vaping

Cases of Vaping-Related Lung Illness Surge, Health Officials Say

Source: New York Times
Date: 09/06/19
Author: Matt Ritchel & Denise Grady

Indiana announced a third death linked to the illness on Friday, and Minnesota a fourth. State and federal health officials are working urgently to understand the causes.

Medical experts and federal health officials on Friday warned the public about the dangers of vaping and discouraged using the devices as the number of people with a severe lung illness linked to vaping has more than doubled to 450 possible cases in 33 states. The number of deaths linked to vaping rose to four from two on Friday.

The Indiana Department of Health announced the third death, saying only that the victim was older than 18. Hours later, officials in Minnesota confirmed that a fourth person had died. The patient, who was 65, had a history of lung disease, but state officials said his acute lung injury was linked to “vaping illicit T.H.C. products.”

The Los Angeles County Department of Public Health was investigating a possible fifth death, saying on Friday afternoon that the fatality was “associated with the use of e-cigarettes, also known as vaping.”

“There is clearly an epidemic that begs for an urgent response,” Dr. David C. Christiani of the Harvard T.H. Chan School of Public Health wrote in an editorial published on Friday in The New England Journal of Medicine.

The editorial called on doctors to discourage their patients from using e-cigarettes and for a broader effort to increase public awareness about “the harmful effects of vaping.”

Officials from the Centers for Disease Control and Prevention echoed that call in a briefing.

“While this investigation is ongoing, people should consider not using e-cigarette products,” said Dr. Dana Meaney-Delman, who is leading the C.D.C.’s investigation into the illness.

C.D.C. officials said they believe that some “chemical” is involved as the cause but they have not identified a single responsible “device, product or substance,” Dr. Meaney-Delman said.

Dr. Christiani wrote in The New England Journal editorial that it was not yet clear which substances were causing the damage. E-cigarette fluids alone contain “at least six groups of potentially toxic compounds,” he wrote, but he noted that many of the patients had also vaped substances extracted from marijuana or hemp. The mixed-up stew of chemicals might even create new toxins, Dr. Christiani suggested. The journal also published a study of two clusters of 53 cases in Wisconsin and Illinois.

What looked like scattered cases earlier this summer has become a full-fledged and widespread public health scare, leaving otherwise healthy teenagers and young adults severely ill.

The first case of the mysterious lung illness, in Illinois, came in April, indicating that the syndrome emerged earlier than the mid-June date that federal officials have often cited as the time the afflictions began.

The patients studied in Illinois and Wisconsin were typically “healthy, young, with a median age of 19 years and a majority have been men,” said Dr. Jennifer Layden, chief medical officer and state epidemiologist for the Illinois Department of Public Health. A third were younger than 18.

The journal article about the Illinois and Wisconsin patients said that 98 percent were hospitalized, half required admission to the intensive care unit, and a third had so much trouble breathing that they needed to be placed on ventilators.

Eighty-four percent had vaped a product including T.H.C., the high-inducing chemical in marijuana. Dr. Layden said a majority had also used a “nicotine-based product,” noting that there were “a range of products and devices.”

The journal article about those cases mentions that the heating coils in vaping devices might release metal particles that could be inhaled.

“The focus of our investigation is narrowing but is still faced with complex questions,” said Ileana Arias, the C.D.C.’s acting deputy director for noninfectious diseases. She added, “We are working tirelessly and relentlessly.”

Mitch Zeller, the director of the Center for Tobacco Products at the Food and Drug Administration, said particular concern is developing around products that are jury-rigged by vaping retailers, or tampered with or mixed by consumers themselves. “Think twice,” he said, urging consumers to avoid vaping products purchased on the street or that they have made themselves.

Public health officials have underscored one fundamental point: that the surge in illnesses is a new phenomenon and not merely a recognition of a syndrome that may have been developing for years.

Indiana on Friday confirmed a third death from a severe lung illness linked to vaping shortly before officials in Minnesota confirmed a fourth. Two other people — one in Illinois, the other in Oregon, both of whom were adults — have died from what appears to be the same type of illness, health officials in those states have said.

Patients afflicted with the illness typically have showed up in emergency rooms with shortness of breath after several days of flulike symptoms, including high fever.

In an especially severe case in Utah, a 21-year-old man had such serious lung damage that even a ventilator could not provide enough breathing help. Doctors had to connect him to a machine that pumped oxygen directly into his bloodstream to keep him alive.

Fluid from his lungs contained white blood cells full of fat, not from the substances he had vaped, but more likely a sort of debris from the breakdown of his lung tissue.

“We were flying in the dark with this kid,” said Dr. Sean J. Callahan, a pulmonologist and critical care specialist at the University of Utah, and an author of a letter about six vaping patients in Utah that was published Friday in The New England Journal of Medicine.

