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Safety of e-cigarette vapors questioned

, Buffalo Business First Reporter-Business First
It’s been years since viewers have sat through a cigarette commercial during the Super Bowl, with commercials for beer and cars dominating advertising.
But this weekend’s game included for the second consecutive year an ad for NJOY King, an electronic cigarette, with a theme of friends helping friends.
The response has been mixed from health advocates. While some say inhaling vapors or “vaping” is safer than smoking traditional tobacco cigarettes, others insist quitting entirely is the healthiest course of action. And it turns out vaping also exposes non-users to nicotine in the same way secondhand smoke affects those who spend time around smokers, though at much lower levels.
That’s according to research by Maciej Goniewicz, an assistant professor of oncology at Roswell Park Cancer Institute’sDepartment of Health Behavior, published by the journal Nicotine and Tobacco Research.
Goniewicz and his team studied vapor from three different brands of e-cigarettes, as well as secondhand smoke exposure of vapors and tobacco smoke generated by dual users. The results showed the e-cigarettes emit nicotine at levels of about 10 times less than conventional tobacco cigarettes, though they did not emit substantial amounts of carbon monoxide and toxic volatile organic compounds.
The study was a collaboration between Roswell Park and researchers at the Medical University of Silesia in Poland.
Though exposure to toxins is substantially lower, there’s still no definitive data on short and longterm health: The U.S. Surgeon General has not yet evaluated the short and longterm health risk from secondhand exposure to vapors.
“We don’t know yet the longterm affects of using these products,” Goniewicz said. “We know there are some traces of some potentially dangerous chemicals in the vapor. We don’t know what will happen after 10-20 years of inhaling this vapor.”
Still, vaping is considerably less dangerous than regular cigarettes, since users and those around them are exposed to significantly less toxins.
“The clear conclusion is that these products are safer than tobacco cigarettes. When you compare them, we believe these products are safer than tobacco cigarettes, but there is no doubt for smokers that quitting is the best way,” he said.
The other growing issue is how to handle vaping indoors, including in public places, restaurants and the workplace. The Food & Drug Administration and individual states place limits on advertising and how and where tobacco cigarettes are sold, but there have not yet been any rulings on exactly whether e-cigarettes fall into the same category.
A number of companies have already taken steps to limit vaping in the workplace, while in other places, it’s the state or municipality making the rules: New York City Council in December voted to ban the use of e-cigarettes in all places where smoking is prohibited. The Niagara Frontier Transportation Authority is now considering a ban on its transit vehicles and within its properties.
Goniewicz said he believes vaping should be limited as well to protect non-users, but it’s a difficult question.
“The main reason we have the indoor smoke-free law is to protect non smokers from being exposed to tobacco smoke,” he said. “We should protect these people from being exposed to vapor. But some people also believe that since we know this product is safer for smokers and it has the potential to save the lives of smokers, how can we encourage smokers to use electronic cigarettes instead of smoking? Any regulation should balance between the potential benefits and harm from the products.”
http://www.bizjournals.com/buffalo/blog/health_matters/2014/02/safety-of-e-cigarette-vapors-questioned.html

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

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-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

