Clear The Air News Tobacco Blog Rotating Header Image

Gateway Drug

Vaping teens more likely to take up regular cigarettes

Adolescents and young adults who try e-cigarettes are more than three times as likely to take up smoking traditional cigarettes as their peers who haven’t tried the devices, a research review suggests.

https://uk.reuters.com/article/us-health-teens-vaping-idUKKBN19H292

E-cigarette use, or vaping, was as least as strong a risk factor for smoking traditional cigarettes as having a parent or sibling who smokes or having a risk-taking and thrill-seeking personality, researchers found.

“E-cigarette use among teens and young adults could increase the future burden of tobacco by creating a new generation of adult smokers who might have otherwise not begun smoking,” said lead study author Samir Soneji of the Dartmouth Institute for Health Policy and Clinical Practice in New Hampshire.

Big tobacco companies, including Altria Group Inc, Lorillard Tobacco Co and Reynolds American Inc, are all developing e-cigarettes. The battery-powered devices feature a glowing tip and a heating element that turns liquid nicotine and other flavorings into a cloud of vapor that users inhale.

Soneji and colleagues analyzed data from nine smaller studies with a total of 17,389 participants ages 14 to 30.

They didn’t examine why many teens and young adults transitioned from vaping to smoking traditional cigarettes, but both options contain nicotine, an addictive drug, Soneji said by email.

The habit of vaping may also make the transition to smoking seem more natural, and teens in particular may gravitate toward friends who smoke once they try vaping, Soneji said.

“To the extent that e-cigarette use mimics the behavior of smoking a cigarette – handling the e-cigarette, the action of puffing, and the inhalation of smoke – it sets the adolescent up for easily transitioning to smoking,” Soneji said. “Like transitioning from driving a Tesla to driving a Chevy.”

Seven studies looked at smoking initiation among more than 8,000 youngsters who had never smoked before. Data pooled from these studies showed that roughly 30 percent of e-cigarette users became smokers, compared with only about 8 percent of people who hadn’t tried vaping. That translates into 3.6 times higher odds of smoking for people who have tried e-cigarettes, researchers report in JAMA Pediatrics.

One limitation of the study is that it included some results from earlier studies with a high drop-out rate, and it’s not clear whether people who left these studies were different from participants who remained in ways that would make them more or less likely to smoke, the authors note. Researchers also lacked data on the type of e-cigarettes used, and they only looked at U.S. studies.

Even so, by pooling data from several smaller studies, the results offer stronger evidence that vaping can encourage young people to progress to smoking, said William Shadel, a researcher at RAND Corporation in Pittsburgh who wasn’t involved in the current study.

“The results are particularly compelling because the studies took into account other variables that put kids at risk of cigarette smoking, like alcohol use and peer cigarette smoking,” Shadel said by email. “These results should help to strengthen arguments for regulatory action that limits young people’s access to e-cigarettes.”

Enticing flavors of liquid nicotine used in e-cigarettes, like strawberry or chocolate, may make vaping appealing to some young people who might not like the taste of traditional cigarettes, said Dr. Brian Primack, a researcher at the University of Pittsburgh who wasn’t involved in the study. Peer pressure may then encourage them to graduate to smoking.

“Young people report that there is a lot of pressure among e-cigarette only users to smoke a ‘real’ cigarette,” Primack said by email. “It may be somewhat analogous to the fact that teens who use flavored alcohol are often pressured socially to step up their game to harder forms of alcohol.”

There’s one clear way for young people to avoid this.

“The biggest thing that people can do is never start using them in the first place,” Primack said.

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.

http://www.businessinsider.com/r-how-e-cigarette-ads-might-sway-teens-to-try-tobacco-products-2017-5?IR=T

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.

California targets candy-flavored tobacco as teen ‘gateway’ to cigarette smoking

More teens are turning to fruit- and candy-flavored tobacco, raising concerns that sweetened e-cigarettes and cigarillos are a gateway to nicotine addiction. A California anti-tobacco campaign targeting teens has ramped up in high schools and at a recent state Capitol rally on Kick Butts Day. Claudia Buck cbuck@sacbee.com

http://www.sacbee.com/news/local/health-and-medicine/article140622513.html

At the checkout counter, the flavors are sweet and enticing: Banana Smash. Twisted Berry. Berry Honey. Cherry Dynamite.

They aren’t in the candy aisle but on the tobacco shelf, often sold in 99-cent two-pack mini-cigars or liquid cartridges for e-cigarettes.

While fewer young Americans are puffing on cigarettes, more teens are using flavored tobacco, typically by vaping with electronic cigarettes or smoking tiny cigars known as cigarillos.

This year, there’s a renewed push to banish flavored tobacco products, which health officials and others fear are luring the next generation of nicotine addicts by targeting teens and kids.

The sweetened flavors are “a gateway to traditional cigarette smoking,” said Scott Gerber, a wellness program director with the Alameda County Office of Education, who attended a recent anti-tobacco state Capitol rally with a handful of high school students from Berkeley and Fremont. Tobacco companies, he said, “are targeting young people with cherry, strawberry, piña colada flavors. … Gummi bears? That’s a youth-friendly flavor, not an adult-friendly flavor.”

Gerber was among about 250 high school students and chaperones who attended the anti-tobacco rally, chanting slogans and carrying signs with messages such as “We want to see a new light, not a lighter” and “We want 7,700 flavors of ice cream, not tobacco!” The rally was part of national Kick Butts Day, co-sponsored by the California Youth Advocacy Network and the Campaign for Tobacco-Free Kids.

