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March, 2014:

WSJ: E-Cigarettes, Shisha Go Up in Smoke in Cambodia

Mar 26th, 2014
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by Sun Narin and Chun Han Wong, writing for the Wall Street Journal:

Cambodian authorities have banned imports and sales of shisha tobacco and electronic cigarettes, saying rising consumption of such products among youths poses health and social problems.

A Cambodian man smokes a cigarette near a traffic sign along a street in Phnom Penh on May 31. The country has banned the use of e-cigarettes and shishas to prevent health and social problems. (AFP/Getty/WSJ)

The ban—approved by Prime Minister Hun Sen on Tuesday—has already prompted an official crackdown in the tourist town of Siem Reap and alarmed business owners in other cities, where shisha lounges have proliferated in the past year.

Shisha, or flavored tobacco smoked through a water pipe, and electronic cigarettes, which emit vapor containing nicotine, have become increasingly popular among young Cambodians, and could hurt their ability to work and study, Cambodia’s National Authority for Combating Drugs said in a statement.

The anti-drug agency doesn’t have precise data on the prevalence of e-cigarettes and shisha smoking, but Kao Boumony, deputy director of law enforcement at the agency, said he has seen anecdotal evidence pointing to high shisha consumption in the capital, Phnom Penh, as well as Siem Reap and the beach resort of Sihanoukville.

Officials are also concerned that shisha could become a gateway drug, particularly among youths who then go on to consume more addictive substances, Mr. Boumony said.

On Tuesday, police enforced the ban by raiding nightspots in Siem Reap, arresting 15 people and confiscating 55 shisha pipes, known as hookahs. The crackdown was meant to “maintain security” and “prevent ill effects on people’s health,” said city governor Khim Bunsong.

Phnom Penh authorities also plan to take action against shisha consumption in the capital, by potentially shutting down shisha lounges, according to Phnom Penh Municipal Governor Pa Socheatvong.

A number of shisha lounges there have already closed their doors, as their owners seek clarity on the new regulations, according to local news reports.

Shisha smoking, whose roots stretch back to ancient Persia and India, has gained worldwide appeal as a social activity, particularly among young adults. Medical authorities, including the World Health Organization, say shisha smoking is as unhealthy as cigarette consumption, exposing users to higher risk of lung disease, cancer and other adverse health effects.

E-cigarettes too have proven controversial amid their rising popularity as a purported tool for helping smokers quit tobacco. The WHO, a United Nations agency, currently advises against the use of e-cigarettes, saying their safety and supposed benefits as a smoking alternative haven’t been scientifically proven.

27 Feb 2014

SCMP: Art Basel coming to Hong Kong in a cloud of cigar smoke

Mar 26th, 2014
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from Howard Winn’s Lai See column in the SCMP:

Cigars and high art don't mix. (SCMP)

Art Basel, the art fair jamboree par excellence, comes to Hong Kong in May. Last year’s event was fun and attracted all those art sophisticates like Roman Abramovich, Kate Moss and so on. But much as we enjoyed the show we were a little disturbed at its relationship with the cigar company Oettinger Davidoff Group, which is one of the fair’s principal sponsors along with UBS, AxaArt and Netjets.

When governments around the world are trying to stop people from smoking because one out of every two people that smokes ultimately dies from a smoking related disease, it seems strange to say the least that Art Basel thinks it is okay to take tobacco money. Tobacco sponsorship is pretty much banned in Hong Kong. So it is something of a surprise to see it surface at Art Basel.

Davidoff signed an agreement with Art Basel in 2012. At the time Hans-Kristian Hoejsegaard, president and CEO of Oettinger Davidoff Group said: “Davidoff and Art Basel is a perfect fit.” The company also said then that its products are “deeply connected to the handicraft traditions involved in the rolling and blending of fine cigars as well as the art of marquetry”, portraying Davidoff as a kind of upmarket craft company.

Art Basel’s co-director Marc Spiegler went on to say: “We seek partners like Davidoff who are intensifying their engagement with the arts.”

When we asked Art Basel about its connection with tobacco money, Spiegler, via its public relations company, told Lai See: “Alongside its enduring support for Art Basel as an associate partner, Oettinger Davidoff has also developed the Davidoff Art Initiative, which is making a significant contribution to the arts by fostering cultural exchange between the art scenes in the Caribbean and in cultural capitals across the world. The two organisations both have roots in the Swiss town of Basel, and both are strongly committed to art and artists.”

