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ERIC JOHNSON: E-cigs’ risks are real while benefits are scant

By Eric Johnson, Op-Ed, Grand Forks Herald
GRAND FORKS — According to the Centers for Disease Control and the U.S. Surgeon General, tobacco kills about 480,000 persons every year in the United States.
In 1964, about 41 percent of adults were cigarette smokers. Today, that rate is down to a little more than 18 percent. Significant strides have been made over the past five decades to reduce smoking and the tremendous health and financial burden it puts on our society.
In North Dakota alone, tobacco use still contributes to about $250 million in health care expenditures.
Encouraging people to quit tobacco remains a high priority with regard to the health of Americans, yet only two states in the nation — Alaska and North Dakota — fund anti-tobacco programs at levels recommended by the CDC.
In North Dakota, our efforts continue to be supported by the public. Public sentiment, expressed at the ballot box and in polling, shows that reducing tobacco use remains a high priority for North Dakotans. In 2008, voters approved Measure 3 to support funding of anti-tobacco programs; and in 2012, the statewide smoke-free law — passed as a ballot measure — got 67 percent of the vote, winning support from a majority of voters in every legislative district.
Some 89 percent of North Dakotans polled in 2013 think the funds designated for tobacco control should stay there.
What works to help people quit tobacco? The U.S. Preventive Task Force and the Surgeon General endorse medications that have proven effectiveness with a known, Food and Drug Administration-approved, safety and side-effect profile.
These include nicotine replacement products such as gum, patches or lozenges, as well as prescription medications such as Chantix (Varenicline) or Wellbutrin (Buproprion).
Proven counseling programs, such as NDQuits (available free to all North Dakotans who use tobacco), also are very effective, particularly when combined with an FDA-approved medication.
Electronic cigarettes (e-cigs) are increasingly popular products that fall into the unproven category. First invented in the 1960s, their popularity has continued to increase as large tobacco companies buy small “mom-and-pop” manufacturers. With more than 250 brands on the market, (“Blu,” “NJOY” and “Vuse” popular in America), e-cigs are battery-powered (some disposable, some rechargeable) with a vaporizer and mouthpiece attached.
When used, commonly referred to as “vaping,” the vaporizer boils the liquid inside, which most frequently contains three major ingredients — humectants (propylene glycol/glycerin, used in fog and smoke machines and antifreeze), nicotine (at varying levels) and flavoring (fruit flavors, bubble gum, cotton candy, bacon and coffee, to name a few).
Unlike other medications that are used to promote quitting tobacco, e-cigs are largely unregulated by the Food and Drug Administration; and to date, we have no real data to show that they are effective as a cessation product nor any data to show that they are safe.
Furthermore, some of these manufacturers have been cited for contaminants in their products, including nickel, arsenic and chromium.
Without FDA oversight, these products aren’t taxed, they can be sold to anyone of any age, and there are no restrictions on advertising, which is why we see and hear ads on TV, in magazines and on the radio.
Though the industry denies it, it’s apparent that these products are being marketed to children (unless we’re supposed to believe that “Hello Kitty” e-cigs are popular among adult users).
E-cig manufacturers, rather than relying on science, really are trying to “normalize” smoking again for the next generation. The recent national Youth Tobacco Survey showed a spike in use of e-cigs by youth, doubling to more than 10 percent in just one year.
In addition, many who use e-cigs become dual users, continuing to use other tobacco products at the same time.
Last but not least, the industry is playing on the desperate idea that anything else would be better than smoking traditional cigarettes. If that’s true, ask yourself why these same companies are so resistant to producing the data to back up their claims.
It’s disappointing that e-cigs have been marketed for more than 35 years and have yet to collect or publish any significant data to show they are safe for users or that they actually help people quit.
Considering these products increasingly are manufactured and marketed by Big Tobacco, I’m not anticipating we’ll see such data any time soon.
The FDA has made it very clear that e-cigs cannot be marketed as smoking cessation products as a result.
As a health care provider, I would love a good, new and novel option to help people quit smoking. Like other conditions I treat as a physician, I want to provide the best possible treatment for my patients, and that means practicing strategies and using medications that have scientific proof that they work and have an established safety profile.
To date, when it comes to quitting tobacco, that answer is not found in electronic cigarettes.
Dr. Johnson is a family physician at Altru Health System in Grand Forks.
http://www.grandforksherald.com/content/eric-johnson-e-cigs-risks-are-real-while-benefits-are-scant

Selling a Poison by the Barrel: Liquid Nicotine for E-Cigarettes

By , New York Times

A dangerous new form of a powerful stimulant is hitting markets nationwide, for sale by the vial, the gallon and even the barrel.

