Clear The Air News Tobacco Blog Rotating Header Image


Does Netflix glamorize tobacco?

Download (PDF, 259KB)

Netflix in hot water for ‘glamourising’ tobacco use

Download (PDF, 44KB)

How e-cigarette ads might sway teens to try tobacco products

When non-smoking teens see ads for e-cigarettes, and are curious about the products advertised, perhaps even identifying with a favorite brand, they might also be more susceptible to taking up cigarettes, a new study finds.

For the study, researchers showed a nationally representative sample of 10,751 U.S. teens advertisements for a wide variety of tobacco products including traditional cigarettes, cigars, chewing tobacco and e-cigarettes. Overall, the teens were more receptive to ads for e-cigarettes than other products and television ads were most likely to prompt brand recall.

“The imagery used by tobacco companies focuses on the aspirations of young people including having fun, being independent, sophisticated, socially accepted, popular, etc.,” said lead study author John Pierce of the University of California, San Diego.

“Those who have an emotive response to these aspirational images are more likely to see use of the product as a way to achieve their aspirations,” Pierce said by email. “It is hypothesized that in adolescents who are committed never smokers, recall of tobacco product advertising will be associated with first movement toward product use within a one-year time frame.”

Big U.S. tobacco companies are all developing e-cigarettes, battery-powered gadgets with a heating element that turns liquid nicotine and flavorings into a cloud of vapor that users inhale.

For the past decade, public health experts have debated whether the devices might help with smoking cessation or at least be a safer alternative to smoking traditional combustible cigarettes, or whether they might lure a new generation into nicotine addiction.

Fewer teens smoke today than a generation ago, but declines in traditional cigarette use have stalled and e-cigarettes have become increasingly popular in recent years. As of 2015, an estimated 16 percent of U.S. high school students used e-cigarettes, compared with about 9 percent for traditional cigarettes, according to the U.S. Centers for Disease Control and Prevention.

While television ads for traditional cigarettes have been illegal in the U.S. for decades, e-cigarette ads are currently allowed on TV, researchers note in Pediatrics.

In the study, Pierce and his colleagues examined how receptive or curious non-smoking teens were about different tobacco products and whether they had a favorite image or advertisement. They also looked at how susceptible the adolescents might be to trying tobacco products based on their ability to recall specific brands they saw in the ads.

The researchers showed each study participant a random selection of five ads each for cigarettes, e-cigarettes smokeless tobacco and cigars based on 959 different promotions that had recently been used to advertise these products.

Overall, 41 percent of the younger teens in the study and half of older adolescents were receptive to at least one tobacco advertisement, the study found.

Across each age group, teens were most receptive to ads for e-cigarettes, followed by traditional cigarettes and smokeless tobacco.

E-cigarette ads shown on television had the highest recall.

Compared to teens in the study who were not at all receptive to the ads, youth who had the highest level of engagement with the promotions were more than six times more likely to be susceptible to trying tobacco products, the study found.

The study isn’t a controlled experiment designed to prove whether or how ads may directly influence tobacco use.

Another limitation is that researchers didn’t have data to show whether or not teens actually used tobacco products after viewing these ads, the authors note.

Even so, the findings suggest that non-cigarette ads for tobacco-related products may be damaging for adolescent health, Rebecca Collins of Rand Corporation in Santa Monica, California, writes in an accompanying editorial.

“This study provides some very provocative data suggesting that the marketing of e-cigarettes, which is not regulated, might be leading to cigarette smoking among teens,” Collins said by email.

Why e-cigs are not a safer alternative to cigarettes

Today’s guest blogger is Blair Thornley, PharmD, a certified specialist in poison information, at Poison Control Center at the Children’s Hospital of Philadelphia.

Electronic cigarettes, or “e-cig” use among teens has increased tremendously in the last two years, from approximately 780,000 in 2013 to more than 3 million students in 2015. Similarly, between 2011 and 2013, exposure to e-cigarette TV ads increased by 256 percent among 12 to 17- year-olds and by 321 percent among young adults between the ages of 18 and 24.

