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Health Risks of E-cigarettes, Smokeless Tobacco, and Waterpipes

Jan 7th, 2015
by Editor.
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http://www.cancer.net/navigating-cancer-care/prevention-and-healthy-living/tobacco-use/health-risks-e-cigarettes-smokeless-tobacco-and-waterpipes

Approved by the Cancer.Net Editorial Board, 01/2015

Key Messages:

Alternatives to smoking, such as e-cigarettes, smokeless tobacco, and waterpipes still contain the addictive chemical nicotine, in addition to other chemicals.
While many of these alternatives may be marketed as being safer alternatives to smoking, they can also cause health risks.
If you smoke or use these products talk with your doctor about ways to quit.
Although cigarette smoking has been steadily—but slowly—declining in the United States, many different alternative tobacco and nicotine delivery products have been gaining popularity. This is partly because many alternative tobacco products—which come in various sizes, flavors, and forms—are marketed and often perceived as being relatively safe.

However, alternative tobacco products, such as e-cigarettes, smokeless tobacco, and waterpipes can cause serious potential health problems, including cancer, because of the chemicals and toxins they contain.

E-cigarettes

Electronic cigarettes, also known as e-cigarettes or vapor cigarettes, are battery-operated devices that resemble traditional cigarettes. However, instead of burning tobacco, they generally contain cartridges filled with nicotine and other chemicals. When the e-cigarette is used, the liquid chemicals in the cartridge are turned into a vapor or steam that is inhaled by the smoker.

Because e-cigarettes have only been readily available in the United States since 2006, there is limited research on their health risks. According to one analysis by the U.S. Food and Drug Administration (FDA), the tobacco solution used in e-cigarettes contains a toxic chemical found in antifreeze and several cancer-causing chemicals, such as nitrosamines. Little more is known about the types or concentrations of chemicals, including nicotine, in e-cigarettes. However, the chemicals in e-cigarettes, the potential harmful effects, and the addictiveness vary based on the brand.

Among all of the alternative tobacco products, e-cigarettes are the least regulated. They have no warning labels and can be sold to people of any age. The FDA has not approved e-cigarettes as a way to quit smoking. People with cancer who want to quit smoking should use the approved methods for quitting smoking.

Learn more about ASCO’s efforts in regulating e-cigarettes.

Smokeless tobacco

Smokeless tobacco products contain tobacco or tobacco blends that are either chewed, sucked, or sniffed. Most smokeless tobacco products are placed between the cheek or lips and gums for a few minutes to hours. They have many names, such as spit tobacco, chew, pinch, or dip, and fall into several categories.

Chewing tobacco.

This is tobacco in the form of loose leaves, leaves pressed together that is commonly known as “plug”, or leaves twisted together to resemble a rope that is commonly known as “twist.” Chewing tobacco is held between the cheek and gum. Usually the tobacco juices are spit out, but long-time users tend to swallow some of the juices.

Snuff.

This is finely ground tobacco that comes in dry or moist forms and is sometimes packaged in ready-to-use pouches. Dry snuff is usually sniffed or swallowed, whereas moist snuff—similar to snus (see below)—is placed between the gum and the lip or cheek and slowly absorbed.

Snus.

This is a tobacco product that originated in Sweden before being introduced to the United States. The moist tobacco powder is usually packaged in a pouch and placed in the mouth, inside the cheek, for absorption. It does not require the user to spit out tobacco juice; however, the pouch must be thrown away after use, not swallowed. Tobacco companies often market snus as a product that cigarette smokers can use in places where smoking is banned. Public health advocates worry that laws banning smoking in certain public places will not effectively encourage people to quit using tobacco products as long as snus is available.

Dissolvable tobacco.

This is powdered tobacco that is compressed to resemble a small, hard candy that dissolves in the mouth. It does not produce any tobacco juice that needs to be spit out or leave behind any substance that the user must throw away.

