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Big tobacco’s big profits

Why are tobacco companies’ profits still booming – despite government regulation and declining smoking rates?

http://www.aljazeera.com/programmes/countingthecost/2017/06/big-tobacco-big-profits-170603092904305.html

Smoking kills. So if you’re in an industry where your product is known to be damaging the health of people who buy it, then you should, in theory, go out of business.

But shares in companies listed in the Bloomberg tobacco producers index have risen 351 percent since 2009, making it one of the best investments of the past decade.

Graphic warning labels and taxes seem to have some effect on reducing the number of smokers but less so on industry profits which keep rising. And investors can’t quit buying the stocks because operating profits continue to go up.

Although some pension funds and life insurers have turned their back on the sector, it’s still not enough to hit big tobacco where it hurts.

Different tax regimes around the world mostly account for the difference in price of cigarettes. But governments are not as hooked as the consumers who buy cigarettes.

Consumers cough up for higher prices because they crave the drug in tobacco – nicotine. Without nicotine addiction, there would be no tobacco industry.

The tobacco industry knows this and has diversified to develop other nicotine products like E-cigarettes. The electronic cigarette market has grown from just $50m in 2005 to an estimated $7.5bn last year, according to Euromonitor. It’s all part of the unique economy of addiction.

New evidence suggests the dangers of cigarettes in the United States have increased despite the fall of smoking rates in recent years. A new study has found that so-called “light” cigarettes may be behind a spike in lung cancer cases, as Heidi Zhou-Castro reports.

Jeremias Paul from the World Health Organization joins Counting the Cost from Geneva to discuss the unique dynamics of the nicotine economy.

Paul thinks the tobacco industry should pay more taxes because they’re making a profit out of people’s addiction.

“If they cause death, they should be taxed to death. In the latest global adult tobacco survey, there was a reduction in tobacco use of about 20 percent, which essentially proves increasing taxes regenerates a lot of revenues but at the same time reduces consumption.”

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.”

How spotting someone vaping triggers the same cravings as real tobacco

Seeing someone use an e-cigarette encourages smokers to light up, a study has warned. Even though they don’t look like a normal cigarette, ‘vape pens’ can trigger the same cravings as real tobacco products.

http://dailytimes.com.pk/infotainment/14-Jan-17/how-spotting-someone-vaping-triggers-the-same-cravings-as-real-tobacco

A study by Chicago University found the devices were a ‘potent trigger’ to encourage young adults to smoke as they mimic the same behaviour – inhaling and exhaling – and use the same hand and mouth movements as regular cigarettes.

The findings cast doubt on how well the smoking ban has worked to put cigarettes ‘out of sight’, as vaping becomes common.

Although the 18 to 35-year-olds in the study who were influenced by e-cigarettes already smoked, the findings also raise concerns about a ‘gateway effect’ encouraging people who smoke to vape as well.

The study, published in journal Nicotine & Tobacco Research, used 108 volunteers ranging from light smokers to those who went through a pack of cigarettes a day.

When they saw someone use a vape pen, they were more likely to want a cigarette or reach for one.

Vape pens look more like pens than cigarettes but still deliver a nicotine hit and puff out vapour.

Research leader Dr Andrea King, director of the clinical addictions research laboratory at Chicago University, said, “Vape pens look different but they share too many salient features of the act of smoking – including inhalation, exhalation and hand-to-mouth behaviours. This makes them a potent trigger, encouraging people to smoke.

Their impact is roughly equal to watching someone light up a cigarette. They made the young adults in our study want to smoke.”

The decade-old UK ban on smoking in public places was designed to make the habit seem less normal by keeping smokers out of offices and pubs.

However, despite calls from the World Health Organisation for countries to consider a similar ban on e-cigarettes, they are becoming increasingly popular.

To measure their effect on susceptible young adults, the researchers planted a pretend volunteer among their study group who smoked either a conventional cigarette or a vape pen.

Both cues increased the desire among research subjects for a cigarette or an e-cigarette. Then 26 of the group were tested 20 minutes later by placing a cigarette on a tray, along with a lighter and an ash tray.

