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Electronic cigarette explosion and burn injuries, US Emergency Departments 2015–2017

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Cinnamon, vanilla and buttery e-cigarette flavors are among the most toxic — and mixing flavors is more damaging than vaping just one

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E-Cigarette Battery Explosions Are Leaving Users Disfigured

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More than 100 pets were poisoned by e-cigarettes in Britain last year

Vaping might be a lot better for pet owners than smoking cigarettes – but the gadgets pose a risk to pets, a new report found.

http://metro.co.uk/2017/06/26/more-than-100-pets-were-poisoned-by-e-cigarettes-in-britain-last-year-6734735/

Vets say that a ‘large increase’ in the number of pets being poisoned by e-cigarettes, according to figures from the Veterinary Poisons Information Service (VPIS).

Last year, 113 pets were poisoned by e-cigarettes in the UK.

The VPIS says, ‘A typical ‘natural’ cigarette could yield, at most, 30mg of nicotine (most have less).

‘E-cigarettes and their refills contain large doses of nicotine (up to 36mg per ml). How well absorbed or how ‘available’ this is for oral or mucosal absorption is not known, but it is reasonable to take any exposure seriously.

‘Ingestion of refill bottles/vials may present a particular hazard as the nicotine may leak over a period of time or may suddenly be released after a variable period in the gut.’

 

E-cigarette fluid poisonings on rise in Maritimes, says expert

IWK Regional Poison Centre received 34 calls related to concentrated nicotine last year, up from one in 2013

http://www.cbc.ca/news/canada/new-brunswick/nicotine-poison-e-cigarette-increase-new-brunswick-1.4141007

The number of poisoning incidents related to the concentrated nicotine cartridges used for electronic cigarettes is increasing, according to the clinical leader of a poison control centre in the Maritimes.

“It’s definitely on the rise as they become more available to the public,” said Laurie Mosher, of the IWK’s Regional Poison Centre in Halifax, which takes calls from health-care professionals in New Brunswick and from citizens in Nova Scotia and P.E.I.

The first call Mosher tracked was in 2013. In 2014, the number jumped to 14, then 21 in 2015, and 34 in 2016, she said.

The incidents involve people of all ages, but children were involved in 12 of last year’s calls, or 35 per cent, said Mosher. That’s up from three calls, or 21 per cent, in 2014.

“As a product becomes more available and more people are using it, and especially people with small children or teenagers in the house, it is likely to go up,” she said.

On Monday, a nine-year-old girl in Fredericton was taken to hospital after drinking an e-cigarette fluid called Unicorn Milk and suffering nausea, chest cramps and dizziness.

The Grade 5 student, who was diagnosed with nicotine poisoning, discovered the vial of concentrated nicotine with her friends on their school playground at É​cole des Bâtisseurs. They all tasted drops from the fluid, which is used for electronic vaping of cigarettes.

The girl’s mother, Lea L’Hoir, said the children were tempted to try the strawberry-flavoured fluid because it smelled good, and its container was decorated with a brightly coloured image of a unicorn.

National total not tracked

The number of such incidents across Canada is unclear. There is no central data collection centre for poisonings, said Mosher.

There are five poison centres across the country that serve all of the provinces, except New Brunswick and Newfoundland, which are covered by 811 and Tele-Care.

New Brunswick’s 811 line has received only one call regarding liquid nicotine poisoning in the past two years, according to the Department of Health.

The call was in November 2016, said department spokesperson Geneviève Mallet-Chiasson.

Mosher worries the numbers will continue to grow. “I think it definitely has potential for concern. So I don’t think we’re making too much of it.”

Even small amounts problematic

The symptoms experienced depend on exposure, said Mosher, who is also a registered nurse. Just a drop or two can lead to nausea or vomiting. It can also be very irritating if the substance gets into the eyes, she said.

“Larger amounts can cause tremors, seizures, and then it can also go the other way and they can have drowsiness,” said Mosher.

“So certainly if a child ingested a mouthful it could be very toxic. We haven’t had any severe toxicity as of now in our centre, but there certainly is potential for that,” she said.