Prolonged use of smokeless tobacco products can lead to serious health issues, such as cancer and heart disease. Some smokeless tobacco contains greater amounts of nicotine—three to four times more—than cigarettes. These products also contain numerous substances that increase the risk of cancer of the mouth and throat. Chewing tobacco also may lead to white patches, called leukoplakia, on the gums, tongue, or lining of the mouth. Although most of these are noncancerous, some show early signs of cancer, and oral cancer often occurs near patches of leukoplakia. Chewing tobacco and other forms of smokeless tobacco can also cause gum disease and increase tooth decay.
Waterpipes

Another popular alternative tobacco product in the United States is the waterpipe. Waterpipes, also called hookahs, among other names, have been smoked in regions such as the Middle East, Asia, and Africa for more than four centuries.

Modern-day waterpipes, which are relatively inexpensive, are composed of four main parts:

  • A small bowl on top of the waterpipe, which holds a special mixture of shredded tobacco and sweetener
  • A broad base to hold water
  • A pipe connecting the bowl to the base
  • A rubber hose attached to a mouthpiece through which smoke is pulled
  • Small packets of the tobacco mixture burned in waterpipes are sold in a variety of flavors, such as apple, mint, and cappuccino. People can smoke waterpipes alone, but waterpipes are often used in social settings, with multiple people sharing the same mouthpiece.

Beyond their low cost and appeal as a traditional and communal activity, unfounded assumptions about their relative safety are driving the waterpipe trend, especially among college students and young people. According to one historical account of the waterpipe’s origin, an Indian physician created the device, believing that by having the smoke first pass through a small amount of water, it would be a less harmful method of inhaling tobacco. Even though there is no proof that water can “filter” tobacco smoke and make it less harmful, this misperception still persists today.

Health concerns about smoking waterpipes include the following:

Exposure to the same toxins as cigarettes but in higher quantities. The smoke produced by a waterpipe contains high levels of many of the same toxic compounds found in cigarettes, including carbon monoxide, heavy metals, and chemicals linked to cancer. These toxins and chemicals are associated with lung, stomach, bladder, and esophageal cancers and have been known to clog arteries and cause heart disease and respiratory diseases, such a lung disease called emphysema that causes difficulty breathing.

In most cases, waterpipe smoking sessions, which typically last up to one hour, expose smokers to much higher levels of these toxins than cigarettes. For example, a smoker may inhale 100% to 200% more smoke during a waterpipe session, compared with a single cigarette.

Potential to spread infectious disease. Sharing a waterpipe with other people can increase the risk of contracting or transmitting diseases, such as tuberculosis, and viruses, such as herpes and hepatitis, especially if the mouthpieces are not cleaned properly.

Nicotine addiction.

The tobacco used in waterpipes contains about the same amount of nicotine as cigarettes, which often leads to addiction.

State Health Officer’s Report on E-Cigarettes

Jan 1st, 2015
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Harmful effects of nicotine

Jan 1st, 2015
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Enhanced corticobulbar excitability in chronic smokers during visual exposure to cigarette smoking cues

Jul 1st, 2014
by Editor.
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http://www.ncbi.nlm.nih.gov/pubmed/24485386

Abstract

BACKGROUND:

Neuroimaging studies of chronic smokers report altered activity of several neural regions involved in the processing of rewarding outcomes. Neuroanatomical evidence suggests that these regions are directly connected to the tongue muscle through the corticobulbar pathways. Accordingly, we examined whether corticobulbar excitability might be considered a somatic marker for nicotine craving.

METHODS:

We compared motor-evoked potential (MEP) amplitudes recorded from the tongue and the extensor carpi radialis (control muscle) of chronic smokers under drug withdrawal and intake conditions as well as a nonsmoker group. All participants were tested during passive exposure to pictures showing a smoking cue or a meaningless stimulus. In the intake condition, chronic smokers were asked to smoke a real cigarette (CSn: group 1) or a placebo (CSp: group 2).

