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Youth Vaping

Why e-cigs are not a safer alternative to cigarettes

Jan 9th, 2017
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Today’s guest blogger is Blair Thornley, PharmD, a certified specialist in poison information, at Poison Control Center at the Children’s Hospital of Philadelphia.

http://www.philly.com/philly/blogs/healthy_kids/Why-e-cigs-are-not-a-safer-alternative-to-cigarettes.html

Electronic cigarettes, or “e-cig” use among teens has increased tremendously in the last two years, from approximately 780,000 in 2013 to more than 3 million students in 2015. Similarly, between 2011 and 2013, exposure to e-cigarette TV ads increased by 256 percent among 12 to 17- year-olds and by 321 percent among young adults between the ages of 18 and 24.

Of those surveyed, 40 percent said that they used e-cigarettes because they tasted good; only 10 percent admitted to using them as a quitting aid for conventional cigarettes. These results seem to suggest that, not only are adolescents using e-cigarettes primarily for recreational purposes, but that their increase in popularity is due to the successful marketing techniques of e-cigarette manufacturers. Many of these efforts mimic the tactics that Big Tobacco used in the mid-1900s, and they’re working – again.

When you look at old tobacco ads next to newer, e-cigarette ads, the similarities are astounding. Until late this past summer, e-cigarettes were not considered tobacco products by the U.S. Food and Drug Administration so marketers did not have to adhere to the same standards and laws as the tobacco companies. They used celebrity spokespeople such as Jenny McCarthy and Courtney Love. Their ads portrayed rugged men and glamorous women sending the message that using e-cigarettes is masculine, sexy, or rebellious. They knew that sex sells, and therefore portrayed their products as something that will make the user more attractive to the opposite sex. Some e-cigarette companies even sponsored sporting events and music festivals because they knew it would help them reach large audiences, including young children and teens.

Many e-liquids come in sweet flavors, with names that are appealing to younger audiences, such as “I love donuts” or “Mama’s cookies”. They also used cartoons, reminiscent of Joe Camel, who successfully marketed cigarettes to kids in the 1990s. Still other ads send the message that they’re healthier than regular cigarettes by encouraging people to “switch, don’t quit”. With all of these tactics, it’s little wonder why e-cigarette use among youth is on the rise.

Another important factor fueling the rise in e-cigarette use is the commonly held belief among young people that they are less harmful than tobacco products. Some teens are unaware that the e-liquids they’re using contain nicotine, and nearly 20 percent of young people believe that they cause no harm at all! The majority of teens are using them out of sheer curiosity, they think it tastes good, and it’s a fun thing to do with their friends. They don’t realize that many of these products contain nicotine, which can lead to a powerful, life-long addiction, as well as a permanent lowering of impulse control among teens.

There is also evidence that the aerosol vapors from the e-cigarette are not as harmless as initially believed. Flavoring is added with a chemical known as diacetyl, which has been linked to serious lung disease. E-liquids may also contain heavy metals, such as nickel, lead or tin. Another risk that has been making headlines recently is the e-cigarette batteries that have exploded in users’ pockets, resulting in serious injuries. Because this trend is so new, scientists are still working to understand the long-term health effects, but all the preliminary evidence seems to indicate that e-cigarettes are no safer than conventional cigarettes, and should not be used recreationally.

With all of this new information, it’s important to establish an open dialogue with your teens and young adults, and make sure they’re aware of the risks associated with e-cigarettes. The more you know, the better equipped you will be to protect your children. If you have any questions about e-cigarettes, you can feel free to call the Poison Control Center at 1-800-222-1222, where a pharmacist or nurse is on staff 24 hours a day to answer your call.

