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Vaping Control

Retail Outlets and Point-of-Sale Marketing of Alternative Tobacco

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Third of NZ students have tried vaping, despite most being non-smokers

http://www.voxy.co.nz/health/5/361613

New research shows that more than a third of New Zealand high school students have tried vaping even though nearly two-thirds of those doing so have never smoked cigarettes.

Vapes, or electronic cigarettes, are not recommended for non-smokers, as the long-term effects are not known, and vapes containing nicotine are likely to be addictive.

“Vaping is not as harmful as smoking, but it is not harmless. Taking up vaping is not a good idea for people who are not otherwise smokers, particularly young people,” says study co-author Dr Terry Fleming from Te Herenga Waka-Victoria University of Wellington’s School of Health.

The study is the first in New Zealand to look at vaping in high school students of all ages. It found 65 percent of teenagers who had tried vaping reported they had never smoked cigarettes, as well as 48 percent of those who said they vaped regularly. Overall, 38 percent of teenagers reported they had tried vaping, 10 percent said they vaped regularly, and 6 percent vaped weekly or more often.

The research also shows vaping is relatively common for students in all school deciles, whereas smoking is now rare in higher decile schools.

“Vaping seems to appeal to a wider range of young people than smoking and unlike smoking it is more common in boys than girls,” says Dr Fleming.

Recently published data from another New Zealand study shows the long-term decline in smoking among Year 10 students that began in 2000 stalled from about 2015 and may even be reversing, particularly in MÄori and low decile schools.

“When you put these findings together, it calls into question the idea that vaping is displacing smoking. The alternative possibility, that vaping is fuelling smoking, must be taken seriously by communities and policymakers,” says study co-author Associate Professor Terryann Clark from the University of Auckland.

Researchers say measures to protect youth, particularly MÄori and disadvantaged youth, from both vaping and smoking harm are needed, such as limits on where vapes and tobacco can be sold and a ban on vaping advertising and sponsorship, including online and social media promotion.

The research is timely, as the Government is currently consulting on new vaping regulations announced earlier in the month.

“New Zealand has fewer restrictions on promoting vaping and on vape flavours than many other countries. Supporting smokers to step down to vaping and non-smokers to stay that way are both important-this is possible with good policy and leadership,” says Dr Fleming.

The research is part of the Youth19 survey, which aims to collect data on a range of issues affecting New Zealand youth. Further results from the survey will be available over the coming year. This survey is a collaboration between Te Herenga Waka-Victoria University of Wellington, the University of Auckland, the University of Otago, and AUT.

STOP the virus spread – BAN VAPING – BAN ENDs

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Regulating Vaping — Policies, Possibilities, and Perils

https://www.nejm.org/doi/full/10.1056/NEJMp1917065

Smoking rates peaked in the United States in the mid 1960s and have since declined to historically low levels. In contrast, use of e-cigarettes has recently soared, particularly among young people. In 2019, more than 27% of high school students reported using e-cigarettes during the past month, as compared with about 6% who reported using combustible cigarettes.1 Use of Juul products accounts for much of the doubling of vaping rates between 2017 and 2019, and these products represent 75% of the multibillion-dollar e-cigarette market. The growth in vaping among young people has alarmed policymakers and many others.

Federal and state governments have implemented numerous policies to combat the growth of vaping. To promote the health of the population, however, policies should protect young people without diminishing the ability of e-cigarettes to help adult smokers transition away from more harmful combustible cigarettes or to serve as a cessation aid for people attempting to quit smoking. This tension presents a quandary for policymakers, since vaping policies often promote one goal at the expense of the other. Furthermore, the facts that certain state and federal policies complement, substitute for, or undermine each other and that some federal policies supersede state policies add another layer of complexity to policymaking in this arena.

Because e-cigarettes vaporize liquid instead of burning tobacco, they are generally thought to be less harmful than combustible cigarettes.2 However, the long-term health effects of inhaling liquid flavoring chemicals and nicotine are unknown.

Juul is a cartridge (“pod”) type of e-cigarette — it is a reusable, rechargeable device that holds a liquid-containing pod, rather than a refillable open-tank system or a disposable device. Juul pods contain higher levels of nicotine than many other e-cigarette products, which makes them a better substitute for combustible cigarettes for smokers. However, high nicotine levels increase the risk of addiction among young people and can harm their cognitive development. Vaping e-cigarettes adulterated with tetrahydrocannabinol (THC) and vitamin E acetate recently caused an outbreak of acute lung disease and deaths.3 Although these harms are seemingly linked to the addition of THC and to the use of e-cigarettes obtained from informal sources rather than to e-cigarettes in general, these complications heighten concerns about e-cigarettes.

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State and federal policymakers are focusing on two key policies for preventing vaping among young people: minimum sales age laws that restrict the sale of e-cigarettes to adolescents and bans on flavored e-cigarettes. Some states have also implemented e-cigarette taxes (see table).

In December 2019, Congress passed so-called Tobacco 21 legislation, which immediately sets a federal minimum age of 21 for purchasing tobacco products, including e-cigarettes. Twenty-four states and the District of Columbia had enacted policies that set the minimum age for purchasing e-cigarettes at either 19 or 21; in other states, the minimum age was 18.

Because most tobacco use begins before 19 years of age, the new federal law has the potential to dramatically reduce current tobacco use among young people and prevent some people from ever using tobacco. However, enforcing bans on sales to minors is difficult in retail locations and even more so online, and young people often obtain e-cigarettes from family members and friends. To reduce access to e-cigarettes among young people, federal and state governments could increase funding for enforcement efforts and collaborate to find better ways to prevent sales to young people in stores and online.