Told they would receive a cash reward of 20 cents for every five minutes they resisted, those who had seen the person smoking a cigarette or vape pen managed to hold out for only 20 minutes.

Dr King said, “Our study focused on a classical Pavlovian trigger, as seeing someone smoke is a known potent cue that can induce others to smoke. We did not expect that the vape pen would be as potent a cue as the regular cigarette, but it was as potent.”

The Surgeon General’s Report on E-Cigarettes: Quitters & Starters

By Dr. Sudip Bose, MD

http://www.huffingtonpost.com/dr-sudip-bose/the-surgeon-generals-repo_b_14046964.html

Jan. 7, 2016 — A report on e-cigarettes released at the end of last year by the US Surgeon General’s office shows a number of risks related to the popular product — particularly regarding young people — that should make them a lot less popular, but likely won’t. The act of “vaping” is often thought of as a safer alternative to smoking, but that’s not necessarily the case. Here are the dangers and potential dangers people should be paying attention to related to e-cigarettes:

The Debate

E-cigs are at the center of one of the most contentious debates in public health. The availability and appeal of using e-cigs as an alternative to smoking cigarettes has been growing quickly over the years for both those who are new to smoking, as an introductory product, and to those who are trying to quit smoking, who see it as a more “healthful” way of trying to kick the smoking habit.

However, e-cigs don’t solve the nicotine problem at all. Yes, e-cigs eliminate tar, and yes, e-cigs eliminate the tobacco — both dangerous elements to one’s health. And that’s definitely good. But what they do not eliminate is the critical element of nicotine. Nicotine is one of the most highly addictive substances on earth. It’s presented in a liquid and then vaporized form in an e-cig; you inhale through the e-cig, and as you inhale, the nicotine and other substances in the liquid are atomized and absorbed into your lungs. The nicotine in an e-cig is a lot more concentrated and potent.

New Users

For those who have never smoked and who are interested in the experience, e-cigs are an entry-level product that have been promoted and marketed as being safe. They’re not. They may be “safer” than cigarettes, but that’s only by degree.

While a new “vaper” isn’t exposed to the other substances of tar and tobacco such as are found in a normal cigarette, he or she is getting concentrated and more potent doses of nicotine. That’s not good. And we’re seeing younger and younger people trying these. Also not good. The e-cig “e-liquid,” which is what produces the vapor that users inhale and exhale, are marketed in an array of flavors that appeal to younger users — junior high and high school age kids — they’re available for order online, and you’re getting addicted right away to the habit of using nicotine. The flavors available boggle the imagination: bubble gum, banana, “Mother’s MIlk,” blueberry-lemon, banana cinnamon nutbread, pomegranate, strawberry — it goes on endlessly. These teenagers — and even younger children — are getting addicted early, which could lead to smoking, and e-cigs can easily become a gateway to trying and developing an addiction to more serious drugs. Addiction correlates to crime. People need to feed their habit, they break into homes to steal things to resell, they commit robberies on the streets, all to get money to feed their addiction. Ultimately they make some very poor choices and place themselves in very dangerous situations.

We may see less cancer as a result of e-cig use, because the tobacco and tar are gone. But we won’t be able to tell that for years or decades to come. Remember there are other chemicals mixed in with the nicotine in the solution that also could cause cancer down the road. The liquid that becomes vaporized in e-cigs, which you inhale and exhale in a cloud of vapor, contains not only nicotine but an array of other substances, such as propylene glycol, glycerine, flavorings and sometimes components like diacetyl, acetyl propionyl, benzaldehyde and the less-threatening sounding vanillin. We know that when inhaled, diacetyl causes a type of bronchitis known as “popcorn lung” — a scarring of the tiny air sacs in the lungs resulting in the thickening and narrowing of the airways. It may sound benign to a degree, but according to the American Lung Association, “it’s a serious disease that causes wheezing and shortness of breath, similar to the symptoms of chronic obstructive pulmonary disease (COPD).”

