Youth Vaping
If Big Tobacco sells e-cigarettes, they’ll ‘recruit a whole new generation’ of smokers: Public Health Ontario
Pending federal regulations should limit flavours, marketing to kids, Dr. Peter Donnelly says
http://www.cbc.ca/news/canada/toronto/big-tobacco-public-health-ontario-1.3815921
If Ottawa lets Big Tobacco into the e-cigarette business it would be handing the industry the chance to hook teenagers on nicotine and turn them into lifelong customers, the chief executive officer of Public Health Ontario says.
“It’s desperately difficult for people to give up smoking once they’re addicted to nicotine,” Dr. Peter Donnelly said. “And my concern is that e-cigarettes and vaping of nicotine-containing mixtures could be a very effective way of recruiting a whole new generation of nicotine-addicted young people who are then very prone to turn to smoking cigarettes.”
The federal government announced last month that it would introduce changes to the Tobacco Act in order to regulate the burgeoning e-cigarette and vaping industry.
Right now, e-cigarettes can only legally be sold in Canada without nicotine — and since they’re not regulated by Health Canada they can’t be marketed as a way to help someone stop smoking.
But what’s legal and what’s actually happening are not necessarily the same thing.
More than 26 per cent of people who vape reported that their last e-cigarette contained nicotine, while another 19 per cent said they didn’t know if their last vape was nicotine-free or not, according to a 2015 study on countrywide tobacco uses and trends by Waterloo’s Propel Centre for Population Health Impact.
The study also found that most specialty vaping stores and online e-cigarette shops offer nicotine-laced vaping liquid, much of which is flavoured to taste nothing like tobacco.
‘Who are they targeting?’
It’s an issue that Donnelly said the pending regulations need to address in order to balance the needs of an adult population trying to quit smoking, with protectionist measures to keep youth from taking up the habit.
The flavours include everything from bubblegum to maple syrup to mint, something that has been the target of public health officials like Donnelly who argue it’s essentially marketing to children.
“I mean who are they targeting?” he said. “I don’t know many adults who are going to go for gummy bears.”
The public health official said he wants to see regulations that would make it illegal to market e-cigarettes to youth, which he said could include putting limits on what kind of flavours could be sold.
Nascent research surrounding e-cigarettes has found that vaping appeals to young people, Donnelly said, perhaps because it seems like a safer alternative.
Conflicting research
“But cigarettes are an outstandingly dangerous product and the worry is that nicotine-dispensing e-cigarettes and vaping products are very attractive to young people,” he said. “If they use them, they’re more likely to go on and smoke cigarettes.”
Canada’s largest tobacco company, meanwhile, says that it’s not interested in getting into the e-cigarette industry to target children.
“I don’t want my kids to smoke,” Imperial Tobacco spokesman Eric Gagnon told CBC’s the fifth estate. “We support reasonable and evidence-based regulation, especially the ones aimed at keeping tobacco products out of the hands of kids.”
Instead, he said, the tobacco industry wants to be able to offer a product that’s less harmful to people who are already addicted to smoking, likening it to McDonald’s offering a salad on their menu as well.
It’s a kind of logic that Dr. Gopal Bhatnagar might understand.
The cardiovascular surgeon at Trillium Health Centre is also the owner of 180 Smoke, a popular chain of vaping shops, and said he believes he’s offering a tool to help smokers quit.
The issue, however, is that because it’s a new product there are few long-term studies measuring its effectiveness. And those that have been done offer conflicting information.
The medical journal, The Lancet, for example, released a study in January that found people were 28 per cent less likely to quit smoking by using e-cigarettes than by turning to other methods. In March, however, it published another piece, which found that vaping is less harmful to someone than traditional cigarettes.
So when asked whether it seemed out of character for a health professional to sell an addictive product like nicotine, Dr. Bhatnagar responded that pharmacists also sell nicotine through gums, patches and sprays.