“It could be life-threatening, depending on how much they got a hold of.”

Label guidelines needed

Mosher contends part of the problem is a lack of labelling guidelines for the cartridges.

Health Canada doesn’t regulate the labelling of vape products, but the sale of the products to people 18 or under is banned.

Mosher said the nicotine comes in different concentrations and the labels are not clear. For example, a label might indicate 16 mg, but there’s a big difference between 16 mg per mL and 16 mg in the entire cartridge.

In addition, the packaging is appealing to young children and the flavours appeal to teenagers.

The lack of warning symbols and lack of child-resistant packaging is very concerning, said Mosher.

“I would treat it like any other poisonous product, it should be kept out of reach of children, it should be regulated,” she said. “And it should not be appealing to young children.”

Call for tougher regulations

Earlier this week, the Canadian Cancer Society called on the federal government to move quickly on tougher regulations surrounding the labelling of vaping products.

A federal bill that would regulate the manufacture, sale and labelling of vaping products awaits approval in the Senate.

The bill would also give Health Canada the regulatory authority to enforce policies on childproof caps and to restrict certain flavours that critics say are aimed at a younger market.

The Centres for Disease Control and Prevention in the U.S. reported in 2014 that the number of calls to poison centres involving e-cigarette liquids rose from one per month in September 2010 to 215 per month in February 2014. Almost 52 per cent of the calls involved children under the age of five.

The first four months of this year, poison centres in the U.S. reported 795 calls about exposure to the liquids.

If a child accidentally ingests the fluid, Mosher recommends calling a poison centre or 911​.

NHMRC CEO Statement: Electronic Cigarettes (E-Cigarettes)

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Experts warn against E-Cigarette dangers

http://www.fox10phoenix.com/news/arizona-news/230569416-story

It’s being seen more often these days: e-cigarettes, or vape pens, is a growing trend among smokers, and a lot of teenagers are vaping as well.

However, experts have a warning about the smokeless alternative, saying there is a big danger that is associated with vape pens.

In burn centers across the country, officials say more and more people are getting hurt, when the devices explode.

“It’s like carrying an M-80 in your pocket,” said Dr. Kevin Foster from the Arizona Burn Center, describing E-Cigarettes that are being used by millions every day.

Foster said prior to 2016, they had no reports of burns related to E-Cigs, but last years, that changed dramatically with 50 separate cases, equaling to approximately one case per week where someone needed treatment for injuries related to exploding e-cigarettes.

Most of the burns are of the second degree, but in several cases, the injuries were much worse, with some needed surgery.

Besides burn injury, experts say those impacted also suffered traumatic injury from the explosion, and possibly chemical injuries from the chemicals inside the battery, considered by Foster to be the culprit. He said because many E-Cigarettes are manufactured overseas, it is hard to determine if these devices and the batteries are safe.

“It’s impossible to look at an E-Cigarette or vaping device, and try to determine if it’s a high quality or low quality,” said Foster.

The dangers mentioned above does not include other, more traditional health concerns associated with tobacco products. While those in the vaping industry argue their products actually control nicotine addiction, doctors at the Arizona Burn Center said they believe none of it is worth the gamble with such devices.

Youths More Likely to Combine E-cigarettes with Other Substances

Are youths more likely to combine e-cigarettes with other substances? A new study of Canadian high school students shows a correlation between e-cigarette use and other risky behaviors, including tobacco and marijuana smoking, binge drinking, and mixing alcohol with energy drinks.

http://www.medicalnewsbulletin.com/youths-likely-combine-e-cigarettes-substances/

E-cigarette popularity has increased significantly amongst global youths since 2011. Recent data also shows a spike in e-cigarette use amongst high school students in Canada, with approximately 20% of students reporting having tried an e-cigarette. With vapor emerging as a supposedly healthier alternative to tobacco smoking, researchers and public health workers have voiced concerns regarding unknown long-term effects of e-cigarette vapor on individuals’ health, the risks of renormalizing smoking in popular culture, and the potential for e-cigarettes to become gateway substances. Evidence suggests that high school students may be more likely to combine e-cigarettes with other substances such as marijuana and alcohol, which pose health risks amongst youths.