We all know why Davidoff is “strongly committed to the arts”. It’s because it is one of the few areas where it can market itself. High art and fine cigars – they’re a natural fit? Wrong. While having an interest in art might be true, the main motivation is that art provides good “cover” that helps to make it look like a good citizen, tries to normalise cigar smoking “as a way of life”, smartens up Davidoff’s corporate image, enhances it products and corporate visibility, and of course helps it to sell more cigars.

Its association with Art Basel, despite what perhaps can be called the hype about art, is a commercial decision, and a marketing cost to promote its business. The fact remains that smoking kills and rather than helping Davidoff seduce more customers, Art Basel should look for other sponsors.

20 Mar 2014

Comments on Kaul & Wolf “The (possible) effect of plain packaging on the smoking prevalence of minors in Australia: a trend analysis”

Mar 26th, 2014
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The seven salvos of sin (taxes)

Mar 25th, 2014
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Tobacco kills one-third to one-half of all people who use it, on average 15 years prematurely. The World Health Organization (WHO) has a target of a 30% reduction in smokers by 2025; but this is one target that would be great to exceed. Alcohol-attributable cancer, liver cirrhosis, and injury caused 1.5 million deaths globally in 2010.

http://blogs.worldbank.org/health/seven-salvos-sin-taxes

Recently, the representatives of ministries of finance and ministries of health, as well as a host of civil society organizations and international organizations, met in Manila to consider lessons to be drawn from the international experience surrounding so-called sin taxes.

What is a sin-tax? It is a tax that is levied on products or services that are socially costly, thus adding to their price and contributing to state revenue. These type of taxes are levied by governments to discourage individuals from partaking in such activities without making the use of the products illegal. To have so many countries from the East Asian region come together at the World Bank-organized event in Manila, sitting together, was itself a symbol of the emerging interest and consensus around issues concerning sin taxes.

Taking a cue from the catchy campaign around seven wins to advance the recent successful passage of a major Sin Tax Reform in the Philippines, and based on the discussion in Manila, I suggest we consider the seven salvos of sin taxes, as follows:

It’s mainly a health issue; it’s only secondarily a taxation issue. The health consequences of continuing to smoke are dire — tobacco is projected to cause 1 billion deaths in the 21st century, ten times what it did in the 20th century, or currently 5.4 million per year. Therefore, any delay is a costly delay; there should be a ‘bias for action,’ striving to make smoking less attractive to those susceptible to engaging in it. East Asia in particular has cigarettes that are affordable. They are packaged (including by single stick) to minimize access costs. This region accounts for a lion’s share of the world’s smokers. Indonesia, alone, accounts for 5% of the world’s smokers, with two-thirds of men and about 7% of women smoking, and quite heavily, as well as a distressing 18% of children age 10 to 14 years.

Market segments matter. The behaviors across the market segments are quite distinct, with noteworthy differences in elasticities across product categories and prices, for example. Smokers may be inclined to shift between (down) product categories, especially when a price increase is induced through the levying of an additional tax or increase in tax rate. Cigarette companies manage their product categories and packages to offer new attractions to smokers across the different market segments.

Arguments against increasing tobacco tax rates are spurious. The industry – represented by growers, manufacturers, distributors and advertising outlets – are collectively a special interest. They mount arguments to try to galvanize public opinion, or create some forms of fear. One of the most often used is the suggestion that increased rates lead to smuggling. In such circumstances, it is important to reframe the argument. The issue is improving tax and customs administration so as to stamp down on illicit trade, rather than being held hostage by such trade and some poorly specified notion of smuggling.

Earmarking can help. Generally, public finance practitioners do not like earmarking, as it can contradict the general efficiency objectives of the public budgeting process. But this is one area where I am prepared to support earmarking in its soft form.