“Combustible tobacco smoking remains the number one preventable cause of disease in our society,” he said. “So I feel that anything that can continue to reduce the smoking rates and lessen the harm caused by tobacco is a very positive thing.”
Big Tobacco sees its future in cigarettes, not vaping
http://theconversation.com/big-tobacco-sees-its-future-in-cigarettes-not-vaping-67363
In 2012, in the early days of the rise of e-cigarettes, Kingsley Wheaton, Director of Corporate and Regulatory Affairs at British American Tobacco, said “Our core business is, and will remain in, tobacco”.
So have the intervening four years made much difference? Apparently not.
This month, senior Philip Morris International executive Werner Barth told shareholders at its investor day presentations the company fully expected its cigarette brands to remain highly profitable. Investment analysts Motley Fool summarised the presentation by saying that Philip Morris planned to have cigarettes “keep bringing in the bulk of its revenue for years to come.”
In 2014, more than one billion smokers spent some $US744 billion on 5.6 trillion cigarettes. By contrast, the global e-cigarette market had estimated sales of $US6.1 billion in 2015 (0.8% of the cigarette market). Bullish forecasts about the future of e-cigarettes are easy to find on the internet. Many of these are undoubtedly efforts to attract investors.
But recent data point to a major slowing in the growth that has been seen in some nations for about five years. In the important US convenience store sector, sales of vapour products fell continuously for seven months (note that this data does not include online or vape shop sales).
A report earlier this year in the industry magazine Tobacco Reporter quoted a Euromonitor tobacco analyst saying:
Western Europe – for the first time in several years – saw positive [tobacco] volume growth as economies recovered and out-switching to illicit and vapour products lessened.
Barth highlighted three high-growth segments for cigarettes: low-tar cigarettes, which Motley Fool noted “have become an important way that some smokers have aimed to address their concerns about potential health impacts of smoking”; slimmer cigarettes (a strategy usually targeted at women); and the capsule market, where smokers can burst a capsule of flavour embedded in the filter.
Low-tar cigarettes have of course been thoroughly discredited as false and misleading harm-reduced products. The Australian Competition and Consumer Commission (ACCC) has banned the light and mild descriptors in Australia. The tobacco industry knew about this deception for decades (see below) but is apparently still happy to benefit from and not actively correct consumer misunderstandings here.
Big Tobacco knew 44 years ago that people did not smoke like tar measuring machines. Legacy Industry Documents Library
In recent years we have seen an incontinence of rebirthing talk from Big Tobacco companies such as Philip Morris, British American Tobacco (BAT), RJ Reynolds and Japan Tobacco International about their commitment to manufacturing non-combustible nicotine delivery devices, particularly e-cigarettes and Philip Morris’ heat not burn products.
The hope for these products, like a conga line of hyped harm-reduction failures of the past, is that they will significantly reduce disease and death from what follows from nicotine addiction.
Tobacco companies of course all wish that two in three of their very best customers didn’t inconveniently die from using their products years earlier than normal life expectancy. They would much rather they could all keep smoking for a normal life span and keep the cash registers turning over.
For decades companies just denied that smoking killed. In the 1990s, these lies were stopped in their tracks when the companies were forced to publicly swallow truth serum in the form of their own newly public internal documents, released via whistleblowers and through litigation. These showed they knew the problems with tobacco all along.
If the industry really cares deeply about the deaths of its customers, this care is not enough to do anything to stop it selling the deadliest forms of nicotine delivery, nor to desist from its major attacks on tobacco-control policies it knows are most effective in reducing smoking. Plain packaging, which started in Australia, continues to attract massively funded attacks and legal challenges, currently in full swing in Canada which is nearing legislation.
Every day British American Tobacco’s twitter feeds around the world are choked with its best efforts to demonise tobacco tax rises, all in the hope that governments will reduce tobacco tax. This would see both smoking and the diseases it causes rise.