The Surgeon General’s Report on E-Cigarettes: Quitters & Starters

Jan 9th, 2017
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By Dr. Sudip Bose, MD

http://www.huffingtonpost.com/dr-sudip-bose/the-surgeon-generals-repo_b_14046964.html

Jan. 7, 2016 — A report on e-cigarettes released at the end of last year by the US Surgeon General’s office shows a number of risks related to the popular product — particularly regarding young people — that should make them a lot less popular, but likely won’t. The act of “vaping” is often thought of as a safer alternative to smoking, but that’s not necessarily the case. Here are the dangers and potential dangers people should be paying attention to related to e-cigarettes:

The Debate

E-cigs are at the center of one of the most contentious debates in public health. The availability and appeal of using e-cigs as an alternative to smoking cigarettes has been growing quickly over the years for both those who are new to smoking, as an introductory product, and to those who are trying to quit smoking, who see it as a more “healthful” way of trying to kick the smoking habit.

However, e-cigs don’t solve the nicotine problem at all. Yes, e-cigs eliminate tar, and yes, e-cigs eliminate the tobacco — both dangerous elements to one’s health. And that’s definitely good. But what they do not eliminate is the critical element of nicotine. Nicotine is one of the most highly addictive substances on earth. It’s presented in a liquid and then vaporized form in an e-cig; you inhale through the e-cig, and as you inhale, the nicotine and other substances in the liquid are atomized and absorbed into your lungs. The nicotine in an e-cig is a lot more concentrated and potent.

New Users

For those who have never smoked and who are interested in the experience, e-cigs are an entry-level product that have been promoted and marketed as being safe. They’re not. They may be “safer” than cigarettes, but that’s only by degree.

While a new “vaper” isn’t exposed to the other substances of tar and tobacco such as are found in a normal cigarette, he or she is getting concentrated and more potent doses of nicotine. That’s not good. And we’re seeing younger and younger people trying these. Also not good. The e-cig “e-liquid,” which is what produces the vapor that users inhale and exhale, are marketed in an array of flavors that appeal to younger users — junior high and high school age kids — they’re available for order online, and you’re getting addicted right away to the habit of using nicotine. The flavors available boggle the imagination: bubble gum, banana, “Mother’s MIlk,” blueberry-lemon, banana cinnamon nutbread, pomegranate, strawberry — it goes on endlessly. These teenagers — and even younger children — are getting addicted early, which could lead to smoking, and e-cigs can easily become a gateway to trying and developing an addiction to more serious drugs. Addiction correlates to crime. People need to feed their habit, they break into homes to steal things to resell, they commit robberies on the streets, all to get money to feed their addiction. Ultimately they make some very poor choices and place themselves in very dangerous situations.

We may see less cancer as a result of e-cig use, because the tobacco and tar are gone. But we won’t be able to tell that for years or decades to come. Remember there are other chemicals mixed in with the nicotine in the solution that also could cause cancer down the road. The liquid that becomes vaporized in e-cigs, which you inhale and exhale in a cloud of vapor, contains not only nicotine but an array of other substances, such as propylene glycol, glycerine, flavorings and sometimes components like diacetyl, acetyl propionyl, benzaldehyde and the less-threatening sounding vanillin. We know that when inhaled, diacetyl causes a type of bronchitis known as “popcorn lung” — a scarring of the tiny air sacs in the lungs resulting in the thickening and narrowing of the airways. It may sound benign to a degree, but according to the American Lung Association, “it’s a serious disease that causes wheezing and shortness of breath, similar to the symptoms of chronic obstructive pulmonary disease (COPD).”

Quitting Smoking

If you’re trying to quit smoking, remember the key drug, nicotine, is still very much available through an e-cig and at much higher, concentrated doses. So while you will be eliminating the tar and tobacco of a cigarette, you’re amping up the accessibility of nicotine. That’s not exactly a great way to wean yourself from something harmful — to add more of it to your system.

We’re seeing a lot more nicotine toxicity. For example, little babies we see in the emergency room — sometimes they get a hold of a cigarette and they chew on it, which is usually not that harmful. But if they get a hold of an e-cigarette and ingest some of that liquid nicotine, which again is so concentrated in an e-cig form, we see nausea, vomiting seizures, paralysis — bad things.

Being that the nicotine is one of the most addictive substances, it’s not really helping you quit your addiction, it’s not the path to accomplishing that. And we’re seeing younger and younger people getting into it.