Of those surveyed, 40 percent said that they used e-cigarettes because they tasted good; only 10 percent admitted to using them as a quitting aid for conventional cigarettes. These results seem to suggest that, not only are adolescents using e-cigarettes primarily for recreational purposes, but that their increase in popularity is due to the successful marketing techniques of e-cigarette manufacturers. Many of these efforts mimic the tactics that Big Tobacco used in the mid-1900s, and they’re working – again.

When you look at old tobacco ads next to newer, e-cigarette ads, the similarities are astounding. Until late this past summer, e-cigarettes were not considered tobacco products by the U.S. Food and Drug Administration so marketers did not have to adhere to the same standards and laws as the tobacco companies. They used celebrity spokespeople such as Jenny McCarthy and Courtney Love. Their ads portrayed rugged men and glamorous women sending the message that using e-cigarettes is masculine, sexy, or rebellious. They knew that sex sells, and therefore portrayed their products as something that will make the user more attractive to the opposite sex. Some e-cigarette companies even sponsored sporting events and music festivals because they knew it would help them reach large audiences, including young children and teens.

Many e-liquids come in sweet flavors, with names that are appealing to younger audiences, such as “I love donuts” or “Mama’s cookies”. They also used cartoons, reminiscent of Joe Camel, who successfully marketed cigarettes to kids in the 1990s. Still other ads send the message that they’re healthier than regular cigarettes by encouraging people to “switch, don’t quit”. With all of these tactics, it’s little wonder why e-cigarette use among youth is on the rise.

Another important factor fueling the rise in e-cigarette use is the commonly held belief among young people that they are less harmful than tobacco products. Some teens are unaware that the e-liquids they’re using contain nicotine, and nearly 20 percent of young people believe that they cause no harm at all! The majority of teens are using them out of sheer curiosity, they think it tastes good, and it’s a fun thing to do with their friends. They don’t realize that many of these products contain nicotine, which can lead to a powerful, life-long addiction, as well as a permanent lowering of impulse control among teens.

There is also evidence that the aerosol vapors from the e-cigarette are not as harmless as initially believed. Flavoring is added with a chemical known as diacetyl, which has been linked to serious lung disease. E-liquids may also contain heavy metals, such as nickel, lead or tin. Another risk that has been making headlines recently is the e-cigarette batteries that have exploded in users’ pockets, resulting in serious injuries. Because this trend is so new, scientists are still working to understand the long-term health effects, but all the preliminary evidence seems to indicate that e-cigarettes are no safer than conventional cigarettes, and should not be used recreationally.

With all of this new information, it’s important to establish an open dialogue with your teens and young adults, and make sure they’re aware of the risks associated with e-cigarettes. The more you know, the better equipped you will be to protect your children. If you have any questions about e-cigarettes, you can feel free to call the Poison Control Center at 1-800-222-1222, where a pharmacist or nurse is on staff 24 hours a day to answer your call.

Local Anti Tobacco Advocate Busts E-cigarette Myths

According to a recently released report by the US Surgeon General, research has confirmed that there has been a significant increase in electronic cigarette (e-cigarette) use in recent years. Just last year alone, in 2015, the increase of electronic cigarette use has more than doubled particularly among our youth (ages 11 – 14), adolescents (ages 15 – 17) and in our young adults (ages 18 – 25) with more than 3 million youth in middle and high school using electronic cigarettes within the past 30 days. A cash cow for the tobacco industry, these numbers are increasing daily. More than 85 percent of electronic cigarette users ages 12 – 17 use flavored e-liquids, which come in a large variety of flavors, and are especially appealing to youth. And the flavors are the leading reason for youth use, according to the Surgeon General’s report.

Tobacco companies have been ramping up their marketing strategies to attract and cause young people to start using electronic cigarettes. In the United States, $3.5 billion dollars in sales is big business for the industry. Electronic cigarette manufacturers spent $125 million dollars in advertising their products with retail stores becoming the most frequent source of youth exposure to the tobacco industry’s advertising approaches. The tobacco industry has gone back to its old tactics that are much the same as the ones used to promote the conventional tobacco products.