Earmarking can assist in making the argument for sin taxes compelling to the public; it can build trust in the public budgeting system, something which is needed in many countries in East Asia. Definitions concerning the soft and hard forms of earmarking are not uniform. In fact, earmarking as an idea seems to be malleable and ductile. These are strengths, not weaknesses. Institutional development has shown numerous cases where jurisdictions have started with earmarking, but through time have moved away from that, as confidence has emerged in their public budgeting processes. Health promotion – based on the idea that prevention is better than cure – sprang to life in the 1980s; it has made a valuable contribution to public health and should be supported by earmarked taxes. Earmarked taxes can also be applied for general public health purposes. For example, Philippines, Thailand, Egypt, and the UK earmark sin taxes for health.

Tax design matters a bit. It is desirable to have automatic annual adjusters built into the law so that excise taxes keep pace with rising incomes and aspirations. It is also noteworthy, that as with many taxes, more tiers create more tears. In other words, the more tiers for differentiating the types of tobacco products (maybe origin, price or quality) the more complicated the tax structure and the more wiggle room given to the tobacco industry for maneuver. Indonesia probably has the most complex (and industry-friendly) tobacco excise regimes in the world. Specific design features can make practices like ‘front-loading’ more difficult for the tobacco companies to sponsor. The challenge to reduce smoking requires numerous other interventions, as well as the use of taxation.

Build an evaluation system into the reform package. The public sector worldwide is beset by good ideas, but around which governments often fail to build tracking systems to measure the changes in behaviors (good and bad). The best time to design these systems is at the start; the Philippines is a good example of doing that. Their sin tax reform is controversial; one way to manage that controversy is with good data about the effects of these reforms. This means building into the reform package, evaluation and data collection on both the effects on the taxation side and also the spending side.

It’s a special time for tobacco taxes. The global move toward universal health coverage, the growing awareness associated with smokers’ health, the revenue need and the institutional appetite for these forms of taxes have probably never been stronger. Cigarette taxes can boost tax intake considerably. Even at current low rates, Indonesia collects more than 1% of GDP in cigarette tax revenue. For countries looking at the transition from lower middle-income status to higher income status – to escape the so-called middle-income trap – arguably, it is a reform that shows institutional maturity and a society that is making the transition to the generally higher performing public institutions associated with higher incomes. The Philippines case showed that, notwithstanding an entrenched industry and integration with growers, real reform can take hold.

E-Cigarettes Won’t Help You Quit, Study Finds

Mar 24th, 2014
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http://consumer.healthday.com/mental-health-information-25/addiction-news-6/e-cigarettes-won-t-help-you-quit-study-finds-686098.html

MONDAY, March 24, 2014 (HealthDay News) — Contrary to some advertising claims, electronic cigarettes don’t help people quit or cut down on smoking, a new study says.

Users of e-cigarettes inhale vaporized nicotine but not tobacco smoke. The unregulated devices have been marketed as smoking-cessation tools, but studies to date have been inconclusive on that score, the study noted.

“When used by a broad sample of smokers under ‘real world’ conditions, e-cigarette use did not significantly increase the chances of successfully quitting cigarette smoking,” said lead researcher Dr. Pamela Ling, an associate professor at the Center for Tobacco Control Research and Education at University of California, San Francisco.

These findings — based on nearly 1,000 smokers — are consistent with other studies and contradict the claims frequently found in e-cigarette advertising, she said.

“Advertising suggesting that e-cigarettes are effective for smoking cessation should be prohibited until such claims are supported by scientific evidence,” Ling said.

For the study, Ling’s team analyzed data reported by 949 smokers, 88 of whom used e-cigarettes at the start of the study.

One year later, 14 percent of the smokers had quit overall, with similar rates in both groups.

“We found that there was no difference in the rate of quitting between smokers who used an e-cigarette and those who did not,” Ling said.

There was no relationship between e-cigarette use and quitting, even after taking into account the number of cigarettes smoked per day, how early in the day a smoker had a first cigarette and intention to quit smoking, Ling added.

However, the researchers noted that the small number of e-cigarette users may have limited the ability to find an association between e-cigarette use and quitting.

The report, published online March 24 in JAMA Internal Medicine, also found that women, younger adults and people with less education were most likely to use e-cigarettes.

One expert said the study is flawed and shouldn’t be taken seriously.

“It’s an example of bogus or junk science,” said Dr. Michael Siegel, a professor of community health sciences at Boston University School of Public Health.