A recent Journal of Adolescent Health (2016) review of year 3 (2014-2015) of the COMPASS study analyzed data from 39,837 Canadian high school students from Grade 9-12 to investigate the correlation between e-cigarette use and binge drinking, mixing energy drinks with alcohol, and smoking tobacco or marijuana. During the course of the COMPASS study, a student-level questionnaire, or Cq, was given to participants during class time in order to collect information regarding substance use within the last 30 days to 12 months. Any student who indicated that they had consistently used a substance within the last 30 days was classified as a current user (e.g. students who reported smoking cigarettes within 30 days prior to taking the questionnaire were categorized as current smokers).

Researchers retained all data for participants that provided full information on necessary variables for the study, such as age, ethnicity, and consistent responses regarding recent substance use. Using these criteria, 2323 respondents were excluded from this study. The remaining data was further divided into subgroups based on sex, ethnicity, and spending money, and placed within a logistic regression model to examine any potential associations between each student’s demographic and their substance use patterns.

Nearly 10% of participating students reported having used e-cigarettes in the last 30 days. Comparatively, approximately 6% were current smokers, 15.97% were marijuana users, 13.69% consumed energy drinks mixed with alcohol, and 16.20% reported occasional binge drinking. While marijuana use was more common among male participants, occasional binge drinking was found to be more prevalent among females. Evidence also showed a higher likelihood of e-cigarette users to use other substances as well (28.66% of e-cigarette users were current tobacco smokers, 53.15% were current marijuana users, 20.09% were occasional binge drinkers, and 41.08% reported mixing alcohol and energy drinks). Researchers found that while the co-occurrence of binge drinking and marijuana use among current e-cigarette users seemed common, e-cigarette users who exclusively only smoked tobacco (and did not binge drink or smoke marijuana) was determined to be rare.

Both current smokers and male students with more spending money were found to be more likely to use e-cigarettes. Similarly, students who reported other health-risky behaviors, such as binge drinking and marijuana use, were more likely to use e-cigarettes than non-drinkers or non-smokers. This data on current e-cigarette use demonstrates a 35% increase amongst the youth of Ontario and Alberta from the previous year of COMPASS data. Furthermore, substance use appears to act as a strong indicator of future e-cigarette use relative to age, sex, ethnicity, and available funds.

As the results of this study have shown, health-risky behaviors appear to have a strong correlation with increased likelihood of e-cigarette use (although there is a lower prevalence of e-cigarette use as smokers increase in age). These findings are useful in terms of public health program planning, as further research may enable prevention efforts to target younger demographics within the youth population who are at a higher risk for e-cigarette or other substance use.

Vapers beware: 10 things to know about e-cigarettes

With catchy names like Smurf Cake and Unicorn Puke and sweet flavors like bubble gum and strawberry, electronic cigarettes may have special appeal to young people, but that doesn’t mean they are safe.

https://www.universityofcalifornia.edu/news/vapers-beware-ten-things-know-about-e-cigarettes

Evidence is mounting that e-cigarettes are exposing a new generation to nicotine addiction and may be leading users toward a cigarette habit. As a result, the U.S. surgeon general last month issued a report declaring youth e-cigarette use “a major public health concern.”

“All Americans need to know that e-cigarettes are dangerous to youth and young adults,” said Surgeon General Vivek Murthy, in releasing the report. “Any tobacco use, including e-cigarettes, is a health threat, particularly to young people.”

The battery-powered devices heat a liquid typically containing nicotine mixed with the chemicals propylene glycol and glycerin as well as flavorings to deliver an aerosol inhaled by the user. While e-cigarettes deliver nicotine without the tar and smoke of traditional tobacco cigarettes, they still are considered tobacco products.

But their healthy halo has helped propel their popularity: E-cigarettes are now so popular that more American youth vape than smoke cigarettes. In just a decade, e-cigarettes have become a multibillion-dollar business led by multinational tobacco companies with outlets not just online but everywhere from vape shops to convenience stores and retail giants like Wal-Mart.