Quitting Smoking

If you’re trying to quit smoking, remember the key drug, nicotine, is still very much available through an e-cig and at much higher, concentrated doses. So while you will be eliminating the tar and tobacco of a cigarette, you’re amping up the accessibility of nicotine. That’s not exactly a great way to wean yourself from something harmful — to add more of it to your system.

We’re seeing a lot more nicotine toxicity. For example, little babies we see in the emergency room — sometimes they get a hold of a cigarette and they chew on it, which is usually not that harmful. But if they get a hold of an e-cigarette and ingest some of that liquid nicotine, which again is so concentrated in an e-cig form, we see nausea, vomiting seizures, paralysis — bad things.

Being that the nicotine is one of the most addictive substances, it’s not really helping you quit your addiction, it’s not the path to accomplishing that. And we’re seeing younger and younger people getting into it.

An Alternative to Smoking

There is a rising “connoisseur-ship” that’s evolved in the world of vaping in which vapers discuss vaping in the same way that wine aficionados discuss the nuances of whatever wine they are drinking. That’s great, but that doesn’t lessen the dangers outlined above.

Are vapers listening? Not really. In 2013, e-cigarette-related sales were $1.7 billion, which was double what they were in 2012. In 2015, those sales had risen to $2.9 billion. Many tobacco manufacturers also are in the e-cigarette game. More than 250 e-cig brands are on the market.

Perhaps this Surgeon General’s report will help refocus attention on the dangers of e-cigarettes and give people enough of a reason to take a pass at the growing trend of vaping.

For more about Dr. Sudip Bose, MD, please go to SudipBose.com and visit his nonprofit TheBattleContinues.org where 100% of donations go directly to injured veterans

Follow Dr. Sudip Bose on Twitter: www.twitter.com/docbose

Nicotine’s Highly Addictive Impact on Youth Underestimated

http://www.medscape.com/viewarticle/873955

Although smoking trends among youth have shifted in recent years from tobacco cigarettes to e-cigarettes, the highly addictive culprit nicotine remains constant, a fact that should be underscored in discussion of risk with youth and their parents.

“I think most people realize nicotine is addictive, but I don’t know if there’s an understanding of just how addictive it is – particularly for youths,” said Lorena M. Siqueira, MD, MSPH, lead author of a new report on nicotine, addiction, and youth that was released by the American Academy of Pediatrics (AAP).

“People think, for instance, only having a few cigarettes a week may be fine and they can quit any time, but they don’t realize that they are already well on their way to dependency,” Dr Siqueira, a member of the AAP Committee on Substance Use and Prevention, told Medscape Medical News.

The report was published in the January issue of Pediatrics.

Evidence shows that the earlier in life a person is exposed to nicotine, the less likely they will be able to quit using tobacco and the more likely they will consume increasingly greater quantities.

The vast majority of tobacco-dependent adults – up to 90% – started smoking before age 18 years. The authors also point out that the earlier a child starts smoking, the greater the risk of continuing to smoke in adulthood.

Approximately two thirds of children who smoke in sixth grade, for example, become regular smokers as adults. In comparison, 46% of youth who begin smoking in the eleventh grade go on to become regular smokers as adults.

In addition, compared to adult smokers, youths require more attempts to quit smoking before being successful. In addition, only about 4% of smokers aged 12 to 19 years have been shown to successfully quit each year, the authors report.

Although e-cigarettes are marketed as a tool for smoking cessation, there is no strong evidence to support these claims, the authors note.

In fact, research, including a study published in JAMA Pediatrics in 2014, indicates that e-cigarettes, which contain nicotine, encourage, rather than discourage, tobacco use in youth.

Since that study’s publication, a number of other studies have shown similar harms, the study’s coauthor, Stanton A. Glantz, PhD, of the Center for Tobacco Research and Education at the University of California, San Francisco, told Medscape Medical News.

“There are now seven published longitudinal studies showing that youths who initiate smoking with e-cigarettes are about three times more likely to be smoking conventional cigarettes a year later,” he said.

“So clearly, e-cigarettes are acting as a gateway to conventional cigarette smoking.”

Instead of making quitting easier, e-cigarettes make it harder, Dr Glantz added.