Another important policy is banning flavored e-cigarettes. Because flavors are more attractive to young people than to adults, a flavor ban could reduce the appeal of e-cigarettes for young people without diminishing their role in harm reduction for adult smokers. Nine states have passed flavor bans, but most have been short-term emergency bans or have been blocked by legal challenges.

In December 2019, the Food and Drug Administration (FDA) announced that it will use its market-review authority to essentially ban all flavors except tobacco and menthol in cartridge (pod-based) e-cigarettes. These changes became effective in February 2020. Disposable e-cigarettes and e-liquids for open-tank–system e-cigarettes typically sold in vape shops are not covered by the policy. The effect of the ban may be limited because of these important exemptions.

Banning all flavors in all tobacco products with few or no exemptions could be more effective than the current narrow ban for several reasons.4,5 First, menthol cigarettes, which remain on the market, have been shown to be appealing to young people. Second, although young people prefer fruit- and candy-flavored pods to menthol-flavored pods, the latter might become more attractive if they are the only flavored pods available. Third, under the current ban, young people may switch to e-cigarettes that are still permitted to contain flavoring. Indeed, adolescents have recently been favoring new flavored, disposable e-cigarettes that resemble Juul devices but have higher nicotine concentrations and cost less.

Another concern is that it is unclear how committed the FDA is to enforcing the flavor ban for cartridge e-cigarettes. The agency has largely declined to act on its authority to regulate e-cigarettes and to fulfill an obligation established by Congress to force products that do not protect public health, such as Juul devices, off the market. State bans on flavored e-cigarettes may therefore still be important.

A final policy is taxation of e-cigarettes. Twenty-one states and the District of Columbia tax both e-cigarettes and combustible cigarettes; the federal government taxes only combustibles.

The effects of such taxes on public health are complicated for several reasons. Levying taxes on e-cigarettes raises their price, thereby deterring some people from vaping. However, such taxes will also drive some vapers toward smoking, since taxes tend to increase the price of e-cigarettes relative to the price of combustibles.4,5 Consequently, the tax rate on e-cigarettes should be set so that it is cheaper to vape than to smoke. Determining optimal tax rates is complicated by the multiple types of e-cigarettes available, the fact that devices and pods are often bought separately, and the ability of companies — not the government — to set prices. Furthermore, too high a tax on e-cigarettes will encourage vaping of lower-priced or black-market e-cigarettes, thus undermining the benefits of the tax.

Given these considerations and the lack of evidence regarding how people respond to taxes on e-cigarettes, it may be preferable to rely on greater enforcement of Tobacco 21 policies and flavor bans to prevent vaping among young people. The appeal of tax revenue, however, may be too strong for governments to resist.

But at what level of government — state or federal — should e-cigarette policies be implemented? There are several advantages to states taking the lead. States may be more nimble regulators than the federal government, each state can regulate to meet its own needs, and state policies can serve as experiments and generate useful evidence. State laws can fill voids when federal regulations are absent or ineffective. States can also provide an impetus for federal action by demonstrating nationwide political will, as they did by passing Tobacco 21 laws. However, differing state policies risk leaving young people in some states unprotected and promoting the flow of e-cigarettes across state lines.

On the other hand, implementing regulations at the federal level has potential advantages over relying on state-based regulation of e-cigarettes because of the broad reach of national policies and their capacity to reduce trafficking across state borders. Nevertheless, as compared with states, the federal government has been slow to implement certain regulations.

Soaring rates of vaping among young people and associated problems have resulted in great urgency and important challenges for policymakers. Despite the urgency, policies should be evidence-based and thoughtfully designed. They require effective, collaborative, and well-funded enforcement by federal and state governments. Policymakers should aim to reduce vaping among young people while maintaining avenues to help smokers quit. Finally, policies should be forward-thinking, since the e-cigarette market is rapidly changing and e-cigarette companies can be more agile than regulators.

Do state regulations on e-cigarettes have impacts on the e-cigarette prevalence?

https://tobaccocontrol.bmj.com/content/early/2020/03/22/tobaccocontrol-2019-055287

Abstract

Background

We examine the association among five types of state regulations on electronic cigarettes (defining e-cigarettes, special tax, packaging, youth access and licensure) and initiation and current usage of e-cigarettes in 50 US states and the District of Columbia.

Methods

Data came from the 2017 Behavioral Risk Factor Surveillance System and the US e-cigarette regulations—50 state review by the Public Health Law Center. Logistic regressions were used to determine the odds of initiation and current use of e-cigarettes among individuals aged 18–24, 25–34 and the whole sample, adjusting for socio-demographic covariates.

Results

Despite the short history of state laws on e-cigarettes, each of the five state laws was associated with lower odds of initiation and use of e-cigarettes in the whole sample. In the 18–24 age group, only the licensure was associated with lower initiation. In the 25–34 age group, the licensure and taxation were related to lower initiation and current usage. There were significant differences of e-cigarette initiation and usage based on the number of state laws regulating e-cigarettes.

Conclusions

Our analysis indicates the potential of states’ policy efforts to regulate e-cigarettes comprehensively in leading significant changes to e-cigarette prevalence in their populations.

British American Tobacco circumventing ad ban, experts say

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Young People Have No Idea How Much Nicotine They Vape: Study

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The truth behind Philip Morris’ cigarette-free future

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Secondhand Exposure to Aerosols From Electronic Nicotine Delivery Systems and Asthma Exacerbations Among Youth With Asthma

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Using e-cigs increases exposure to toxic chemicals for most users

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