Ads tout them as a cool, harmless alternative to cigarettes. E-cigarette users, or vapers, have contests to see who can blow the largest cloud of vapor.

But there’s more to e-cigarettes than meets the eye. The surgeon general’s report aligns with increasing scrutiny of e-cigarettes, from new regulations to a growing body of research into health effects.

Here are 10 things to know about e-cigarettes:

E-cigarettes contain nicotine

E-cigarettes contain nicotine, which is addictive and can harm the developing adolescent brain, said UC San Francisco professor of medicine Stanton Glantz.

A lot of the kids who take up vaping are at low risk for smoking, but once they start using e-cigarettes, they are three to four times more likely to start using cigarettes, Glantz said.

“The biggest health concern with e-cigarettes is they are prolonging and expanding the tobacco industry,” Glantz said.

Glantz, director of UCSF’s Center for Tobacco Control Research and Education, said he was initially neutral on e-cigarettes, but now finds them concerning. Among other hazards, e-cigarettes produce ultrafine particles than can trigger inflammatory problems and lead to heart and lung disease.

“The data is just becoming overwhelming,” Glantz said.

E-cigarettes expose people to more than ‘harmless water vapor’

E-cigarettes are billed as producing “harmless water vapor,” but, strictly speaking, the vapor produced when users exhale is actually an aerosol that contains a mixture of nicotine, flavorings and other ingredients that can be toxic.

Stanford University pediatrics professor Bonnie Halpern-Felsher has studied young people’s perceptions of e-cigarettes. In September, she launched a free, downloadable youth tobacco prevention toolkit with an e-cigarette module, funded by the UC Tobacco-Related Disease Research Program (TRDRP) and the California Department of Education.

“Youth are definitely using e-cigarettes because they think they are cool,” Halpern-Felsher said. “Adolescents and young adults don’t know a lot about e-cigarettes. They think it’s just water or water vapor. They don’t understand it’s an aerosol. They don’t understand that e-cigarettes can have nicotine. They don’t understand that flavorants themselves can be harmful.”

The flavors can be toxic

More than 7,000 varieties of flavored e-cigarettes are on the market.

UC Riverside professor of cell biology Prue Talbot screened the cytotoxicity (quality of being toxic to cells) of 36 refill fluids and found that some were highly toxic. The most cytotoxic flavor, Cinnamon Ceylon, contained a chemical called cinnamaldehyde, which gives cinnamon its flavor and whose side effects may include coughing and sore throats. Talbot has been studying more flavors and is building a database to help determine the most dangerous ones.

“Flavors are something that could be potentially regulated,” Talbot said.

Vaping has secondhand and thirdhand effects

Unlike cigarettes, which emit smoke from the lit end, e-cigarettes don’t produce sidestream emissions between puffs, but they still generate secondhand and thirdhand effects when users exhale the mainstream vapor.

In a TRDRP-funded study, Berkeley Lab researcher Hugo Destaillats led a team that found 31 chemicals that include several toxicants at significant levels in e-cigarette vapor. The most toxic chemicals included acrolein, a severe eye and respiratory irritant; and formaldehyde, an irritant and probable carcinogen.

Emissions varied by type of device and voltage.

“The way you heat the liquid drastically determines if you produce a lot of compounds or just a few,” Destaillats said. “As you increase the voltage, toxic byproduct concentrations increase exponentially.”

The batteries can explode

There were 134 reports of e-cigarette batteries overheating, catching fire or exploding between 2009 and January 2016, according to the Food and Drug Administration, which will host a public workshop in April to gather information about e-cigarette battery safety concerns.

E-cigarette batteries “can explode without notice,” Talbot said. “People can be quite severely injured.”

E-liquids are poisonous if swallowed

Calls to poison control centers about e-cigarette exposure in young children have skyrocketed nationally in recent years. In California, the number of calls involving e-cigarettes increased from 19 in 2012 to 243 in 2014, according to the UC-administered California Poison Control System. More than 60 percent of those e-cigarette calls were related to nicotine poisoning in children 5 and under.