The drug is nicotine, in its potent, liquid form — extracted from tobacco and tinctured with a cocktail of flavorings, colorings and assorted chemicals to feed the fast-growing electronic cigarette industry.

These “e-liquids,” the key ingredients in e-cigarettes, are powerful neurotoxins. Tiny amounts, whether ingested or absorbed through the skin, can cause vomiting and seizures and even be lethal. A teaspoon of even highly diluted e-liquid can kill a small child.

But, like e-cigarettes, e-liquids are not regulated by federal authorities. They are mixed on factory floors and in the back rooms of shops, and sold legally in stores and online in small bottles that are kept casually around the house for regular refilling of e-cigarettes.

Evidence of the potential dangers is already emerging. Toxicologists warn that e-liquids pose a significant risk to public health, particularly to children, who may be drawn to their bright colors and fragrant flavorings like cherry, chocolate and bubble gum.

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The liquid stimulant used in e-cigarettes, when ingested or absorbed through the skin, can cause vomiting, seizures or death. CreditFrank Franklin II/Associated Press

“It’s not a matter of if a child will be seriously poisoned or killed,” said Lee Cantrell, director of the San Diego division of the California Poison Control System and a professor of pharmacy at the University of California, San Francisco. “It’s a matter of when.”

Reports of accidental poisonings, notably among children, are soaring. Since 2011, there appears to have been one death in the United States, a suicide by an adult who injected nicotine. But less serious cases have led to a surge in calls to poison control centers. Nationwide, the number of cases linked to e-liquids jumped to 1,351 in 2013, a 300 percent increase from 2012, and the number is on pace to double this year, according to information from the National Poison Data System. Of the cases in 2013, 365 were referred to hospitals, triple the previous year’s number.

Examples come from across the country. Last month, a 2-year-old girl in Oklahoma City drank a small bottle of a parent’s nicotine liquid, started vomiting and was rushed to an emergency room.

That case and age group is considered typical. Of the 74 e-cigarette and nicotine poisoning cases called into Minnesota poison control in 2013, 29 involved children age 2 and under. In Oklahoma, all but two of the 25 cases in the first two months of this year involved children age 4 and under.

In terms of the immediate poison risk, e-liquids are far more dangerous than tobacco, because the liquid is absorbed more quickly, even in diluted concentrations.

“This is one of the most potent naturally occurring toxins we have,” Mr. Cantrell said of nicotine. But e-liquids are now available almost everywhere. “It is sold all over the place. It is ubiquitous in society.”

The surge in poisonings reflects not only the growth of e-cigarettes but also a shift in technology. Initially, many e-cigarettes were disposable devices that looked like conventional cigarettes. Increasingly, however, they are larger, reusable gadgets that can be refilled with liquid, generally a combination of nicotine, flavorings and solvents. In Kentucky, where about 40 percent of cases involved adults, one woman was admitted to the hospital with cardiac problems after her e-cigarette broke in her bed, spilling the e-liquid, which was then absorbed through her skin.

The problems with adults, like those with children, owe to carelessness and lack of understanding of the risks. In the cases of exposure in children, “a lot of parents didn’t realize it was toxic until the kid started vomiting,” said Ashley Webb, director of the Kentucky Regional Poison Control Center at Kosair Children’s Hospital.

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Nicotine solutions at Volt Vapes in Boise, Idaho. The “e-liquid” comes in colors and flavors that experts say may entice children. CreditKatherine Jones/The Idaho Statesman, via Associated Press

The increased use of liquid nicotine has, in effect, created a new kind of recreational drug category, and a controversial one. For advocates of e-cigarettes, liquid nicotine represents the fuel of a technology that might prompt people to quit smoking, and there is anecdotal evidence that is happening. But there are no long-term studies about whether e-cigarettes will be better than nicotine gum or patches at helping people quit. Nor are there studies about the long-term effects of inhaling vaporized nicotine.

 Unlike nicotine gums and patches, e-cigarettes and their ingredients are not regulated. The Food and Drug Administration has said it plans to regulate e-cigarettes but has not disclosed how it will approach the issue. Many e-cigarette companies hope there will be limited regulation.

“It’s the wild, wild west right now,” said Chip Paul, chief executive officer of Palm Beach Vapors, a company based in Tulsa, Okla., that operates 13 e-cigarette franchises nationwide and plans to open 50 more this year. “Everybody fears F.D.A. regulation, but honestly, we kind of welcome some kind of rules and regulations around this liquid.”

