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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/

‘Vaping’ Santa Billboard Causes Backlash

By Gillian Mohney

ht vaping santa kb 131218 16x9 608 Vaping Santa Billboard Causes Backlash
E-cigarette company draws controversy after using “vaping” Santa in billboard. (VaporShark/Facebook)

This might put Santa on the naughty list.
The e-cigarette company Vapor-Shark is facing backlash after putting up a billboard of a “vaping” Santa Claus in Florida. The Campaign for Tobacco-Free Kids complained the ad was similar to old cigarette ads aimed at children and called it ” a new low.”
Even e-cigarettes fans said the ad was inappropriate.
“Showing Santa vaping, globally recognized as a children’s icon, is irresponsible and is and will be seen as a ploy to appeal to under age customers,” said Aaron Frazier, a self-described “vapor,” on the company’s Facebook Page. 
“We disagree … it’s a difference of opinion” said Vapor Shark CEO Brandon Liedel of their dissenters. “The only type of kid that would be persuaded by Santa Claus is a 5-year-old. I think a gorgeous woman would be more persuasive for a teenager.”
http://abcnews.go.com/blogs/health/2013/12/18/vaping-santa-billboard-causes-backlash/

Tobacco down among youths; marijuana up

By Cheryl Wetzstein – The Washington Times
More and more younger Americans are snuffing out their cigarettes — at least those filled with tobacco, a new national survey suggests.
The number of 8th, 10th and 12th graders who said they smoked tobacco cigarettes in the last 30 days fell again — to fewer than one in 10 adolescents — in 2013, according to Monitoring the Future (MTF), an annual survey of more than 40,000 students.
Since most smokers begin tobacco habits at a young age, the new data are being welcomed by public health officials, as it shows a long-term trend away from smoking.
Since the peak year of 1997, “the proportion of students currently smoking has dropped by two-thirds — an extremely important development for the health and longevity of this generation of Americans,” said Lloyd Johnston, principal investigator of the MTF and a research professor at the University of Michigan’s Institute for Social Research.
The MTF results on young-adult marijuana use, however, were more troubling, researchers said.
More teens in all grades took a sanguine view of marijuana — 60 percent of high-school seniors said smoking pot was not harmful.
At the same time, the MTF showed that more students were smoking marijuana: For eighth graders, use of marijuana in the past month rose from 5.8 percent in 2008 to 7 percent in 2013. For 10th graders, past-month usage was up from 13.8 percent to 18 percent, and for 12th graders, it rose 19.4 percent to 22.7 percent.
Seeing more 13- and 14-year-olds using marijuana is a significant cause for alarm, said Nora D. Volkow, director of the National Institute on Drug Abuse.
Young teens, whose experimentation with marijuana leads to regular use, “are setting themselves up for declines in IQ and diminished ability for success in life,” said Dr. Volkow, adding that marijuana use can interfere with memory and cognitive functionality.
Marijuana is not a benign substance, added Gil Kerlikowske, director of the Office of National Drug Control Policy. He and Dr. Volkow highlighted MTF findings that, in states where marijuana can be prescribed as a medicinal product, a third of the marijuana-smoking 12th graders said one of the ways they got the product was through “someone else’s” prescription.
Marijuana, which can act as a stimulant, depressant or hallucinogen in humans, remains illegal under federal law. However, 20 states and the District permit marijuana use for medicinal purposes — such as reducing nausea and pain related to cancer treatments — and Colorado and Washington state have legalized the production, sale and use of recreational marijuana. Groups like the Marijuana Policy Project want to see marijuana products regulated like tobacco and alcohol products.
In August, the Justice Department said it would not target the marijuana industry in states where it is legal as long as states keep pot away from children, other states, criminal cartels and federal property.
Dr. Volkow said Wednesday her agency would be also be watching emergency-room admissions, traffic accidents and school-performance statistics to see if they are affected by more liberal marijuana laws.
In other highlights of the MTF:
• Fewer teens said they used synthetic marijuana products, known by such names as K2 and Spice. Public officials have raised alarms about the dangers associated with these cheap, new drugs.
• Current alcohol use fell in all grades — to 10.2 percent among eighth graders, 25.7 percent in 10th graders and 39.2 percent in 12th graders.
• Non-medical use of prescription drugs, like Vicodin and OxyContin, dropped again.
http://www.washingtontimes.com/news/2013/dec/18/tobacco-down-among-youths-marijuana-up/#ixzz2nw9i3fhm
<h1>Tobacco down among youths; marijuana up</h1>
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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/