New E-cigarette shop opens in downtown Fargo

Fargo, ND (WDAY TV) – A new store opening to customers Friday on Broadway in Fargo hopes to tap into the growing business of electronic cigarettes.
E-cigarette sales hit the $500 million mark in 2012, and with that number expected to triple, Infinite Vapor hopes to get a piece of that $1.7 billion pie.
Kelsey Eaton- Manager, Infinite Vapor: “E-Cigarettes are a different way; an alternative to quitting smoking.
Cody Fruehling- First Infinite Vapor Customer: “Yeah, I’m addicted to the nicotine, but I’m also addicted to the feeling of smoking and that’s what the vapor offers.”
The E-cigarettes use flavored nicotine liquid to produce vapor that is then inhaled; therefore, no tobacco or tar is present.
Eaton: “A, they taste good, and B, they don’t smell, so you’re not smelly and it’s not all over your stuff and your hands don’t reek.”
With liquid flavors like banana and yummy gummy, public officials are concerned that E-cigarettes are catering to a younger crowd.
Robyn Litke Sall- Tobacco Prevention Coordinator, Fargo Public Health: “Sounds to me more like frozen yogurt flavor than it does E-cigarette flavor, so I really would strongly caution parents that this could be very attractive to their youth.”
With zero FDA regulation, E-cigarettes are allowed to be sold to minors, but Infinite Vapor manager Kelsey Eaton says they are taking the moral high ground.
Eaton: “We treat it just the same as any tobacco or nicotine product as in we take IDs. We don’t sell to anyone under 18.”
And just like traditional tobacco, E-cigarettes are banned in public places in North Dakota, while Minnesota still allows them.
The FDA is expected to place regulations on E-cigarettes in the near future.
http://www.wday.com/event/article/id/90738/

E-cigarette store to open in downtown Fargo

By: Dave Olson, INFORUM
FARGO – A chain of stores that began selling electronic cigarettes in the Twin Cities this past April is setting up a shop in downtown Fargo.
Bill Boldenow said he plans to open his Infinite Vapor store at 68 Broadway by Friday, but if that doesn’t happen, it’ll open “at the very latest the second week of December.”
Boldenow said the store will sell e-cigarettes and the e-juice that goes into them. E-cigarettes are pen-like devices that use a small battery and heating element to vaporize the e-juice, mimicking a cigarette.
While proponents such as Boldenow say e-cigarettes are safer than smoking, but some anti-smoking advocates are concerned the increasingly popular product isn’t regulated and has not been extensively tested.
Safe alternative?
E-juice typically contains nicotine along with some type of flavoring. When vaporized, e-juice is inhaled similar to the way smoke from a cigarette is inhaled, but without the carcinogens found in tobacco.
“We feel it’s a much safer alternative than tobacco, which we know is unsafe,” Boldenow said, adding that the e-juice Infinity Vapor sells is made in Minnesota and tested for consistency at a lab at St. Cloud State University.
“Infinity Vapor is a premium electronic cigarette shop that carries really high-quality products,” Boldenow said.
“A lot of the stuff you see out there these days – in gas stations and whatnot – are kind of a knockoff version,” he added.
Boldenow said e-juice nicotine levels can be adjusted to personal tastes, and he said many people who use e-cigarettes do so as a way to quit smoking.
“I want to promote people getting off of smoking,” he said. “I truly in my heart believe it is (a way to do that).”
Heather Nelson, part owner of the SnG Vapor store in Grand Forks, said more than a few of her customers kicked their smoking habit by turning to e-cigarettes.
“I’ve got a lot of people that (say), ‘I was smoking two packs a day for 30-plus years’ and in just a couple months they’ve gotten to a point where they are nicotine-free,” said Nelson, whose business has been operating in Grand Forks for about three years.
Nelson said the shop makes its own e-juice using a combination of four ingredients – nicotine; vegetable gelatin; coffee/tea flavorings; and pharmaceutical-grade propylene glycol.
Though propylene glycol is a chemical found in antifreeze, Nelson said it is a safe ingredient.
Regulation-free
But because e-juice is not regulated by the U.S. Food and Drug Administration, it is difficult to say just how safe or unsafe a particular batch may be, said Robyn Litke Sall, a tobacco prevention coordinator at Fargo Cass Public Health.
“We don’t yet know what all is contained in e-cigarettes. We don’t know if the vapor is harmful or not,” Sall said, adding that because of the lack of information, many health officials are concerned about statistics that indicate use of e-cigarettes among young people has doubled in recent years. In 2011, the market for e-cigs was $2 billion worldwide, according to an estimate by an industry group.
Because e-cigarettes look much like regular smokes, some wonder if they could be a gateway to smoking, said Sall, who added that scientific evidence is lacking when it comes to claims e-cigarettes help people stop smoking.
“Until there might be such evidence, we certainly can’t endorse it, or use it as a cessation device,” Sall said.
Both Boldenow and Nelson said they will not sell products to people under 18, assertions that don’t quell Sell’s concerns. She said a store may have a policy against selling to people under 18, but there is no law that prevents a business from doing so.
If a business decides to change their policy due to factors like competition, “there’s no penalty there,” Sall said.
Competitive advantage
E-cigarettes were included in North Dakota’s recently passed ban on indoor smoking in public places, meaning anyplace that is smoke-free by law must also be vapor-free.
Minnesota’s state law banning smoking in workplaces, bars and restaurants does not include e-cigarettes, but some communities in the state have their own ordinances regulating such products.
Moorhead is a city with no e-cigarette regulations, and that might give businesses an edge over their competition on the North Dakota side of the Red River, said Jake Bruns, owner of Mick’s Office, a downtown Moorhead bar.
Bruns said few of his customers use e-cigarettes, which are already widely available at convenience stores in the area. But he said that might change with a store opening that is devoted to the devices.
“There could be some marketing opportunities there,” he said.
http://www.inforum.com/event/article/id/419678/group/homepage/