In 2014, 73 percent of high school students and 56 percent of middle school students who used tobacco products in the past 30 days reported using a flavored tobacco product, according to the federal Centers for Disease Control and Prevention.

Wheatland High School student Angelina Hom, 15, who belongs to a campus group called SOWHAT (Students Of Wheatland High Against Tobacco), said she’s seen the negative impacts of tobacco firsthand in family members and hopes more of her peers get the message to avoid tobacco.

Convenience stores near her Northern California school have prominent displays of brightly colored, fruity-flavored tobacco products positioned close to the checkout counter, she said. “You go to pay for your food and there’s a wall full of of tobacco and cigarettes. It targets kids into thinking it’s cool.”

E-cigarettes are the most commonly used tobacco product among middle and high school teens in California. An estimated 217,000 Californians between the ages of 12 and 17 currently smoke traditional cigarettes or e-cigarettes, according to state health officials.

In stores, although tobacco products by law must be behind glass, it’s not unusual to find Swisher Sweets, candy-flavored cigarillos sold in two-packs for less than a dollar, sitting near candy bars and snacks, at eye level of young customers.

“Having it advertised as candy unlocks the door to the world of addiction,” said shopper Jenni Richardson, 24, in a midtown Sacramento convenience store where Swisher Sweets sit directly above the ice cream freezer case. A self-described recovering heroin addict, Richardson said tobacco products are dangerously addictive, noting it was far easier for her to quit narcotics than nicotine.

Last summer, the growth in e-cigarette use helped prompt California to toughen state tobacco laws, raising the minimum age for legally buying cigarettes and cigars from 18 to 21, the first change since tobacco control laws went into effect 144 years ago. Also for the first time, those laws now apply to e-cigarettes, which have become hugely popular for their myriad fruit and candy-scented flavors, with names such as Watermelon Krush, Apple Pie a la Mode and Blueberry Cotton Candy.

Some counties have banned all sales of flavored tobacco, including Yolo County, which prohibits sales in the county’s unincorporated areas, starting May 1. The intent was to deter use by youths, said Keri Hess, the county’s tobacco prevention youth coordinator.

“Lots of kids who use e-cigarettes would never dream of trying a regular cigarette because they say it tastes gross. They know the hazards of regular cigarettes and tobacco, but they don’t recognize the health hazards of e-cigarettes,” Hess said.

In Yolo County, 73 percent of stores carried e-cigarettes last year compared with 46 percent in 2013.

The state’s crackdown came as illegal sales of tobacco to minors were up last year by more than a third from 2015, according to the state Department of Public Health’s annual survey, which took place before the legal age was changed. Using teenage decoys trying to buy smokes, the annual survey found that 10.3 percent of 793 stores sold tobacco to underage buyers, the highest rate in eight years.

Citing research that shows brain development continues until around age 25, state health officials say nicotine is a “highly addictive neurotoxin” that can permanently damage adolescent and young adult brains.

“The younger people are when they start smoking or using nicotine, the more likely they are to become addicted,” said State Public Health Officer Dr. Karen Smith during a news conference last summer. Every year in California, she noted, 34,000 people die of tobacco-related diseases.

She said the surge of teens vaping with e-cigarettes is no accident, given the “aggressive marketing” and the proliferation of gadgets and flavors by tobacco companies. Calling them “enticing gateway products,” Smith said e-cigarettes are “fueling the addiction” to nicotine.

Since 2009, the U.S. Food and Drug Administration has banned the sale of cigarettes with fruit and candy flavors, part of federal efforts to reduce tobacco addiction among youths. More recently, the FDA is focusing on cigars and cigarillos (mini-cigars). In December, it issued warning letters to four tobacco companies, including Swisher International Inc., maker of Swisher Sweets, for selling cigars in “youth-appealing” flavors, such as grape, wild cherry and strawberry.

If the companies don’t take action, they could face civil penalties, criminal prosecution and seizure of products, according to the FDA.

“Flavored cigarettes appeal to kids and disguise the bad taste of tobacco, but they are just as addictive as regular tobacco products and have the same harmful health effects,” said Mitch Zeller, director of the FDA’s Center for Tobacco Products, in a statement. He said continued bans on flavored tobacco are essential to “protect future generations from a lifetime of addiction.”

To students at the recent state Capitol rally, the brightly colored packaging and sweetened flavors are “like candy,” enticing teens and kids to get hooked on nicotine at an early age, said Naphatsorn Kaewwanna, 18, a high school senior with the Asian American Drug Abuse Program in Los Angeles County.

“We should put a stop to it,” she said.

 

When Public Health and Big Tobacco Align

Nobody trusts the tobacco industry, and it’s easy to understand why. For decades, industry executives knew that smoking caused cancer and heart disease yet publicly denied the dangers of cigarettes. It relentlessly attacked its critics. Documents that emerged in the 1990s showed that the industry targeted teenagers, knowing that the earlier someone became addicted to cigarettes, the more likely they would be lifelong smokers. And so on.

https://www.bloomberg.com/view/articles/2017-03-09/when-public-health-and-big-tobacco-align

In the 1980s and 1990s, the public health community went to war with the tobacco industry. Though the war largely ended in 1998 with Big Tobacco agreeing to a multi-billion-dollar settlement with the states, it remains a powerful memory for public health.