Unlike the marketing campaigns of yesteryear, advertising approaches and themes today have a significant advantage with the use of internet and social media creating a more effective and wider outreach to attract youth and young adults, causing them to start using tobacco products at a much earlier age. In 2014, more than 7 out of 10 middle and high school students stated that they have been exposed to tobacco advertising. Research has shown that youth who use tobacco products like electronic cigarettes or chew, are most likely to go on to use other tobacco products like the traditional tobacco cigarette. In 2015, nearly 6 out of 10 high school cigarette smokers were also using electronic cigarettes.

The tobacco industry has claimed that electronic cigarettes are safer than the traditional tobacco cigarette. The tobacco industry has also claimed that the chemicals in e-liquids are not harmful to the user. The tobacco industry has suggested that electronic cigarettes can and may be used as a cessation tool to quit smoking. On the contrary, the newly released US Surgeon General’s report has confirmed these claims to be myths. The US Surgeon General’s report has busted these myths by saying;

The use of products containing nicotine poses dangers to youth, pregnant women, and fetuses. The use of products containing nicotine in any form among youth, including electronic cigarettes, is unsafe.

The liquid usually has nicotine, which comes from tobacco, flavoring; and other additives. Many electronic cigarettes contain nicotine, which is highly addictive. The nicotine in electronic cigarettes and other tobacco products can prime young brains for addiction to other drugs, such as cocaine and methamphetamine. Electronic aerosol is not harmless. The aerosol or vapor created by electronic cigarettes can contain ingredients harmful and potentially harmful to the public’s health.

There have been no conclusive study results or evidence to confirm that electronic cigarettes are a possible cessation tool for those who want to quit smoking. On the contrary, there is sufficient evidence to substantiate that the use of electronic cigarettes promotes users to use both electronic cigarettes along with smoking the conventional tobacco cigarette and that can potentially place the user at risk for exposure to higher levels of nicotine in the body that may ultimately lead to acute toxicity and possible death from over-exposure to nicotine.

The US Surgeon General’s full report titled: E-Cigarette Use Among Youth and Young Adults, can be found on the Surgeon General’s official website:

Electronic cigarette retailers use Pokémon Go to market products

Download (PDF, 2.52MB)

South Australia looks to restrict e-cigarettes

Electronic cigarettes will be subject to the same restrictions as tobacco products under new laws proposed by the South Australian government.

Under current laws the devices can legally be sold to children and used in places where ordinary cigarettes cannot.

But Substance Abuse Minister Leesa Vlahos says the changes will bring them into line with conventional cigarettes, banning the sale to children, their use in enclosed public spaces and preventing any advertising or promotion.

Big Tobacco wins big with vaping

Big Tobacco, with its legion of lobbyists, and evil geniuses, is almost always a step ahead of regulators and health officials. It wasn’t until May of this year that the FDA finally finalized a rule extending its authority to all nicotine products — including e-cigarettes, cigars, hookah and pipe tobacco, among others. The lack of such authority is why we saw ads for nicotine vaping products on TV, and such products sold legally to teens and kids.

When cigarette smoking rates among teens hit historic lows in the past decade, flavored products (from cigars to vaping) filled the void. When the FDA announced the oversight change, it cited research by the agency and the CDC showing current e-cigarette use among high school students has skyrocketed from 1.5 percent in 2011 to 16 percent in 2015 (an over 900 percent increase) and hookah use has risen significantly. In 2015, 3 million middle and high school students were current e-cigarette users, and data showed high school boys smoked cigars at about the same rate as cigarettes.

A separate study by the FDA and the National Institutes of Health shows that in 2013-2014, nearly 80 percent of current youth tobacco users reported using a flavored tobacco product in the past 30 days – with the availability of appealing flavors consistently cited as a reason for use, the FDA reported.

And now, a new, disturbing study shows just how successfully Big Tobacco is cultivating more nicotine addicts, and how belated the FDA was to take action to oversee the new products. The research, published in the Journal of the American Medical Association, found that teenagers with a regular vaping habit aren’t just more likely to take up smoking — they have higher odds of developing a heavy cigarette habit, Reuters reported.

Vaping devices have been advertised as way to help smokers quit, but the lead author of the study says his findings call that cessation claim into question.