Mr. Paul estimated that this year in the United States there will be sales of one million to two million liters of liquid used to refill e-cigarettes, and it is widely available on the Internet. Liquid Nicotine Wholesalers, based in Peoria, Ariz., charges $110 for a liter with 10 percent nicotine concentration. The company says on its website that it also offers a 55 gallon size. Vaporworld.biz sells a gallon at 10 percent concentrations for $195.

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The website of Liquid Nicotine Wholesalers. The Food and Drug Administration has yet to impose rules on e-liquids’ sale.

Mr. Paul said he was worried that some manufacturers outside the United States — China is a major center of e-cigarette production — were not always delivering the concentrations and purity of nicotine they promise. Some retailers, Mr. Paul said, “are selling liquid and they don’t have a clue what is in it.”

 Cynthia Cabrera, executive director of Smoke Free Alternatives Trade Association, said she would also favor regulations, including those that would include childproof bottles and warning labels, and also manufacturing standards. But she said many companies already were doing that voluntarily, and that parents also needed to take some responsibility.

“You wouldn’t leave a bottle of Ajax out,” she said. Advocates of e-cigarettes sometimes draw comparisons between nicotine and caffeine, characterizing both as recreational stimulants that carry few risks. But that argument is not established by science, and many health advocates take issue with the comparison.

“There’s no risk to a barista no matter how much caffeine they spill on themselves,” said Dr. Neal L. Benowitz, a professor at the University of California, San Francisco, who specializes in nicotine research. “Nicotine is different.”

Without proper precautions, like wearing gloves while mixing e-liquids, these products “represents a serious workplace hazard,” he said.

The nicotine levels in e-liquids varies. Most range between 1.8 percent and 2.4 percent, concentrations that can cause sickness, but rarely death, in children. But higher concentrations, like 10 percent or even 7.2 percent, are widely available on the Internet. A lethal dose at such levels would take “less than a tablespoon,” according to Dr. Cantrell, from the poison control system in California. “Not just a kid. One tablespoon could kill an adult,” he said.

http://www.nytimes.com/2014/03/24/business/selling-a-poison-by-the-barrel-liquid-nicotine-for-e-cigarettes.html?_r=0

Local Students Celebrate "Kick Butts" Day

KX News, Bismarck
Click here to watch video of this story.

It’s national “Kick Butts” day… A day to encourage people to snuff tobacco out of their lives.
It’s not promoted by officials, but rather by students.
Courtney Plante shows you how Students Against Destructive Decisions are doing their part to warn their peers.
Today’s announcements at St. Mary’s are a bit different than usual.
Members of SADD, or Students Against Destructive Decisions are quizzing students about things like e-cigarettes.
Andrew Stromme wants his friends to realize the dangers of tobacco use.
“I do have some people I know that do smoke, and they’re trying to quit. They really start to realize how big of a problem it is, and how hard it is to let go,” said Andrew Stromme, St. Mary’s SADD member.
Across town, things are a little more in your face.
SADD members at Century hand out suckers and have students smell candies that are similar to flavors of e-cigarettes.
 “They are advertising to kids and people my age. So we got colorful wrappers that look like candy,” said Hannah Rexine, SADD member.
Their goal — prevent friends from using tobacco.
Or help them quit once they’ve started.
“A lot of people at my old middle school did smoke and it’s hard seeing people make those decisions so young and it can effect your future so greatly,” said Hannah Rexine, SADD member.
9th grade math teacher Marcy Feickert says there are quite a few students that use e-cigarettes.
She says educational messages like this show students how advertisements are targeting people their age.
“The kids jaws literally dropped looking at all the packaging and how attractive the packaging is now for e-cigarettes,” said Marcy Feickert.
At both schools the lesson for students is clear…
Don’t start smoking…
“I don’t want to start it because I know it’s addictive. It’s a good thing to stay away from”
“I think it’s a waste of money…all tobacco is”
Don’t fall for ads…
“E-cigarettes are the new fad right now, I mean people are trying them just because they look cool,” said Courtney Seilerm, SADD Advisor.
“You see it in the commercial, all of the colorful packaging, that appeals to younger children,” said Andrew Stromme, SADD member.
Do kick butts.
Reporting in Bismarck for KX News, I’m Courtney Plante.
At the end of the day students at St. Mary’s get cookies for correct trivia answers.