FDA’s anti-smoking campaign to target teens

By 

Early next year, half a century after the U.S. surgeon general first proclaimed the deadly effects of smoking, the Food and Drug Administration will launch a public health campaign unlike any the federal government has ever attempted.
Slick, data-driven and well-funded, the effort could cost up to $600 million over the next five years, all of it paid for by the tobacco industry under a 2009 law.
It will feature carefully crafted anti-smoking messages targeting specific types of teenagers, from rural kids who watch “Duck Dynasty” and drive pickups to gay and lesbian teens who prefer the nightclub scene.
In contracting with top-flight advertising firms, conducting intense demographic research and micro-targeting subsets of the 12-to-17-year-old crowd, the FDA is hoping to take a page from the marketing playbook of corporate America.
“It’s the federal government going to ad firms of the quality and ability that the tobacco industry has always used,” said Matthew Myers, president of the Campaign for Tobacco-Free Kids, a national advocacy group. “They’re ensuring that the media designed to educate and reach at-risk young people is of the same quality that the tobacco industry has used to attract them.”
The federal government can scarcely compete with the tobacco industry, whichspent more than $8 billion on advertising and promotions during 2011, according to the most recent data available from the Federal Trade Commission.
But Mitch Zeller, head of the FDA’s Center for Tobacco Products, said he hopes that in undertaking the first federally funded anti-smoking campaign aimed exclusively at young people, the government can put a dent in the number of teenagers who smoke their first cigarette each day — now roughly 3,300, with an estimated 700 to 800 becoming addicted.
“Once they become regular smokers or regular tobacco users, then it’s the progression to addiction, disease and premature death,” Zeller said. “We have a responsibility . . . to reduce the death and disease toll from tobacco use. That includes educating kids about the harms of tobacco use in an effective way, in a way that will reach them.”
Previous government-backed anti-smoking initiatives have not been on this scale. Some individual states have run campaigns designed to discourage youth smoking — efforts largely financed by a 1998 settlement under which tobacco companies paid states billions of dollars to settle Medicaid claims for tobacco-related health-care costs.
Last year, the Centers for Disease Control and Prevention launched the first federally funded national anti-smoking campaign, but that was geared toward getting existing smokers to stop, not toward teen prevention.
For the new campaign, the FDA is turning to people such as Jeff Jordan, 29. The agency has given him $152 million and a mission: Find a way to cut through the cluttered modern media landscape and persuade teenagers to steer clear of tobacco. And not just any teenagers, but those particularly at risk for becoming smokers, such as Hispanics, Asian Americans, African Americans, gays and lesbians.
Jordan’s San Diego-based firm, Rescue Social Change Group, has spent years developing anti-smoking campaigns that target slivers of youth culture, from teens in Northern Virginia’s alternative rock scene to gay, lesbian, bisexual and transgender teens in Las Vegas. He said he believes that to have any chance of reaching those and other at-risk populations, the government must break free of generic messages aimed at reaching all teens.
“If half the population likes blue, and the other half likes yellow, a government agency will make their campaign green,” Jordan told an audience in Finland in 2012. “But they need to realize that being everything to everyone doesn’t work in marketing. They need to segment their audience and tailor their campaigns to be effective.”
The FDA has committed $300 million to the anti-smoking ad blitz in 2014 and 2015, with the possibility of doubling that in coming years. While a chunk of the money will initially be used to target teens who have never smoked or are intermittent tobacco users, most will be aimed at young people with higher risks of becoming addicted to tobacco.
Kathy Crosby, an FDA official and advertising industry veteran overseeing the campaigns, said the agency hopes to replicate the ways in which corporate America focuses on certain demographic groups, including notoriously hard-to-reach teenagers.
“Brands are masters at understanding the marketplace, understanding the dynamics of the marketplace and carving out a way to reach their target audiences,” Crosby said. “That’s what we’re trying to do.”
Neither the FDA nor the firms it has hired have offered specifics about the campaigns, saying they are a work in progress. But Jordan said the first and most important step is researching which teens to target, then crafting messages that ring true to that group.
“No public health effort before has truly fit into a youth culture, the way they see their culture,” said Jordan, whose small firm has doubled in size to nearly 60 employees and opened a Washington office since starting to work on the FDA project. “The most important part is to be authentic and credible. . . . If we can make a campaign that’s specifically designed for a group, that looks like them, sounds like them, identified with them, we can help them see that people like them are deciding smoking is unhealthy.”
He calls the approach “creating bull’s-eyes” at the fringes of youth culture. “If it actually works,” he said, “we’re talking about reducing [smoking] rates among the groups that are most resistant to a generally targeted message.”
Previous anti-smoking campaigns created by the various firms hired by the FDA offer hints about what to expect. The ads tend to be more edgy than people might expect from a government-backed campaign and often feature young people talking in blunt terms to peers about the consequences of tobacco use.
The firms involved also are adept at getting messages out in ways beyond traditional television and radio advertising, such as creating specialized Web sites and blogs, using Twitter and Facebook, hosting events at bars and staging concerts headlined by bands popular among target audiences.
Better World Advertising, a firm that the FDA has hired to target Native American teens, created a campaign in New York to encourage doctors to talk more with patients about the risks of tobacco, and another in California reminding parents of the dangers of secondhand smoke. The slogan for the latter: “When you smoke, they smoke.”
Another firm working with the FDA, Draftfcb, recently helped the government revamp the image of Smokey Bear.
Zeller, the FDA’s top tobacco official, knows a thing or two about the potential benefits of an aggressive anti-smoking campaign. In the early 2000s, he spent time as an executive at the nonprofit American Legacy Foundation, where he oversaw the “Truth Campaign.”
Funded by a massive tobacco-industry settlement in 1998, the campaign was characterized by in-your-face ads meant to educate teens about the tobacco industry’s misleading marketing practices.
“I know how to do this, and I know what works,” Zeller said in an interview with The Washington Post earlier this year. “And what works is, get really smart people from the outside, do it under contract, do the right research, develop the right messages, have a laser beam focus on who your target is and then buy your media correctly. And then spend money. Because it’s a dose response. Once you’ve done those first three or four things, the more you invest, the more impact you will have.”
Studies have concluded that the “truth” campaign had a tangible effect, discouraging some young people from starting to smoke and prompting others to think twice about their habit.
Another recent study estimated that 1.6 million Americans tried to quit smoking after last year’s CDC campaign, which featured stark images and pleas from adult ex-smokers suffering from a variety of ailments, including amputated limbs and throat cancer.
Whatever shape the FDA’s anti-smoking ads take, Jordan said he’s encouraged to see the government trying to reach teenagers in new and creative ways, in part by taking a chance on firms like his, which aren’t exactly mainstream.
“From the perspective of a federal agency, we’re by no means a quiet company,” he said. “Our work is risque and really in your face, and it’s meant to really cause change. I’m thankful they were willing to take the risk.”
http://www.washingtonpost.com/national/health-science/fdas-anti-smoking-campaign-to-target-teens/2013/12/09/5b24030a-4d73-11e3-be6b-d3d28122e6d4_story.html