The very last thing that Big Tobacco hopes for harm-reduced nicotine products is that they will cannibalise their mainstay cigarette markets. Instead, the business model is dual use (people smoking where and when they can smoke, and vaping when they can’t); luring ex-smokers back as customers with promises of negligible harm from vapoursied nicotine products; and intriguing young people who have never used any nicotine product and who are increasingly never likely to, to start experimenting with vaping and hopefully doing it regularly.
In the United States, the latest National Youth Tobacco Survey shows the historically continuing fall in youth smoking has come to a screaming halt coincident with record use of e-cigarettes. The anxiety in the tobacco industry about this must be all-consuming.
There is now a small group of experts in public health who are now openly or covertly collaborating with the tobacco industry over e-cigarettes. They are being comprehensively played. In mouthing its newfound concern for tobacco’s harms, the industry’s harm-reduction division personnel can now cosy up to a suite of naïve or historically amnesic public heath urgers who lend Big Tobacco a credibility it craves.
Meanwhile, down the Big Tobacco corridor in the cigarette divisions, the harm-reduction staff’s colleagues continue promoting smoking and attempting to thwart effective tobacco control as usual.
This new, embarrassing and appeasing embrace is rather like charity leaders warmly embracing a mafia boss for his generous annual cheque, knowing full well from where the largesse was derived.
E-Cigarettes: Good Idea? Bad Idea?
To vape or not to vape subject of SPH Bicknell Lecture tomorrow
https://www.bu.edu/today/2016/2016-william-j-bicknell-lecture-e-cigarettes-good-idea-bad-idea/
To anyone who has followed the controversy around the perceived merits and health risks of e-cigarettes, the research and reactions can seem a jumble.
The handheld electronic devices, which vaporize a flavored liquid containing nicotine, have been touted as effective quit-smoking tools, safer than conventional cigarettes.
They’ve also been slammed as a gateway to tobacco cigarette use in young adults, with studies showing they contain detectable levels of toxic chemicals.
The School of Public Health will wade into the debate tomorrow, Wednesday, October 19, when two of the world’s leading experts on electronic cigarettes share the stage at the 2016 William J. Bicknell Lecture. Headlined E-cigarettes: Good Idea? Bad Idea? it is free and open to the public.
Linda Bauld, a University of Stirling professor of health policy and deputy director of the UK Centre for Tobacco and Alcohol Studies, says that while e-cigarettes are not risk-free, they are an important alternative to “a uniquely deadly product that kills one in two of its regular users.” She says there is no firm evidence that e-cigarettes are a gateway to conventional cigarette use among young adults.
Andrea Villanti, director for regulatory science and policy at the Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, agrees that the devices are effective quit-smoking aids, but says there is a need for clear, accurate information about their potential harms. She says vaping devices are “a diverse product class and must not be treated as a single product.”
The discussion comes in the wake of the recent decision by the US Food and Drug Administration (FDA) to extend its tobacco oversight authority to e-cigarettes. The controversial FDA regulations require manufacturers to detail what is in their products and apply for marketing permission by 2018.
Moderating tomorrow’s Bicknell lecture is Ronald Bayer, a Columbia University Mailman School of Public Health professor of sociomedical sciences, whose research focuses on issues of social justice and ethics related to tobacco and other health concerns. Bayer says he views the e-cigarette hand-wringing as “not just a scientific controversy—it’s also political.” He plans to explore why public health groups in the UK “have seen in the evidence a justification for enthusiastically embracing e-cigarettes as a harm-reduction strategy for smokers, while in the United States there has been deep skepticism, if not hostility, in the tobacco control community.”
According to data from the Centers for Disease Control and Prevention (CDC), 12.6 percent of adults tried an e-cigarette in 2014. Only 3.2 percent of adults who had never smoked cigarettes tried them, but the CDC and some public health advocates have been alarmed by a dramatic rise in their use among teenagers. The CDC reports that in 2015, 16 percent of high school students said they had used electronic cigarettes in the past 30 days—an increase from 1.5 percent in 2011.