19th Annual Kick Butts Day used to promote a tobacco-free lifestyle

By Sun Staff , Jamestown Sun
The 19th annual Kick Butts Day, a national day when youths are encouraged to stand up and speak out against tobacco companies, is Wednesday.
Central Valley Health District and the North Dakota Center for Tobacco Prevention and Control Policy are using this occasion to educate youth about the dangers of tobacco.
Research shows that 600 North Dakota youths under the age of 18 become new daily smokers every year, and 14,000 youths will die prematurely from smoking. In addition, 1.9 million packs of cigarettes are bought or smoked each year by youth younger than 18.
Tobacco companies are spending millions in North Dakota each year to get the youth smoking rates up, according to Jeanne Prom, executive director for the Center. Prom said that some of the tactics tobacco companies use to attract youth are candy- and fruit-flavored tobacco products, providing discounts and sales that make their products affordable and paying retailers to prominently display tobacco products in high-traffic areas.
Julie Hoeckle with Central Valley Health District said that Kick Butts Day is a great way to educate youths in the community on the importance of remaining tobacco-free and to inform everyone about the harmful marketing schemes tobacco companies are using to trap youths into using tobacco.
“It’s essential that we continue to educate our youth about tobacco marketing practices so they can identify those tactics and avoid being lured into tobacco use,” Hoeckle said. “Education is key in tobacco prevention.”
Another effective way to reduce youth smoking rates is to increase the cost of tobacco, Hoeckle said. Research supported by the Centers for Disease Control and Prevention and the American Lung Association shows that increasing North Dakota’s tobacco tax from 44 cents to $2 would reduce youth smoking rates by 25 percent.
“By making tobacco less affordable, kids are less likely to try using tobacco,” Prom said. “North Dakota projections show us that a $2 cigarette tax has the potential to prevent nearly 8,000 kids from ever starting to use tobacco and can save millions of dollars in health care costs.”
To learn about tobacco prevention, contact Hoeckle or Nancy Neary at 252-8130 or visit www.breathend.com.
http://www.jamestownsun.com/content/19th-annual-kick-butts-day-used-promote-tobacco-free-lifestyle

Youth poisonings by e-cigarette juice increase tenfold in Minnesota

By: John Lundy, Forum News Service, INFORUM
DULUTH – The tenfold increase in Minnesota youngsters poisoned by e-cigarette juice last year is alarming, a local anti-smoking advocate said.
“It’s a startling increase and something we should be very concerned about,” said Pat McKone, Duluth-based director of tobacco control programs and policy for the American Lung Association of the Upper Midwest.
But it needs to be viewed in context, said Duluth e-cigarette proprietor Daniel Albrecht, citing a much greater number of poisonings from other products.
The Minnesota Department of Health reported Tuesday that 50 teens and children were victims of poisonings related to e-cigs in 2013, compared with five the year before. More than half of those poisoned were younger than 3, and nine of the 50 were teenagers. Another 24 adults were poisoned, a news release said.
The data came from the Minnesota Poison Control System.
More than 200 Minnesota retailers sell the product, which is an electronic device that vaporizes water to supply liquids. The liquids used in e-cigarettes often include flavors such as cotton candy, bubble gum and grape. They may or may not contain nicotine.
Most e-cigarette shops opened in the past year, including two in Duluth.
Albrecht owns one of those, E-cig Empire, with his brother Mike. Most of the e-juice sold is with child-resistant caps, Albrecht said, and what he calls the vaping community is pushing for all of it to be child-safe.
“Everyone in the vaping community is all for keeping it out of the hands of children and minors,” Albrecht said. “And we’re all for that sort of legislation.”
But other products take a greater toll, Albrecht said. Close to 3,200 calls were made to Minnesota Poison Control related to personal-care products last year, he said, and almost 2,400 calls were made regarding household products.
But Albrecht said he opposes eliminating any flavors and argued that those flavors aren’t offered to appeal to children.
“As adults, we all have a right to choose,” he said. “We all had to put up with smoking the traditional analog cigarettes and they all tasted nasty and smelled gross, and now we have an alternative that we could have flavoring in it.”
Minnesota legislators are considering regulating e-cigarettes. Duluth, Cloquet and Hermantown are among Minnesota cities that already have adopted regulatory actions.
Four states — New Jersey, Utah, Arkansas and North Dakota — have passed legislation banning the use of e-cigarettes in public places.
McKone said the latest report goes hand in hand with a U.S. Centers for Disease Control and Prevention report last year that e-cigarette use had doubled among teenagers from 2011 to 2012.
None of last year’s poisonings resulted in hospitalizations or serious illness, state Health Commissioner Ed Ehlinger said.
But McKone said the fact that symptoms were alarming enough to cause calls to the Poison Control System speaks for itself.
“I hope we don’t have to have a fatality to say it wasn’t so bad,” McKone said. “I think as a parent myself any time I would be in a position to be calling Poison Control and concerned about my child having ingested something and having symptoms — that’s more than enough cause for us to be concerned.”
But responsible parenting can prevent those problems, Albrecht said.
“I think parents of children need to be much more responsible and keep things out of reach,” he said.
Symptoms of nicotine poisoning may include nausea, vomiting, diarrhea, seizures and/or difficulty breathing, the Health Department news release said. A fatal dose of nicotine for an adult is between 50 and 60 milligrams. E-juice containers may include between 18 and 24 milligrams.