National Report: North Dakota Ranks 1st in Protecting Kids from Tobacco

Washington, DC – Fifteen years after the 1998 state tobacco settlement, North Dakota ranks 1st in the nation in funding programs to prevent kids from smoking and help smokers quit, according to a national report released today by a coalition of public health organizations.
North Dakota currently spends $9.5 million a year on tobacco prevention and cessation programs, which meets the funding level recommended by the U.S. Centers for Disease Control and Prevention (CDC).  North Dakota is one of only two states, along with Alaska, that currently fund tobacco prevention programs at CDC-recommended levels.
Other key findings for North Dakota include:
•        North Dakota this year will collect $64.3 million in revenue from the 1998 tobacco settlement and tobacco taxes and will spend just 14.8 percent of it on tobacco prevention programs.
•        The tobacco companies spend $27.9 million a year to market their products in North Dakota. This is 3 times what the state spends on tobacco prevention.
The annual report on states’ funding of tobacco prevention programs, titled “A Broken Promise to Our Children: The 1998 State Tobacco Settlement 15 Years Later,” was released by the Campaign for Tobacco-Free Kids, American Heart Association, American Cancer Society Cancer Action Network, American Lung Association, the Robert Wood Johnson Foundation and Americans for Nonsmokers’ Rights.
A 2008 voter-approved ballot initiative requires North Dakota to fund a tobacco prevention and cessation program at the CDC-recommended level.  In just two years, from 2009 to 2011, North Dakota reduced smoking among high school students by 13.5 percent (from 22.4 percent to 19.4 percent who smoke).
North Dakota made further progress in 2012 when voters overwhelmingly approved a comprehensive smoke-free law that applies to all workplaces, including restaurants and bars.  Health advocates are urging North Dakota leaders to also increase the state’s cigarette tax, which at just 44 cents per pack ranks 46th in the nation and is well below the state average of $1.53 per pack.
“We applaud North Dakota for its strong commitment to preventing kids from smoking, helping smokers quit and protecting all its citizens from harmful secondhand smoke,” said Matthew L. Myers, President of the Campaign for Tobacco-Free Kids. “North Dakota is making a smart investment in tobacco prevention that will save lives and save money by reducing tobacco-related health care costs. To further reduce tobacco use, North Dakota’s leaders should also increase the tobacco tax.”
In North Dakota, 19.4 percent of high school students smoke, and 400 more kids become regular smokers each year. Tobacco annually claims 800 lives and costs the state $247 million in health care bills.
Nationally, the report finds that most states are failing to adequately fund tobacco prevention and cessation programs. Key national findings of the report include:
•        The states this year will collect $25 billion from the tobacco settlement and tobacco taxes, but will spend just 1.9 percent of it – $481.2 million – on tobacco prevention programs. This means the states are spending less than two cents of every dollar in tobacco revenue to fight tobacco use.
•        States are falling woefully short of the CDC’s recommended funding levels for tobacco prevention programs. Altogether, the states have budgeted just 13 percent of the $3.7 billion the CDC recommends.
There is more evidence than ever before that tobacco prevention and cessation programs work to reduce smoking, save lives and save money. Florida, which has a well-funded, sustained tobacco prevention program, reduced its high school smoking rate to just 8.6 percent in 2013, far below the national rate. One study found that during the first 10 years of its tobacco prevention program, Washington state saved more than $5 in tobacco-related hospitalization costs for every $1 spent on the program.
Tobacco use is the number one cause of preventable death in the U.S., killing more than 400,000 people and costing $96 billion in health care bills each year. Nationally, about 18 percent of adults and 18.1 percent of high school students smoke.
More information, including the full report and state-specific information, can be obtained at www.tobaccofreekids.org/reports/settlements.
 