E-cigarettes show mixed results in helping smokers quit

While some people have quit smoking with e-cigarettes, on average, adult smokers who use e-cigarettes are about 30 percent less likely to stop smoking cigarettes, Glantz said. Also, e-cigarettes are associated with more, not less, cigarette smoking among adolescents.

“If you are a middle-aged person who has been smoking for 20 years, maybe it is good to switch to e-cigarettes,” Destaillats said. “But if you are a teenager and never have smoked, then it is not a good idea to use e-cigarettes.”

The minimum age has risen

In June, California became the nation’s second state, following Hawaii, to raise the minimum age for tobacco sales to 21, and for the first time added e-cigarettes to the definition of tobacco products. In August, the FDA extended its tobacco oversight to e-cigarettes, banning sales to those under 18.

“It sends a message to youth that e-cigarettes are in the same category of all tobacco products,” Halpern-Felsher said.

E-cigarettes will be taxed

Under Proposition 56, the tobacco tax passed by California voters in November, the state will tax e-cigarettes for the first time, starting April 1. It’s estimated that the price of a typical 30-milliliter bottle of e-liquid could increase to about $30 from $20.

“Anytime you increase the price, people buy less,” Glantz said.

The tax revenue will enhance education efforts by boosting funding for the state Tobacco Control Program. The surgeon general’s report also will make it easier for states to integrate e-cigarettes into tobacco education campaigns and could lead to more regulations, Glantz said.

E-cigarettes may be safer than cigarettes, but unknown risks remain

Expect more information to emerge about e-cigarettes as studies examine long-term effects.

“It’s often assumed that e-cigarettes are safer than cigarettes, but that could be an incorrect assumption,” Talbot said. “We don’t yet know the long-term health effects of e-cigarettes.”

Decades of research have helped scientists determine that cigarette smoke creates more than 7,000 chemicals, at least 69 of which are known to cause cancer and many of which are poisonous.

So, while e-cigarettes deliver fewer cancer-causing chemicals than cigarettes, research has yet to reveal how e-cigarettes fully impact heart and lung health and their cancer-causing potential, Glantz said.

He estimates that e-cigarettes are about one-third to one-half as dangerous as cigarettes.

In other words, they are still plenty dangerous.

“Regular cigarettes are super unhealthy,” Destaillats said. “E-cigarettes are just unhealthy.”

There’s Nothing Sexy About An E-Cigarette Exploding In Your Face

http://www.forbes.com/sites/robwaters/2017/01/17/theres-not-much-sexy-about-an-e-cigarette-exploding-in-your-face/#2bab2377177e

Rob Waters ,

Contributor

I write about health, science and our crazy healthcare system.

Opinions expressed by Forbes Contributors are their own.

The last time I wrote about electronic cigarettes in this space, the post generated about as many comments as I’ve received from any piece (with the possible exception of the hate mail I got when I wrote about the need to permit federal funding for research looking at gun violence). The commenters called me a liar, an idiot and…well, you get the idea.

In that earlier post, I noted that e-cigarette marketers were peddling their products as cool and sexy. The ads are full of women with bare shoulders or in slinky blue satin who “smoke in style” (as an ad for blu e-cigarettes exclaims), while dangling their devices. Now, the continuing spate of news about e-cigs blowing up in the faces or pockets of users made me wonder what a new set of anti-e-cigarette commercials might look like. (Note to California Dept. of Public Health: there’s an idea for you here.)

E-cigarette devices have burst into flames in people’s pockets, blown up in their mouths or exploded while charging. Videos of them starting a fire from the pocket of a Fresno, California, bus rider or in a Leeds, England, market are now making the rounds on the Internet.

But this is no laughing matter.

Earlier this month, the Food and Drug Administration announced it is investigating the dangers of “battery-operated nicotine-delivery devices” as they clinically, but accurately, refer to e-cigarettes. The agency has documented 134 incidents of e-cigarette batteries overheating, exploding or catching fire.

The FDA will hold a two-day public workshop to discuss safety issues surrounding the batteries used in e-cigarettes on April 19 and April 20, 2017, that scientists and members of the public are invited to attend. Some wonder why it took so long.