“I thought he was going to die,” Dr. Callahan said. “I kept thinking, his parents were there, if this were me and my wife, how crushed we would be for something that is completely avoidable. I worry that these products are really geared toward young people and kids, and we need a call to ban these things. That’s my call to action as a father and a doctor.”

The patient survived, and went home after two weeks in the hospital.

It is too soon to tell whether people with vaping injuries will recover fully, or sustain lasting lung damage, Dr. Callahan said.

He added that doctors need to take better histories of young patients who come in with pneumonialike symptoms to try to find the real cause. Some patients and their families are forthcoming about vaping, but others are not. In one case, he said, medical residents were puzzled by what could have caused the illness. He asked the patient’s mother to leave the room and then, instead of asking if the patient vaped, he simply asked, “What do you vape?” The answer was T.H.C.

The state of New York, where 34 people have become ill, said on Thursday that vaping samples from eight of its cases showed high levels of a compound called vitamin E acetate. Investigators there are focusing on the possibility that the oily substance might be playing a key role in the illness.

However, some of the more than 100 vaping samples being examined by the federal government did not test positive for vitamin E acetate, so that compound remains only one of many possible causes of the heavy lung inflammation.

September, 2019|Oral Cancer News|

E-cig users develop some of the same cancer-related molecular changes as cigarette smokers

Source: EurekAlert!
Date: February 14, 2019

If you think vaping is benign, think again.

A small USC study shows that e-cig users develop some of the same cancer-related molecular changes in oral tissue as cigarette smokers, adding to the growing concern that e-cigs aren’t a harmless alternative to smoking.

The research, published this week in the International Journal of Molecular Sciences, comes amid a mushrooming e-cig market and mounting public health worries. On a positive note, recent research found vaping is almost twice as effective as other nicotine replacement therapies in helping smokers quit.

But among adolescents, vaping now surpasses smoking, and there’s evidence that e-cig use leads to nicotine addiction and future smoking in teens.

“The existing data show that e-cig vapor is not merely ‘water vapor’ as some people believe,” said Ahmad Besaratinia, an associate professor at Keck School of Medicine of USC and the study’s senior author. “Although the concentrations of most carcinogenic compounds in e-cig products are much lower than those in cigarette smoke, there is no safe level of exposure to carcinogens.”

Besaratinia emphasized that the molecular changes seen in the study aren’t cancer, or even pre-cancer, but rather an early warning of a process that could potentially lead to cancer if unchecked.

The researchers looked at gene expression in oral cells collected from 42 e-cig users, 24 cigarette smokers and 27 people who didn’t smoke or vape. Gene expression is the process by which instructions in our DNA are converted into a functional product, such as a protein. Certain alterations in gene expression can lead to cancer.

They focused on oral epithelial cells, which line the mouth, because over 90 percent of smoking-related cancers originate in epithelial tissue, and oral cancer is associated with tobacco use.

Both smokers and vapers showed abnormal expression, or deregulation, in a large number of genes linked to cancer development. Twenty-six percent of the deregulated genes in e-cig users were identical to those found in smokers. Some deregulated genes found in e-cig users, but not in smokers, are nevertheless implicated in lung cancer, esophageal cancer, bladder cancer, ovarian cancer and leukemia.

Besaratinia and his team plan to replicate his findings in a larger group of subjects and explore the mechanisms that cause gene deregulation. He’s also launching another experiment in which smokers switch to e-cigs; he wants to see whether any changes in gene regulation occur after the switch.

“For the most part, the participants are as curious as we are to know whether these products are safe,” he said.

In addition to Besaratinia, the study’s other authors are first author Stella Tommasi, Andrew Caliri, Amanda Caceres, Debra Moreno, Meng Li, Yibu Chen and Kimberly Siegmund, all of USC.

The research was supported by grants from the National Institute of Dental and Craniofacial Research of the National Institutes of Health (1R01DE026043) and the University of California Tobacco-Related Disease Research Program (TRDRP-25IP-0001 and TRDRP-26IR-0015).

February, 2019|Oral Cancer News|

The US surgeon general just issued a rare advisory about e-cigs like the Juul — here’s why vaping is so dangerous

In a rare national advisory, the top US public health official warned Americans of the dangers of e-cigarettes like the Juul, a popular device that lets users inhale nicotine vapor without burning tobacco.

US Surgeon General Jerome Adams said in the advisory on Tuesday that e-cigs like the Juul are a particular danger to kids and teens and called for fresh measures to halt their rising popularity.

“We need to protect our kids from all tobacco products, including all shapes and sizes of e-cigarettes,” Adams said in a statement, adding, “We must take action now to protect the health of our nation’s young people.”

The advisory singles out Juul multiple times, saying the sleek devices are popular among teens because they’re easy to conceal and don’t emit much odor. It tells parents, health professionals, and teachers to be on the lookout for all forms of nicotine-delivery devices, including e-cigs.

Adams’ announcement comes on the heels of warnings from several other federal agencies about a rise in e-cig use, including from the Centers for Disease Control and Prevention and the Food and Drug Administration.