BU Today spoke to Bauld and Villanti about their views on the subject.
BU Today: Proponents of strict regulations say e-cigarettes are a gateway to regular cigarette use, especially for young adults. Is that just a worry or is it a fact?
Bauld: This may be a worry, but it is not an established fact. There is no firm evidence from anywhere—despite a couple of US studies and one Swiss study that followed up nonsmokers who used e-cigarettes and found some of them had tried tobacco—that this is occurring. There are high rates of experimentation with e-cigarettes among teenagers in the United States and some evidence of this in the UK and other jurisdictions. However, regular use is confined to teenagers and young adults who already smoke tobacco.
Villanti: A primary goal of tobacco control is to keep all youth from using tobacco or nicotine products, and it’s important to know how new tobacco or nicotine products impact use among young users. While we have long-term population surveillance data on cigarettes in youth, we only have a few data points on e-cigarettes, as they are a relatively new product.
Cross-sectional data have shown declines in past 30-day youth cigarette use at the same time that there has been a rise in past 30-day youth e-cigarette use. In fact, the most recent data show that youth cigarette use is at an all-time low, which is encouraging. The data also indicate that past 30-day youth e-cigarette use did not increase significantly from 2014 to 2015 and may be leveling off. The largest proportion of youth e-cigarette use is infrequent, which is more consistent with experimentation than regular use.
Focusing only on the gateway between e-cigarette and cigarette use detracts from understanding the full picture of youth tobacco and nicotine use and its impact on public health.
Do you think the FDA was right to regulate e-cigarettes as tobacco products? What’s your view on requiring premarket approvals for companies?
Bauld: E-cigarettes are not tobacco products, and in my view, a separate regulatory framework would have been more appropriate. However, I do appreciate the view of my FDA colleagues, which is that they wished to create a regulatory framework that includes all nicotine products. In the United States, it is disappointing to see that nicotine replacement therapy does not have a harm-reduction license to allow usage while cutting down on cigarette smoking or longer-term usage to avoid relapse to smoking. That needs to change.
I also appreciate the need for product standards of e-cigarettes and other vaping devices and am aware that the FDA regulations had this as one aim. However, the required premarket approval process and the rather arbitrary cutoff for products already on the market that won’t need approval will in my view create advantages for tobacco and tobacco companies over independent e-cigarette manufacturers. This is a potential unintended consequence of the FDA regulations and will perpetuate smoking.
Villanti: The short answer is yes. If prudently regulated, e-cigarettes hold promise as one means to move smokers to a less harmful product and reduce the devastating death and disease burden caused by combustible tobacco products such as cigarettes, cigars, or hookah.
Despite noncombustible tobacco and nicotine without tobacco being less toxic than combustible tobacco, e-cigarettes (and other new nicotine delivery devices) cannot fulfill any promise they may have of harm reduction if we do not know what is in them, who is manufacturing them, and how they are marketed and advertised. So, regulation is essential to ensure they are of good quality and as safe as possible and that the benefits are maximized while harms are minimized.
Shouldn’t we applaud e-cigarettes as a smoking-cessation device?
Bauld: The evidence on smoking cessation with e-cigarettes is positive overall, although the quality of evidence remains weak. The update of the Cochrane Review, published earlier this year, makes that clear. In the UK, we have a public health consensus statement endorsed by our main health charities, government agencies, and professional bodies. This makes clear that all the evidence suggests e-cigarettes are significantly less harmful than tobacco and smokers should not be discouraged from using them. In addition, smokers choosing to use e-cigarettes can receive free support (counseling and the offer of additional, licensed stop-smoking medications) through our National Health Service smoking cessation services. Smokers who access these services and also use an e-cigarette have very good cessation rates.
Villanti: The great opportunity of e-cigarettes is that they have been adopted by large numbers of smokers. Current research suggests that e-cigarettes can increase quit attempts, reduce symptoms of nicotine withdrawal, prevent relapse, and potentially serve as a pathway to cessation of cigarettes. Further high-quality, randomized controlled trials and rigorous observational studies are important to confirm findings from the research to date.
