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Australia’s prohibition of e-cigarettes is out of step with the evidence

May 2nd, 2016
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http://theconversation.com/australias-prohibition-of-e-cigarettes-is-out-of-step-with-the-evidence-58725

A new report by the Royal College of Physicians in the United Kingdom says electronic cigarettes (e-cigarettes) are much safer than smoking and encourages their widespread use by smokers. It concludes that e-cigarettes have huge potential to prevent death and disease from tobacco use.

The review identifies e-cigarettes as a valuable tool to help smokers quit. For those who are unable to quit with currently available methods, e-cigarettes can substitute for smoking by providing the nicotine to which smokers are addicted without the smoke that causes almost all of the harm. This approach is supported by the scientific and public health community in the UK and is consistent with a previous review by Public Health England, the government health agency.

E-cigarettes are the most commonly used aid to quit smoking in the UK. According to the new review, evidence available so far suggests e-cigarettes are at least as effective as nicotine replacement therapy, such as patches or chewing gum. More than one million people have quit smoking in the UK using e-cigarettes. Quit rates are likely to be even higher with professional counselling and with more advanced devices.

E-cigarettes have been available in the UK since 2007 as a general consumer product – with some additional restrictions on advertising and minimum age of sale. They’re used almost exclusively in the UK by smokers who are trying to cut down or quit smoking, or who have quit smoking.

Concerns about e-cigarettes

In Australia, e-cigarettes containing nicotine are prohibited. Most Australian health organisations such as the National Heart Foundation, Cancer Council Australia and the Australian Medical Association take a very risk-averse approach based on potential harms. They say e-cigarettes could be a gateway to smoking for non-smokers; they may make the act of smoking socially acceptable again (renormalisation); there may be unknown long-term safety risks; and dual use may delay quitting.

The new review explores the evidence for these concerns and says they are mostly unfounded.

In the UK, there is no evidence e-cigarettes are a gateway to smoking. E-cigarette use is almost entirely restricted to current or past smokers. Use by children who would not otherwise have smoked appears to be minimal.

The report found no evidence to suspect the use of e-cigarettes renormalises smoking. On the contrary, smoking rates in the UK have been falling as e-cigarette use rises.

E-cigarette vapour contains some toxins and the report acknowledges some harm from long-term use cannot be dismissed. However, it supports the widely held view that the hazard to health is unlikely to exceed 5% of the risk of smoking, and may well be substantially lower. This level of harm is similar to nicotine replacement therapy and is likely to reduce with further technological advances. Similarly, the report concludes the harm to bystanders from vapour exposure is negligible.

Many e-cigarette users continue to smoke as well for a period of time (dual use) but there is no evidence this has reduced the number of smokers who quit. Indeed, dual use is often a transitional phase and many users will go on to quit completely as is the case of smokers concurrently using nicotine replacement therapy. A recent study found dual use reduces smoking intake and is less hazardous.

Implications for Australia

Australia has a comprehensive tobacco control policy including high tobacco taxes, mass media campaigns and smoke-free policies that stimulate quit attempts. However, smoking is highly addictive and most of Australia’s three million smokers try and fail repeatedly to quit, even with existing therapies

Based on the UK experience, e-cigarettes could assist many Australian smokers to quit or could replace cigarettes with a much safer source of nicotine. This could potentially save many thousands of lives each year.

As established smokers are more likely to be socioeconomically disadvantaged or to have mental health problems, the burden of disease falls disproportionately on these groups who have higher levels of addiction to nicotine and greater difficulty quitting.

The precautionary position taken by Australian health organisations and governments is not supported by the available evidence and overseas experience. The growing evidence for safety and effectiveness of e-cigarettes significantly outweighs any potential risks to public health.

A rational, evidence-based approach would be to make e-cigarettes available in Australia as consumer products and to encourage their use while minimising uptake by people who would not otherwise have used nicotine products. Ongoing monitoring and appropriate proportionate regulation would help minimise any risks.

E-cigarettes represent a massive opportunity for Australian smokers and have the potential for large-scale improvements in individual and public health, and social inequality. We cannot afford not to embrace them.