An Alternative to Smoking

There is a rising “connoisseur-ship” that’s evolved in the world of vaping in which vapers discuss vaping in the same way that wine aficionados discuss the nuances of whatever wine they are drinking. That’s great, but that doesn’t lessen the dangers outlined above.

Are vapers listening? Not really. In 2013, e-cigarette-related sales were $1.7 billion, which was double what they were in 2012. In 2015, those sales had risen to $2.9 billion. Many tobacco manufacturers also are in the e-cigarette game. More than 250 e-cig brands are on the market.

Perhaps this Surgeon General’s report will help refocus attention on the dangers of e-cigarettes and give people enough of a reason to take a pass at the growing trend of vaping.

For more about Dr. Sudip Bose, MD, please go to SudipBose.com and visit his nonprofit TheBattleContinues.org where 100% of donations go directly to injured veterans

Follow Dr. Sudip Bose on Twitter: www.twitter.com/docbose

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

Jan 5th, 2017
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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

 

Local Anti Tobacco Advocate Busts E-cigarette Myths

Jan 5th, 2017
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http://www.caledonianrecord.com/features/health/local-anti-tobacco-advocate-busts-e-cigarette-myths/article_65ee5497-ed23-5131-b69d-a503312368c3.html

According to a recently released report by the US Surgeon General, research has confirmed that there has been a significant increase in electronic cigarette (e-cigarette) use in recent years. Just last year alone, in 2015, the increase of electronic cigarette use has more than doubled particularly among our youth (ages 11 – 14), adolescents (ages 15 – 17) and in our young adults (ages 18 – 25) with more than 3 million youth in middle and high school using electronic cigarettes within the past 30 days. A cash cow for the tobacco industry, these numbers are increasing daily. More than 85 percent of electronic cigarette users ages 12 – 17 use flavored e-liquids, which come in a large variety of flavors, and are especially appealing to youth. And the flavors are the leading reason for youth use, according to the Surgeon General’s report.

Tobacco companies have been ramping up their marketing strategies to attract and cause young people to start using electronic cigarettes. In the United States, $3.5 billion dollars in sales is big business for the industry. Electronic cigarette manufacturers spent $125 million dollars in advertising their products with retail stores becoming the most frequent source of youth exposure to the tobacco industry’s advertising approaches. The tobacco industry has gone back to its old tactics that are much the same as the ones used to promote the conventional tobacco products.

Unlike the marketing campaigns of yesteryear, advertising approaches and themes today have a significant advantage with the use of internet and social media creating a more effective and wider outreach to attract youth and young adults, causing them to start using tobacco products at a much earlier age. In 2014, more than 7 out of 10 middle and high school students stated that they have been exposed to tobacco advertising. Research has shown that youth who use tobacco products like electronic cigarettes or chew, are most likely to go on to use other tobacco products like the traditional tobacco cigarette. In 2015, nearly 6 out of 10 high school cigarette smokers were also using electronic cigarettes.

The tobacco industry has claimed that electronic cigarettes are safer than the traditional tobacco cigarette. The tobacco industry has also claimed that the chemicals in e-liquids are not harmful to the user. The tobacco industry has suggested that electronic cigarettes can and may be used as a cessation tool to quit smoking. On the contrary, the newly released US Surgeon General’s report has confirmed these claims to be myths. The US Surgeon General’s report has busted these myths by saying;

The use of products containing nicotine poses dangers to youth, pregnant women, and fetuses. The use of products containing nicotine in any form among youth, including electronic cigarettes, is unsafe.

The liquid usually has nicotine, which comes from tobacco, flavoring; and other additives. Many electronic cigarettes contain nicotine, which is highly addictive. The nicotine in electronic cigarettes and other tobacco products can prime young brains for addiction to other drugs, such as cocaine and methamphetamine. Electronic aerosol is not harmless. The aerosol or vapor created by electronic cigarettes can contain ingredients harmful and potentially harmful to the public’s health.