To this day, most tobacco-control advocates view the cigarette companies as being every bit as duplicitous and evil as they were in the bad old days. Some years ago, I asked Stanton Glantz, perhaps the leading anti-tobacco scientist in the U.S., what his ultimate goal was. He didn’t say it was to eliminate the scourge of smoking. He said: “To destroy the tobacco industry.”

What brings this to mind is an excellent cover story in the upcoming issue of Bloomberg Businessweek about the efforts of the tobacco industry to devise and market so-called reduced risk products like electronic cigarettes — products that give users their nicotine fix without most of the attendant carcinogens that come with combustible tobacco.

Although the tobacco companies have done decades of R&D on smokeless products, the business was dominated early on by startups like NJOY, which is today the largest independent e-cigarette company in America. From the start NJOY has said that a big part of its mission was “to end smoking-related death and disease.” And from the start, messages like that have been scorned by the public health community.

Ingesting nicotine in some smokeless fashion is vastly safer than smoking a combustible cigarette. (In the words of the late South African tobacco scientist Michael Russell, “People smoke for the nicotine but die from the tar.”) Last year, the Royal College of Medicine issued a report saying that e-cigarettes were some 95 percent safer than cigarettes.

Even so, the public health community in the U.S., led by the Centers for Disease Control and Prevention, has done everything it can to demonize smokeless products. Some of this has been with good reason: to try to keep kids from picking up an addictive habit. But this effort has also helped to create the impression that smokeless products are as dangerous as cigarettes. One result, sadly, is that many long time smokers have refused to try them, even though they could save their lives.

My sense in talking to tobacco-control officials over the years is that too many of them simply don’t believe in a reduced-harm approach. We give heroin addicts methadone not because methadone is good but because it is better than heroin. With cigarettes, however, the public health mindset appears to be all or nothing — that the only “right” thing for smokers to do is to go cold turkey.

But the lingering distrust of the tobacco industry has also had a lot to do with public health’s unwillingness to acknowledge the potential benefits of alternative products. Matt Myers, the president of the Campaign for Tobacco Free Kids, has often complained, for instance, about the marketing of e-cigarettes, saying that companies are using the same tactics to hook teenagers that Big Tobacco once used.

With the e-cigarette market clearly established, the four big tobacco companies — BAT, Reynolds American, Altria (formerly Philip Morris) and Philip Morris International (spun off from Altria) — have proclaimed themselves all in.

Philip Morris International is an especially interesting case: Not only does it have an array of e-cigarettes and other smokeless products, but as the Bloomberg Businessweek story points out, it has publicly proclaimed that its goal is to lead the world into “a smoke-free future.” The home page of its website asks, “How long will the world’s leading cigarette company be in the cigarette business?”

As astonishing as it is that a company with $26 billion in tobacco revenue last year would be calling for the end of cigarettes, I believe Philip Morris is sincere. It has spent around $3 billion in research. Its new flagship product, called IQOS, heats tobacco but doesn’t burn it — which the company believes will be more satisfying to smokers than vaping. IQOS already has 7 percent of the tobacco market in Japan, and is being rolled out in other countries.

Philip Morris recently asked the British government that tobacco products “be taxed according to their risk profile.” In other words, it wants the government to impose higher taxes on cigarettes to encourage smokers to move to reduced-risk products. What tobacco company has ever done that before?

In the U.S., Philip Morris has done something extraordinary: It has made a submission to the Food and Drug Administration to get the right to market IQOS as a reduced risk product. The expensive submission consumed 2.3 million pages and is backed by a great deal of research, including several clinical trials. So far, none of the U.S. e-cigarette companies have attempted to get such a designation, and it is a big problem. How do you sell a reduced risk product when you can’t tell anybody it reduces risk?

The business case for diving into this market is that it’s a product category that’s growing, while the cigarette market is shrinking. Philip Morris doesn’t want to be left behind. But there is no particular need for the company to set out such a transformative agenda, at least not yet. The small smokeless companies are not much of a threat. NJOY filed for bankruptcy last fall. And under a 2009 law, every company in the e-cigarette industry will have to file something called a premarket tobacco application with the FDA by August 2018. The submissions will cost, on average, over $450,000, and the companies will have to show that their products have some public health benefit. There is a legitimate chance that some small companies won’t be able to clear the hurdle.

No, Philip Morris is pushing as hard as it is, I believe, because it wants to get on the right side of the issue, finally — to be viewed as a good corporate citizen. When I spoke to Glantz the other day about the company’s new anti-smoking agenda, he said, “I don’t believe them.” (He added, “If they were serious, they would stop marketing cigarettes right now.”)

No doubt many others in the tobacco-control community feel the same way. They still loathe Big Tobacco, and view Philip Morris’s new strategy as just another deception. But the truth is, if there is ever going to be a serious move from cigarettes to less dangerous products, it will have to come from Big Tobacco. They have the R&D resources, they have the marketing apparatus — and, it appears, they have the will.

Public-health advocates don’t have to trust Philip Morris, or any other tobacco company. They don’t have to believe what I believe in order to arrive at the same conclusion: that the advocates should be rooting for the companies’ innovations — pushing them, double-checking their data, making sure regulations are in place to prevent their products from being marketed to kids. The advocates should also be spreading the word that there is an alternative to cigarettes. Who really cares whether it’s Big Tobacco or some other entity that reduces smoking deaths? What matters is that it happens.