Marlborough Man 2016: Smoking icon has swapped his horse for a helicopter and become a Stetson-wearing WOMAN in new e-cigarette ad campaign

Apr 30th, 2016
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The old fashioned Marlboro Man has been replaced by a woman

The new face of e-cigarettes is shown using a helicopter to round up cattle

Imperial Tobacco campaign received a boost after a report released by the Royal College of Physicians (RCP) backed E-cigarettes

After using a helicopter to round up a large herd of cattle in the wild west, the Stetson-wearing herder pulls down her bandana and takes a puff from her blue-tipped e-cigarette.

The old fashioned Marlboro Man has been replaced by a woman for the face of the new e-cigarette ad campaign.

However her career was facing an uncertain future with television adverts promoting e-cigarettes set to be banned next month under an EU directive on tobacco.

The World Health Organisation had warned in 2014 that vaping was dangerous but now Imperial Tobacco’s blu e-Cigs campaign received a boost after a report released by the Royal College of Physicians (RCP) backed E-cigarettes.

The RCP’s new report concluded that e-cigarettesbring benefits for public health and said they should be widely promoted to smokers to help them quit tobacco.

In a report likely to further fuel a debate over electronic cigarettes, the influential British doctors group also stressed that tobacco smoking is both addictive and lethal but concluded that e-cigarettes are ‘much safer than smoking’.

E-cigarettes are not a gateway to smoking, the RCP said, and do not lead to the normalisation of the habit – two issues often cited by critics who fear the devices can lure children and young people into smoking habits.

‘None of these products has to date attracted significant use among adult never-smokers, or demonstrated evidence of significant gateway progression into smoking among young people,’ the RCP’s 200-page report said.

E-cigarettes, which heat nicotine-laced liquid into vapour, have rapidly grown into a global market for ‘vaping’ products that was estimated at around $7 billion in 2015.

Tobacco smoking kills half of all smokers, plus at least another 600,000 people a year non-smokers via second-hand smoke.

This makes it the world’s biggest preventable killer, with apredicted death toll of a billion by the end of the century,according to the World Health Organization (WHO).

Many public health experts think e-cigarettes, or vapes,which do not contain tobacco, are a lower-risk alternative to smoking, but some questions remain about their long-term safety.

Linda Bauld, a professor at Stirling University, deputy director of the UK Centre for Tobacco and Alcohol Studies and aco-author of the RCP report, said that unlike tobacco, nicotine does not cause cancer, heart and lung diseases.

‘The ideal is for people to use nothing,’ she said, but when the alternative is smoking, people should be encouraged to use nicotine ‘delivered in a cleaner form than in deadly cigarettes’.

‘This is what tobacco harm reduction is – it reduces the harm from tobacco while recognising that some people will still use nicotine in other safer forms.’

John Britton, chair of the RCP Tobacco Advisory Group which published the report, acknowledged that e-cigarettes were ‘a topic of great controversy’ but said his group’s analysis ‘laysto rest almost all of the concerns over these products’.

The anti-smoking group ASH UK welcomed the report, saying it showed ‘that switching to vaping is a positive and sensible life choice’ for smokers.

‘Electronic cigarette vapour does not contain smoke, which is why vaping is much less harmful,’ said Deborah Arnott, ASH’s chief executive.

PAYING THE PRICE: THE DEATH OF THE MARLBORO MEN

With his rugged looks and cool cowboy image, the Marlboro Man was the star of the smoking advertisements until they were scrapped in the late Nineties.

Several actors and models have been the face of Marlboro including David Millar, who died of emphysema in 1987, and David McLean, who died of lung cancer in 1995.

Another who pushed the product, Wayne McLaren, died before his 52nd birthday in 1992 and Dick Hammer – better known for his role as Captain Hammer in the TV show Emergency! – passed away from lung cancer in 1999, aged 69.

It wasn’t until state governments banned the use of humans or cartoons to promote tobacco advertisements in the UK that the role was axed.

Eric Lawson who played the iconic cigarette-puffing cowboy during the late 1970s passed away aged 72 from respiratory failure in January 2014.

Last year Darrell Winfield became the sixth Marlboro man to pass away from an unspecified ‘lengthy illness’ at his ranch in Riverton, Wyoming, while in hospice care.

Winfield was a real-life rancher who worked on a cattle farm in 1968 when he was first discovered by the Leo Burnett advertising agency and transformed into a world-recognized model.