Don Davis contributed to this report.
http://www.inforum.com/event/article/id/429747/

Chuck Schumer goes after marketing of e-cigarettes to kids

BY / NEW YORK DAILY NEWS

Fearful big tobacco could hook a new crop of smokers, Sen. Chuck Schumer says he’s backing legislation to stub out the marketing of e-cigarettes to children.
Schumer said tobacco companies are upping the appeal of vaping devices by making kid-friendly flavors like cotton candy and gummy bears.
“They are making a campaign to go after kids and that must stop,” Schumer said Sunday.
He vowed to push the so-called Protecting Children From Electronic Cigarette Advertising Act through the Senate. The legislation would close loopholes in advertising laws that tobacco companies have exploited to hook kids.
Schumer cited a study published last week in JAMA Pediatrics, which found that adolescents who smoke e-cigarettes are seven times more likely to smoke traditional cigarettes.
http://www.nydailynews.com/news/politics/chuck-schumer-e-cigarette-marketing-kids-article-1.1716091#ixzz2vgNEUEZf

Letter: Big tobacco goes after ‘replacement smokers’

By: Beth Hughes, Bismarck, INFORUM
Even though the risks of using tobacco are well documented, it remains the No. 1 cause of preventable death and disease in the country. This year alone, nearly 500,000 Americans will die prematurely because of smoking. Unfortunately, tobacco marketing efforts recruit two new young smokers to replace each tobacco user who dies.
It’s well documented that tobacco companies market to youth in an effort to recruit “replacement smokers.” Research from the Centers for Disease Control and Prevention tells us that smoking and smokeless tobacco use are initiated and established primarily during adolescence. In fact, nearly 9 out of 10 smokers start smoking by the age of 18. Tobacco companies know this and continually look for new ways to hook our youth.
Tobacco companies pay convenience stores – many located near schools – and other tobacco retailers to prominently display advertisements for their products near the entrances, exits and checkouts. Tobacco companies also target a new generation of potential tobacco users by designing items to appeal to youth, such as fruit-flavored products in colorful packaging that make tobacco look and smell like candy.
In addition to new flavors and packaging, price is another factor that affects tobacco use. In states with low tobacco taxes, like North Dakota, it’s easier to make tobacco products affordable, and that makes it easier for youth to obtain tobacco. Research supported by the CDC and the American Lung Association shows that increasing a tobacco tax is one of the most effective ways to reduce youth tobacco use; by making tobacco less affordable, kids are less likely to buy it.
The Center for Tobacco Prevention and Control Policy uses media campaigns to educate the public about the dangers of tobacco use. The Center also works with local public health units across the state to educate our communities on tobacco prevention so our children live healthier lives as fewer of them become addicted to nicotine.
We are committed to preventing tobacco use among our youth and adult populations. We’ve made great progress, but there is more work to be done. Showing support for tobacco prevention efforts in your community is a great start to help reduce youth tobacco use rates. Here is what you can do:
• Support tobacco-free and smoke-free policies within your community. When youth are not exposed to tobacco, it increases their chance to remain tobacco free.
• Support policies that restrict how tobacco is marketed. Tobacco companies are aggressive marketers that target youth through retail displays, internet marketing and magazines that are popular with teens.
• Support tobacco tax increases. Our youth are less likely to use tobacco if it is less affordable.
These strategies are CDC Best Practice strategies – strategies that are proven to reduce youth tobacco use rates. We ask the community to join us in this fight by showing your support for tobacco prevention.