The tobacco wars are long over. Continuing to fight the cigarette companies may bring a certain satisfaction to the veterans on the public-health side. But joining forces is the way to save lives.

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

To contact the author of this story:
Joe Nocera at jnocera3@bloomberg.net

To contact the editor responsible for this story:
Philip Gray at philipgray@bloomberg.net

Twelve myths about e-cigarettes that failed to impress the TGA

Australia’s Therapeutic Goods Administration (TGA) last week rejected an application to liberalise the scheduling of nicotine (see from page 71).

http://theconversation.com/twelve-myths-about-e-cigarettes-that-failed-to-impress-the-tga-72408

This prompted the predictable round of protests from proponents of e-cigarettes who have long touted them as the next public health wonder of the world, even as important as antibiotics.

But unlike antibiotics, which are heavily regulated, require a prescription, and must demonstrate both safety and efficacy to regulatory bodies, e-cigarettes and the liquids used in them are virtually unregulated.

Tobacco harm reduction has had a history of monumental failures. It started with the global multi-million dollar promotion of filters. One of these was the infamous asbestos-filtered “micronite filters” in Kent cigarettes. More recently, we saw the now outlawed consumer deceptions of the light and mild cigarette fiasco. And on the way we even had “reduced carcinogen” brands.

These were designed to keep people smoking and slow the mass exodus that began in the early 1960s. Millions did just that. Only quitting and the decreasing incidence of smoking (ie. never starting) have dramatically decreased the tobacco disease epidemic.

It would be wonderful if e-cigarettes were finally a harm reduction holy grail. But there are many reasons to remain cautious.

Here I look at 12 mantras about e-cigarettes that seem to have failed to impress the TGA.

1. Vaping is ‘95% less harmful than smoking’

A hand-picked group of 12 produced this magic number when asked to rank the health risks of 12 nicotine delivery products, including cigarettes. Several of the group had no research record or expertise in tobacco control; some had histories of financial connections with manufacturers of e-cigarettes and tobacco companies. There were no toxicologists, cancer or cardiovascular specialists among the authors.

The “95%” number was uncritically repeated in a Public Health England report, which even described e-cigarettes as “around 95% safer [not less dangerous] than smoking” (my emphasis). Incredulous toxicologists have since pointed out “there is no evidence for the 95% estimate”.

The extreme pro e-cigarette activist Carl Phillips, who has a long history of support from tobacco manufacturers, summed it up beautifully:

This specific point estimate (synonymous with “5% as bad for you as smoking”) has rapidly evolved into “fact” (in the political sense of that term). It is repeated in a large fraction of popular press reports and widely used in arguments, snipes, and broadsides from vaping advocates. It seems to have emerged from nowhere when the Public Health England report asserted the figure. That traced to what was actually a huge misinterpretation of what was only a made-up number, from one junk-science journal article.
Phillips may be unique in believing the number is closer to 1%. His supporters in the tobacco and vaping industries are probably very happy with the PR potential of that estimate.

2. Vaping is orders of magnitude less harmful than smoking

Because vapers don’t inhale smoke, with its toxic cocktail of carcinogens, irritants and carbon monoxide, this is almost certainly going to be the consensus when sufficient longitudinal data emerge, particularly when it comes to cancer. However, the already mentioned “group of 12” has claimed that “The paucity of evidence for serious harm to users of e-cigarettes over the years since they were first marketed in 2006, with millions purchased, in itself is evidence” of vaping being all but benign.

Even perceptive vapers have seen through this nonsense. It took several decades for the full effects of smoking tobacco to emerge. Worrying evidence about cardio-respiratory effects is already mounting. These highly respected researchers estimated the long-term effects of vaping may equate to 50% of the risk of cardio-respiratory harm that tobacco causes, what they call a “substantial” exposure.

Tobacco-caused cancers may well reduce in people who only vape. But cancer deaths represent only 37% of all tobacco deaths: cardio-respiratory deaths make up most of the rest.

3. Nicotine in vaping is benign

While some make facile comparisons of the risks of nicotine with drinking coffee, the International Agency for Research on Cancer recently noted “evidence has indicated the potential for nicotine to cause DNA damage” and “inhibit apoptosis, and stimulate cell proliferation and angiogenesis …”, declaring that evaluation of electronic cigarettes and nicotine is a “high priority”.

The recent US Surgeon General Report highlighted the adverse effects of nicotine on brain development in young people and in pregnancy. A recent study has further revealed previously unrecognised negative effects of nicotine, and vaping, on the heart.

4. Vaping has caused 6.1 million European smokers to quit

This factoid was megaphoned from a paper authored by a researcher with a history of funding from e-cigarette manufacturers. It was a secondary analysis of a cross-sectional survey since pilloried in the journal Addiction, where it was published. As any epidemiology student knows, causality can never be claimed from cross sectional studies. Among other criticisms, the critics asked:

How many of those who claim that they have stopped with the aid of e-cigarettes would have stopped anyway, and how many of those who used an e-cigarette but failed to stop would have stopped had they used another method.
They also noted the questions asked would have allowed those who quit for only a short period to say they had “stopped”.