PLAIN PACKAGING WORKS: REPORT

Feb 26th, 2016
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https://ajp.com.au/news/plain-packaging-works-phaa/

Tobacco plain packaging has been a remarkable success, and has already saved thousands of lives, according to the Public Health Association of Australia (PHAA) and other groups.

A report released today concludes that the effects of plain packaging are “underestimated” but these positive outcomes are expected to grow.

Plain packaging, which was a first for Australia, was introduced in December 2012 by the Gillard Government. Researchers now believe it has been essential in the decline of smoking rates.

PHAA Tobacco spokesperson Professor Mike Daube, who chaired the Australian government’s expert committee says “it is great news for everyone except big tobacco”.

“We know that smoking in adults and children and cigarette sales are declining, but it is especially rewarding that this meticulous independent analysis attributes part of that decline to plain packaging alone, even within its first three years.”

He adds that the plain packaging legislation has resulted in a stunning outcome.

“Even leaving aside the rest of the decline, and impacts on children, plain packaging alone has been responsible for tens of thousands of adults quitting since its introduction in late 2012.”

PHAA chief executive Michael Moore claims that plain packaging is a proven success.

“It is saving lives even in the short term, and will save many more in the years to come. No wonder the tobacco industry opposed it so desperately. All their arguments have failed, and plain packaging has become one of Australia’s most successful exports.”

“We congratulate all major parties for their continuing support of tobacco control and plain packaging. This is a triumph for public health and for a bipartisan approach to our largest preventable cause of death and disease. There is still work to be done, and the tobacco companies and their allies will do everything they can to keep selling their lethal products. This early outcome shows that the legislation is working, and Australia is winning the war on tobacco.”

Also the National Heart Foundation welcomed the results of the report.

Adding further credence to the results, the report also concluded that “this effect is likely understated and is expected to grow over time,” it said in a media statement today, adding it was another win against so-called “big tobacco”.

The figures come from the Government’s Tobacco Plain Packaging – Post Implementation Review that confirms approximately one quarter of the total decline in smoking rates were attributable to plain packaging since the legislation was introduced in December 2012.

National Heart Foundation tobacco control spokesperson, and President of the Australian Council on Smoking and Health, Maurice Swanson says this report sends a clear message that plain packaging on tobacco products works.

“The report undeniably shows that the legislation is working and has been the catalyst for tens of thousands of adults quitting and saved the lives of many thousands of Australians,” says Swanson

“The legislation was always designed for long-term impact and if these results are merely the start of the journey, a smoke-free Australia could one day be a reality.”

EU questions ‘continued relevance’ of tobacco deal

Feb 24th, 2016
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https://euobserver.com/economic/132442

A long-awaited report assessing an agreement between tobacco multinational Philip Morris International (PMI), the European Union and its member states says the deal “effectively met its objective”, but may not be fit for the future.

“The evidence suggests, even if no direct causality can be established, that the PMI Agreement has effectively met its objective of reducing the prevalence of PMI contraband on the illicit EU tobacco market, as shown by a drop of around 85% in the volume of genuine PMI cigarettes seized by Member States between 2006 and 2014,” the commission said in the report, published on Wednesday (24 February).

The agreement is due to expire in July, and the commission has promised to take the assessment into account in its decision over whether or not to attempt to renew it.

While the “technical assessment” published on Wednesday does not contain a decision in favour or against renewal, it questions “the continued relevance” of the deal.

The EU executive has assessed the costs and benefits of the tobacco agreement, which made the EU and PMI partners in the fight against cigarette smuggling and counterfeiting, and whose benefits have included payments from PMI to national budgets and the EU budget of around €1 billion, in total. The EU budget received 9.7 percent of this amount.

The report says that PMI used the agreement “on multiple occasions” to give national and EU anti-fraud authorities “information of direct investigative value”.

“This information has regularly led to seizures by Member States’ enforcement authorities, and in many cases to arrests and criminal indictments,” the report says, without quantifying what constitutes regularly.

“Transnational criminal organisations were dismantled and potential losses to Member States’ and the EU budget of several million euros were prevented,” the authors write. Elsewhere in the report, they say that cigarette smuggling is costing national and EU budgets more than €10 billion annually, in lost public revenue.

They also add “it can also be argued that PMI’s incentives in this type of assistance to enforcement might as well be independent from the existence of the PMI Agreement”.