“Our most recent study is the first to show that teenagers who vape not only experiment with cigarettes, but are also more likely to become regular smokers,” said Adam Leventhal, director of the University of Southern California’s Emotion and Addiction Laboratory in Los Angeles.

Rather than keeping kids and teens from smoking, the flavored nicotine products can act as bridge to smoking, said Dr. Brian Primack, a University of Pittsburgh researcher who wasn’t involved in the study.

“… young people who may not have otherwise ended up smoking started with palatable, flavored e-cigarettes — and then after they became accustomed to e-cigarette use, many transitioned to traditional cigarette smoking,” Primack told Reuters. Which is exactly what is happening.

Vaping may put your smile at risk

New cell study shows e-cigarette vapors damage cells of the mouth

Here’s news that could put a frown on your face. New data show that electronic cigarettes pose a threat to cells in the mouth — and ultimately a vaper’s smile.

Electronic-cigarette use, or vaping, among teens is on the rise. The number of kids that tried vaping quadrupled between 2013 and 2015. In the United States, more kids now vape than smoke tobacco cigarettes. Ads on TV and the internet show e-cigarettes as being safe and fun. However, scientists have been turning up evidence that vaping is not harmless. And now researchers have found that e-cigarette vapors can pose risks to the gums and teeth.

Irfan Rahman works at the University of Rochester in New York. This biochemist studies the potential harm posed by-products and pollutants, including e-cigs. Last year, Rahman told Science News that many teens and young adults said vaping made their throats dry and scratchy. Some told his group that vaping made them cough and their mouths bleed. “We’ve got to start looking into these things and see what’s going on,” Rahman concluded.

E-cigarettes are battery-operated devices. A metal coil inside the device gets very hot. When a flavored liquid passes over these coils, it vaporizes into a gas that users breathe in. E-liquids contain mixtures of chemicals that produce different flavors. Most mixes contain some nicotine, too. (Nicotine is the addictive substance that gives cigarettes their “buzz.”) The liquids tend to be labeled as food grade, which means they are safe enough to eat. But heating these liquids can change their chemical composition. Experts say these chemical changes can make the vapors more toxic — more harmful — than the e-liquids themselves.

His team has now started to do just that.

The researchers have begun to probe what e-cig vapors do to cells of the mouth. They started by growing different types of human mouth cells in the lab. They looked at cells that make up the gums. They also looked at ligament cells that attach teeth to the gums. They exposed each type of cells to the chemicals from e-cigarette vapors.

Those vapors can alter the DNA in these cells, the scientists found. Exposing the cells to e-cig vapors damaged their DNA. DNA damage can change the genetic instructions that tell a cell how to grow and function. Over time, such changes might trigger the development of cancer. The vapors also can harm the cells by causing sustained inflammation.

Taken together, these changes point to a risk of cancer, gum disease and possibly tooth loss for anyone using e-cigarettes. Rahman’s team described its new findings in a paper published October 24 in the journal Oncotarget.

Inflammation — a chemical ‘red flag’ of danger

Mouth cells exposed to e-cigarette vapors gave off warning signals known as inflammatory markers. These markers signal that a process called inflammation is underway. Flavored e-cigs caused more of these inflammatory markers and signs of DNA damage to appear than did unflavored e-cig vapors. Because these flavor chemicals are not present in regular cigarettes, Rahman calls this finding especially worrisome. Indeed, he says, the flavored vapors may pose cellular risks that are unique to e-cigarettes.

Overall, Rahman saw lower levels of inflammation in cells treated with e-cig vapors than would be expected from treating cells with smoke from tobacco cigarettes. Still, that doesn’t mean e-cigs are safer than regular cigarettes, Rahman cautions, because researchers still don’t know what the long-term health effects of e-cig use might be.

Inflammatory markers are chemicals that “tell our bodies that something is going wrong. They send signals that these cells have been damaged,” explains Maciej Goniewicz. He’s a toxicologist at the Roswell Park Cancer Institute in Buffalo, N.Y. Like Rahman, he studies the health effects of e-cigarette vapors. Goniewicz was not involved in the new research on mouth cells.