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

Kentucky Regional Poison Control Center sees 333-percent increase

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

E-cigarettes: Should They Be Regulated as Cigarettes?

., Commissioner, Chicago Department of Public Health

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

Keep E-Cigarettes Away From Teens

Chicago Sun Times Editorial Board
Electronic cigarettes, those hip new cigarettes that blow a thick white vapor rather than smoke, are clearly less harmful than real cigarettes.
But that doesn’t mean e-cigarettes are harmless.
And until we know something different, that’s how we ought to treat them.
Folks who are wary of e-cigarettes — battery-operated nicotine inhalers that do not produce smoke — are going after them on two fronts. This group includes Mayor Rahm Emanuel, New York’s city council, other municipalities and states as well as the U.S. Food and Drug Administration.
The first is a no-brainer: keeping e-cigarettes out of the hands of teens and pre-teens. We cheer on efforts to do that in the city of Chicago and at the national level.
E-cigarettes don’t burn tar or tobacco, removing the risk of exposure to carcinogens in cigarette smoke. But they contain nicotine and the risks there, particularly to young people, are well documented. Nicotine is highly addictive, can impact the development of young brains, raises the heart rate and is one of the elements of smoking associated with heart disease.
E-cigarettes are being marketed aggressively to young people and come in flavors clearly meant to entice, such as bubble gum, pina colada and cherry. It appears to be working: between 2011 and 2012, use among middle and high school students more than doubled, according to the U.S. Centers for Disease Control. The risks of young people getting hooked on e-cigarettes and then switching to the more noxious traditional cigarettes are all too real.
Fortunately, Illinois already has joined about half the states in banning the sale of e-cigarettes to anyone under 18, effective Jan. 1. The FDA appears poised to take action across the country, with the agency noting with “great concern” the rise in youth e-cigarette usage. The wisest course is to ban the sale or marketing to anyone under 18.
The Chicago City Council could take that a step farther under an ordinance introduced last week. The mayor proposed prohibiting the sale of methol and flavored tobacco products, including e-cigarettes, within 500 feet of Chicago schools, up from 100 feet.
The mayor also wants to ban the smoke-less cigarettes anywhere that regular cigarettes are banned, including virtually all of indoor Chicago expect homes and cars, and at least 10 feet from business entrances. This is the second front that critics of e-cigarettes are pursuing. New York City will consider a similar ban this month.
This one is a little trickier but not by much. Without smoke, the risks to non-smokers nearby are clearly diminished. But the risks are not eliminated — there is concern that nicotine and chemicals such as formaldehyde and acetone are present in the e-cigarette vapor as well as other particles that can cause heart problems.
There is only limited and preliminary research on the potential hazards of e-cigarette vapors to others, leaving us in the do-no-harm category.
Until we know the full second hand effects of smoke-less cigarettes, it’s prudent to restrict them in the same way we do regular cigarettes. The City Council can and should be a forerunner in this area.
If and when the science on this questions is settled, a ban could be reconsidered.
Until then, do no harm.
http://www.suntimes.com/opinions/24065452-474/keep-e-cigarettes-away-from-teens.html