Longitudinal studies with a minimum of 12 months follow-up of randomly selected cohorts have shown sobering results, a long way from the hype of vaping having the equivalent efficacy of antibiotics. One such follow-up reported:

Daily use of e-cigarettes while smoking appears to be associated with subsequent increases in rates of attempting to stop smoking and reducing smoking, but not with smoking cessation.
A companion paper reported daily use of tank-system (refillable) e-cigarettes were the only type of e-cigarette to show a significant improvement in smoking cessation. The very latest data from England show about half of daily e-cigarette users are also smoking (slide 9) and the rate at which English smokers have tried to stop is the lowest in 2016 (30.9%) than it has been since 2007 (42.5%) when the study began (slide 22).

This raises important questions about whether e-cigarettes may be keeping many smokers smoking, while helping others to quit.

5. Just cutting back smoking (rather than quitting) significantly reduces risk

It’s obvious, surely, if you don’t quit but only cut down the amount you smoke, the reduced smoking is going to reduce the harm you are doing? Obvious that is, until you actually look at very large studies that have looked at the death rates down the track in those who reduce but don’t quit.

First, two examples followed 479,156 men for 11 years and found no association between smoking reduction and all cancer risk but a significant decrease in risk of lung cancer, with the size of risk reduction “disproportionately smaller than expected”. Second, a study of 51,210 people followed from the 1970s until 2003 found no evidence smokers who cut down their daily cigarette consumption by more than 50% reduced their risk of premature death significantly.

Vaping advocate and Addiction editor Professor Robert West puts it succinctly:

I think as far as using an e-cigarette to reduce your harm while continuing to smoke is concerned there really isn’t good evidence that it has any benefit.
And as we saw earlier, a large proportion of people who vape, continue to smoke.

6. Vape is just like water vapour and (often) nicotine

But let’s not forget some 8,000 beguiling often kiddie-friendly flavours in e-juice that help the nicotine go down (with apologies to Mary Poppins) have mostly been approved as food additives but have never been approved for inhalation. Here’s what the US flavouring industry said:

The manufacturers and marketers of ENDS [electronic nicotine delivery systems], and all other flavored tobacco products, and flavor manufacturers and marketers, should not represent or suggest that the flavor ingredients used in these products are safe because they have … status for use in food because such statements are false and misleading.
And then there’s the liquid propylene glycol in which the nicotine and flavour chemicals are vapourised. Dow Chemical, which manufactures it, says unambiguously, reflecting human data:

… breathing spray mists of these materials should be avoided. In general, Dow does not support or recommend the use of Dow’s glycols in applications where breathing or human eye contact with the spray mists of these materials is likely …
Vapers average about 200 inhalations a day, with this study finding a range of 6 to 611 puffs. That’s an average 73,050 deep lung bastings a year, and right up to 223,168. Like cigarette smoke, vape mist contains fine, ultra-fine and nanoparticles, including metals and silicate. It is anything but just like inhaling steam in a shower.

Put simply, we have no data on what happens to people’s long-term respiratory or cardiovascular health when they pull these nanoparticles deep into their lungs daily, over many years, at the above rates.

7. Nicotine-free cigarettes contain no nicotine

E-cigarette advocates were excited about a recent study reporting many US teens did not vape for nicotine, but for the flavours. In NSW, it is illegal to sell vape liquid containing nicotine. But a NSW Health random check found many samples contained it. Other examples in the US, and elsewhere, of alleged “non-nicotine” refills turning out to contain nicotine exist, hence the headline “‘Nicotine-Free’ E-Cigs Still Deliver the Juice”.

The US Food and Drug Administration (FDA) summed up:

Testing also suggested that quality control processes used to manufacture these products are inconsistent or non-existent.

8. Second-hand vape is harmless, so it should not be restricted

I’d rather sit next to a vaper than a smoker. But those vape clouds we see and then don’t see don’t just vanish. They can be measured. This study of a vapers’ meeting where 59-86 people were vaping found counts of PM2.5 airborne particles (fine particulate matter, 2.5 micrometers or less in diameter) 125-330 times higher than in the same room when empty. This is higher than particle concentrations recorded in bars where cigarette or waterpipe smoking are allowed. That will likely explain the other real-world experiences reported by vapers like this.

If vaping were allowed in bars, restaurants and planes, we all would face behaviour like this scene. Try imagining workable regulatory wording that would allow “discreet” vaping by a few, but prohibited exuberant “clouding” by a group of vapers drinking in a bar.

If vaping emissions were really benign, indoor vaping advocates should take courage and call for it to be allowed in classrooms, crèches, hospitals and neonatal wards. The fact they don’t rather suggests they know well such a position would be irresponsible.

9. There’s no good evidence for e-cigarettes being a gateway to smoking in young people

In England, this appears to be the case. But in the USA, there’s a rapidly growing body of evidence suggesting a possible effect. Centers for Disease Control data from 2015 demonstrate a concerning sudden cessation and plateau in the previous decline of US high school students smoking tobacco, while e-cigarette use is skyrocketing.

Smoking was plummeting in young people in the USA and UK long before e-cigarettes appeared. Today, more young people in the US are using nicotine than ever, which may signal health and brain developmental problems down the track.

10. E-cigarette explosions are overrated

E-cigarette advocates point out other lithium battery-powered items like mobile phones and laptops have exploded, so we should all calm down about dramatic explosions.

However, vapers have noted explosions tend to take place, not just during re-charging, but during use, leading to mounting reports from hospitals of terrible burns and injuries.