In November, after new CDC data pointed to a 78% increase in e-cig use among high-school students, FDA Commissioner Scott Gottliebannounced moves to further restrict sales of e-cigarettes to prevent them from getting into the hands of young people. That included a crackdown on flavored offerings, which researchers say appeal strongly to young people.

Several days before the FDA’s announcement, Juul Labs, the Silicon Valley startup behind the most popular e-cig in the US, temporarily halted sales of its flavored varieties in stores until they agreed to adopt the company’s new age restrictions and a stronger system for making sure customers are at least 21 years old.

‘E-cigarettes and youth don’t mix’

Though smoking conventional cigarettes is uniquely deadly, and vaping appears to be somewhat healthier (especially for adults looking to switch), public health experts are concerned about how e-cigarettes affect young people.

Because of their runaway popularity, e-cigs could create a new generation of Americans hooked on nicotine, one of the world’s most addictive substances and the key ingredient in e-cigs like the Juul, these experts warn. Their concern comes in part from a host of studies suggesting that teens who vape are significantly more likely to go on to smoke regular cigarettes than teens who never vape.

This finding could be related to the way nicotine affects the developing brains of young people. Though the research on e-cigs is still limited because the devices are so new, researchers have a wealth of data on the negative effects of nicotine on teens who start smoking early.

In brain-imaging studies of adolescents who started smoking in their teens, researchers have found signs of reduced activity in the prefrontal cortex, the part of the brain tied to planning and decision-making. The same teens performed worse on memory and attention tasks than teens who didn’t smoke.

Nicholas Chadi, a clinical pediatrics fellow at Boston Children’s Hospital, spoke about the Juul at the American Society of Addiction Medicine’s annual conference this spring. He described some anecdotal effects of nicotine vaping that he’d seen among teens in and around his hospital.

“After only a few months of using nicotine,” the teens “describe cravings, sometimes intense ones,” Chadi said, adding that “after only a few hundred cigarettes — or whatever the equivalent amount of vaping pods — some start showing irritability or shakiness when they stop.”

Most e-cigs contain toxic metals, and using them may increase the risk of a heart attack

Beyond the effects of e-cigs on the developing brain, a host of health issues related to e-cigs is beginning to emerge.

This spring, scientists looked at the compounds in several popular brands of e-cigs aside from the Juul and found some of the same toxic metals that are in conventional cigarettes, such as lead.

A study published this month found that people who vape tended to have high concentrations of some of these toxic chemicals in their bodies.

In another study published this summer, scientists concluded that there was substantial evidence tying daily e-cig use to an increased risk of a heart attack. And this fall, a small study with rats suggested that vaping could have a negative effect on wound healing that’s similar to the effect of regular cigarettes.

But many teens may not be aware of these health risks. Researchers say that could be because so little research has focused on the Juul, which has captured a nearly 80% market share in the US.

So for a study published in October, researchers from Stanford University’s School of Medicine surveyed young people who vaped and asked them whether they used the Juul or another e-cigarette.

From their sample of 445 high-school students, the researchers observed that teens who used the Juul tended to say they vaped more frequently compared with those who used other devices. Juul users also appeared to be less aware of how addictive the devices could be, compared with teens who used other e-cigs.

“I was surprised and concerned that so many youths were using Juul more frequently than other products,” Bonnie Halpern-Felsher, a professor of pediatrics who was a lead author of the study, said in a statement.

“We need to help them understand the risks of addiction,” she added. “This is not a combustible cigarette, but it still contains an enormous amount of nicotine — at least as much as a pack of cigarettes.”

December, 2018|Oral Cancer News|

Youth vaping has soared in 2018, new data show

Source: www.wsj.com
Authors: Betsy McKay and Jennifer Maloney

Number of high schoolers who used e-cigarettes in the past 30 days has risen some 75% in 2018

Teen use of e-cigarettes has soared this year, according to new research conducted in 2018 that suggest fast-changing youth habits will pose a challenge for public-health officials, schools and parents.

The number of high-school students who used e-cigarettes in the past 30 days has risen roughly 75% since last year, according to a person who has seen new preliminary federal data.

That would equate to about three million, or about 20% of high-school students, up from 1.73 million, or 11.7% of high-school students in the most recently published federal numbers from 2017.

Nearly a third of 13-to-18-year-olds who responded to a separate survey conducted by The Wall Street Journal with research firm Mercury Analytics said they currently vape.

The new numbers offer a rare look at evolving teen vaping habits. Sales of e-cigarettes are expected nearly to double this year over 2017, and researchers have wondered how much of that increase is because of teen use. But there can be a long lag time between the collection of data and public reports.

Most of the teens who vape said they are doing it for reasons other than to quit smoking, according to the Journal’s survey conducted in 49 states in May. More than half said they do it because they like the flavors that e-cigarette liquids come in and they think vaping is fun. More than two-thirds said they believe vaping can be part of a “healthy life.”