RESULTS:

Results show that MEP amplitudes recorded from the tongues of participants in the CSn and CSp groups under the withdrawal condition were selectively enhanced during exposure to a smoking cue. However, this effect on tongue MEP amplitudes disappeared in the intake condition for both the CSn and CSp groups.

LIMITATIONS:

Limitations include the fact that the study was conducted in 2 different laboratories, the small sample size, the absence of data on chronic smoker craving strength and the different tastes of the real and placebo cigarettes.

CONCLUSION:

These results suggest that, in chronic smokers, tongue muscle MEP amplitudes are sensitive to neural processes active under the physiological status of nicotine craving. This finding implicates a possible functional link between neural excitability of the corticobulbar pathway and the reward system in chronic smokers.

Demographic characteristics, nicotine dependence, and motivation to quit as possible determinants of smoking behaviors and acceptability of shocking warnings in Italy

May 12th, 2014
by Editor.
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http://www.ncbi.nlm.nih.gov/pubmed/24900980

Abstract

INTRODUCTION:

This paper presents the final results of a cross-sectional study started in 2010. It compares the perceived efficacy of different types of tobacco health warning (texts versus shocking pictures) to quit or reduce tobacco use.

METHODS:

The study conducted between 2010 and 2012 in Italy enrolled adults smokers. Administering a questionnaire demographic data, smokers behaviors were collected. Showing text and graphic warnings (the corpse of a smoker, diseased lungs, etc.) the most perceived efficacy to reduce tobacco consumption or to encourage was quit.

RESULTS:

666 subjects were interviewed; 6% of responders referred that they stopped smoking at least one month due to the textual warnings. The 81% of the smokers perceived that the warnings with shocking pictures are more effective in reducing/quitting tobacco consumption than text-only warnings. The younger group (<45 years), who are more motivated to quit (Mondor’s score ≥ 12), and females showed a higher effectiveness of shocking warnings to reduce tobacco consumption of, 76%, 78%, and 43%, respectively with P < 0.05.

CONCLUSIONS:

This study suggests that pictorial warnings on cigarette packages are more likely to be noticed and rated as effective by Italian smokers. Female and younger smokers appear to be more involved by shock images. The jarring warnings also appear to be supporting those who want to quit smoking. This type of supportive information in Italy may become increasingly important for helping smokers to change their behavior.

Selling a Poison by the Barrel: Liquid Nicotine for E-Cigarettes

Mar 23rd, 2014
by AdminCTA.
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http://www.nytimes.com/2014/03/24/business/selling-a-poison-by-the-barrel-liquid-nicotine-for-e-cigarettes.html?_r=0

A dangerous new form of a powerful stimulant is hitting markets nationwide, for sale by the vial, the gallon and even the barrel.

The drug is nicotine, in its potent, liquid form — extracted from tobacco and tinctured with a cocktail of flavorings, colorings and assorted chemicals to feed the fast-growing electronic cigarette industry.

These “e-liquids,” the key ingredients in e-cigarettes, are powerful neurotoxins. Tiny amounts, whether ingested or absorbed through the skin, can cause vomiting and seizures and even be lethal. A teaspoon of even highly diluted e-liquid can kill a small child.

But, like e-cigarettes, e-liquids are not regulated by federal authorities. They are mixed on factory floors and in the back rooms of shops, and sold legally in stores and online in small bottles that are kept casually around the house for regular refilling of e-cigarettes.

Evidence of the potential dangers is already emerging. Toxicologists warn that e-liquids pose a significant risk to public health, particularly to children, who may be drawn to their bright colors and fragrant flavorings like cherry, chocolate and bubble gum.