When mobile phones explode, we see global recalls as happened with the Samsung Galaxy Note 7. The lack of regulatory standards for e-cigarettes and their components stands in stark contrast to these other products. I’m very pleased e-cigarettes are banned on airlines, but wonder about what would happen if one exploded in stowed luggage.

11. Big Tobacco really wants its smoking customers to switch to e-cigarettes

If this was true, how do we then explain the companies continue to do all they can to wreck effective tobacco control policies like plain packaging, graphic health warnings and significant tobacco tax hikes?

In Hong Kong in December 2016 British American Tobacco was still lobbying against graphic health warnings. And Philip Morris was threatening Uruguay over its advanced tobacco control policies, until it lost its case at the World Bank’s International Centre for Settlement of Investment Disputes in 2016.

Surely, if they were sincere here, they should be pleased governments are trying to get smokers to quit? Philip Morris has been running targeted advertising campaigns with major youth appeal. And new evidence collated from its own documents demonstrates its interest in e-cigarettes, as long ago as 1990, was only ever for them to be used as a complement to cigarettes.

Big Tobacco has heavily invested in e-cigarettes, with all major tobacco companies now having them in their portfolios. The big picture here is that Big Tobacco wants people to smoke and vape, not vape instead of smoking.

12. Leading public health agencies encourage ‘light touch’ regulation

This is mostly the case in England, but very much not the case in many other nations. Advocates constantly point to two e-cigarette “friendly” reports from the UK Royal College of Physicians and Public Health England, which had several common authors.

But 18 nations ban e-cigarettes outright, with more having various degrees of restrictions. Among leading agencies with strong concerns about e-cigarettes are the US Surgeon General, the World Health Organization, the FDA, 31 mostly major health agencies that petitioned the FDA to regulate e-cigarettes, Australia’s National Health and Medical Research Council and now the TGA.

E-cigarettes have been generating a huge wave of research interest over the past few years. The next decade promises to throw the light of much needed evidence on many of the issues above. In the meantime, the Australian TGA’s caution should be respected.

E-cigarettes attracting more youths towards world of tobacco

You might have thought e-cigarettes cut down tobacco consumption, but the reality is a bit different.

A study, by University of California- San Francisco,suggests that it actually attracts more youths towards tobacco consumption.

It has been published in Pediatrics.

Researchers from University Of California in the United States of America said they did not find any evidence of decline in the consumption of tobacco. In fact, the usage of e-cigarettes & cigarettes has gone higher among adolescents in 2014 compared to the numbers from 2009.

“We didn’t find any evidence that e-cigarettes are causing youth smoking to decline,” said lead author Lauren Dutra.

The analysis by the researchers also saw that section of youth who start smoking e-cigarettes are more likely to draw themselves in consuming traditional cigarettes in later part of their lives.

“While some of the kids using e-cigarettes were also smoking cigarettes, we found that kids who were at low risk of starting nicotine with cigarettes were using e-cigarettes,” Dutra said. “Recent declines in youth smoking are likely due to tobacco control efforts, not to e-cigarettes.”

In August 2016, the U.S. Food and Drug Administration, already restricted the purchase of e-cigarettes to adults aged 18 years and older. The FDA also directed to have a warning label on e-cigarettes which will start from August 2018.

The authors also said that there has been a decline in cigarette smoking youth but the decline has not been rapid after the advent of e-cigarettes in the U.S. between the years 2007 and 2009.

The authors performed an in-depth analysis of the psychological characteristics of the consumers of e-cigarettes. The research showed that the smokers tend to display some characteristics which non-smokers are less likely to show.

Characteristics like the tendency to live with a person who smokes or to wear clothing which displays tobacco product logo. The smokers in the national youth survey showed these characteristics, while the youth who were only using e-cigarettes displayed less of these qualities.

“E-cigarettes are encouraging – not discouraging – youth to smoke and to consume nicotine, and are expanding the tobacco market,” said senior author Stanton A. Glantz.

These new results are consistent with a similar study that took place in California last year by the researchers at the University of Southern California. The researchers also found that adolescents who consumed ecigarettes, but not traditional cigarettes have displayed less risk factors which were commonly found among cigarette smokers. (ANI)

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.”

Starting with e-cigs triples odds of starting cigarettes among college students; the evidence just keeps piling up

Tory Spindle and colleagues at VCU recently published a study, “Electronic cigarette use and uptake of cigarette smoking: A longitudinal examination of U.S. college students,” that followed 3757 students at Virginia Commonwealth University for a year to examine the relationship between e-cigarette use among never cigarette smokers at the beginning and whether they were smoking conventional cigarettes a year later. They found, controlling for a wide range of demographic and behavioral variables, that e-cigarette users at baseline were about 3.4 times as likely to be smoking cigarettes a year later as young adults who were not using e-cigarettes.

This effect is consistent with a similar study of young adult males in Switzerland as well as all the studies of adolescents.

Here are the highlights and the abstract:

HIGHLIGHTS

• E-cig and cigarette use has not been studied in college students longitudinally.
• Ever and current e-cig use increased non-smokers chances of trying cigarettes.
• Historically internalizing/externalizing factors predict cigarette uptake strongly.
• Most internalizing/externalizing factors examined did not predict e-cig uptake.
• Males and marijuana users were more likely to initiate e-cig use.

ABSTRACT

Introduction:

Electronic cigarette (e-cigarette) use prevalence is increasing among U.S. adolescents and adults but recent longitudinal data for college/university students are scarce.