“What the evidence shows is youths who use e-cigarettes are much less likely to stop smoking than youths who don’t use e-cigarettes, so not only are they not beneficial, as promoted, or even useless, they actually [work against] cessation.”

Among key attractions to e-cigarettes – and arguments that adolescents are likely to raise with parents ― is the idea that at least they are not as harmful as tobacco, Dr Siqueira said.

“It’s not unlike the prescription drug epidemic – adolescents think, ‘If my grandmother takes it, then it must be safe,’ so this is sort of the same thing,” she said.

The report also notes that e-cigarettes are not without toxic hazards of their own. Accidental poisonings associated with e-cigarette use have increased from one per month in 2010 to 215 per month in 2014, including one death.

“The take-home message is that there’s no arguing that nicotine is highly addictive, and it’s not just in cigarettes but it’s in all of these other products that are being cleverly marketed to youths to include ingredients and flavors to increase the palatability,” she said.

A new report from the University of Michigan’s Monitoring the Future study shows some encouraging trends regarding e-cigarettes. According to the study, after gaining popularity earlier in the decade, the percentage of US teens who use e-cigarettes declined for the first time from 2015 to 2016. The percentage of adolescents who used e-cigarettes in the past 30 days declined from 16% to 13% for 12th graders, from 14% to 11% for 10th graders, and from 8% to 6% among 8th graders; each change was statistically significant.

The report had even more encouraging news for cigarette smoking. The levels of smoking among 8th-, 10th-, and 12th-grade teens are the lowest they have been since annual tracking began 42 years ago.

“Since the peak year in 1997, the proportion of students currently smoking has dropped by more than three quarters — an extremely important development for the health and longevity of this generation of Americans,” principal investigator Lloyd Johnston, PhD, University of Michigan, Ann Arbor, said in a release.

The authors have disclosed no relevant financial relationshps. Dr Glantz has received research funding from the National Institutes of Health and from the Truth Initiative, a tobacco use prevention nonprofit organization.

UK public health experts move to quash e-cigarette fears in wake of US report

https://www.onmedica.com/newsarticle.aspx?id=be447bf6-8e2a-430a-9ba1-7783e5078bd8

UK public health experts have moved to quash fears about the potential dangers of e-cigarettes in the wake of the US Surgeon General’s report* setting out the urgent need to curb the rising popularity of vaping among young people in the US.

Clinicians should not be put off from helping smokers to quit or cut their risk of harm by switching to vaping, they insist.

In his report,* published earlier this week, Dr Vivek Murthy pointed to the evidence on the impact of nicotine on the developing brain, and its ability to trigger lifelong addiction, as well as the potentially harmful additives found in some e-cigarettes.

Use of e-cigarettes among high school students in the US had soared by 900% in the past five years, surpassing all other forms of conventional tobacco use, he said.
“We must protect our nation’s young people from a lifetime of nicotine addiction and associated problems by immediately addressing e-cigarettes as an urgent public health problem. Now is the time to take action,” he urged.

But Professor Kevin Fenton, national director of health and wellbeing at Public Health England, said that while he understood the concern about the rapid uptake of e-cigarettes in the US, attempts to regulate these products in the US had been difficult, and the situation in the UK was very different.

“We have comprehensive regulations in place, including a ban on selling e-cigarettes to under-18s and tough restrictions on advertising, as well as minimum standards for safety, maximum nicotine levels and health warnings on packs,” he said.

“Our review of the evidence found e-cigarette use carries a fraction of the risk of smoking, a conclusion reiterated by the Royal College of Physicians earlier this year. No new evidence has been published to contradict this, however we are closely monitoring any emerging evidence,” he added.

Professor Peter Hajek, Director of the Tobacco Dependence Research Unit at Queen Mary University of London (QMUL), reiterated the findings of the Royal College of Physicians report, which identified vaping “as a great public health opportunity,” rather than a threat.

“The new US report’s conclusions do not tally with what the actual data show. It is simply not true that e-cigarettes are a tobacco product or that vaping lures children to smoking or that it creates dependence in non-smokers,” he insisted.