Costs

There was little cost involved on the side of the EU, the report notes, but that is also because in the first ten years of the PMI-EU deal, the EU could have made better use of the investigative powers it was granted under the agreement.

“Low administrative costs were also partly due to the fact that the Commission has in the past underinvested in the full implementation of the PMI Agreement including the auditing of the compliance by PMI with the obligations under the Agreement, to which only limited resources were dedicated,” the report says.

“The Commission has in recent years brought improvements to the way how the PMI Agreement is managed in practice, even if resources remain stretched,” it adds.

In its assessment, the commission also says that while the deal may have worked well in the past, the world has changed since it was signed in 2004.

“The market and legislative framework has changed significantly since the entry into force of the Agreement,” it said. Many of the rules in the agreement are now EU law, and some parts of the deal contradict international obligations that are expected to come into force soon.

The report also acknowledges criticism that the deal allows too cozy a relationship between tobacco companies and the EU, but says this is “essentially a matter of political appreciation and falls outside the scope and mandate of this technical assessment”.

It does state dryly “that the tobacco industry has launched a legal challenge against the 2014 Tobacco Product Directive (TPD), which prompts some to question whether it is opportune for the EU to enter into a contract with an entity on policy issues related to the ones legally challenged”.

MEPs

The assessment has been long-awaited by several members of the European Parliament, who have been critical of the deal.

The EU commissioner Kristalina Georgieva responsible for the deal is due to appear in front of the plenary session of the European Parliament on Thursday (25 February).

Last December, EUobserver published a four-part series of articles about the EU’s agreement with tobacco company PMI

Part one: Will EU renew $1.25bn deal with tobacco firm PMI?

Part two: EU sleuths ignore special powers on tobacco smuggling

Part three: Scant evidence EU tobacco deal curbed smuggling

Part four: How did the EU spend its €110 million in tobacco money?

Report

  1. Technical assessment of the experience made with the Anti-Contraband and Anti-Counterfeit Agreement

Electronic cigarette use and indoor air quality in a natural setting

Feb 15th, 2016
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Download (PDF, 218KB)

Did limits on payments for tobacco placements in US movies affect how movies are made?

Jan 28th, 2016
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E-cigarettes suppress immune defenses, alter inflammation and boost bacterial virulence

Jan 27th, 2016
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Researchers at the University of California, San Diego School of Medicine and Veterans Affairs San Diego Healthcare System report data suggesting that e-cigarettes are toxic to human airway cells, suppress immune defenses and alter inflammation, while at the same time boosting bacterial virulence. The mouse study is published January 25 by the Journal of Molecular Medicine.

“This study shows that e-cigarette vapor is not benign — at high doses it can directly kill lung cells, which is frightening,” said senior author Laura E. Crotty Alexander, MD, staff physician at the Veterans Affairs San Diego Healthcare System and assistant clinical professor at UC San Diego School of Medicine. “We already knew that inhaling heated chemicals, including the e-liquid ingredients nicotine and propylene glycol, couldn’t possibly be good for you.

This work confirms that inhalation of e-cigarette vapor daily leads to changes in the inflammatory milieu inside the airways.”

Crotty Alexander reported the preliminary results of this work at the American Thoracic Society annual meetings in 2014 and 2015. But now her team has also seen their findings hold up in mice. Inflammatory markers — signs of full-body inflammation — in the airways and blood of mice that inhaled e-cigarette vapors for one hour a day, five days a week, for four weeks were elevated by 10 percent compared to unexposed mice.

“We don’t know specifically which lung and systemic diseases will be caused by the inflammatory changes induced by e-cigarette vapor inhalation, but based on clinical reports of acute toxicities and what we have found in the lab, we believe that they will cause disease in the end,” Crotty Alexander said. “Some of the changes we have found in mice are also found in the airways and blood of conventional cigarette smokers, while others are found in humans with cancer or inflammatory lung diseases.”

Conversely, bacterial pathogens exposed to e-cigarette vapor benefited. Specifically, Staphylococcus aureus bacteria were better able to form biofilms, adhere to and invade airway cells and resist human antimicrobial peptides after exposure to e-cigarette vapor.

E-cigarette vapor extract-exposed bacteria were also more virulent in a mouse model of pneumonia. All mice infected with normal methicillin-resistant S. aureus (MRSA), an antibiotic-resistant “superbug,” survived. Meanwhile, 25 percent of mice infected with MRSA pre-exposed to e-cigarette vapor died.