The liquid stimulant used in e-cigarettes, when ingested or absorbed through the skin, can cause vomiting, seizures or death. Credit Frank Franklin II/Associated Press

The liquid stimulant used in e-cigarettes, when ingested or absorbed through the skin, can cause vomiting, seizures or death. Credit Frank Franklin II/Associated Press

“It’s not a matter of if a child will be seriously poisoned or killed,” said Lee Cantrell, director of the San Diego division of the California Poison Control System and a professor of pharmacy at the University of California, San Francisco. “It’s a matter of when.”

Reports of accidental poisonings, notably among children, are soaring. Since 2011, there appears to have been one death in the United States, a suicide by an adult who injected nicotine. But less serious cases have led to a surge in calls to poison control centers. Nationwide, the number of cases linked to e-liquids jumped to 1,351 in 2013, a 300 percent increase from 2012, and the number is on pace to double this year, according to information from the National Poison Data System. Of the cases in 2013, 365 were referred to hospitals, triple the previous year’s number.

Examples come from across the country. Last month, a 2-year-old girl in Oklahoma City drank a small bottle of a parent’s nicotine liquid, started vomiting and was rushed to an emergency room.

That case and age group is considered typical. Of the 74 e-cigarette and nicotine poisoning cases called into Minnesota poison control in 2013, 29 involved children age 2 and under. In Oklahoma, all but two of the 25 cases in the first two months of this year involved children age 4 and under.

In terms of the immediate poison risk, e-liquids are far more dangerous than tobacco, because the liquid is absorbed more quickly, even in diluted concentrations.

“This is one of the most potent naturally occurring toxins we have,” Mr. Cantrell said of nicotine. But e-liquids are now available almost everywhere. “It is sold all over the place. It is ubiquitous in society.”

The surge in poisonings reflects not only the growth of e-cigarettes but also a shift in technology. Initially, many e-cigarettes were disposable devices that looked like conventional cigarettes. Increasingly, however, they are larger, reusable gadgets that can be refilled with liquid, generally a combination of nicotine, flavorings and solvents. In Kentucky, where about 40 percent of cases involved adults, one woman was admitted to the hospital with cardiac problems after her e-cigarette broke in her bed, spilling the e-liquid, which was then absorbed through her skin.

The problems with adults, like those with children, owe to carelessness and lack of understanding of the risks. In the cases of exposure in children, “a lot of parents didn’t realize it was toxic until the kid started vomiting,” said Ashley Webb, director of the Kentucky Regional Poison Control Center at Kosair Children’s Hospital.

Nicotine solutions at Volt Vapes in Boise, Idaho. The “e-liquid” comes in colors and flavors that experts say may entice children. Credit Katherine Jones/The Idaho Statesman, via Associated Press

Nicotine solutions at Volt Vapes in Boise, Idaho. The “e-liquid” comes in colors and flavors that experts say may entice children. Credit Katherine Jones/The Idaho Statesman, via Associated Press

The increased use of liquid nicotine has, in effect, created a new kind of recreational drug category, and a controversial one. For advocates of e-cigarettes, liquid nicotine represents the fuel of a technology that might prompt people to quit smoking, and there is anecdotal evidence that is happening. But there are no long-term studies about whether e-cigarettes will be better than nicotine gum or patches at helping people quit. Nor are there studies about the long-term effects of inhaling vaporized nicotine.

Unlike nicotine gums and patches, e-cigarettes and their ingredients are not regulated. The Food and Drug Administration has said it plans to regulate e-cigarettes but has not disclosed how it will approach the issue. Many e-cigarette companies hope there will be limited regulation.

“It’s the wild, wild west right now,” said Chip Paul, chief executive officer of Palm Beach Vapors, a company based in Tulsa, Okla., that operates 13 e-cigarette franchises nationwide and plans to open 50 more this year. “Everybody fears F.D.A. regulation, but honestly, we kind of welcome some kind of rules and regulations around this liquid.”