“The prevalence of smoking among young people is at an all-time low and regular use of nicotine containing e-cigarettes among never-smokers is extremely rare. Ongoing vigilance is needed, but so far, e-cigarettes have acted as a gateway away from smoking, for adults and adolescents alike,” he continued.

The report also ignores the huge benefits of vaping for adult smokers in helping them switch from “deadly smoking,” he added.

“The worst part of the report is its policy recommendations. They may be well meant, but no consideration is given to their likely unintended consequences. Limiting smokers’ access to the much less risky option of vaping is likely to contribute to keeping smokers smoking and smoking-related disease and death going at the current rate,” he said.

Linda Bauld, Professor of Health Policy at the University of Stirling and Co-Chair of the Smoking in Pregnancy Challenge Group, said the evidence presented in the report on the potential harms of vaping during pregnancy had been fundamentally misunderstood, and was based on studies in rats and mice, not people.

“While we need more research on e-cigarettes, pregnant women who find it difficult to stop smoking should not be discouraged from using them. This is the position and current advice in the UK endorsed by a range of organisations,” she pointed out.

The Surgeon General’s report might make clinicians more hesitant about discussing e-cigarettes with pregnant women who smoke. “That would be harmful to maternal and child health and must be avoided,” she insisted.

Don’t Look to E-Cigarettes as a Panacea for Smoking

To the Editor:

Re “Experts Say Vaping Alarm Is Overdone” (front page, Nov. 2):

A positive if unintended result of the e-cigarette controversy is that highlighting the relative dangers of tobacco cigarettes and e-cigarettes further deglamorizes them both. The discussion presents the public with the unpleasant truth that nicotine isn’t a recreational drug.

Addiction to nicotine in tobacco is the norm, not the exception, and smoking addiction is about compulsive behavior and suffering, not pleasure. All the current studies show that people who quit smoking enjoy improved mental health, more positive moods and better quality of life than those who continue to smoke.

Nicotine replacement comes in many forms, including e-cigarettes. It can help ease smokers out of smoking, but only if they stop completely. The case for e-cigarettes would be stronger if the United States, like the British National Health Service, offered clinical assistance to help addicted smokers quit, rather than just relying on our culture of self-help.

DANIEL F. SEIDMAN

New York

The writer, a clinical psychologist, is director of smoking cessation services at Columbia University.

To the Editor:

E-cigarettes are not the panacea to tobacco-caused addiction, death and disease. E-cigarettes are unregulated tobacco products, and e-cigarette companies are making unproven health claims.

The Food and Drug Administration has not found any e-cigarette to be safe and effective in helping smokers quit. Instead, almost 60 percent of all e-cigarette users continue to smoke cigarettes.

Tobacco use is the leading cause of preventable death and disease in our country, and there is real concern that if e-cigarettes delay or prevent smoking cessation, the overall burden on health caused by tobacco will remain unacceptably high.

In 2009, a bipartisan majority in Congress charged the F.D.A. with oversight over tobacco products, including new products. The agency has taken steps to use this authority, and it should proceed with its process that allows manufacturers to provide evidence to show that their products are less harmful.

Trusting the tobacco industry and circumventing robust scientific review and oversight of these products would be a mistake.

HAROLD P. WIMMER

National President and Chief Exec.

American Lung Association

Chicago

One More Reason To Swear Off Tobacco: The Inflammatory Trap Induced By Nicotine

http://www.science20.com/news_articles/one_more_reason_to_swear_off_tobacco_the_inflammatory_trap_induced_by_nicotine-179670

An Umeå-based team in collaboration with US researchers reveals a new link between nicotine and inflammation. They report that nicotine strongly activates immune cells to release DNA fibres decorated with pro-inflammatory molecules, so called neutrophil extracellular traps (NETs). The continuous exposure to these NETs can harm the tissue and could explain the hazardous consequences of tobacco consumption for human health.