The results were consistent with e-liquids from seven different manufacturers, demonstrating that the findings are not limited to one formula or brand.

Crotty Alexander and team also recently reported that MRSA bacteria exposed to conventional cigarette smoke are more resistant to killing by the immune system than unexposed bacteria.

Source:
University of California – San Diego

Exposure to Electronic Cigarette Advertising Among Middle School and High School Students — United States, 2014

Jan 5th, 2016
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http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6452a3.htm?s_cid=mm6452a3_w

Abstract

Introduction:

Electronic cigarette (e-cigarette) use has increased considerably among U.S. youths since 2011. Tobacco use among youths in any form, including e-cigarettes, is unsafe. Tobacco product advertising can persuade youths to start using tobacco. CDC analyzed data from the 2014 National Youth Tobacco Survey to estimate the prevalence of e-cigarette advertisement exposure among U.S. middle school and high school students.

Methods:

The 2014 National Youth Tobacco Survey, a school-based survey of middle school and high school students in grades 6–12, included 22,007 participants. Exposure to e-cigarette advertisements (categorized as “sometimes,” “most of the time,” or “always”) was assessed for four sources: retail stores, Internet, TV and movies, and newspapers and magazines. Weighted exposure estimates were assessed overall and by school type, sex, race/ethnicity, and grade.

Results:

In 2014, 68.9% of middle and high school students (18.3 million) were exposed to e-cigarette advertisements from at least one source. Among middle school students, exposure was highest for retail stores (52.8%), followed by Internet (35.8%), TV and movies (34.1%), and newspapers and magazines (25.0%). Among high school students, exposure was highest for retail stores (56.3%), followed by Internet (42.9%), TV and movies (38.4%), and newspapers and magazines (34.6%). Among middle school students, 23.4% reported exposure to e-cigarette advertising from one source, 17.4% from two sources, 13.7% from three sources, and 11.9% from four sources. Among high school students, 21.1% reported exposure to e-cigarette advertising from one source, 17.0% from two sources, 14.5% from three sources, and 18.2% from four sources.

Conclusions and Implications for Public Health Practice:

Approximately seven in 10 U.S. middle and high school students were exposed to e-cigarette advertisements in 2014. Exposure to e-cigarette advertisements might contribute to increased use of e-cigarettes among youths. Multiple approaches are warranted to reduce youth e-cigarette use and exposure to e-cigarette advertisements, including efforts to reduce youth access to settings where tobacco products, such as e-cigarettes, are sold, and regulation of youth-oriented e-cigarette marketing.

Introduction

Electronic cigarettes (e-cigarettes) are battery-powered devices capable of delivering nicotine and other additives (e.g., flavorings) to the user in an aerosol form. E-cigarette use has increased considerably among U.S. youths in recent years. During 2011–2014, past-30-day e-cigarette use increased from 0.6% to 3.9% among middle school students and from 1.5% to 13.4% among high school students; in 2014, e-cigarettes became the most commonly used tobacco product among middle school and high school students (1). Youth use of tobacco in any form (combustible, noncombustible, or electronic) is unsafe (2,3). E-cigarettes typically deliver nicotine derived from tobacco, which is highly addictive, might harm brain development, and could lead to sustained tobacco product use among youths (2). In April 2014, the Food and Drug Administration (FDA) issued a proposed rule to deem all products made or derived from tobacco subject to FDA jurisdiction (4).

In the United States, e-cigarette sales have increased rapidly since entering the U.S. marketplace in 2007, reaching an estimated $2.5 billion in sales in 2014 (5,6). Corresponding increases have occurred in e-cigarette advertising expenditures, which increased from $6.4 million in 2011 to an estimated $115 million in 2014 (7,8). Tobacco product advertising is causally related to tobacco product initiation among youths (9). Many of the themes used in conventional tobacco product advertising, including independence, rebellion, and sexual attractiveness, also are used to advertise e-cigarettes (9,10). Moreover, almost all tobacco use begins before age 18 years, during which time there is great vulnerability to social influences, such as youth-oriented advertisements and youth-generated social media posts (9). This report assesses exposure to e-cigarette advertisements among U.S. middle school and high school students.