U.S. Food and Drug Commissioner Scott Gottlieb said last week that teen use “has reached an epidemic proportion.” He announced new measures to curb teen vaping and warned he is considering banning flavored products.

The preliminary federal numbers from 2018 are from the government’s latest National Youth Tobacco Survey, according to the person familiar with the data. The survey was conducted in the spring.

The number of high-school users of combustible, or traditional, cigarettes increased slightly from the 2017 survey, this person said.

Monitoring the Future, a long-running youth survey conducted by the University of Michigan, found in 2017 that 16.6% of 12th-graders and 13.1% of 10th-graders had vaped nicotine, marijuana or flavoring in the previous 30 days. Richard Miech, the survey’s principal investigator, said he believes there has been a “considerable jump” in adolescent vaping this year.

This year’s sales growth has been driven largely by the Juul, a slim device that resembles a flash drive and has become a status symbol among teens, who often vape sweet-flavored liquids like mango. Juul has a 72.8% dollar share of the estimated $2.5 billion market in channels measured by market-research firm Nielsen, according to a Wells Fargo analysis.

Health officials are concerned that the high levels of nicotine in some liquids can alter the chemistry of developing brains, making them more sensitive to addiction.

Juul Labs Inc. says its device is intended to help adult smokers quit. “We cannot be more emphatic on this point: No minor or non-nicotine user should ever try JUUL,” a spokeswoman said. “Our packaging includes a prominent nicotine label and clearly states for adult smokers.”

Parents and educators say they are trying to do more to combat vaping with children back to school. “There is a lot more that needs to be done because at this point there are so many thousands of kids who are addicted to nicotine,” said Meredith Berkman, a founder of Parents Against Vaping E-Cigarettes, which advocates for action to restrict e-cigarette access.

Trinity School in New York City, for example, plans this year to incorporate more material on e-cigarettes into its health-education program for students, said John Allman, head of school. “Parents are letting us know about this,” he said of teen use.

The Journal survey was conducted online with 1,722 participants initially, and most of the survey questions focused on 1,007 participants who said they either vape, used to vape, or know someone who vapes. Nearly three-quarters of the 1,007 participants were 17 or 18 years old; 62% were white, 21% were African-American and 18% were Hispanic. Rates of e-cigarette use are higher in older than younger teens.

A total of 501 participants said they vape: 153 regularly, and 348 occasionally. Their most common reasons for vaping were for the flavors, and because they think it’s cool. “I just enjoy the flavor and blowing really big clouds,” one participant wrote.

“It made me feel good the first time I tried it, and I got hooked,” wrote another.

When asked what they were inhaling, 71% said flavors, and 61% said nicotine.

More than two-thirds of the current vapers said they believe vaping can be part of a healthy life, though they believe there are some risks. More than half said their views of vaping had been influenced by posts on social media, an issue that has public-health experts concerned.

The percentage of respondents who said they vape is unusually high, and should be interpreted with caution, said David Abrams, a professor in the College of Global Public Health at New York University. “We can’t make too much of it,” he said, because the survey was conducted online, and the questions weren’t all asked the way they are asked on large academic or government surveys.

Measures taken by the FDA, Juul, schools and parents to limit underage access to vaping devices since this spring may also be having an effect, some experts say. “It’s possible that prevalence and use may decline over time,” said Jidong Huang, an associate professor of health management and policy at Georgia State University who studies e-cigarette use.

September, 2018|Oral Cancer News|

E-cigarettes ‘could give you mouth cancer by damaging your DNA’

Source: metro.co.uk
Author: Zoe Drewett

Researchers say vaping could lead to an increased risk of developing mouth cancer. A study carried out by the American Chemical Society found evidence to suggest using e-cigarettes raises the level of DNA-damaging compounds in the mouth. If cells in the body are unable to repair the DNA damage after vaping, the risk of cancer can increase, the study claims.

The long-term effects of e-cigarettes are not yet known but researchers say they should be investigated further (Picture: PA)

The researchers admit the long-term health effects of using electronic cigarettes are still unknown. Researcher Dr Romel Dator said: ‘We want to characterize the chemicals that vapers are exposed to, as well as any DNA damage they may cause.’

Since they were introduced in 2004, e-cigarettes have been marketed as a safer alternative to smoking. But the team carrying out the study claim genetic material in the oral cells of people who vape could be altered by toxic chemicals. E-cigarettes work by heating a liquid – which usually contains nicotine – into an aerosol that the user inhales. It is often flavoured to taste like fruit, chocolate or bubblegum.

‘It’s clear that more carcinogens arise from the combustion of tobacco in regular cigarettes than from the vapor of e-cigarettes,’ Silvia Balbo, the project’s lead investigator said. ‘However, we don’t really know the impact of inhaling the combination of compounds produced by this device. ‘Just because the threats are different doesn’t mean that e-cigarettes are completely safe.’ The latest study, due to be presented at a meeting of the American Chemical Society this week, analysed the saliva and mouth cells of five e-cigarette users before and after a 15-minute vaping session.