Tobacco use causes death of nearly six million people annually according to WHO. Nicotine is the major addictive and toxic component in tobacco products. In cells, nicotine signals via nicotine acetylcholine receptors to mediate dangerous effects on the consumer’s body. Nicotine is a major cause of inflammatory diseases among smokers and also non-smokers by passive inhalation, such as for instance chronic obstructive lung disease (COPD). COPD is widely spread and affects more than 10 percent of the adult population in westernised countries. The molecular mechanisms underlying this inflammatory activity of nicotine are not well understood.

In a recently published article in the Journal of Leukocyte Biology, researchers at the Laboratory for Molecular Infection Medicine Sweden (MIMS) at Umeå University reveal a novel link between nicotine and inflammation. They found that nicotine activates neutrophils, in an undesirable fashion.

Neutrophils are the most abundant type of white blood cells that circulate in the blood stream ready to attack invading microbes with an arsenal of antimicrobial compounds. Neutrophils are essential to prevent infection by engulfing invading microbes, or by releasing reactive oxygen species as well as DNA fibres from their own nuclei, termed neutrophil extracellular traps (NETs). NET release is a mixed blessing. Loaded with antimicrobial enzymes and pro-inflammatory molecules NETs are harmful to invading microbes, however, they can also potently harm the host’s own tissue, if not controlled in the right manner. In recent years, NETs have been attributed to be mediators of tissue damage in several inflammatory diseases, such as for instance small vessel vasculitis, arthritis and cancer.

For the first time, Ava Hosseinzadeh and colleagues at MIMS show that nicotine triggers NET release. The signal to trigger NETs is mediated by a specific acetylcholine receptor found on neutrophils and further signalled into the cell via a protein kinase known as Akt.

“This particular finding explains the missing piece of the puzzle of tobacco usage and inflammation,” says Ava Hosseinzadeh, who worked on this project during her doctoral dissertation. “This novel finding opens new avenues to understand the consequences of tobacco usage for human health and should be seen as one more convincing argument to quit nicotine usage in any form.”

“The next evident step is to demonstrate the NET-inducing capacity of nicotine in animal models and human samples,” says Constantin Urban, associate professor and project leader at Umeå University. “Such ‘in vivo’ studies will enable us to attract new funders and potentially interest of the pharma industry. Our finding could hopefully lead to novel anti-inflammatory therapies of tobacco usage related diseases.”

Think e-cigs are safe for kids? You’ll think twice after reading this

A study found 75 percent of flavored e-cigarettes contain a chemical linked to severe respiratory disease

The teenage brain is particularly vulnerable to addiction

“Popcorn lung’’ can develop

http://www.miamiherald.com/living/health-fitness/article91033197.html

Electronic cigarettes, or e-cigarettes, have become so popular that they surpassed conventional cigarettes as the most commonly used tobacco product among youth in 2014, according to the Centers for Disease Control and Prevention.

E-cigarette use among youth has soared — from 1.5 percent in 2011 to 13.4 percent in 2014 among high school students, and from 0.6 percent in 2011 to 3.9 percent in 2014 among middle school students, according to the CDC.

E-cigarettes, battery-powered devices that provide doses of nicotine and other additives to the user in an aerosol, are often falsely viewed as a harmless alternative to conventional cigarettes because e-cigarettes do not contain tar, which can lead to tobacco-related diseases.

But, there are real dangers for users of e-cigarettes, especially for youth, medical experts say.

An adolescent brain is particularly vulnerable to addiction because it is still developing, said Dr. Judy Schaechter, chair of the department of pediatrics at UHealth — University of Miami Health System. Nicotine addiction can then become more severe and difficult to break.

Nicotine addiction can also become a gateway to conventional cigarettes and other substances, said Dr. Loretta Duggan, an adolescent medicine fellow at Nicklaus Children’s Hospital. A person with a family history of addiction or an addictive personality can also be very vulnerable.

“It can make it easier to lead to illicit drug use,” Duggan said.

Nicotine can increase heart rate and blood pressure as well as contribute to cardiovascular and heart disease, Duggan said. E-cigarettes can cause strokes and cancer because nicotine can negatively affect blood vessels.

“Even though e-cigarettes seem harmless, a real risk exists,” Duggan said.