Mr. Paul estimated that this year in the United States there will be sales of one million to two million liters of liquid used to refill e-cigarettes, and it is widely available on the Internet. Liquid Nicotine Wholesalers, based in Peoria, Ariz., charges $110 for a liter with 10 percent nicotine concentration. The company says on its website that it also offers a 55 gallon size. Vaporworld.biz sells a gallon at 10 percent concentrations for $195.

Mr. Paul said he was worried that some manufacturers outside the United States — China is a major center of e-cigarette production — were not always delivering the concentrations and purity of nicotine they promise. Some retailers, Mr. Paul said, “are selling liquid and they don’t have a clue what is in it.”

Cynthia Cabrera, executive director of Smoke Free Alternatives Trade Association, said she would also favor regulations, including those that would include childproof bottles and warning labels, and also manufacturing standards. But she said many companies already were doing that voluntarily, and that parents also needed to take some responsibility.

“You wouldn’t leave a bottle of Ajax out,” she said. Advocates of e-cigarettes sometimes draw comparisons between nicotine and caffeine, characterizing both as recreational stimulants that carry few risks. But that argument is not established by science, and many health advocates take issue with the comparison.

“There’s no risk to a barista no matter how much caffeine they spill on themselves,” said Dr. Neal L. Benowitz, a professor at the University of California, San Francisco, who specializes in nicotine research. “Nicotine is different.”

Without proper precautions, like wearing gloves while mixing e-liquids, these products “represents a serious workplace hazard,” he said.

The nicotine levels in e-liquids varies. Most range between 1.8 percent and 2.4 percent, concentrations that can cause sickness, but rarely death, in children. But higher concentrations, like 10 percent or even 7.2 percent, are widely available on the Internet. A lethal dose at such levels would take “less than a tablespoon,” according to Dr. Cantrell, from the poison control system in California. “Not just a kid. One tablespoon could kill an adult,” he said.

University of California study: e-cigs “new route” to nicotine addiction

Mar 6th, 2014
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Study found adolescents who use e-cigs are less likely to quit smoking tobacco cigarettes

https://www.consumeraffairs.com/e-cigarette-warnings-and-lawsuits

Here’s the latest chapter in the continuing debate over whether e-cigarettes are a cure or an affliction: a study from the University of California San Francisco that finds e-cigs may in fact be a new route to conventional smoking and nicotine addiction.

In what is said to be the first analysis of the relationship between e-cigarette use and smoking among adolescents in the United States, UCSF researchers found that adolescents who used the devices were more likely to smoke cigarettes and less likely to quit smoking. The study of nearly 40,000 youth around the country also found that e-cigarette use among middle and high school students doubled between 2011 and 2012, from 3.1 percent to 6.5 percent.

“Despite claims that e-cigarettes are helping people quit smoking, we found that e-cigarettes were associated with more, not less, cigarette smoking among adolescents,” said lead author Lauren Dutra, a postdoctoral fellow at the UCSF Center for Tobacco Control Research and Education.

“E-cigarettes are likely to be gateway devices for nicotine addiction among youth, opening up a whole new market for tobacco,” she said. The study was published online on March 6 in JAMA Pediatrics.

A trade group took issue with the study, saying it “is implying conclusions that simply aren’t borne out by the data.”

In a prepared statement, Cynthia Cabrera, Executive Director, Smoke Free Alternatives Trade Association (SFATA), said: “As the survey summary itself states, it wasn’t designed to derive any insight about motivation or a possible causal relationship between use of e-cigarettes and combustible cigarettes. What the survey data does show is that cigarette smoking among teens has decreased.”

FDA action expected

The U.S. Food and Drug Administration (FDA) has been considering regulations that could restrict advertising and sales of the popular battery-powered devices, which look like cigarettes and deliver an aerosol of nicotine and other chemicals.

Several states and cities, including New York and Los Angeles, have banned the use of e-cigs, generally treating them as though they were tobacco products.