There have been no conclusive study results or evidence to confirm that electronic cigarettes are a possible cessation tool for those who want to quit smoking. On the contrary, there is sufficient evidence to substantiate that the use of electronic cigarettes promotes users to use both electronic cigarettes along with smoking the conventional tobacco cigarette and that can potentially place the user at risk for exposure to higher levels of nicotine in the body that may ultimately lead to acute toxicity and possible death from over-exposure to nicotine.

The US Surgeon General’s full report titled: E-Cigarette Use Among Youth and Young Adults, can be found on the Surgeon General’s official website: https://e-cigarettes.surgeongeneral.gov.

Revealed: 90% of vaping shops served a child in a sting operation

Jan 3rd, 2017
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An undercover trading standards operation found 90 per cent of vaping shops visited in Sandwell sold nicotine-inhaling products to an underage volunteer.

http://www.expressandstar.com/news/local-news/2017/01/03/revealed-90-of-vaping-shops-served-a-child-in-a-sting-operation/

Out of ten shops visited by the volunteer for Sandwell Trading Standards, nine sold them products containing nicotine, such as e-cigarettes and e-liquids.

Council Trading Standards officers are advising retailers to be vigilant and responsible when selling e-cigarettes and liquid nicotine, applying the same checks as they do to the sale of any other age-restricted products.

In response to the investigation’s findings, cabinet member for public health and protection, Councillor Preet Gill, said: ”Clearly this is an unacceptable result. It’s important that retailers have procedures in place to ensure they do not break the law.

“Research suggests that e-cigarettes could act as a gateway to smoking tobacco cigarettes and the long-term health effects of using an electronic cigarette are still unknown.”

Bob Charnley, Trading Standards and Licensing manager, said: “It’s our job to protect children by ensuring that businesses are aware of the changes in law and understand their responsibility to ensure such products are not sold to minors.”

He added: ”We have written to all the offending businesses reminding them of their legal obligations and that a further failure may result in enforcement action such as a criminal prosecution.”

This is despite it having been illegal to sell nicotine-inhaling products to anyone under 18 from October 1, 2015.

Retailers caught flouting the law could face a fine of up to £2,500, as well as a criminal record.

It has not yet been revealed which shops were caught out in the sting in Sandwell.

The ASH (Action on Smoking and Health) charity, which seeks to cut tobacco use, said about 2.8m adults in Great Britain use e-cigarettes. That is up from 700,000 four years ago. Users include 1.4m smokers and 1.3m former smokers.

But only 15 per cent of the public surveyed that e-cigarettes are ‘a lot less harmful’ than smoking.

Anybody who is unclear about the law should contact Sandwell Trading Standards on 0121 569 6580.

 

Nicotine’s Highly Addictive Impact on Youth Underestimated

Jan 3rd, 2017
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http://www.medscape.com/viewarticle/873955

Although smoking trends among youth have shifted in recent years from tobacco cigarettes to e-cigarettes, the highly addictive culprit nicotine remains constant, a fact that should be underscored in discussion of risk with youth and their parents.

“I think most people realize nicotine is addictive, but I don’t know if there’s an understanding of just how addictive it is – particularly for youths,” said Lorena M. Siqueira, MD, MSPH, lead author of a new report on nicotine, addiction, and youth that was released by the American Academy of Pediatrics (AAP).

“People think, for instance, only having a few cigarettes a week may be fine and they can quit any time, but they don’t realize that they are already well on their way to dependency,” Dr Siqueira, a member of the AAP Committee on Substance Use and Prevention, told Medscape Medical News.

The report was published in the January issue of Pediatrics.

Evidence shows that the earlier in life a person is exposed to nicotine, the less likely they will be able to quit using tobacco and the more likely they will consume increasingly greater quantities.

The vast majority of tobacco-dependent adults – up to 90% – started smoking before age 18 years. The authors also point out that the earlier a child starts smoking, the greater the risk of continuing to smoke in adulthood.

Approximately two thirds of children who smoke in sixth grade, for example, become regular smokers as adults. In comparison, 46% of youth who begin smoking in the eleventh grade go on to become regular smokers as adults.