Given the wide variety of products and ingredients, it is hard to know which specific e-cigarette products are most effective as cessation devices. We also do not know the quality or safety specifications of those products, as we do with cessation medications and nicotine replacement therapies that have been FDA-approved. Smokers seeking a pathway to quitting deserve a device that is effective and meets quality and safety standards.
If the biggest concern is youth starting to vape, what can be done to keep e-cigarettes away from kids?
Bauld: In the European Union, the Tobacco Products Directive, which was introduced in May 2016, prohibits all broadcast advertising of e-cigarettes. In my own country, Scotland, further advertising restrictions (on billboards, free samples) will be introduced next year. Some limits on marketing are proportionate because of concerns about marketing to children, and age-of-sale laws are also in place in the UK. However, I believe some promotion is needed, particularly at the point of sale, to provide adult smokers with accurate information about these products and support switching. We can’t completely ignore the UK’s eight million adult smokers because of fears about youth uptake. An appropriate balance has to be struck.
Villanti: A first step in preventing youth from starting to use tobacco or nicotine products was the FDA’s decision to bring all products under its authority. This provided youth access restrictions across all products, including cigars, hookah, and e-cigarettes. Minimum age of e-cigarette purchase enacted at the federal level, and enforcement of these laws by state and local agencies, will reduce youth access.
Our experience in tobacco control has identified other interventions, like advertising restrictions. A novel intervention would be to extend the ban on flavored cigarettes to all tobacco products, especially the most harmful combustible products. Other possible interventions include adopting standards that reduce the toxicity and addictiveness of products to the lowest possible levels; additional limits on youth access, like raising the nationwide minimum age of sale for tobacco to 21; or taxing products in proportion to their harms.
The 2016 William J. Bicknell Lecture in Public Health is tomorrow, Wednesday, October 19, from 10 a.m. to noon at the School of Medicine Instructional Building Hiebert Lounge, 72 East Concord St. The event is free and open to the public. The lectureship is named in honor of the late William J. Bicknell, founder and chair emeritus of the SPH global health department (formerly the international health department). Live streaming will be available here.
Lisa Chedekel can be reached at chedekel@bu.edu.
Young people exposed to vaping ads less likely to think occasional smoking is bad for health
Exposure to advertisements for e-cigarettes may decrease the perceived health risks of occasional tobacco smoking, suggests new research from the University of Cambridge, prompting concern that this may lead more young people to experiment with smoking.
http://www.cam.ac.uk/research/news/young-people-exposed-to-vaping-ads-less-likely-to-think-occasional-smoking-is-bad-for-health
Estimates suggest that among children who try smoking, between one third and one half are likely to become regular smokers within two to three years. However, young people are now more likely to experiment with e-cigarettes than they are with tobacco cigarettes. For example, a 2014 study found that 22% of children aged 11-15 in England had experimented with e-cigarettes, compared to 18% for tobacco cigarettes.
There is concern that the increasing exposure of children to e-cigarette adverts could be contributing to high rates of experimentation; in the US, adolescents’ exposure to e-cigarette adverts on TV more than trebled between 2011 to 2013. E-cigarette brands often market themselves as helping people quit smoking and as healthier and cheaper alternatives to tobacco cigarettes.
In this study from researchers at the Behaviour and Health Research Unit, University of Cambridge, and the University of North Carolina Gillings School of Global Public Health, and published today in the journal Tobacco Control, more than 400 English children aged 11-16 who had never smoked or ‘vaped’ previously were recruited and randomly allocated to one of three groups. One group was shown ten adverts that depicted e-cigarettes as glamorous, a second group was shown ten adverts that portrayed them as healthy, and a third control group was shown no adverts.