In Congress, five U.S. Senators introduced the “Protecting Children from Electronic Cigarette Advertising Act” last month. It would prohibit the marketing of e-cigs to children and teens.

“We cannot risk undoing decades of progress in reducing youth smoking by allowing e-cigarette makers to target our kids,” Sen. Barbara Boxer (D-Calif.) said. “This bill will help protect our children from an industry that profits from addiction.”

Manufacturers promote the devices as safer alternatives to cigarettes and as smoking cessation aids. They are sold in flavors such as chocolate and strawberry that are banned in conventional cigarettes because of their appeal to youth.

Cabrera denied that the e-cig industry is targeting children.

“Our industry does not sell or market to minors, and it is our view that no one under 18 should use electronic cigarettes. Electronic cigarettes and vaping products are intended strictly for adults who smoke cigarettes. We fully support limitations on the sale of these products to youth at retail to further reduce access to anyone under 18,” she said.

Students studied

In the new UCSF study, the researchers examined survey data from middle and high school students who completed the National Youth Tobacco Survey in 2011 and 2012.

The authors found that the devices were associated with higher odds of progression from experimenting with cigarettes to becoming established cigarette smokers. Additionally, adolescents who smoked both conventional cigarettes and e-cigarettes smoked more cigarettes per day than non-e-cigarette users.

“It looks to me like the wild west marketing of e-cigarettes is not only encouraging youth to smoke them, but also it is promoting regular cigarette smoking among youth,” said senior author Stanton A. Glantz, PhD, UCSF professor of medicine and director of the Center for Tobacco Control Research and Education.

Contrary to advertiser claims that e-cigarettes can help consumers stop smoking conventional cigarettes, teenagers who used e-cigarettes and conventional cigarettes were much less likely to have abstained from cigarettes in the past 30 days, 6 months, or year. At the same time, they were more likely to be planning to quit smoking in the next year than smokers who did not use e-cigarettes.

The new results are consistent with a similar study of 75,000 Korean adolescents published last year by UCSF researchers, which also found that adolescents who used e-cigarettes were less likely to have stopped smoking conventional cigarettes.

In combination, the two studies suggest that “e-cigarettes may contribute to nicotine addiction and are unlikely to discourage conventional cigarette smoking among youths,” said the scientists.

The federal Centers for Disease Control and Prevention reported last year that the majority of adolescents who have ever smoked e-cigarettes also have smoked regular cigarettes. An estimated 1.78 million U.S. students have used the devices as of 2012, the CDC reported.

London Evening Standard: E-cigarettes to be banned for under-18s in Government crackdown on smoking

Jan 28th, 2014
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from the London Evening Standard:

Under-18s are to be blocked from buying electronic cigarettes under new legislation being planned by the Government.

Adults will also be prevented from buying cigarettes for anyone under 18 as part of a package of tough new laws designed to clamp down on teenage smoking.

E-cigarettes are currently enjoying a sales boom, with the number of UK users now estimated to have reached 1.3million.

The law, which will be introduced this week as an amendment to the Children and Families Bill, will also ban ‘proxy purchasing’ – knowingly buying tobacco on behalf of someone under 18.

Adults caught breaking the law, which ministers hope will come into force by the autumn, could be given a £50 fixed penalty notice or fined up to £2,500.

Public Health Minister and Conservative MP Jane Ellison said: “Two thirds of smokers say they smoked regularly before they were 18, showing that this is an addiction largely taken up in childhood.

“We must do all we can to help children lead a healthy life. That’s why this measure is designed to help protect children from the dangers of being bought cigarettes by irresponsible adults – something that I hope concerned parents and responsible retailers will welcome.”b,

While many people view the tobacco-free devices as a better alternative to traditional cigarettes, health experts remain deeply concerned about the long-term effects they could have on users’ health.

E-cigarettes provide a hit of nicotine – a highly addictive drug – and some fear they reinforce the behaviour of smoking, making it harder to give up in the long term.