Inflammation can be helpful. It helps turn on the body’s immune system. This allows it to fight off foreign invaders that don’t belong in the body, such as bacteria and viruses. Inflammation also can help the body heal itself after an injury.

But chronic inflammation, the type that doesn’t go away, is not good. And chronic inflammation is what Rahman and his colleagues worry might occur in a vaper’s mouth. Long-term inflammation of the gums can cause disease. Gum disease can destroy the tissue and bone that hold teeth in place. Severe gum disease even can lead to tooth loss.

The new research corroborates a study Goniewicz published earlier this fall. The bronchial (BRON-kee-ul) tubes are airways that lead to the lungs. Flavored e-cigarette vapors caused similar signs of inflammation to bronchial tube cells as Rahman’s group now reports in mouth cells. The e-cig vapors caused less damage to the bronchial cells than tobacco smoke did. Still, Goniewicz emphasizes, “We are seeing that the e-cigarettes do some harm to cells.”

Looking for the big picture

Fawad Javed is a dentist at the University of Rochester. Studying cells in the lab are important for several reasons, he says. “If somebody that smokes or vapes comes to me with oral disease, I need to understand why this is happening.” Javed worked with Rahman on the new study. Seeing changes on the chemical level can point dentists to the root cause of disease, he argues. And once that’s known, he explains, heath professionals can begin to figure out how to prevent disease.

In the lab, scientists can control and manipulate growing conditions. This allows them to scout for specific effects. Still, the scientists know there are many more things at play in the body than can be probed with dishes of cells in some laboratory. To get the full picture of what the new research means for oral health, scientists will have to combine what they learn in cell studies with data from human vapers.

Rahman and Javed have begun doing just that. They have started collecting samples from the mouths of vapers. Called gingival (JIN-jih-vul) crevicular (Kreh-VIC-u-ler) fluid, this watery substance comes from the tiny pockets between the gums and the teeth. That fluid shows evidence that vaping has caused similar inflammation in the saliva and gum fluid of e-cigarette users that Rahman’s team has seen in the cells they exposed in the lab.

But their work is far from over. More research is needed before they will know for sure what potential threats vaping poses to the mouth and gums, Rahman says.

The debate on regulation of e-cigarettes in China

China manufactures 80% of the world’s e-cigarettes.1

The domestic Chinese e-cigarette market has expanded since 2014, with a 33% increase in sales in 2015 alone.2 The 2014 China Global Youth Tobacco Survey, which studied 155 117 students aged 13–15 years, showed that 45·0% of them had heard about—and 1·2% had used—e-cigarettes.3 Some members of the global public health community are calling for regulation of e-cigarettes, but, owing to inconclusive evidence on their impact,4 no simple and unified guidelines exist to assist countries in such regulation. In China, a regulatory framework has been debated between the public health community and government agencies since 2005. We aim to analyse the development of a regulatory system for e-cigarettes and the interests and strategies of policy makers in China, and hope that this Comment might assist other countries undergoing similar debates on the regulation of e-cigarettes.

There have been dramatic changes in the way that e-cigarettes are marketed in China since they first emerged in 2005. Back then, e-cigarette companies promoted their products as a cigarette-like but healthier alternative to tobacco, as a tool to help quit smoking, and as gifts,5 which attracted attention from tobacco control advocates and government agencies.

However, with little evidence on the health effects of e-cigarettes, and little international experience in their regulation, government agencies were initially hesitant to take over regulatory responsibility. The ensuing debate centred on whether to categorise e-cigarettes as tobacco, medicinal, general, or harmful products—each coming under different agencies with different regulatory mechanisms.

Over a decade later, this issue is still unresolved.

The China Food and Drug Administration expressed its position in 2006 that “Electronic Nicotine Delivery Systems (ENDS) should not be managed as medical equipment.”6 The State Tobacco Monopoly Administration (STMA) refused to classify e-cigarettes as tobacco products but rather as potentially harmful chemical products, recommending regulation under State Administration of Work Safety.

Nonetheless, the e-cigarette industry was challenged by the media and public health advocates for its marketing ploys. The industry then changed its strategy to promote e-cigarettes as fashionable, innovative, leisure consumer goods, and built a fan base, both online and offline. Many e-cigarette centres, clubs, and bars were established in major cities to help disseminate and portray the culture of vaping, and to increase sales of e-cigarettes.