“That’s because the study does not examine the rate of successful smoking cessation among e-cigarette users who want to quit smoking or cut down substantially on the amount that they smoke, and who are using e-cigarettes in an attempt to accomplish this,” Siegel said. “Instead, the study examines the percentage of quitting among all smokers who have ever tried e-cigarettes for any reason.”

Many of the smokers who tried e-cigarettes may have done so out of curiosity, Siegel said.

“It is plausible, in fact, probable, that many of these 88 smokers were not actually interested in quitting or trying to quit with electronic cigarettes,” he said. “These products have become very popular and have gained widespread media attention, and it is entirely possible that many of these smokers simply wanted to see what the big fuss is all about.”

Calling that a “fatal flaw” in the research, Siegel said it “destroys the validity of the authors’ conclusion.”

It would be a tragedy, he said, if policy makers use the study to draw conclusions about the effectiveness of e-cigarettes for smoking cessation purposes.

Erika Ford, assistant vice president for national advocacy at the American Lung Association, said the study confirms what is already clear — “e-cigarettes are not associated with quitting among smokers.”

Ford noted that most e-cigarette companies no longer make claims that their products help smokers quit. “But there is a need for the FDA [U.S. Food and Drug Administration] to begin their oversight of these products. It’s time for the FDA to find out which products are making no smoking claims and which ones might be in violation of current law,” she said.

The FDA plans to introduce regulations for e-cigarettes, but hasn’t yet. In the past, the agency has warned companies about making false claims and for poor manufacturing practices.

More information

For more information on quitting smoking, visit the American Cancer Society.

SOURCES: Pamela Ling, M.D., M.P.H., associate professor, Center for Tobacco Control Research and Education, University of California, San Francisco; Michael Siegel, M.D., M.P.H., professor, Department of Community Health Sciences, Boston University School of Public Health; Erika Ford, assistant vice president for national advocacy, American Lung Association; March 24, 2014, JAMA Internal Medicine, online

Cigarette graphic warning labels and smoking prevalence in Canada

Mar 23rd, 2014
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Cigarette graphic warning labels and smoking prevalence in Canada: a critical examination and reformulation of the FDA regulatory impact analysis.

https://www.ncbi.nlm.nih.gov/pubmed/24218057

Abstract

BACKGROUND:

The estimated effect of cigarette graphic warning labels (GWL) on smoking rates is a key input to the Food and Drug Administration’s (FDA) regulatory impact analysis (RIA), required by law as part of its rule-making process. However, evidence on the impact of GWLs on smoking prevalence is scarce.

OBJECTIVE:

The goal of this paper is to critically analyse FDA’s approach to estimating the impact of GWLs on smoking rates in its RIA, and to suggest a path forward to estimating the impact of the adoption of GWLs in Canada on Canadian national adult smoking prevalence.

METHODS:

A quasi-experimental methodology was employed to examine the impact of adoption of GWLs in Canada in 2000, using the USA as a control.

FINDINGS:

We found a statistically significant reduction in smoking rates after the adoption of GWLs in Canada in comparison with the USA. Our analyses show that implementation of GWLs in Canada reduced smoking rates by 2.87-4.68 percentage points, a relative reduction of 12.1-19.6%; 33-53 times larger than FDA’s estimates of a 0.088 percentage point reduction. We also demonstrated that FDA’s estimate of the impact was flawed because it is highly sensitive to the changes in variable selection, model specification, and the time period analysed.

CONCLUSIONS:

Adopting GWLs on cigarette packages reduces smoking prevalence. Applying our analysis of the Canadian GWLs, we estimate that if the USA had adopted GWLs in 2012, the number of adult smokers in the USA would have decreased by 5.3-8.6 million in 2013. Our analysis demonstrates that FDA’s approach to estimating the impact of GWLs on smoking rates is flawed. Rectifying these problems before this approach becomes the norm is critical for FDA’s effective regulation of tobacco products.

Selling a Poison by the Barrel: Liquid Nicotine for E-Cigarettes

Mar 23rd, 2014
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http://www.nytimes.com/2014/03/24/business/selling-a-poison-by-the-barrel-liquid-nicotine-for-e-cigarettes.html?_r=0

A dangerous new form of a powerful stimulant is hitting markets nationwide, for sale by the vial, the gallon and even the barrel.