The children were then asked a series of questions aimed at determining their attitudes towards smoking and vaping. Children shown the adverts were no more or less likely than the control group to perceive tobacco smoking as appealing and all three groups understood that smoking more than ten cigarettes a day was harmful. However, both groups of children exposed to the e-cigarette adverts, both healthy and glamorous, were less likely to believe that smoking one or two tobacco cigarettes occasionally was harmful.
Dr Milica Vasiljevic from the Department of Public Health and Primary Care at the University of Cambridge says: “While we can be optimistic that the adverts don’t seem to make tobacco smoking more appealing to young people, they do appear to make occasional smoking seem less harmful. This is worrying, as we know that even occasional tobacco smoking is bad for your health, and young people who smoke occasionally believe they are somehow immune to its effects and do not feel the need to quit.”
The group of children that were shown adverts depicting e-cigarettes as glamorous also believed e-cigarette vaping to be more prevalent than did the other two groups.
Professor Theresa Marteau, Director of the Behaviour and Health Research Unit and a Fellow of Christ’s College, University of Cambridge, adds: “E-cigarette marketing across Europe is regulated under the new EU Tobacco Products Directive, which came into effect on the 20th May this year. The Directive limits the exposure of children to TV and newspaper e-cigarette adverts. However, it does not cover advertising in the form of posters, leaflets, and adverts at point of sale, nor does it cover the content of marketing materials depicting e-cigarettes as glamorous or healthy. The findings from our study suggest these omissions could present a threat to the health of children.”
The study was funded by the Department of Health.
Vaping causes harmful brain changes in teens
http://kdhnews.com/harker_heights_herald/opinion/wellness_works/vaping-causes-harmful-brain-changes-in-teens/article_f374527c-6008-11e6-a1aa-0ff6548b2a48.html
Last week, we looked at the rapid rise of e-cigarettes (e-cigs) as a popular alternative nicotine delivery device. Many people using e-cigs are aware of the many dangerous chemicals present in cigarette smoke, including tar and various other carcinogens. There is truth to the statement that e-cigs lack the many dangerous chemicals present in smoke, and in fact England Public Health estimates in their report that e-cigs are 95% safer than regular cigarettes, although this is based mostly on expert opinion.
That said, nicotine itself, without any other chemicals, can have significant health effects. Nicotine harms the fetus in pregnancy, causing lasting consequences to brain and lung development. It also causes long-term effects on memory and attention when used by adolescents and teenagers, with lasting cognitive and behavioral impacts. Other chemicals in e-cigs, such as the liquid creating the base and certain flavor additives, may have negative effects. Flavor chemicals used in e-cigs are food grade, but that does not mean they are safe to vaporize and inhale into the lungs. Poisonings also have occurred from getting cartridge contents in the mouth, skin, and eyes, including a tragic death in 2014 when a child ate the nicotine liquid. E-cigs should be kept well away from children.
Despite that advice, e-cig use is now more common among teenagers than traditional cigarette use. In fact, they increased in popularity so quickly that the CDC reported e-cig use doubled from 2011 to 2012 among US middle and high school students. Aggressive marketing, including kid-friendly flavors like bubble gum and gummy bear, as well as easy online purchase options, are likely culprits. Vaping is increasing in popularity with teenagers, the very population most likely to be harmed by nicotine use. It bears repeating: Nicotine causes long-term effects on working memory and attention when used by adolescents and teenagers, with lasting cognitive and behavioral changes.
E-cigs still have many unknowns. Although many adult smokers are interested in e-cigs for smoking cessation, there is not currently high-quality research demonstrating that they are effective for this purpose. We don’t know for certain how much nicotine or what other chemicals are in them, which brands are safest, or how helpful they may be as a smoking-cessation aid. We do know they are not safe for pregnant women and teenagers. If you do chose to vape, be sure to cut back on cigarette use and get information on quitting smoking from your doctor. And seriously, keep them away from your kids and teens.
Dr. Jacob MINOR is board-certified by the American Board of Otolaryngology. He practices at Seton Medical Center Harker Heights.