Hughes, Ph.D., is a registered respiratory therapist, and chairwomen, North Dakota Tobacco Prevention and Control Committee.
http://www.inforum.com/event/article/id/428702/group/Opinion/

E-cigarettes ignite debate over regulation, sales

LANSING, Mich. (AP) — Banning the sale of electronic cigarettes to kids may seem like a no-brainer, yet Gov. Rick Snyder’s administration and a number of health advocacy groups oppose legislation that does just that. They say it doesn’t go far enough.
Players on both sides of the state’s e-cigarette debate agree that the nicotine-dispensing devices should be kept away from minors, but opinions differ when it comes to regulating the relatively unstudied vaporizers.
Tobacco companies support two bipartisan Senate bills prohibiting the sale and use of e-cigarettes and other devices that deliver nicotine if the buyer is younger than 18 years old. Sen. Glenn Anderson, D-Westland, said he is sponsoring the legislation because it’s “outrageous” that a minor can legally buy and use a highly addictive product. The bills unanimously passed the Senate Thursday.
But Snyder’s administration and health advocates say the bills would give e-cigarettes a “special status” and protect them from standard tobacco regulations. They want e-cigarettes to be treated like traditional cigarettes, not only in regards to minors, but taxes and public use laws as well. Such regulations would ban e-cigarette use in workplaces or restaurants, a restriction that’s currently left up to individual businesses.
“The appropriate thing to do in Michigan now is to act to help protect the population against the potential health risks of e-cigarettes, about which we know very little,” said Dr. Matthew Davis, chief medical executive for the Community Health Department.
Electronic cigarettes are cylindrical battery-powered devices that heat a liquid to produce vapor. While the liquid often includes nicotine, which can be derived from tobacco, e-cigarettes have not been officially designated as tobacco products. The U.S. Food and Drug Administration regulates cigarettes and smokeless tobacco and has said it intends to propose changes to its authority to regulate e-cigarettes, too.
Twenty-seven states ban the sale of e-cigarettes to minors, according to the National Conference of State Legislatures. Most of those state laws are similar to the Senate legislation.
Opponents are countering with a House bill that would treat e-cigarettes as tobacco products.
Rep. Gail Haines, R-Lake Angelus, introduced the bill Wednesday after working with the administration and health groups such as the American Cancer Society and American Lung Association. She declined to comment before the bill was assigned to a committee.
Anderson said an effort to designate e-cigarettes as tobacco products would fail ahead of the FDA’s decision.
“Most of us would prefer for the FDA to make the decision, and they are going to do it probably sometime this year, but I don’t want to wait,” bill sponsor Sen. Rick Jones, R-Grand Ledge, said. “I want to stop the sale to children now, immediately.”
E-cigarettes are often produced by the same parent companies as traditional cigarettes and have grown increasingly popular over the past few years. U.S. middle and high school students’ use of e-cigarettes more than doubled from 2011 to 2012, the Centers for Disease Control and Prevention reported in September. The share of high school students who had used e-cigarettes in the past 30 days increased from 1.5 percent to 2.8 percent in the survey. More than 1.78 million middle and high school students tried e-cigarettes in 2012.
“As I read to a fourth grade last week, one of the children said, ‘My friends and I bought some and we played with them,'” Jones said on the Senate floor.
Mark Bilger, 18, asked his mother to contact Anderson about concerns over e-cigarettes in September after studying them for his debate club. Bilger, a senior at Detroit Catholic Central High School, said he noticed e-cigarettes were “becoming a real problem in my school” and that students occasionally use them in class “when the teacher’s back is turned” without getting caught “because there’s no smell, there’s only vapor.”
“I think it’s a step in the right direction,” Bilger said about the Senate legislation. “But I think they need some of the same regulations traditional cigarettes have, where you regulate what you put in it and have more testing on it.”
Lance McNally, 39, is one of Jones’ constituents who began using e-cigarettes in December. He owns three e-cigarettes and still smokes traditional cigarettes. He wants to transition fully to vaporizers because “there’s no stench.”
While McNally only uses tobacco-flavored e-cigarette liquid, he said his wife goes for more unusual flavors.
“Strawberry, cheesecake — those are the two main ones,” he said.
McNally said he’s not worried about flavors or advertisements appealing to minors because “I’m not seeing an inundation of marketing.” E-cigarette legislation is unnecessary because many retailers already won’t sell them to minors, he said.
“I don’t think they should be regulated like cigarettes,” McNally said. “I’m kind of a deregulation guy to begin with. I don’t see where the government needs to be wasting its energy and time and my money on another product.”
http://www.usatoday.com/story/news/nation/2014/03/07/e-cigarettes-regulation-sales/6181091/