There is very little research about other effects that e-cigarettes, which include other additives, can have on the body, Schaechter said. But, e-cigarettes can have a negative effect on the brain, causing inflammation to the lungs and developing tissue.

Schaechter noted reports of e-cigarette users suffering from “popcorn lung” or bronchiolitis obliterans. That is an irreversible life-threatening disease that causes scarring within small air sacs in the lungs, resulting in a severe cough and shortness of breath that gets progressively worse over time.

According to a study released by the Harvard School of Public Health, 75 percent of flavored e-cigarettes and their refill liquids were found to contain diacetyl, a flavoring chemical linked to cases of severe respiratory disease such as “popcorn lung.”

E-cigarettes are often attractive to adolescents because of their kid-friendly flavors, packaging and advertisements.

According to a CDC study released in April, there is a link between exposure to e-cigarette advertisements and the use of e-cigarettes by middle and high school students. Spending on e-cigarette advertising rose from $6.4 million in 2011 to an estimated $115 million in 2014.

The high rate of e-cigarette use among adolescents suggests that adolescents who would not have otherwise used tobacco products are picking up the habit, according to a study released this summer by the American Academy of Pediatrics.

Parents can guard against these dangers. Talk to children as young as 6, before they are influenced by their peers, Duggan said.

Parents should also not indulge in e-cigarette use, Schaechter said.

“We know children of smokers are more likely to smoke,” Schaechter said. “If parents don’t want their children to pick up addictive habits, they shouldn’t do it.”

Also, monitor their social media, TV and cellphone usage, where adolescents can view e-cigarette advertisements.

The Food and Drug Administration (FDA) issued new rules in May that for the first time extend federal regulatory authority to e-cigarettes, banning their sale to anyone under 18 and requiring that adults under the age of 26 show a photo identification to buy them.

The new rules also require manufacturers to register with the FDA, disclose detailed reports of their products’ ingredients and obtain permission to sell their products.

“We can work with teens to break addiction, unlike with our parents and grandparents, who didn’t have the type of knowledge that we have today,” Duggan said.

 

Nicotine Addiction Clinical Presentation

http://emedicine.medscape.com/article/287555-clinical

Nicotine addiction is now referred to as tobacco use disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). [2]

There are 11 possible criteria, of which at least 2 must be present in the last 12 months:

1. Tobacco taken in larger amounts or over longer periods of time
2. Persistent desire or unsuccessful efforts to cut down or control use
3. A great deal of time is spent on activities necessary to obtain or use tobacco
4. Craving or a strong desire or urge to use tobacco
5. Recurrent tobacco use resulting in a failure to fulfill major role obligations at work, school, or home
6. Continued tobacco use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by effects of tobacco (eg, arguments with others about tobacco use)
7. Important social, occupational, or recreational activities are given up or reduced because of tobacco use
8. Recurrent tobacco use in situations in which it is physically hazardous (eg, smoking in bed)
9. Tobacco use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by tobacco
10. Tolerance, as defined by either the need for markedly increased amounts of tobacco to achieve the desired effect or a markedly diminished effect with continued use of the same amount of tobacco.
11. Withdrawal, as manifested by either the characteristic withdrawal syndrome or the use of tobacco to relieve or avoid withdrawal symptoms.

Symptoms of withdrawal include difficulty concentrating, nervousness, headaches, weight gain due to increased appetite, decreased heart rate, insomnia, irritability, and depression. These symptoms peak in the first few days but eventually disappear within a month.

Symptoms of nicotine toxicity, otherwise known as acute nicotine poisoning, include nausea, vomiting, salivation, pallor, abdominal pain, diarrhea, and cold sweat.

A previous history of depression, use of antidepressants in the past, and onset of depression during previous attempts to quit smoking should be obtained.

The time to first cigarette and total cigarettes per day are the 2 strongest predictors of nicotine addiction. The nicotine dependence and nicotine withdrawal could be treated by means of the following [4, 29] :

• Other forms of nicotine delivery
• Drugs that selectively target one or more of the underlying mechanisms
• Behavioral treatments, acupuncture, and other therapies