The drug is nicotine, in its potent, liquid form — extracted from tobacco and tinctured with a cocktail of flavorings, colorings and assorted chemicals to feed the fast-growing electronic cigarette industry.

These “e-liquids,” the key ingredients in e-cigarettes, are powerful neurotoxins. Tiny amounts, whether ingested or absorbed through the skin, can cause vomiting and seizures and even be lethal. A teaspoon of even highly diluted e-liquid can kill a small child.

But, like e-cigarettes, e-liquids are not regulated by federal authorities. They are mixed on factory floors and in the back rooms of shops, and sold legally in stores and online in small bottles that are kept casually around the house for regular refilling of e-cigarettes.

Evidence of the potential dangers is already emerging. Toxicologists warn that e-liquids pose a significant risk to public health, particularly to children, who may be drawn to their bright colors and fragrant flavorings like cherry, chocolate and bubble gum.

The liquid stimulant used in e-cigarettes, when ingested or absorbed through the skin, can cause vomiting, seizures or death. Credit Frank Franklin II/Associated Press

The liquid stimulant used in e-cigarettes, when ingested or absorbed through the skin, can cause vomiting, seizures or death. Credit Frank Franklin II/Associated Press

“It’s not a matter of if a child will be seriously poisoned or killed,” said Lee Cantrell, director of the San Diego division of the California Poison Control System and a professor of pharmacy at the University of California, San Francisco. “It’s a matter of when.”

Reports of accidental poisonings, notably among children, are soaring. Since 2011, there appears to have been one death in the United States, a suicide by an adult who injected nicotine. But less serious cases have led to a surge in calls to poison control centers. Nationwide, the number of cases linked to e-liquids jumped to 1,351 in 2013, a 300 percent increase from 2012, and the number is on pace to double this year, according to information from the National Poison Data System. Of the cases in 2013, 365 were referred to hospitals, triple the previous year’s number.

Examples come from across the country. Last month, a 2-year-old girl in Oklahoma City drank a small bottle of a parent’s nicotine liquid, started vomiting and was rushed to an emergency room.

That case and age group is considered typical. Of the 74 e-cigarette and nicotine poisoning cases called into Minnesota poison control in 2013, 29 involved children age 2 and under. In Oklahoma, all but two of the 25 cases in the first two months of this year involved children age 4 and under.

In terms of the immediate poison risk, e-liquids are far more dangerous than tobacco, because the liquid is absorbed more quickly, even in diluted concentrations.

“This is one of the most potent naturally occurring toxins we have,” Mr. Cantrell said of nicotine. But e-liquids are now available almost everywhere. “It is sold all over the place. It is ubiquitous in society.”

The surge in poisonings reflects not only the growth of e-cigarettes but also a shift in technology. Initially, many e-cigarettes were disposable devices that looked like conventional cigarettes. Increasingly, however, they are larger, reusable gadgets that can be refilled with liquid, generally a combination of nicotine, flavorings and solvents. In Kentucky, where about 40 percent of cases involved adults, one woman was admitted to the hospital with cardiac problems after her e-cigarette broke in her bed, spilling the e-liquid, which was then absorbed through her skin.

The problems with adults, like those with children, owe to carelessness and lack of understanding of the risks. In the cases of exposure in children, “a lot of parents didn’t realize it was toxic until the kid started vomiting,” said Ashley Webb, director of the Kentucky Regional Poison Control Center at Kosair Children’s Hospital.

Nicotine solutions at Volt Vapes in Boise, Idaho. The “e-liquid” comes in colors and flavors that experts say may entice children. Credit Katherine Jones/The Idaho Statesman, via Associated Press

Nicotine solutions at Volt Vapes in Boise, Idaho. The “e-liquid” comes in colors and flavors that experts say may entice children. Credit Katherine Jones/The Idaho Statesman, via Associated Press

The increased use of liquid nicotine has, in effect, created a new kind of recreational drug category, and a controversial one. For advocates of e-cigarettes, liquid nicotine represents the fuel of a technology that might prompt people to quit smoking, and there is anecdotal evidence that is happening. But there are no long-term studies about whether e-cigarettes will be better than nicotine gum or patches at helping people quit. Nor are there studies about the long-term effects of inhaling vaporized nicotine.