Furthermore, the extent that e-cigarette use is associated with the onset of cigarette smoking and the factors that lead to the uptake of ecigarettes in college students has not been explored.

Methods:

3757 participants from a Mid-Atlantic university (women: 66%; White: 45%; Black: 21%; Asian: 19%; Hispanic/Latino: 6%) were surveyed in 2014 and again in 2015.

Results:

Among participants reporting never smoking at time 1, those who had ever tried e-cigarettes or were currently using e-cigarettes (at least one use in past 30 days) were more likely to have ever tried cigarettes by time 2 relative to individuals who had not used e-cigarettes. Ever use of e-cigarettes (but not current use) also increased participants’ likelihood of being current cigarette smokers at time 2. Among initial never users of e-cigarettes or cigarettes, males and ever marijuana users had an increased probability of trying e-cigarettes by time 2. Furthermore, less perseverance (an index of impulsivity) and ever use of other tobacco products increased initial never users’ chances of trying both cigarettes and e-cigarettes by time 2.

Conclusions:

Given that never-smoking participants who had tried e-cigarettes were more likely to initiate cigarette use later, limiting young adults’ access to these products may be beneficial. As the long-term health implications of e-cigarette use become clearer, predictors of e-cigarette use could help identify future populations likely to use and abuse these products.

Here is the full citation: Spindle, et al. Electronic cigarette use and uptake of cigarette smoking: A longitudinal examination of U.S. college students. Addictive Behaviors 2017; 67:66-72. http://dx.doi.org/10.1016/j.addbeh.2016.12.009

 

High school vapers often become heavy smokers

Also worrisome: Teen vaping rates are skyrocketing, according to a new report by the U.S. Surgeon General’s office

https://www.sciencenewsforstudents.org/article/high-school-vapers-often-become-heavy-smokers

E-cigarette use grew an astounding 900 percent among high school students from 2011 to 2015. That’s according to a report by the U.S. Surgeon General’s office, released December 8. It highlights the harmful effects of e-cigarettes, especially to young people.

E-cigarettes first went on sale in the United States in 2007. Back then, companies advertised them as an aid to help adults give up smoking tobacco. But nonsmokers soon took up e-cigs too . Among them have been teens and even preteens. The Surgeon General’s report says the newly recognized drastic leap in e-cig use could lead many teens to try smoking.

And that would put a new generation of Americans at risk of nicotine addiction, says Thomas Wills. He works at the University of Hawaii at Manoa. He’s also an expert on teen smoking rates.

The Surgeon General’s report and other information about the health effects of e-cigarettes can be found at anew website: Know the Risks: E-cigarettes & Young People.

Two additional new studies back up what the Surgeon General’s office is saying. Both also shine some light on why teens choose to vape — and why some young vapers transition to smoking cigarettes.

Studies had shown that teens who vape are more likely to try cigarette smoking. And that’s disturbing because in the United States alone, the number of teen vapers nearly quadrupled between 2013 and 2015 — to more than 3 million. However, it has not been clear whether these kids who move on to tobacco “are just experimenting with smoking or whether they go on to become regular users,” says Adam Leventhal. He’s an addiction scientist at the University of Southern California, in Los Angeles.

The distinction is important, he says. Teens who become regular smokers during high school are more likely to develop a lifelong addiction to nicotine. According to the Surgeon General’s Report, nine out of 10 adult smokers tried their first cigarettes during adolescence.

To dig into why some teens make this transition, Leventhal and his colleagues recruited more than 3,000 Los Angeles-area 10th graders into a study. The students filled out surveys in the fall and spring. Those questions asked the teens about whether they had vaped or smoked. The researchers then looked at whether the answers had differed between early and late in the school year.

And indeed they did. Vaping seemed to up the likelihood that a teen would start smoking, these data showed.

The researchers broke students into groups, based on their answers in the fall to whether and how often they vaped. One group reported never vaping. A second group said they had tried vaping, but not within the past month. A third group reported vaping on one or two days in the past month. The last group said they had vaped even more than that in the last 30 days.

And the likelihood that a student smoked in the spring doubled in each successive group. For instance, by the spring, students who had previously tried vaping were about two times as likely to use cigarettes as were teens who had never vaped. Each jump to a group that vaped more frequently roughly doubled the likelihood that a student would report frequent, heavy cigarette smoking in the spring. (People who smoked cigarettes on three or more days in the past month were deemed frequent smokers. Lighting up two or more cigarettes on any day was considered heavy use.)

Leventhal’s group published its findings online November 8 in the Journal of the American Medical Association.

The share of teens in this study who reported vaping was slightly lower than the national average. One in three students in the study said they had ever tried vaping. That’s about 4 percentage points lower than the national average for 10th graders. Similarly, about 9 percent of the California kids surveyed said they had vaped in the past month. That’s 5 percentage points lower than the U.S. average 10th graders, according to a February 2016 report. It was conducted by researchers at the University of Michigan in Ann Arbor.

One reason for the lower vaping rate in California could be that kids there also are somewhat less likely to smoke than elsewhere in the country, notes Wills.

It still isn’t clear why some teens make the transition from vaping to smoking, he says. Young people who vape might learn to like the feeling of lighting up, holding a cigarette-like device or inhaling. These are behaviors that are common to both electronic and tobacco cigarettes. That might make it easier for teens to transition to tobacco cigarettes. It’s also possible that kids who use e-cigarettes are getting hooked on nicotine, says Wills. This is the chemical that makes tobacco smoking so addictive. It’s also found in most e-cig liquids.