Methods

Data from the 2014 National Youth Tobacco Survey (NYTS) were analyzed to assess exposure to e-cigarette advertisements from four sources: retail stores (convenience stores, supermarkets, or gas stations); Internet; TV and movies; and newspapers and magazines. NYTS is a cross-sectional, school-based, self-administered, pencil-and-paper questionnaire administered to U.S. middle school (grades 6–8) and high school (grades 9–12) students.* A three-stage cluster sampling procedure was used to generate a nationally representative sample of U.S. students who attend public and private schools in grades 6–12. In 2014, 207 of 258 selected schools (80.2%) participated, yielding a sample of 22,007 participants (91.4%) among 24,084 eligible students; the overall response rate was 73.3%.

Sources of exposure to e-cigarette advertisements were assessed by participants’ responses to the following four questions: 1) Internet: “When you are using the Internet, how often do you see advertisements or promotions for electronic cigarettes or e-cigarettes?” 2) Newspapers and magazines: “When you read newspapers or magazines, how often do you see advertisements or promotions for electronic cigarettes or e-cigarettes?” 3) Retail stores: “When you go to a convenience store, supermarket, or gas station, how often do you see advertisements or promotions for electronic cigarettes or e-cigarettes?” 4) TV and movies: “When you watch TV or go to the movies, how often do you see advertisements or promotions for electronic cigarettes or e-cigarettes?” For each question, respondents could select the following options: they do not use the specific source (e.g., “I do not read newspapers or magazines”), “never,” “rarely,” “sometimes,” “most of the time,” or “always.” Respondents who said they saw promotions or advertisements “sometimes,” “most of the time,” or “always” were considered to have been exposed to advertisements from the source; those who selected “never” or “rarely” were considered not exposed. Respondents who did not use a source were also classified as not exposed.† Data were weighted to account for the complex survey design and adjusted for nonresponse. National prevalence estimates with 95% confidence intervals and population estimates were computed; population estimates were rounded down to the nearest tenth of a million. Estimates of exposure for each source were assessed overall and by school type, sex, race/ethnicity, and grade. T-tests were used to calculate differences between groups; a p-value <0.05 was considered statistically significant. The number of exposure sources were summed for each student and reported as the proportion who were exposed to one, two, three, or four sources.

Results

All students. Overall, 68.9% of participants (an estimated 18.3 million students) were exposed to e-cigarette advertisements from ≥1 source (Figure). Retail stores were the most frequently reported exposure source (54.8% of respondents, or an estimated 14.4 million students), followed by the Internet (39.8%, 10.5 million), TV and movies (36.5%, 9.6 million), and newspapers and magazines (30.4%, 8.0 million) (Table). Exposure to e-cigarette advertisements on the Internet and in newspapers and magazines was reported more frequently by females than males. Exposure in retail stores was higher among non-Hispanic whites (whites) than non-Hispanic blacks (blacks) and students of other non-Hispanic races/ethnicities. Exposure from TV and movies was higher among blacks and Hispanics than whites. Exposure was higher among students in higher grade levels for all sources. Overall, 22.1% of participants (5.8 million students) reported exposure to e-cigarette advertising from one source, 17.2% (4.5 million) from two sources, 14.1% (3.7 million) from three sources, and 15.4% (4.1 million) from four sources (Figure).

Middle school students. Among middle school students, 66.4% (7.7 million) were exposed to e-cigarette advertisements from at least one source (Figure). Retail stores were the most frequently reported source of exposure (52.8% of respondents, or an estimated 6.0 million middle school students), followed by the Internet (35.8%, 4.1 million), TV and movies (34.1%, 3.9 million), and newspapers and magazines (25.0%, 2.8 million) (Table). Exposure to e-cigarette advertisements on the Internet was higher among female than male middle school students. Exposure in retail stores was higher among whites than blacks and other non-Hispanic race/ethnicities. Exposure from TV or movies was higher among blacks than whites. A single source of exposure was reported by 23.4% of participants (2.7 million middle school students); two sources by 17.4% (2.0 million), three sources by 13.7% (1.5 million), and four sources by 11.9% (1.3 million) (Figure).