Unlike nicotine gums and patches, e-cigarettes and their ingredients are not regulated. The Food and Drug Administration has said it plans to regulate e-cigarettes but has not disclosed how it will approach the issue. Many e-cigarette companies hope there will be limited regulation.

“It’s the wild, wild west right now,” said Chip Paul, chief executive officer of Palm Beach Vapors, a company based in Tulsa, Okla., that operates 13 e-cigarette franchises nationwide and plans to open 50 more this year. “Everybody fears F.D.A. regulation, but honestly, we kind of welcome some kind of rules and regulations around this liquid.”

Mr. Paul estimated that this year in the United States there will be sales of one million to two million liters of liquid used to refill e-cigarettes, and it is widely available on the Internet. Liquid Nicotine Wholesalers, based in Peoria, Ariz., charges $110 for a liter with 10 percent nicotine concentration. The company says on its website that it also offers a 55 gallon size. Vaporworld.biz sells a gallon at 10 percent concentrations for $195.

Mr. Paul said he was worried that some manufacturers outside the United States — China is a major center of e-cigarette production — were not always delivering the concentrations and purity of nicotine they promise. Some retailers, Mr. Paul said, “are selling liquid and they don’t have a clue what is in it.”

Cynthia Cabrera, executive director of Smoke Free Alternatives Trade Association, said she would also favor regulations, including those that would include childproof bottles and warning labels, and also manufacturing standards. But she said many companies already were doing that voluntarily, and that parents also needed to take some responsibility.

“You wouldn’t leave a bottle of Ajax out,” she said. Advocates of e-cigarettes sometimes draw comparisons between nicotine and caffeine, characterizing both as recreational stimulants that carry few risks. But that argument is not established by science, and many health advocates take issue with the comparison.

“There’s no risk to a barista no matter how much caffeine they spill on themselves,” said Dr. Neal L. Benowitz, a professor at the University of California, San Francisco, who specializes in nicotine research. “Nicotine is different.”

Without proper precautions, like wearing gloves while mixing e-liquids, these products “represents a serious workplace hazard,” he said.

The nicotine levels in e-liquids varies. Most range between 1.8 percent and 2.4 percent, concentrations that can cause sickness, but rarely death, in children. But higher concentrations, like 10 percent or even 7.2 percent, are widely available on the Internet. A lethal dose at such levels would take “less than a tablespoon,” according to Dr. Cantrell, from the poison control system in California. “Not just a kid. One tablespoon could kill an adult,” he said.

Effects of standardised cigarette packaging on craving, motivation to stop and perceptions of cigarettes and packs

Mar 18th, 2014
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http://www.ncbi.nlm.nih.gov/pubmed/24559249

Abstract

OBJECTIVE:

To assess whether standardised packs of the form introduced in Australia are associated with a reduction in acute craving and/or an increase in motivation to stop, and to replicate previous findings on perceptions of packaging, perceptions of smokers using it and perceived effects on behaviour.

DESIGN:

Following abstinence of at least 12 h, 98 regular and occasional smokers were randomised to exposure to their own cigarette package, another branded package or a standardised package.

MAIN OUTCOME MEASURES:

Craving (QSU-brief), motivation to stop, both at baseline and post-exposure. Ratings of 10 attributes concerning package design, perceived smoker characteristics and effects on behaviour, post-exposure only.

RESULTS:

For craving, a mixed model ANCOVA showed a significant interaction of packaging and time of measurement (F(2,94) = 8.77, p < .001, partial η(2) = .16). There was no significant main effect or interaction for motivation to stop smoking (p = .9). The standardised pack was perceived to be significantly less appealing and less motivating to buy cigarettes, smokers using them were perceived as less popular and cigarettes from them expected to taste worse.

CONCLUSION:

Standardised cigarette packaging may reduce acute (hedonic) craving and is associated with more negative perceptions than branded packaging with less prominent health warnings.

Tobacco industry manipulation of data on and press coverage of the illicit tobacco trade in the UK

Mar 10th, 2014
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University of California study: e-cigs “new route” to nicotine addiction

Mar 6th, 2014
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Study found adolescents who use e-cigs are less likely to quit smoking tobacco cigarettes

https://www.consumeraffairs.com/e-cigarette-warnings-and-lawsuits

Here’s the latest chapter in the continuing debate over whether e-cigarettes are a cure or an affliction: a study from the University of California San Francisco that finds e-cigs may in fact be a new route to conventional smoking and nicotine addiction.

