Teens still see their favorite movie stars — yes, you, Nicole Kidman, and you, Jennifer Aniston — glamourously smoking in photos and on the silver screen, so it may be tough for a government public safety announcement to effectively counter those influences.
3. Loosen warning labels on nicotine-replacement products. Zeller said the FDA might want to consider loosening the labeling on over-the-counter nicotine patches and gum, which currently state that users should not use them for longer than 8 to 12 weeks without consulting a doctor. “We need to look at how other Westernized nations, like Great Britain, are looking at nicotine,” he said. Other countries take the tack that smokers may always be addicted to nicotine and may need to be on some replacement product for life — which is far safer for them than continuing to inhale cancer-causing chemicals in tobacco.
The wrinkle: The FDA hasn’t determined how e-cigarettes should fit into the array of smoking-cessation products. Some smokers have told Zeller that the battery-operated devices are the only things that work to get them to stop smoking tar-filled cigarettes. But scant research has been done on the products to determine first, whether the vapor they release is safe to inhale, and second, whether e-cigarettes deliver the same quick nicotine rush to the brain that smokers seek. Those nicotine bursts aren’t delivered by FDA-approved nicotine replacement products.
4. Ramp up enforcement. The FDA has been making vigorous efforts to crack down on retailers who are selling cigarettes to minors. More than 10,000 stores throughout the U.S. have received warning letters since 2010, Zeller said, after minors serving as undercover agents were able to purchase cigarettes without an ID check. Hundreds of stores in Massachusetts were also warned that they would be fined if they didn’t change their practices.
The wrinkle: It’s tough to know how well the efforts have worked. The decline in smoking rates among teens has largely leveled off and many are still getting their hands on tobacco products.
http://www.bostonglobe.com/lifestyle/health-wellness/2013/11/05/fda-cigarette-future-could-non-addictive/sEZZVH2vR9JJ6OKviItX4J/story.html