England’s chief medical officer, Professor Dame Sally Davies, said: “We do not yet know the harm that e-cigarettes can cause to adults let alone to children, but we do know they are not risk free.

“E-cigarettes can produce toxic chemicals and the amount of nicotine and other chemical constituents and contaminants, including vaporised flavourings, varies between products meaning they could be extremely damaging to young people’s health.”

Currently there is no restriction on people under the age of 18 buying e-cigarettes, and they are hugely popular among teenagers in Briton.

But it is feared that children are turning to the smokeless devices – designed to help users quit – before moving on to traditional cigarettes.

Many secondary schools across the UK have resorted to banning e-cigarettes over fears they are encouraging pupils to take up smoking.

Smoking rates have fallen to their lowest ever, in the wake of the ban on smoking in public and a series of shocking public health campaigns highlighting the dangers of cigarettes.

But more than 1,000 people end up in hospital every day as a result of smoking, and experts have warned that the growth in e-cigarettes could reverse some of the good work that has been done in tackling the dangerous habit.

The latest move comes as Department of Health figures reveal that 41% of 15-year-olds who smoke say they usually buy their cigarettes from other people rather than buying them from a shop.

And 95% of 11- to 15-year-olds who smoke have managed to get someone else to buy cigarettes for them in a shop at least once in the past year.

The proxy purchase of alcohol is already illegal, and retailers have been calling for the creation of a proxy purchasing offence for tobacco for many years.

Smoking is one of the biggest causes of death and illness in the UK. Every year around 100,000 people die from smoking, and it is linked to a string of other potentially fatal illnesses including heart disease and strokes.

Deborah Arnott, chief executive of health charity Action on Smoking and Health (ASH) said: “ASH supports the government decision to make it illegal to sell e-cigarettes to under-18s.

“Although our research shows the only children using e-cigarettes are already smokers, and even then the numbers are small, this is a rapidly growing market and these products are being heavily promoted.”

She said of proxy purchasing of tobacco: “We know that buying cigarettes from adults is a major source of supply for under-age smokers, so in principle making buying cigarettes for children illegal is a good idea. We’d also like to see a retail licensing system put in place so that cigarettes could only legally be sold in shops not in car boot sales and markets.”

26 Jan 2014

AFP: French court rules e-cigs fall under tobacco monopoly

Jan 15th, 2014
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from the AFP:

A French commercial court ruled on Monday that e-cigarettes qualify as tobacco products and should only be sold by registered tobacconists.

The ruling by the court in Toulouse is subject to appeal but could eventually see the distribution of e-cigarettes limited by a state-imposed monopoly on tobacco sales.

The decision comes amid a global boom in sales of e-cigarettes — battery-powered, vapour-releasing tubes that are promoted as a healthier alternative to traditional tobacco products.

The case stems from a complaint made by a local tobacconist against the Esmokeclean e-cigarette shop in the southern town of Plaisance-du-Touch.

The court in nearby Toulouse gave its verdict Monday, ordering Esmokeclean to stop selling and advertising e-cigarettes as it was violating the “state monopoly on the sale of tobacco” — a decision that could set a precedent.

Cigarettes and other tobacco products can only be sold in France at registered outlets and their advertising is banned.

The court said e-cigarettes fall into that category despite containing no tobacco.

A lawyer for Esmokeclean said the company would appeal the ruling and in the meantime would be allowed to continue selling and advertising e-cigarettes.

Governments have struggled with how to regulate e-cigarettes since their emergence and growing popularity in recent years.

Supporters claim they are harmless and a valuable tool in helping smokers to quit.

The World Health Organisation has advised against them however, saying their potential health risk “remains undetermined”.

In October European lawmakers rejected a bid to classify e-cigarettes as medicinal products, which would have restricted their sale to pharmacies.

9 Dec 2013

The Health Consequences of Smoking—50 Years of Progress

Jan 1st, 2014
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