Researchers found levels of the toxic chemicals formaldehyde, acrolein and methylglyoxal had increased after vaping. Now they plan to follow up on the preliminary study with a larger one involving more e-cigarette users. They also want to see how the level of toxic chemicals differs between e-cigarette users and regular cigarette smokers.

According to a 2016 report by the US Surgeon General, 13.5% of middle school students, 37.7% of high school students and 35.8% of 18 to 24-year-olds have used e-cigarettes, compared with 16.4% of adults aged 25 and over. Ms Balbo, a professor at the Masonic Cancer Center at the University of Minnesota, said:

‘Comparing e-cigarettes and tobacco cigarettes is really like comparing apples and oranges.  The exposures are completely different. ‘We still don’t know exactly what these e-cigarette devices are doing and what kinds of effects they may have on health, but our findings suggest that a closer look is warranted.’

 

August, 2018|Oral Cancer News|

Smoking hits new low; about 14 percent of US adults light up

Source: https://flipboard.com
Author: Mike Strobbe, AP Medical Writer

NEW YORK (AP) — Smoking in the U.S. has hit another all-time low.

About 14 percent of U.S adults were smokers last year, down from about 16 percent the year before, government figures show.

There hadn’t been much change the previous two years, but it’s been clear there’s been a general decline and the new figures show it’s continuing, said K. Michael Cummings of the tobacco research program at Medical University of South Carolina.

“Everything is pointed in the right direction,” including falling cigarette sales and other indicators, Cummings said.

The new figures released Tuesday mean there are still more than 30 million adult smokers in the U.S., he added.

Teens are also shunning cigarettes. Survey results out last week showed smoking among high school students was down to 9 percent, also a new low.

In the early 1960s, roughly 42 percent of U.S. adults smoked. It was common nearly everywhere — in office buildings, restaurants, airplanes and even hospitals. The decline has coincided with a greater understanding that smoking is a cause of cancer, heart disease and other health problems.

Anti-smoking campaigns, cigarette taxes and smoking bans are combining to bring down adult smoking rates, experts say.

The launch of electronic cigarettes and their growing popularity has also likely played a role. E-cigarettes heat liquid nicotine into a vapor without the harmful by-products generated from burning tobacco. That makes them a potentially useful tool to help smokers quit, but some public health experts worry it also creates a new way for people to get addicted to nicotine.

There was no new information for adult use of e-cigarettes and vaping products, but 2016 figures put that at 3 percent of adults.

Vaping is more common among teens than adults. About 13 percent of high school students use e-cigarettes or other vaping devices.

The findings on adult smokers come from a national health survey by the Centers for Disease Control and Prevention. About 27,000 adults were interviewed last year.

June, 2018|Oral Cancer News|

Teen E-Cig Users More Likely to Smoke

Source: www.newswise.com
 

Newswise — As e-cigarette usage among high school students continues to climb, a recent study from The Journal of the American Medical Association reveals an unsettling trend: that adolescent e-cigarette users are more likely than their non-vaping peers to initiate use of combustible tobacco products such as cigarettes, cigars and hookahs. The reason may lie in a common denominator between e-cigarettes and their combustible counterparts: nicotine.

While the study hints that more research is needed to determine if this association is merely casual, it’s important to note that while e-cigarettes don’t contain tobacco, the battery-powered devices do deliver nicotine in aerosol form.

“Nicotine’s addictive properties are a risk for any age group, but with adolescents, the stakes are even higher,” says Dr. K. Vendrell Rankin, director of Texas A&M University Baylor College of Dentistry’s Tobacco Treatment Services.

For teens, mental health as well as key emotional and cognitive systems are at stake.

“Major cognitive functions and attention performance are still in the process of developing during adolescence,” says Rankin, also a professor and associate chair in public health sciences at TAMBCD. “Nicotine increases the risk of developing psychiatric disorders and lasting cognitive impairment and is associated with disturbances in working memory and attention. Reliance on nicotine to manage negative emotions and situations impairs the development of coping skills.”

In addition to affecting the emotional and cognitive development of teens, nicotine is highly addictive. In fact, the younger a person is when they begin using nicotine, the more likely they are to become addicted and the stronger the addiction may become. According to the American Lung Association, of adults who smoke, 68 percent began smoking at age 18 or younger.

In other words, the younger users are when they try or start using nicotine, the more nicotine receptors they will have and the more they may struggle with nicotine cravings throughout  their lives.

“Everybody has a certain amount of nicotine receptors in the brain,” Rankin says. “When you start smoking, vaping or supplying nicotine to them, they multiply. If you stop smoking or vaping, the receptors don’t go away.”

Nicotine use very quickly escalates into addiction, even when dealing with tobacco-free, odorless “vaping” associated with e-cigarettes. That’s because nicotine in any form triggers the release of neurotransmitters such as adrenaline and dopamine, which dramatically impacts a number of body systems. Dopamine floods the brain, and nicotine cravings increase.