As the e-cigarette industry developed, the Chinese tobacco monopoly decided to include e-cigarette development in its own strategy. It established a task force led by the STMA’s leaders to coordinate issues related to all new tobacco products. Its local branches, an affiliated research centre, and two e-cigarette companies agreed to cooperate in development of e-cigarettes co-branded with the key existing cigarette brands.7

The trajectory of e-cigarette regulatory development has also been affected by the changing policy context in China. First, many tobacco control measures have been implemented, such as increases in tobacco tax, revision of advertising laws, non-smoking directives to government officials, and a national smoke-free law under process.

Second, as China’s economy has begun to slow down since 2009, a core strategy of the Chinese administration to stimulate economic vitality is through deregulation of industries. The government also encourages industries to form associations for improved self-regulation. With more than 1000 brands, 6000 products, and over 1800 companies in the industry, leading e-cigarette companies echoed this central policy by establishing the first National Association of Electronic Cigarettes in 2015.8

The Ministry of Industry and Information Technology (MIIT)—the supervising ministry for STMA—seems to support the self-regulation of the e-cigarette industry. By encouraging small and medium e-cigarette companies to form into associations, MIIT might be able to manage the industry more easily.

However, MIIT suggested that the STMA should seriously consider and push forward the regulation of e-cigarettes and other tobacco products.9 At the time of writing, the central government has yet to make a decision on how to regulate e-cigarettes.

Whether e-cigarettes end up being regulated by the STMA or through self-regulation by the e-cigarette industry, we call upon the central government to include e-cigarettes in all future tobacco surveys, and establish a regulatory system as soon as possible to at least ban sales to children, prevent e-cigarette marketing towards youth and non-smokers, and require disclosure of ingredients and labelling—as a first step until the science is clear.

Xiaoxin Xu, *Xinsong Wang, Xiulan Zhang, Yanli Liu, Huan He, Judith Mackay

School of Social Development and Public Policy, Beijing Normal University, Beijing 100875, China (XX, XW, XZ, YL); School of Public Administration, Southwestern University of Finance and Economics, Chengdu, Sichuan, China (HH); and Vital Strategies, Kowloon, Hong Kong Special Administrative Region, China (JM)
We declare no competing interests.

1 Shan J. E-cigarette controls considered for safety. China Daily, Jan 7, 2015. htm (accessed May 31, 2016).
2 Beijing Hua Yan Zhong Shang Yanjiu Yuan. Analysis of e-cigarettes market status in China and trend forecasting, 2015–2020. Beijing: Beijing Hua Yan Zhong Shang Yanjiu Yuan, 2015 (in Chinese).
3 Global Youth Tobacco Survey. Fact sheet: China 2014. Chinese Center for Disease Control and Prevention, WHO, and Centers for Disease Control and Prevention. (accessed May 24, 2016).
4 Levy DT, Cummings KM, Villanti AC, et al. A framework for evaluating the public health impact of e-cigarettes and other vaporized nicotine products. Addiction 2016; published online April 25. DOI:10.1111/ add.13394.
5 Tobacco China Online. Healthy “cigarettes” appearing at Canton Fair, customers mostly from overseas. 2005. (in Chinese) (accessed May 24, 2016).
6 China State Food and Drug Administration. Notice on classifi cation of products including the system of re-leveling of leukocyte (2006, No 268, State Food and Drug Administration), Article 41. In: China State Food and Drug Administration, ed. Beijing: China State Food and Drug Administration, 2006.
7 Jiang Z, Gu M. Shanghai Lvxin and CNTC cooperate on e-cig, taking the high ground. 2014. http://fi (in Chinese) (accessed May 4, 2016).
8 Cecmol. National Association of Electronic Cigarettes established. 2015. (in Chinese) (accessed May 4, 2016).
9 Dongfang Yancao Wang. The speech by Miao Yu at the 2016 Tobacco Work Meeting (excerpt). 2016. (in Chinese) (accessed May 4, 2016).