In addition, compared to adult smokers, youths require more attempts to quit smoking before being successful. In addition, only about 4% of smokers aged 12 to 19 years have been shown to successfully quit each year, the authors report.

Although e-cigarettes are marketed as a tool for smoking cessation, there is no strong evidence to support these claims, the authors note.

In fact, research, including a study published in JAMA Pediatrics in 2014, indicates that e-cigarettes, which contain nicotine, encourage, rather than discourage, tobacco use in youth.

Since that study’s publication, a number of other studies have shown similar harms, the study’s coauthor, Stanton A. Glantz, PhD, of the Center for Tobacco Research and Education at the University of California, San Francisco, told Medscape Medical News.

“There are now seven published longitudinal studies showing that youths who initiate smoking with e-cigarettes are about three times more likely to be smoking conventional cigarettes a year later,” he said.

“So clearly, e-cigarettes are acting as a gateway to conventional cigarette smoking.”

Instead of making quitting easier, e-cigarettes make it harder, Dr Glantz added.

“What the evidence shows is youths who use e-cigarettes are much less likely to stop smoking than youths who don’t use e-cigarettes, so not only are they not beneficial, as promoted, or even useless, they actually [work against] cessation.”

Among key attractions to e-cigarettes – and arguments that adolescents are likely to raise with parents ― is the idea that at least they are not as harmful as tobacco, Dr Siqueira said.

“It’s not unlike the prescription drug epidemic – adolescents think, ‘If my grandmother takes it, then it must be safe,’ so this is sort of the same thing,” she said.

The report also notes that e-cigarettes are not without toxic hazards of their own. Accidental poisonings associated with e-cigarette use have increased from one per month in 2010 to 215 per month in 2014, including one death.

“The take-home message is that there’s no arguing that nicotine is highly addictive, and it’s not just in cigarettes but it’s in all of these other products that are being cleverly marketed to youths to include ingredients and flavors to increase the palatability,” she said.

A new report from the University of Michigan’s Monitoring the Future study shows some encouraging trends regarding e-cigarettes. According to the study, after gaining popularity earlier in the decade, the percentage of US teens who use e-cigarettes declined for the first time from 2015 to 2016. The percentage of adolescents who used e-cigarettes in the past 30 days declined from 16% to 13% for 12th graders, from 14% to 11% for 10th graders, and from 8% to 6% among 8th graders; each change was statistically significant.

The report had even more encouraging news for cigarette smoking. The levels of smoking among 8th-, 10th-, and 12th-grade teens are the lowest they have been since annual tracking began 42 years ago.

“Since the peak year in 1997, the proportion of students currently smoking has dropped by more than three quarters — an extremely important development for the health and longevity of this generation of Americans,” principal investigator Lloyd Johnston, PhD, University of Michigan, Ann Arbor, said in a release.

The authors have disclosed no relevant financial relationshps. Dr Glantz has received research funding from the National Institutes of Health and from the Truth Initiative, a tobacco use prevention nonprofit organization.

Brand Loyalty Low Among Teen E-Cig Users

Dec 29th, 2016
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Half of surveyed users did not know which brand they used

Half of teens who use e-cigarettes reported vaping no particular brand, and about a third reported using e-cigarette devices for substances other than nicotine, according to an analysis of recent survey data by researchers from the CDC.

The most commonly reported e-cigarette used by the middle school and high school students participating in the 2015 National Youth Tobacco Survey (NYTS) was the heavily promoted brand ‘blu’, manufactured by Fontem Ventures-Imperial Brands (formerly Imperial Tobacco Group).

Roughly one in four surveyed teen e-cigarette users (26.4%) reported using that brand, while 12.2% reported using the next most popular brand, ‘VUSE’, manufactured by R.J. Reynolds.

The survey results were reported Thursday in the CDC’s Morbidity and Mortality Weekly Report.

“Electronic cigarettes are now the most commonly used tobacco product among U.S. youths; in 2015, 5.3% of middle school students and 16% of high school students reported using e-cigarettes in the past 30 days,” CDC researcher Tushar Singh, MD, PhD, and colleagues wrote, adding that not much has been known about the brands preferred by teens and the substances used in e-cigarette devices.