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

Crutch or cure: issues surround use of e-cigarettes

By Stephen Rickerl/Fremont Tribune
The meteoric rise in popularity of e-cigarettes has some people scratching their heads as to whether the tobacco-less devices are a new tool in smoking cessation or a Trojan horse that could undo decades of anti-smoking campaigns.
Electronic cigarettes are devices that primarily consist of a battery, heating coil, wick and tank or cartridge that holds flavored liquid and nicotine. As a user puffs on the e-cigarette, the battery heats the coil and the liquid is turned essentially into a vapor that is inhaled like a traditional cigarette.
But e-cigarette users don’t consider themselves smokers, they’re “vapers,” and they don’t smoke – they “vape.” Many of the devices look more like a lightsaber than a Lucky Strike.
Even though the products do not contain tobacco, and do not use combustion to deliver nicotine to the user, there are a number of issues, questions and criticisms surrounding the use of e-cigarettes.
Among the unknowns are whether e-cigarettes are a solution or part of the problem, the answer to which would likely depend on who you ask.
The Fremont Area Medical Center does not support the use of the products as a tool to quit smoking because they are not FDA approved.
Dr. James Sullivan of Fremont Family Care, a clinic associated with FAMC, said smoking is a great health hazard and doctors like it when people are thinking of ways to quit. But he, as a member of the medical community, has a couple of issues with the devices.
First, he said, the devices are unregulated, and outside of strict FDA oversight and testing, there is no way to be certain how much nicotine is being delivered to the user. Another issue Sullivan has with the devices is that the liquid nicotine, the addictive part of smoking, can have harmful health effects – especially in young people and in high doses.
In traditional smoking cessation programs, nicotine in gum or patches slowly weans the user off the drug.
“The e-cigarettes design is basically the same thing, ‘let’s replace the toxic nature of smoking and inhaling that and give you back the nicotine while you quit,’” Sullivan said. “The problem is you don’t know what dose of nicotine you’re getting by inhaling it.
“We need to know a reliable dose that is getting in. For that reason we are reticent to use it,” he added. “I don’t know if a lot of people are quitting, because nicotine is the addictive part. So people are just now using e-cigarettes instead of regular cigarettes, so they’re not using it as a tool to quit, just as a replacement.”
Other criticisms of the devices have included the fact that there are no laws in place banning the sale of the products to minors, and the e-juice — the liquid containing the nicotine — comes in a range of flavors from traditional tobacco to gummy bears, caramel and root beer.
In 2010 the FDA, based on limited studies of samples, issued warning letters to electronic cigarette distributors for various violations of the Federal Food, Drug and Cosmetic Act including “violations of good manufacturing practices, making unsubstantiated drug claims and using the devices as delivery mechanisms for active pharmaceutical ingredients.”
In reporting its results of those limited studies “FDA found significant quality issues that indicate that quality control processes used to manufacture these products are substandard or non-existent. FDA found that cartridges labeled as containing no nicotine contained nicotine and that three different electronic cigarette cartridges with the same label emitted a markedly different amount of nicotine with each puff.”
The American Lung Association in a public health statement said there are 250 different brands of e-cigarettes for sale in the U.S., and those brands are likely to have a wide variation of chemicals that each contain. The lung association said an FDA study in 2009 found detectable levels of toxic cancer-causing chemicals, including an ingredient used in anti-freeze.