High school students. Among high school students, 70.9% of respondents (an estimated 10.5 million high school students) reported exposure to e-cigarette advertisements from at least one source (Figure). Similar to middle school students, more than half of reported e-cigarette advertising exposures (56.3%, 8.3 million) occurred in retail stores, followed by the Internet (42.9%, 6.3 million), TV and movies (38.4%, 5.6 million), and newspapers and magazines (34.6%, 5.1 million) (Table). Exposure in retail stores was higher among whites than blacks and other non-Hispanic race/ethnicities. Exposure from TV and movies was higher among blacks than whites. One source of exposure was reported by 21.1% of participants (3.1 million high school students), two sources by 17.0% (2.5 million), three sources by 14.5% (2.1 million), and four sources by 18.2% (2.7 million) (Figure).

Conclusions and Comments

In 2014, nearly seven in 10 (18.3 million) U.S. middle school and high school students were exposed to e-cigarette advertisements from at least one source, and approximately 15%, or 4.1 million students, were exposed to e-cigarette advertisements from all four sources. Approximately half were exposed to e-cigarette advertisements in retail stores, whereas approximately one in three were exposed on the Internet, on TV or at the movies, or while reading newspapers or magazines. Although there were slight variations by sex and race/ethnicity, the magnitude of exposure was consistent across groups. Implementation of comprehensive efforts to reduce youth exposure to e-cigarette advertising and promotion is critical to reduce e-cigarette experimentation and use among youths.

Retail store exposure to e-cigarette advertising in this study (54.8%) was lower than levels of exposure to conventional cigarette and other tobacco product advertising reported in the NYTS in 2014 (80.6%), but comparable to exposure on the Internet (39.8% versus 46.8%, respectively) and in newspapers and magazines (30.4% versus 34.3%, respectively) (11).§ Advertising for conventional tobacco products, such as cigarettes, has been shown to prompt experimentation as well as increase and maintain tobacco product use among youths (9). Similarly, according to a recent randomized controlled study, adolescents who were exposed to e-cigarette advertisements on TV were 54% more likely to say they would try an e-cigarette soon, and 43% more likely to say they would try an e-cigarette within the next year, compared with adolescents who were not exposed to e-cigarette advertisements (12). The study also determined that youths exposed to e-cigarette advertisements were more likely to agree that e-cigarettes can be used in places where smoking is not allowed (12). This is consistent with findings that certain e-cigarette marketers are using advertising tactics similar to those used in the past to market conventional cigarettes, including youth-oriented themes, and promoting e-cigarette use as an alternative in places where smoking is not allowed (2,9,10). An analysis of 57 online e-cigarette vendors determined that 70.2% of vendors used more than one social network service to market e-cigarettes (13). Moreover, 61.4% of vendors only required users to click a pop-up or dialog box to self-verify age, and 35.1% of vendors had no detectable age verification process. This unrestricted marketing of e-cigarettes, coupled with rising use of these products among youths (1), has the potential to compromise decades of progress in preventing tobacco use and promoting a tobacco-free lifestyle among youths (2,9).

Research supports the importance of a multifaceted approach to youth tobacco prevention involving multiple levels of government (2,9,14). Local, state, and federal efforts to reduce youth access to the settings where tobacco products, including e-cigarettes, are sold could reduce youth e-cigarette initiation and consumption, as well as advertising exposure. Potential strategies include requiring that tobacco products, including e-cigarettes, be sold only in facilities that never admit youths; limiting tobacco outlet density or proximity to schools; and requiring that e-cigarette purchases be made only through face-to-face transactions. Adding e-cigarettes and other tobacco products to the list of current tobacco products prohibited from being sent through U.S. mail and requiring age verification for online sales at purchase and delivery could also prevent sales to youths. In addition, potential strategies at the federal or state level include regulation of e-cigarette advertising in media, Internet, and retail settings that are demonstrated to appeal to youths or are viewed by a substantial number of youths. The evidence base for restricting advertisements for conventional tobacco products indicates that these interventions would be expected to contribute to reductions in e-cigarette advertisement exposure and use among youths as well (2,9). To effectively implement these strategies, there is a need for fully funded and sustained comprehensive state tobacco control programs that address all forms of tobacco use, including e-cigarettes (14). These programs are critical to support the implementation and maintenance of proven population-based interventions to reduce tobacco use among youths, including tobacco price increases, comprehensive smoke-free laws, and high impact mass media campaigns (14). However, in 2015, states appropriated only 1.9% ($490.4 million) of combined revenues of $25.6 billion from settlement payments and tobacco taxes for all states on comprehensive tobacco control programs,¶ representing <15% of the CDC-recommended level of funding ($3.3 billion) for all states combined (14). Only two states (Alaska and North Dakota) currently fund tobacco control programs at CDC-recommended levels. Additionally, parents, caregivers, and health care providers can talk to children about the dangers of tobacco use, encourage or set limits on media use, and teach children critical media viewing skills to increase their resistance to pro-tobacco messages (15).