In what is said to be the first analysis of the relationship between e-cigarette use and smoking among adolescents in the United States, UCSF researchers found that adolescents who used the devices were more likely to smoke cigarettes and less likely to quit smoking. The study of nearly 40,000 youth around the country also found that e-cigarette use among middle and high school students doubled between 2011 and 2012, from 3.1 percent to 6.5 percent.

“Despite claims that e-cigarettes are helping people quit smoking, we found that e-cigarettes were associated with more, not less, cigarette smoking among adolescents,” said lead author Lauren Dutra, a postdoctoral fellow at the UCSF Center for Tobacco Control Research and Education.

“E-cigarettes are likely to be gateway devices for nicotine addiction among youth, opening up a whole new market for tobacco,” she said. The study was published online on March 6 in JAMA Pediatrics.

A trade group took issue with the study, saying it “is implying conclusions that simply aren’t borne out by the data.”

In a prepared statement, Cynthia Cabrera, Executive Director, Smoke Free Alternatives Trade Association (SFATA), said: “As the survey summary itself states, it wasn’t designed to derive any insight about motivation or a possible causal relationship between use of e-cigarettes and combustible cigarettes. What the survey data does show is that cigarette smoking among teens has decreased.”

FDA action expected

The U.S. Food and Drug Administration (FDA) has been considering regulations that could restrict advertising and sales of the popular battery-powered devices, which look like cigarettes and deliver an aerosol of nicotine and other chemicals.

Several states and cities, including New York and Los Angeles, have banned the use of e-cigs, generally treating them as though they were tobacco products.

In Congress, five U.S. Senators introduced the “Protecting Children from Electronic Cigarette Advertising Act” last month. It would prohibit the marketing of e-cigs to children and teens.

“We cannot risk undoing decades of progress in reducing youth smoking by allowing e-cigarette makers to target our kids,” Sen. Barbara Boxer (D-Calif.) said. “This bill will help protect our children from an industry that profits from addiction.”

Manufacturers promote the devices as safer alternatives to cigarettes and as smoking cessation aids. They are sold in flavors such as chocolate and strawberry that are banned in conventional cigarettes because of their appeal to youth.

Cabrera denied that the e-cig industry is targeting children.

“Our industry does not sell or market to minors, and it is our view that no one under 18 should use electronic cigarettes. Electronic cigarettes and vaping products are intended strictly for adults who smoke cigarettes. We fully support limitations on the sale of these products to youth at retail to further reduce access to anyone under 18,” she said.

Students studied

In the new UCSF study, the researchers examined survey data from middle and high school students who completed the National Youth Tobacco Survey in 2011 and 2012.

The authors found that the devices were associated with higher odds of progression from experimenting with cigarettes to becoming established cigarette smokers. Additionally, adolescents who smoked both conventional cigarettes and e-cigarettes smoked more cigarettes per day than non-e-cigarette users.

“It looks to me like the wild west marketing of e-cigarettes is not only encouraging youth to smoke them, but also it is promoting regular cigarette smoking among youth,” said senior author Stanton A. Glantz, PhD, UCSF professor of medicine and director of the Center for Tobacco Control Research and Education.

Contrary to advertiser claims that e-cigarettes can help consumers stop smoking conventional cigarettes, teenagers who used e-cigarettes and conventional cigarettes were much less likely to have abstained from cigarettes in the past 30 days, 6 months, or year. At the same time, they were more likely to be planning to quit smoking in the next year than smokers who did not use e-cigarettes.

The new results are consistent with a similar study of 75,000 Korean adolescents published last year by UCSF researchers, which also found that adolescents who used e-cigarettes were less likely to have stopped smoking conventional cigarettes.

In combination, the two studies suggest that “e-cigarettes may contribute to nicotine addiction and are unlikely to discourage conventional cigarette smoking among youths,” said the scientists.

The federal Centers for Disease Control and Prevention reported last year that the majority of adolescents who have ever smoked e-cigarettes also have smoked regular cigarettes. An estimated 1.78 million U.S. students have used the devices as of 2012, the CDC reported.

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