The analytic sample of the 2015 NYTS included 4,021 students who reported ever using e-cigarettes, “even once or twice.” Respondents were asked what brands of e-cigarettes they had used, with eight specific brands listed, and whether they had ever used an e-cigarette device for vaping a substance other than nicotine.

Data were weighted to account for the complex survey design and to adjust for nonresponse. Prevalence estimates were also reported for the type of e-cigarette ever used, brands, and whether e-cigarettes were used for substances other than nicotine.

A total of 13.5% of sixth through eighth graders and 37.7% of ninth through 12th graders reported ever-use of e-cigarettes.

Among the adolescents reporting ever having used an e-cigarette, 14.5% used only disposable e-cigarettes, 53.4% used only rechargeable/refillable e-cigarettes, and 32.1% used both types.

Half of the student respondents (50.7%, representing 3.18 million teens) did not know the brand of the e-cigarette they had used.

Use of e-cigarettes for a substance other than nicotine was similar among middle school (33.7%) and high school (32.2%) users, and it was higher among males than females (37.3% of high school male e-cigarette users versus 26.2% of high school female respondents).

In a separate survey of high school age e-cigarette users in Connecticut, reported last year in Pediatrics, 18% of respondents reported using cannabis in an e-cigarette device.

“In the present analysis, it is unknown whether students who had used an e-cigarette for a non-nicotine substance had also used an e-cigarette for nicotine, which might underestimate nicotine use,” Singh and colleagues wrote.

“Nicotine content in e-cigarettes is of public health concern because exposure to nicotine is the main cause of tobacco product dependence, and nicotine exposure during adolescence, a critical period for brain development, can cause addiction, can harm brain development, and could lead to sustained tobacco product use among youths.”

Study limitations cited by the researchers included the self-reported nature of the survey, the limited number of specific e-cigarette brands included in the survey, and the lack of data on which substances other than nicotine were being used.

The researchers concluded that increased monitoring of product types, brands, and ingredients preferred by adolescent e-cigarette users is warranted, “to guide measures to prevent and reduce use of e-cigarettes among youths.”

Teens are vaping more than ever, and not just nicotine

Dec 29th, 2016
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The latest report from the CDC digs into teens’ relationship with ecigarettes

Vaping is more popular with teens than ever, with more than one-third of high school students reporting having tried e-cigarettes. And teens aren’t always using e-cigs for nicotine, according to a new US Centers for Disease Control and Prevention report that dug into teen vaping behavior.

To evaluate e-cig use, the CDC and the US Food and Drug Administration poured through surveys filled out by 17,000 middle and high school students across the US in 2015. About 38 percent of high school students and 13 percent of middle school students reported that they’ve tried e-cigarettes.

That could be an underestimate, too, since the students were reporting their own behavior, and surveys based on self-reports are known to be unreliable.

The CDC is interested in vaping is because we still don’t know exactly how using e-cigarettes could affect a teen’s development. A medical group in the UK lauded e-cigs as useful tools to help current smokers quit, but the CDC said in a statement there’s no evidence that they work. What’s more, e-cig use during adolescence could kickstart an addiction, and the US Surgeon General Vivek Murthy warns that nicotine in any form is unsafe for teenagers. Still, more than 3 million teens used e-cigs in 2015, a tenfold increase over four years that Murthy called a public health crisis. But to stop it, the CDC has to understand it better.

In today’s report, one-third of e-cigarette users reported using their devices for something other than nicotine. This was more common for male white and Hispanic students than non-Hispanic black students. The survey didn’t get into what exactly the students were using their vape pens for, if not nicotine. But other studies point to pot as the most likely substance.

More than half of the e-cig users stuck to reusable electronic cigarettes — the ones you can refill with new liquid nicotine cartridges — as opposed to the disposable kind.

Although most of the students didn’t know what brand they were using, the ones who did used blu and VUSE most frequently.