Teenage E-Cigarette Use Likely Gateway to Smoking

By Caroline Chen, Bloomberg News
E-cigarettes facing municipal bans and scrutiny by U.S. regulators received a new slap on the wrist from scientists: A report today suggests the devices may be a gateway to old-fashioned, cancer-causing smokes for teens.
Youths who reported ever using an e-cigarette had six times the odds of smoking a traditional cigarette than those who never tried the device, according to a study published today in the journal JAMA Pediatrics. E-cigarette use didn’t stop young smokers from partaking in regular cigarettes as well.
The global market for e-cigarettes may top $5 billion this year, according to Euromonitor International Ltd. estimates. Makers of the devices, including Altria Group Inc. (MO), the largest U.S. tobacco company, market them online and on TV, where traditional tobacco ads are banned, and some have added flavors such as bubble gum to the nicotine vapor that may have extra appeal for youths. That allure is why the U.S. Food and Drug Administration needs to restrict the devices, opponents say.
“The FDA needs to act now,” Vince Willmore, spokesman for the Washington-based Campaign for Tobacco-Free Kids, said in a telephone interview. “We think it’s overdue.”
Concerns about underage use of e-cigarettes were raised last year when the U.S. Centers for Disease Control and Prevention in Atlanta reported that use of the devices by youths doubled in 2012 from a year earlier.
“E-cigarettes are likely to be gateway devices for nicotine addiction among youth, opening up a whole new market for tobacco,” said Lauren Dutra, a post-doctoral fellow at the University of California at San Francisco and the report’s lead author. “We’re most worried about nicotine addiction initiation in youth.”

Enticing Product

E-cigarettes “are enticing for kids,” said Donovan Robinson, dean of students at Chicago’s Lincoln Park High School. He said today’s findings weren’t surprising. “They’ll say, ‘Hey, now let’s try the real thing.’”
Children in middle and high school, the target of the research, don’t think about health consequences, he said.
“Everything is a fad with teenagers,” Robinson said. They use e-cigarettes “because it looks cool. Teenagers see somebody doing something cool, and they want to do it.”
The latest research analyzed data from the 2011 and 2012 National Youth Tobacco Survey, conducted by the Centers for Disease Control and Prevention. Almost 40,000 middle and high school students from about 200 schools across the U.S. participated in the survey. Students were asked about their frequency of use of e-cigarettes, conventional cigarettes, cigars, pipes, and other tobacco products.

No Tar

While battery-powered e-cigarettes enable the ingestion of heated nicotine, users avoid the tars, arsenic and other chemicals common in tobacco products that have been linked to cancer, supporters have said.
The study today shows correlation, not causation, said Cynthia Cabrera, executive director of Smoke-Free Alternatives Trade Association, the Washington-based e-cigarette association.
“I’ve yet to see any science that shows there’s a gateway effect,” Cabrera said in a telephone interview. “We want to work with facts and science, we don’t want to make knee-jerk decisions based on emotional responses.”
Cabrera warned against drawing inferences on teen use based on the use of flavors in e-cigarettes.
“We do know that thousands of people were able to switch over to vapor products because of the flavors,” she said in a telephone interview. “Would we deny people who were in a group who could die from tobacco to use flavors that helped them get off killer tobacco?”

Nicotine Effects

Opponents have countered that nicotine alone is so toxic it’s been used in the past as a pesticide. They say the health effects of nicotine, which has proven to be habit forming, are unclear and deserve more study. Until that’s done, they’ve said, advertising of the devices should be closely monitored to make sure it isn’t aimed at underage smokers.
“We’re concerned that the marketing for e-cigarettes risks re-glamorizing smoking” among youths who won’t make the distinction between electronic and conventional cigarettes, Willmore said.
In December, a billboard in Miami used Santa Claus to market e-cigarettes and in the recent Sports Illustrated bathing suit issue there was an ad for one of the devices “right in the middle of a bikini bottom,” he said.
“You couldn’t design an ad more appealing to a teenage boy,” Willmore said.

Pivotal Year

This is expected to a pivotal year for producers of electronic cigarettes, with all major tobacco companies either launching new products or expanding their e-cigarette sales exposure, said Kenneth Shea, a Bloomberg analyst. Altria, Reynolds American Inc. and Lorillard Inc. are all expected to pursue U.S. exposure for their e-cigarettes, while closely held Logic Technology Development LLC and Sottera Inc., the maker of the e-cigarette NJoy, try to keep pace, Shea wrote in a report this month.
While tobacco companies have been under the FDA’s watchful eye since Congress gave the agency authority over the $90 billion industry in 2009, e-cigarettes haven’t been subject to the same oversight. The agency is now in the process of readying new rules for the industry designed to establish clear manufacturing standards and set boundaries for how the products can be marketed.
Federal regulators aren’t the only government officials moving to control use of e-cigarettes. On March 4, the Los Angeles City Council voted to join New York and Chicago in banning the use of the electronic products in in workplaces, restaurants and many public areas.