Because of potential unknown risks, many school districts and public bodies are enacting policies to treat e-cigarettes like traditional cigarettes.
The Fremont Board of Education at its October meeting voted to approve the first reading of a policy that would treat e-cigarettes the same as traditional, or “burn” cigarettes – effectively banning their use on school grounds. The new policy is expected to pass a second and final reading at the board’s November meeting.
“I think from a school district’s perspective the reason we included them is we felt like they could be a distraction from the learning taking place in the classroom and also in the school,” said Mark Shepard, executive director of business and support services at Fremont Public Schools. “Our concern in adding it to the policy is it’s basically modeling a behavior that students should not be engaged in.”
Chad Burns, owner and CEO of American Vapor — a new e-cigarette store in Fremont — agrees that minors shouldn’t use the product and will not sell to minors, but disagrees with the findings of the incomplete FDA study.
“Right now our state doesn’t regulate (sales to minors). We can sell to anyone legally, morally we do not,” Burns said. “We self-regulate. If you’re not able to buy cigarettes, you’re not able to buy this. It’s 18 and older period. That’s self-imposed, but morally it’s the right thing to do.”
Burns said his business also self-regulates when it comes to the quality and consistency of e-juice.
“Everything we purchase is made here in the U.S. and we know where it is coming from. Most of them are local producers and we know what they’re doing,” Burns said. “Everything that we purchase, we purchase at zero nicotine and then we are right there when they add the nicotine, and it’s all computerized. You punch in how big of a bottle you’re putting the nicotine into and how many milligrams of nicotine you want in that bottle. The computer puts in the exact amount – to the drop.”
Burns said he would welcome FDA regulation of the industry.
“It would be a good idea because there are some shops out there that aren’t following the same standards,” he said. “Personally I want to know what I’m vaping, I don’t order anything offline – even for my personal use. We don’t like the companies that aren’t regulating because they’re giving us a bad name. And as this industry progresses, the weak will be weeded out of the herd.”
Shane Ekdahl, owner and business manager of American Vapor, said the store has been open two weeks and in that time business has been steady.
“People are just bringing their friends in by the droves,” he said. “It’s unreal.”
Ekdahl said about 20 percent of their customers are experienced vapers, but the other 80 percent are traditional smokers new to vaping.
Matt and Brandy Tulak said they smoked 14 and 17 years respectively. Neither has picked up a cigarette since they began vaping a week ago.
Matt Tulak said he was always the smoker who talked about quitting but never did. In vaping he sees the opportunity to satisfy his nicotine cravings without taking in additional chemicals associated with traditional smoking.
“You’re not getting all the nasty chemicals you’re getting from the cigarette,” he said. “I was getting to the point where I was wheezing at night going to bed. Now I don’t wake up in the morning and have that heavy chest,”
Brandy Tulak said they vape now because they like it better than smoking. They don’t smell like cigarettes and their sense of taste and smell are improving. She said she also likes that she can customize her device.
“You can customize your vapers to make them pretty, to speak to what you like,” she said. “With a cigarette you get stench, yellow teeth, wrinkles all that nasty stuff – and it’s not pretty.”
http://fremonttribune.com/news/local/crutch-or-cure-issues-surround-use-of-e-cigarettes/article_0c7c6547-458a-5d2f-8b3c-515f2c1f1c9b.html