This includes spit, or smokeless tobacco, which in the past was promoted as a replacement to smoking. The result: The creation of a large group that began using spit tobacco as a smoking replacement but eventually became dual users.

“We are seeing the same phenomena with the e-cigarette,” says Rankin. To better understand the similar association between e-cigarettes and combustible tobacco product use among teens, Rankin says further research could be replicated on a national level, as the study published in The Journal of the American Medical Association focused on Los Angeles high school students.

E-cigarette companies currently advertise their products to a broad audience that includes 24 million youths, and proposed U.S. Food and Drug Administration regulations would not limit e-cigarette marketing. Bold marketing tactics, celebrity endorsements, endless flavor choices and a plethora of online videos instructing users on how to mix their own e-cigarette liquid, or “e-juice,” have only added fuel to the fire. There currently are no federal laws in place to restrict minors from purchasing e-cigarettes.

There is a glimmer of hope on the horizon. In April, the FDA released the details of a proposal to extend its tobacco authority to e-cigarettes, including minimum age and identification restrictions intended to prevent sales to minors. A final ruling is slated for summer 2015.

In the meantime, many Texas cities have set their own regulations and ordinances banning the sale of e-cigarettes to minors. Any e-cigarette regulation in Texas will have to occur city by city, Rankin says, since the state doesn’t have comprehensive smoke-free laws.

“I don’t think e-cigarettes are going to drop off,” Rankin says. “It’s the newest — or most popular — kid on the block right now.”

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

August, 2015|Oral Cancer News|

The Debate Over E-Cigarettes Begins

Source: TIME.com
Author: Mandy Oaklander
 

The debate over the safety of e-cigarettes, and whether they will help smokers to quit, or simply make it easier for them to start or continue lighting up, heated up this week.

On one side of the disagreement are those pushing for regulation. In 2013, the World Health Organization (WHO) began a review of data on e-cigarettes and based on studies conducted so far, last month recommended tighter regulation of the devices to protect consumers’ health. But in a new article published in the journal Addiction, other scientists argue that the WHO misinterpreted the data in a “misleading” way and that the group’s advice for more stringent oversight is problematic.

In the Addiction paper, the authors take issue with nine of WHO’s conclusions, some of which surround the safety of e-cigarettes, their toxin levels, and how likely younger people are to adopt them. They cite some of the same data as the original WHO review did, but interpret it differently, arguing that the benefits of e-cigarettes, especially as an effective tool in helping some smokers to quit, outweigh potential risks from the chemicals and nicotine used in the devices. Therefore, they say, e-cigarettes should be more accessible than the WHO recommendations would allow.

“…The WHO’s approach will make it harder to bring these products to market than tobacco products, inhibit innovation and put off smokers from using e-cigarettes, putting us in danger of foregoing the public health benefits these products could have,” said Ann McNeill, lead author of the paper and professor of tobacco addiction at King’s College London, in a press release. They’re not the only ones who have pushed back against the recommendations. More than 50 experts in public health signed a letter calling for a lighter approach, reported the New York Times.

Why the opposing interpretations of the same data? E-cigarettes are so new that research hasn’t had a chance to catch up with their meteoric rise in popularity. Some of the data based on earlier models of the devices, for example, might not even apply to e-cigs as we know them today, since the product has evolved so rapidly. The body of research is small. And because the devices are so new, much of it is funded by e-cigarette manufacturers.

In the latest paper in Addiction, for example, some of the work by one of the heavily-cited authors of the paper was conducted with funding from the e-cigarette industry.

On the first page in the “competing interests” section, the article discloses the following about Konstantinos Farsalinos of the Onassis Cardiac Surgery Center in Greece:

Some studies performed by KF were carried out using funds provided to his institution (Onassis
Cardiac Surgery Center) by e-cigarette companies.

In the paper’s 45 references, Farsalinos is listed as an author in nine of them; it’s unknown which of those studies were conducted with the help of e-cigarette funding.

It’s not uncommon for someone who makes a product to then sponsor research on that product, and it doesn’t mean the findings are worthless, says Steven Schroeder, a professor in the department of medicine and head of the Smoking Cessation Leadership Center at the University of California, San Francisco. (Schroeder does not conduct research on e-cigarettes.) But it also doesn’t mean the results are entirely objective, either. The potential for bias leads journal editors such as those at the peer-reviewed Addiction to require conflict disclosures from both its authors and its senior editorial staff.

It’s not clear yet whether e-cigarettes will turn out to hurt or help smokers. It’s probable that they will contribute to a range of health effects, both positive — as a smoking cessation device — and negative — as a potential gateway to tobacco-based cigarettes or other drugs. The evidence, at the moment, points in both directions.

 

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy. 
 