Bans Criticized

The municipal restrictions were criticized by Miguel Martin, president of Logic Technology, the second-largest independent e-cigarette maker in the U.S. Localities should wait for the FDA to make its views known before taking action, Martin said in an interview before the council vote.
“I find it odd that everybody looks to the FDA for guidance on everything else, but because it’s politically expedient, they don’t on this,” Martin said.
http://www.bloomberg.com/news/2014-03-06/teenage-e-cigarette-use-likely-gateway-to-smoking.html

Researchers claim electronic cigarettes "gateway" to real smoking but experts unsure

ByRYAN JASLOW / CBS NEWS
A new study may confirm some fears health officials had about electronic cigarettes. Researchers found teens who use e-cigarettes may be more likely to become addicted to actual cigarettes, doctors at the University of California San Francisco reported on March 6 in JAMA Pediatrics.
“E-cigarettes are likely to be gateway devices for nicotine addiction among youth, opening up a whole new market for tobacco,” Dr. Lauren M. Dutra, a postdoctoral scholar at UCSF School of Medicine, said in a university press release.
But, the study did not definitively prove that young e-cigarette smokers turned to tobacco after smoking the products, since it examined two large data pools of teens in 2011 and 2012 rather than tracking the same people for two years. Some experts have questioned the conclusions drawn by researchers.
Part of the findings suggest kids who used the products also experimented with conventional cigarettes and weren’t any more likely to quit using them, as some proponents had suggested.
E-cigarettes are metallic tubes that allow liquid nicotine to be converted into an inhalable vapor without the use of combustion. The battery-powered devices look like pens or cigarettes, and can come in flavors including strawberry, licorice and chocolate.
Researchers looked at survey data collected from more than 17,000 middle and high school students in 2011 and more than 22,500 in 2012.
In 2011, 3.1 percent of adolescents said they tried an e-cig once and 1.1 percent were current users. By 2012, 6.5 percent of adolescents had tried the products and 2 percent were current users.
Ever using and current use of e-cigarettes increased odds of experimenting with conventional cigarettes, smoking at least 100 cigarettes (ever smoking), or smoking at least 100 cigarettes and smoking within the past 30 days (current smoking). Teens who smoked both conventional cigarettes and e-cigarettes smoked more cigarettes per day than non-e-cigarette users, they also found.
Teens who used e-cigarettes and conventional cigarettes were much less likely to have abstained from cigarettes in the past 30 days, 6 months or the last year, despite some proponents claiming it could be used to help people quit smoking, Dutra added.
“Our results suggest that e-cigarettes are not discouraging use of conventional cigarettes,” she said.
Product users however were more likely to say they planned to quit smoking real cigarettes in the next year compared to smokers who did not also use e-cigs.
Previously, the Centers of Disease Control and Prevention had reported upticks in the number of adolescents and adults using electronic cigarettesin recent years. Nationally, cigarette-smoking rates have fallen in adults.
“This rapid rise has stimulated a vigorous debate in the tobacco control community over the potential public health impact of (e-cigarettes) and about how best to regulate them,” wrote Dr. Frank J. Chaloupka, a professor of economics who directs the Health Policy Center at the University of Illinois at Chicago in an editorial published in the same issue.
The article highlights some of the concerns about the public health harms, he added, noting the doubling of ever use of e-cigarettes among teens between 2011 and 2012, and the reduced likelihood to stop smoking conventional cigarettes among the experimenters.
“While much remains to be learned about the public health benefits and/or consequences of (e-cigarettes) use, their exponential growth in recent years, including their rapid uptake among youths, makes it clear that policy makers need to act quickly,” he wrote.
The Food and Drug Administration does not currently regulate e-cigarettes unless they claim health benefits, such as getting people to quit smoking.The FDA has previously announced intentions to tighten regulation of the products.
However, some experts questioned the conclusion drawn by the authors that e-cigs could be a gateway to smoking the real thing.
“The data in this study do not allow many of the broad conclusions that it draws,” Thomas J. Glynn, a researcher at the American Cancer Society, told The New York Times.
“The authors seem to have an axe to grind,” Dr. Michael Siegal, a professor of community health sciences at Boston University School of Public Health who has previously spoken in favor of e-cigarettes, told Reuters. “I could equally argue that what this study shows is that people who are heavy smokers are attracted to e-cigarettes because they are looking to quit.”
Last September, 40 state attorneys general asked the federal government to tighten regulation, charging e-cigarettes are marketed to young people through its fruit and candy flavors and cartoon-like advertising.
New York City, Chicago and Los Angeles have banned e-cigarette uses in some public places, putting them in the same category of other tobacco products.
http://www.cbsnews.com/news/researchers-claim-electronic-cigarettes-gateway-to-real-smoking-but-experts-unsure/