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E-cigarettes aren’t risk-free, but still less harmful than cigarettes

A simple search of ‘Sourcewatch Heritage Institute’ shows who controls their paid for writings.

PHE has egg on its face for its 95% safer faux pas based on a single report from 12 people, as emerging studies show ecigs are anything but safe. Indeed PHE is now at a loss to explain that the longest (10 year) longitudinal study of 200,000 UK adult vapers showed that Ecigs DO NOT WORK FOR SMOKING CESSATION(Beard- West). A similar recent smaller study at Georgia State Uni proved the same. A study by Kulick et al of 50,000 adults in 28 EC countries found ecigs depressed smoking cessation. Franzen et al found ecigs elevated the heart rate for longer than cigarettes. Tang et al of NYU found aldehydes in ecigs are more toxic than nitrosamines in cigarettes & lead to endothelial cell damage, DNA damage of heart & bladder cells. The tobacco industry is in the business of selling nicotine, an addictive psychoactive drug. They want the electronic delivery device to be their new delivery service so they can continue to profit from the demise of others & the continued addiction of youth to nicotine. As shown elsewhere more than 60% of ecig users become dual users thus a double whammy they will never shake. HKG must ban these devices & SCMP should ban such infomercials.

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For many cigarette smokers, quitting the habit is a fantasy. However, there are new alternatives to smoking that could turn that into a reality, unless governments get in the way.

Tobacco harm reduction is the idea that smokers should have access to products that meet their nicotine needs in ways that are less harmful than cigarettes. Smokers should not be limited to a single all-or-nothing option: smoke cigarettes or nothing.

New products, such as e-cigarettes and heat-not-burn products, can deliver nicotine in less risky ways than combustible cigarettes. This doesn’t mean there is zero risk [1], but there is far less risk compared to smoking cigarettes.

In a government-commissioned report, Public Health England estimated that e-cigarettes could be 95 per cent less harmful [3] than tobacco cigarettes. In the United States, the Food and Drug Administration is starting to embrace tobacco harm reduction. The New Zealand Ministry of Health recently announced [4] that vaping and heated tobacco products can be sold in the country.

Japan and South Korea are allowing citizens access to new and innovative alternatives to smoking.

This is not to diminish reasonable concerns, such as seeking to limit the use of these products by children. However, these alternative products can be made available to smokers while addressing any legitimate concerns that might exist. Governments should ensure they don’t throw up needless legal obstacles that would prevent innovative products from being available to their citizens.

Daren Bakst, senior research fellow, Roe Institute for Economic Policy Studies, The Heritage Foundation

Source URL: https://www.scmp.com/comment/letters/article/2159806/e-cigarettes-arent-risk-free-still-less-harmful-cigarettes

E-Cigarettes May Lead More to Smoke Cigarettes Than to Quit

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New study suggests two-way association between experimenting with e-cigarettes and experimenting with smoking among young people

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More evidence that youth e-cig use promotes cigarette smoking

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Trajectories of E-Cigarette and Conventional Cigarette Use Among Youth

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Five myths about e-cigs and some of the evidence that they are, well, myths

The latest e-cig love fest at the 2017 E-cig Summit in England has been bouncing around the internet, so I thought it would be worth summarizing some of the evidence debunking common e-cig myths. The list of citations is nowhere near exhaustive, but illustrates why these myths are myths.

https://tobacco.ucsf.edu/five-myths-about-e-cigs-and-some-evidence-they-are-well-myths

Myth 1: There is no gateway effect.

A recent meta-analysis shows 100% consistent evidence that never cigarette smoking youth who begin nicotine use with e-cigarettes are significantly more likely to progress to cigarette smoking than youth who do not use e-cigarettes. There have been several additional longitudinal studies published that have shown the same thing since this meta-analysis was published, including one from England.

There are also consistent data showing that e-cigarettes attract youth at low risk of beginning tobacco use with cigarettes and expanding the overall nicotine use market.

Myth 2: E-cigarettes increase smoking cessation.

A meta-analysis showed that, considering all available data at the time, e-cigarettes are associated with depressed cessation. While some of the studies published since then show increased smoking cessation among e-cigarette users, the overall pattern remains depressed cessation.

Myth 3: E-cigarettes are 95% safer than conventional cigarettes.

This assumption is based on the paper by Nutt et al that represented the opinions of a few ‘experts” without citing any specific supporting evidence. The process by which this paper was prepared has been criticized for conflicts of interest among some of the authors. More important, since then there has been a substantial literature published indicating important cardiovascular and pulmonary risks associated with e-cigarette use. Cardiovascular and pulmonary disease kill about 2/3 of smokers.

Myth 4: Even if smokers don’t quit when they use e-cigarettes they smoke fewer cigarettes and the health risks go down substantially in smokers that reduce consumption.

The claim that smokers who use e-cigarettes is also not consistently supported by the evidence. More important, even low levels of smoking convey substantial risks, especially for cardiovascular disease, where smoking even a few cigarettes is as dangerous as smoking 20 cigarettes a day.

Myth 5: Nicotine is addictive, but it doesn’t pose any other substantial risks.

Nicotine is a reproductive toxin. While not a carcinogen, nicotine plays an important role in promoting tumor progression by promoting cell proliferation and inhibiting normal cell death by activating nicotinic acetylcholine receptors and β adrenergic receptors. Nicotine also promotes the angiogenesis needed to supply blood to growing tumors. Nicotine’s effects on nicotinic acetylcholine receptors also accelerates atherosclerosis.It also aggravates lung disease and other diseases.

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