More research is needed, Wills says, to probe the role of nicotine in teens’ transition from vaping to smoking.

The influence of ads

“Use of e-cigarettes has been rising exponentially among youth,” says Hongying Dai. “Little is known about the factors contributing to this rise,” she adds. Dai is an epidemiologist — a scientist who studies disease risk. She works at the University of Missouri-Kansas City. This researcher wondered whether the number of e-cig advertisements that kids see might affect how likely they were to vape. So she analyzed data from a national survey for clues that might confirm this.

More than 22,000 U.S. middle- and high-school students had filled out the survey about their smoking and vaping habits.

Compared to kids who rarely saw e-cig ads, those who saw them at least “sometimes” were much more likely to vape. Students who frequently ran into ads on the internet were about three times as likely to vape as were teens who reported never seeing such online ads. Kids who vaped also reported high exposure to e-cigarette ads in stores, newspapers and magazines, on TV and at the movies.

Family also seemed to play some role. Kids were more likely to vape if someone in their household used e-cigarettes, the researchers showed.

E-cigarette ads that target teens often portray vaping as glamorous or attractive, notes the Surgeon General’s report. Wills says the tobacco industry used these same tactics to encourage cigarette smoking by young people a generation ago.

Still, some questions remain. For instance, Dai asks, how accurately did the teens report encountering e-cigarette ads? And do all kids notice e-cig ads equally? Or are kids who vape just more likely to pay attention to vape ads?

Dai says she expected to see a link between ads and vaping. Tobacco advertising has been linked to increases in youth smoking rates, she notes. It therefore makes sense that exposure to e-cig advertising could affect teen vaping, she says.

Findings from the second study appear in the August Journal of Adolescent Health.

National view: Lung cancer battle raises concerns about e-cigs, other ‘nicotine-delivery devices’

November has been Lung Cancer Awareness Month and a good time to recall an old saying in the lung cancer community: “If you’ve got lungs, you can get lung cancer.” Lung cancer is everybody’s fight.

http://www.duluthnewstribune.com/opinion/national-view/4168141-national-view-lung-cancer-battle-raises-concerns-about-e-cigs-other

It’s the deadliest cancer in America, accounting for 25 percent of all cancer deaths. Lung cancer is also the leading cause of cancer deaths among women. The National Cancer Institute estimates that 71,600 women will die of lung cancer this year. And you may be surprised to learn that of the women who get lung cancer, approximately 1 in 5 are nonsmokers.

Unfortunately, the false stigma that automatically ties smoking to lung cancer has severely hindered life-saving lung cancer research. In fact, of the $5.3 billion the National Cancer Institute receives every year from the federal government, only 6.5 percent is devoted to lung cancer.

That’s a big part of the reason my husband, U.S. Rep. Rick Nolan, is a founder and co-chairman of the bipartisan Congressional Lung Cancer Caucus. For us, and for millions of other families, lung cancer and the need for more federal support for prevention, treatment and, ultimately, a cure, is personal. Our youngest daughter, Katherine, is battling nonsmoking stage 4 small cell lung cancer. And Rick’s father and aunt both had lung cancer.

Of course, the battle against lung cancer is being waged on many fronts, including efforts to discourage young people from smoking. In that regard, experts increasingly are concerned that hard-won progress against lung cancer could be curbed by the growing popularity of “nicotine-delivery devices,” particularly electronic cigarettes, or e-cigarettes, that turn nicotine into an inhalable liquid vapor, and hookah, which are water pipes used to smoke flavored tobacco.

Simply stated, we don’t really know how dangerous these products are or what chemicals and components users are taking into their bodies. For example, we know little about the safety of propylene glycol, a substance contained in many e-cigarettes. And tests have found that some e-cigarettes contain small amounts of nitrosamines and formaldehyde, both cancer-causing agents.

Thankfully, after years of public review and comment, new Food and Drug Administration regulations are being rolled out to address these concerns. Over the next two years, the FDA will be given more authority to require manufacturers to report the content of their products to the public.

Until then, though, the chemicals — and the potential health effects — will remain largely unknown.

Young people are particularly attracted to the exotic and fruity flavors available in e-cigarettes and specialty tobaccos. In fact, a 2014 Minnesota Department of Health survey of more than 70 schools revealed that 13 percent of high school students and 3 percent of middle school students had used e-cigarettes. Those figures are even higher nationwide as these nicotine-delivery devices have become big business. By some estimates, U.S. sales of e-cigarettes and other more-specialized e-smoking products reached $5.5 billion in 2015.

The new FDA regulations will make it harder for children and teenagers to obtain e-cigarettes, hookah tobacco and cigars. Even now, it’s illegal to sell these products to anyone younger than 18 or in vending machines accessible to minors. The FDA also no longer allows stores to give away samples of new tobacco products.

These measures will help in the battle against lung cancer, but we all need to take our own steps to promote tobacco-free families, homes and communities.

Remember, if you’ve got lungs, you can get lung cancer. We’ve all got lungs, so we all have a stake in this fight.

Mary Nolan of Crosby, Minn., is a member of the Congressional Families Cancer Prevention Program of the Prevent Cancer Foundation and is the wife of U.S. Rep. Rick Nolan. She wrote this for the News Tribune