September, 2014|Oral Cancer News|

Scientists say that E-Cigarettes and Snuff are not harmless

Author: Eliza Gray

Source: time.com

New research casts doubt on nicotine’s safety—even if you aren’t smoking

New research from the American Heart Association journal Circulation shows that patients who stopped using smokeless tobacco after a heart attack had improved life expectancy—similar to that of people who quit smoking. The finding offers new information about the dangers of smokeless tobacco, the risks of which are not as well understood as cigarettes’.

“That was a big surprise for us,” said Dr. Gabriel Arefalk, lead researcher and a cardiologist at Uppsala University Hospital in Uppsala, Sweden. “For smoking, it has been known for decades now that people benefit from discontinuation, especially after having suffered a heart attack, but for snus we had no idea what to expect.

”The researchers reviewed data on 2,474 heart attack survivors under 75 in Sweden who used snus (oral snuff) from 2005 to 2009. About 675 quit. During the two years of follow-up, 69 of those who continued using snus died, compared with only 14 quitters. Based on this data, researchers determined that those who quit snus had almost half the mortality risk of those who didn’t quit, which is similar to the benefit of smoking cessation, according to a release from the American Heart Association.

Dr. Arefalk, who is also a clinician, said the researchers wanted to study the problem because they didn’t know what to tell patients about the risks of using snus after a heart attack. He cautioned that the study was small and far from enough to determine a causal relationship, but added “It’s the best evidence we’ve got so far, so from our perspective at our clinic, [the advice to patients] is probably that you should discontinue all kinds of tobacco,” if you’ve had a heart attack, Dr. Arefalk told TIME

The study is one more piece of evidence that ads to our understanding that smokeless tobacco carries its own risk. Though the study was about snus, it has implications for other kinds of nicotine delivery systems, including e-cigarettes.

The FDA is currently taking comment from experts over the next few weeks as the agency tries to determine the best rules to regulate the nascent e-cig industry, which is approaching nearly $2 billion in U.S. annual sales. And though there isn’t yet enough information or scientific research to back this up, common sense says that e-cigs, which do not burn and contain fewer chemicals than regular tobacco cigarettes, must be better for a smoker’s health. Yet, some cardiologists, as TIME learned, are reluctant to see electronic cigarettes as harm-reduction tools.

For starters, nicotine is not a benign substance, especially when it comes to cardiovascular health. As Dr. Steven Nissen, Department Chair of Cardiovascular Medicine at the Cleveland Clinic, put it, nicotine has “profound effects on the heart.” The highly addictive drug can lead to surges in heart rate, constriction in the blood vessels, and spikes in blood pressure—the very effects that heart medications are designed to counteract.“To come up with new diabolically clever way to addict Americans to nicotine is a terrible idea,” says Dr. Nissen. “[E-cigarette companies] are pitching very hard that they can make smoking safer. [But] nicotine is an addictive drug, no matter if you smoke it or ‘aerosolize’ it. Why you would want to addict another generation to nicotine is beyond me. Public health suggests we should fight electronic cigarettes the same way we fought tobacco.”

Another concern, beyond the possible impact of nicotine, are concerns about small, potentially toxic, particles and what they can do to the sensitive cardiovascular system, says Dr. Aruni Bhatnagar, a professor of medicine at the University of Louisville and spokesperson on electronic cigarettes for the American Heart Association

Dr. Bhatnagar is studying the toxic effects of e-cig vapor on mice. Like all doctors, he is careful to point out that we don’t know enough about these devices. But he says that wishful thinking about harm reduction could be especially problematic when it comes to cardiovascular health. The risk of cardiovascular disease for a person who smokes only 2-3 cigarettes a day is already 80 percent of the risk to a pack-a-day smoke. “Very low levels of smoke are very dangerous for cardiovascular tissues. Cancer is more linear—you have to smoke a large amount for a very long period of time to get lung cancer,” he says. “But reducing harmful levels is not going to mitigate the cardiovascular risk. That is why we are greatly concerned about e-cigarettes when it comes to the high sensitivity of cardiovascular tissues to a low level of these pollutants

”Electronic cigarette manufacturers and their customers often point to the low levels of particles in electronic cigarette smoke as compared to the appropriate levels of air pollution determined by agencies like OSHA. But, Dr. Bhatnagar says, these claims can be misleading because the thresholds take into account the necessity of polluting the air to some degree—they aren’t an endorsement of a safe level of pollution. From a cardiovascular perspective, he says: “There is no threshold, there is no level of these particles that you can say is safe.”

For now: Smokers—and snuffers, and e-cig smokers—beware.

 

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

June, 2014|Oral Cancer News|

FDA proposes rules to disclose e-cigarette ingredient information and ban sales to children

Source: usatoday.com
Author: Wendy Koch

 

As electronic cigarettes soar in popularity, the U.S. government Thursday is proposing historic rules to ban their sale to minors and require warning labels as well as federal approval.