These findings are subject to at least three limitations. First, advertising exposure was self-reported and is subject to recall bias. Second, data were collected only from students who attended public or private schools and might not be generalizable to middle school- and high school-aged youths who are being homeschooled, youths who have dropped out of school, or youths in detention centers. However, data from the Current Population Survey indicate that 97.5% of U.S. youths aged 10–13 years and 95.4% of those aged 14–17 years were enrolled in a traditional school in 2014.** Finally, exposure to e-cigarette advertisements might have been underestimated, as survey questions asked only about exposure from four sources, and did not assess exposure from other potential sources such as sporting events, radio, or billboards.

This report highlights youth exposure to e-cigarette advertisements, which might be contributing to increasing youth experimentation with and use of e-cigarettes in recent years. Multiple approaches are warranted to reduce youth e-cigarette use and exposure to e-cigarette advertisements, including efforts to reduce youth access to the settings where tobacco products, including e-cigarettes, are sold, and regulation of youth-oriented e-cigarette marketing. The implementation of these approaches, in coordination with fully funded and sustained comprehensive state tobacco control programs, has the potential to reduce all forms of tobacco use among youths, including e-cigarette use.

CDC: Youth exposure to electronic cigarettes ads contributing to use

Jan 5th, 2016
by Editor.
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http://wtop.com/health/2016/01/cdc-youth-exposure-to-e-cig-ads-contributing-to-use/

WASHINGTON — Children in the United States are seeing lots of ads for e-cigarettes — and the Centers for Disease Control and Prevention says that is one big reason why the use of e-cigs is soaring among the young.

A new CDC report says seven in 10 middle and high school students have seen these advertisements which — like cigarette ads of yore — use themes of sex, independence and rebellion to sell their products.

“The e-cigarette advertising we’re seeing is like the old-time Wild West; no rules, no regulations and heavy spending,” says CDC Director Tom Frieden.

Data from the CDC’s 2014 National Youth Tobacco Survey, found that 68.9 percent of teens and tweens saw e-cigarette ads from one or more media source. And those advertisements can have a great impact.

“Kids just pick up advertising messages really well and from young ages,” says Joanna Cohen, director of the Institute for Global Tobacco Control at the Johns Hopkins Bloomberg School of Public Health.

She cites a key study conducted in the 1990s to prove her point. It showed that children as young as 3 years old recognized the Joe Camel cartoon figure more than they recognized Mickey Mouse.

Last year, researchers at Hopkins wrote of the potential health hazards of e-cigarettes. The report — published in the journal PLOS ONE — was based on a mouse study that found evidence that e-cigs may compromise the immune system.

Frieden says while there may be some limited benefit to short-term e-cigarette use for adults trying to wean themselves off regular cigarettes, the risk for kids is unacceptable.

He cites a possible impact on brain development, and notes that e-cigs still contain nicotine, which can be extremely addictive.

Government statistics show while cigarette smoking is down among teens, the use of e-cigs is way up. The CDC says e-cigarettes could reverse the trend, with many young people eventually transitioning to far more dangerous tobacco products.

“We are really excited that smoking rates are coming down among kids, but we have to keep working to make sure that they stay low,” says Cohen.

Maryland and Virginia are among the states that have already banned sales of e-cigarettes to minors, and similar legislation has been introduced in the District, but there has been no movement in the D.C. council.

But it may take much more than a ban to solve the problem, Frieden says.

E-cigarettes are readily available for anyone of any age to purchase on the Internet, and the CDC’s Frieden indicates an all-out awareness campaign may be needed.

He suggests states may want to use some of the money they received as part of a big settlement with tobacco companies in the late 1990s. But such action may have to wait until the Food And Drug Administration announces a long-awaited formal proposal to regulate e-cigarettes as a tobacco product.

Report on Tobacco Control for the Region of the Americas

Jan 1st, 2016
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