Both of these brands are owned by big tobacco companies, and are among the most heavily advertised. Millions of teens are exposed to ads for ecigarettes online and in stores. These ads take a leaf out of big-tobacco’s book, promising independence and sex appeal to manipulate people into buying. And they work: more exposure to e-cig advertisements corresponds with more e-cig use in young adults, according to previous CDC research.

The CDC has repeatedly called for restricting e-cig marketing, but they have no control over advertisements. But regulation of the devices is growing; just this year, the FDA ruled that e-cigarettes and vape pens fall under the regulatory umbrella of tobacco products, which means the agency can ban sales to people under 18. We’ll see if the numbers of teenage users drop when the CDC analyzes the data from 2016.

High school vapers often become heavy smokers

Dec 14th, 2016
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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.

UK public health experts move to quash e-cigarette fears in wake of US report

Dec 9th, 2016
by Editor.
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https://www.onmedica.com/newsarticle.aspx?id=be447bf6-8e2a-430a-9ba1-7783e5078bd8

UK public health experts have moved to quash fears about the potential dangers of e-cigarettes in the wake of the US Surgeon General’s report* setting out the urgent need to curb the rising popularity of vaping among young people in the US.

Clinicians should not be put off from helping smokers to quit or cut their risk of harm by switching to vaping, they insist.

In his report,* published earlier this week, Dr Vivek Murthy pointed to the evidence on the impact of nicotine on the developing brain, and its ability to trigger lifelong addiction, as well as the potentially harmful additives found in some e-cigarettes.

Use of e-cigarettes among high school students in the US had soared by 900% in the past five years, surpassing all other forms of conventional tobacco use, he said.
“We must protect our nation’s young people from a lifetime of nicotine addiction and associated problems by immediately addressing e-cigarettes as an urgent public health problem. Now is the time to take action,” he urged.

But Professor Kevin Fenton, national director of health and wellbeing at Public Health England, said that while he understood the concern about the rapid uptake of e-cigarettes in the US, attempts to regulate these products in the US had been difficult, and the situation in the UK was very different.

“We have comprehensive regulations in place, including a ban on selling e-cigarettes to under-18s and tough restrictions on advertising, as well as minimum standards for safety, maximum nicotine levels and health warnings on packs,” he said.

“Our review of the evidence found e-cigarette use carries a fraction of the risk of smoking, a conclusion reiterated by the Royal College of Physicians earlier this year. No new evidence has been published to contradict this, however we are closely monitoring any emerging evidence,” he added.

Professor Peter Hajek, Director of the Tobacco Dependence Research Unit at Queen Mary University of London (QMUL), reiterated the findings of the Royal College of Physicians report, which identified vaping “as a great public health opportunity,” rather than a threat.

“The new US report’s conclusions do not tally with what the actual data show. It is simply not true that e-cigarettes are a tobacco product or that vaping lures children to smoking or that it creates dependence in non-smokers,” he insisted.

“The prevalence of smoking among young people is at an all-time low and regular use of nicotine containing e-cigarettes among never-smokers is extremely rare. Ongoing vigilance is needed, but so far, e-cigarettes have acted as a gateway away from smoking, for adults and adolescents alike,” he continued.

The report also ignores the huge benefits of vaping for adult smokers in helping them switch from “deadly smoking,” he added.

“The worst part of the report is its policy recommendations. They may be well meant, but no consideration is given to their likely unintended consequences. Limiting smokers’ access to the much less risky option of vaping is likely to contribute to keeping smokers smoking and smoking-related disease and death going at the current rate,” he said.

Linda Bauld, Professor of Health Policy at the University of Stirling and Co-Chair of the Smoking in Pregnancy Challenge Group, said the evidence presented in the report on the potential harms of vaping during pregnancy had been fundamentally misunderstood, and was based on studies in rats and mice, not people.

“While we need more research on e-cigarettes, pregnant women who find it difficult to stop smoking should not be discouraged from using them. This is the position and current advice in the UK endorsed by a range of organisations,” she pointed out.

The Surgeon General’s report might make clinicians more hesitant about discussing e-cigarettes with pregnant women who smoke. “That would be harmful to maternal and child health and must be avoided,” she insisted.

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