Three years after saying it would regulate e-cigarettes, the Food and Drug Administration is moving to control not only these battery-powered devices but also cigars, pipe tobacco, hookahs (water pipes) and dissolvable tobacco products. Currently, the FDA regulates cigarettes, roll-your-own tobacco and smokeless products such as snuff.

The proposed rules won’t ban advertising unless the products make health-related claims nor will they ban the use of flavors such as chocolate or bubble gum, which public health officials say might attract children.

“This is an important moment for consumer protection,” said FDA Commissioner Margaret Hamburg, noting tobacco remains “the leading cause of death and disease in this country.” The rules will require manufacturers to report their ingredients to the FDA and obtain its approval. They also ban free tobacco samples and most vending-machine sales.

“Some of these regulations will be very restrictive,” said Ray Story, founder of industry group TVECA (Tobacco Vapor Electronic Cigarette Association), who added he obtained his own pre-release copy of the rules. He said they could be costly for smaller businesses and slow the growth of a product that advocates say has helped many smokers kick the habit.

Still, Story said, consumers might benefit, because “it provides them a product that will be consistent.” E-cigarettes contain varying ingredients and levels of nicotine that are heated into a vapor that users inhale in a practice known as “vaping.” Most look like conventional cigarettes but some resemble everyday items such as pens and USB memory sticks.

The rules come as e-cigarette sales, buoyed by TV ads with Hollywood celebrities , have soared in recent year and debate has risen about whether the devices are more apt to lure kids toward tobacco or help adults quit smoking.

An increasing number of states have cracked down by extending indoor smoking restrictions to e-cigarettes. Last month, U.S. poison centers reported a surge in illnesses linked to the liquid nicotine used in the devices.

While they don’t contain many of the harmful chemicals of conventional cigarettes, the FDA found trace amounts of toxic and carcinogenic ingredients in several samples in late 2008 when the e-cigarette market was just beginning in the United States. It sought to regulate them as drug-delivery devices, but in 2010, a federal judge ruled it could only do so if they made therapeutic claims. So in April 2011, the agency said it would regulate them as tobacco products, because the nicotine is derived from tobacco leaves.

“It’s taken more than three years to issue a proposed rule, which we think is inexcusable,” said Vince Willmore of the Campaign for Tobacco-Free Kids, an anti-smoking group. “It’s allowed a Wild West marketplace with irresponsible marketing and no control over the product.” He says the FDA should quickly finalize the rules, which face a 75-day public comment period and further review.

The proposed rules walk a narrow path. They will require tobacco products that weren’t on the market by Feb. 25, 2007 — a date set by a federal law — to apply for FDA review within 24 months after the rules are issued. The products can stay on the market pending FDA’s review, says Mitch Zeller, director of FDA’s Center for Tobacco Products, adding they can seek an exemption from additional reviews if minor changes are made.

Despite these requirements, the proposal doesn’t contain the marketing restrictions sought by some critics that were almost sure to trigger litigation. Craig Weiss, CEO of NJoy, a top-selling e-cigarette, said he supports “reasonable regulation” but would “respond very forcefully to any attempt to limit my free speech right to promote my product.”

Several dominant e-cigarette manufacturers, which now include the nation’s three largest cigarette makers — Philip Morris, R.J. Reynolds and Lorillard — have embraced limited regulation such as a ban on sales to minors. Yet they’ve argued that their e-products shouldn’t be regulated as tightly as conventional cigarettes — an approach the FDA appears to be taking.

The FDA said the rule aims to bolster product safety. It said since e-cigarettes have not been fully studied, consumers have no way to know how much nicotine or other chemicals they contain and whether they’re safe or beneficial.

 

FDA’s 20-year road to regulating tobacco:

August 1996: FDA issues rules to ban tobacco sales to minors and its advertising near schools or playgrounds

March 2000: U.S. Supreme Court, in 5-4 decision, rules that Congress did not give FDA such authority

December 2008: FDA, after detaining import shipments of e-cigarettes, declares they’re unapproved drug delivery devices

April 2009: E-cigarette distributor Smoking Everywhere files suit against the FDA, joined a month later by Sottera (doing business as NJOY)

June 2009: Congress passes law granting FDA authority to regulate tobacco products

January 2010: U.S. District Court for the District of Columbia bans FDA from stopping e-cigarette imports

June 2010: FDA issues final rules to ban the sale of cigarettes and smokeless tobacco to minors and to restrict their marketing

December 2010: U.S. Court of Appeals for the D.C. Circuit, upholding lower court decision, rules e-cigarettes can be regulated as tobacco products but not as drugs/devices unless marketed for therapeutic purposes

April 2011: FDA says it intend to expand to its authority over tobacco products to include e-cigarettes

June 2011: FDA issues new graphic warning labels that will need to be placed on cigarette packs and ads by Sept. 2012

April 2014: FDA proposes rules to regulate e-cigarettes and cigars as tobacco products

 

* This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

 

April, 2014|Oral Cancer News|