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January 20th, 2016:

Alcohol in e-Cigarettes May Impair Motor Skills

UPDATED January 20, 2016 // Some e-cigarettes contain enough alcohol (used to vaporize nicotine) to affect motor skills, without the user knowing it, new research shows.

“e-Cigarettes are not regulated right now, and this study raises major questions about the acute and long-term safety of e-cigarettes. It’s one thing to drink alcohol, it’s another thing to inhale it,” senior investigator Mehmet Sofuoglu, MD, PhD, Department of Psychiatry, Yale University School of Medicine and VA Connecticut Healthcare System, told Medscape Medical News.

“We didn’t do a driving simulation, but you kind of have to wonder whether people using e-cigarettes would have impaired driving,” he added.

The study was published online December 24 in Drug and Alcohol Dependence.

Unaware of Motor Effects

The researchers studied 21 adults aged 21 to 35 years who reported drinking socially and using an e-cigarette at least once in the past year. They had them puff from two commercially available e-cigarettes containing either high (23.5%) or low (0.4%) amounts of alcohol and measured acute changes in subjective drug effects, psychomotor performance, and alcohol metabolites in urine.

Although neither group reported feeling differently after inhaling the vapor, “performance on the Purdue Pegboard Dexterity Test improved under the trace, but not under the 23.5% alcohol condition,” the researchers report.

“What struck us,” Dr Sofuoglu said, “is that they didn’t feel like they had any subjective drug effects” after using the e-cigarette with high alcohol content, yet there was a decline in psychomotor performance compared with individuals who used the e-cigarette with only a trace amount of alcohol.

Although plasma alcohol levels remained undetectable during testing, three participants had measurable levels of an alcohol metabolite in their urine after puffing from the e-cigarette with 23.5% alcohol. “So there was also some biochemical evidence that people were actually getting alcohol, and this was impairing their psychomotor performance,” Dr Sofuoglu said.

“To our knowledge, no previous studies have systematically examined the acute effects of alcohol inhaled from an e-cigarette,” the investigators note in their report, and the prevalence and patterns of alcohol exposure from e-cigarette use remain unknown.

About 75% of the commercial e-cigarette liquids the researchers tested contained less than 1% alcohol. However, anecdotal evidence from the Internet suggests that some e-cigarette users “spike” their e-liquids with various types of alcohol, and alcohol may be deliberately added to e-liquids to thin viscous solutions, as recommended by do-it-yourself e-liquid forums, they say. In addition, “alcohol e-cigarettes” may soon be coming on the market.

“Consequently, whether from commercially prepared products or from self-made e-liquids, many e-cigarette users are likely repeatedly inhaling variable levels of alcohol during routine e- cigarette use,” the investigators note.

“Given the widespread and unregulated use of e-cigarettes, especially by youth and other vulnerable populations, further studies are needed to evaluate both the acute safety and long-term health risks of using alcohol-containing e-cigarettes,” the investigators conclude.

The presence of alcohol in e-cigarettes might reinforce the addictive properties of both nicotine and alcohol if inhaled, they note. It is also “concerning,” Dr Sofuoglu said, that people in recovery from alcohol addiction could be exposed to a small dose of alcohol without knowing it.

Invalid Conclusion

(Vaping Promotor) Michael Siegel, MD, MPH, professor, Department of Community Health Sciences, Boston University School of Public Health, in Massachusetts, who reviewed the study for Medscape Medical News, has strong reservations about the study.

“After reviewing the study, I have to question the validity of the conclusions. Specifically, I do not believe the conclusions of the study are supported by its actual findings.

The results of this study do not provide a solid basis to conclude that vaping a high-alcohol e-liquid impairs motor performance,” Dr Siegel said.

“This article,” he noted, “concludes that vaping high-alcohol e-liquids causes motor impairment that could lead to motor vehicle crashes from alcohol intoxication, despite finding that there was no alcohol detectable in the blood of high-alcohol e-liquid vapers. This extrapolation is not warranted, and therefore, the study conclusions are not valid.”

Funding for the study was provided by the New England Mental Illness Research, Education, and Clinical Center, the Department of Veterans Affairs, the National Institute for Drug Abuse, and the FDA Center for Tobacco. The authors have disclosed no relevant financial relationships.

After twelve years of success, ASH passes FCA baton to HealthBridge

After more than a decade of successful leadership and myriad public health victories, Laurent Huber of Action on Smoking and Health (ASH) in the U.S. passed the leadership of the Framework Convention Alliance on Tobacco Control (FCA) to Francis Thompson of HealthBridge Canada. The change was effective January 1, 2016.

The FCA was formed during negotiations of the WHO Framework Convention on Tobacco Control (FCTC) to be the voice of the global public health community, and it has been lauded for its role in achieving a strong international treaty to combat the tobacco epidemic. Huber was the first director of the FCA, and he shepherded the FCA through negotiations and implementation of the first global public health treaty. Thompson has served as FCA policy director for several years.

“I regard the Framework Convention on Tobacco Control as vitally important for global health and, without a doubt, the role of the FCA in motivating, organizing and coordinating the input of civil society into the treaty-making process was crucial to its success,” stated Dr. Gro Harlem Brundtland, Director-General, World Health Organization, 1998-2003.

The FCTC was conceived at a time when multinational tobacco companies were moving into low income countries in earnest, seeing potential profits from populations who, unlike in the high income counties, had not been educated on the dangers of smoking. The World Health Organization estimates that, without dramatic changes, tobacco will claim one billion lives in the 21st century. The FCTC is meant to be that dramatic change.

Early in the FCTC negotiations, ASH made the decision to commit itself to go beyond domestic US tobacco control and confront Big Tobacco on the world stage. At the time, there was no global civil society movement to combat tobacco. The FCA was formed to combine the voices of dozens (later hundreds) of public health groups to demand strong global action. ASH played a critical role in forming the informal coalition. FCA was later incorporated in Geneva, Switzerland in 2003, with Mr. Huber as its director. Today, FCA includes over 500 organizations from over 100 countries.

The FCA became a broad civil society coalition widely recognized by governments, non-governmental organizations, the World Health Organization (WHO), and the United Nations for its vital role in shaping the FCTC, the first global public health treaty negotiated under the auspices of the WHO.

During the past 15 years, the global tobacco control community experienced several successes.

• The FCTC entered into force on February 27, 2005 in near record time for a UN treaty. The FCTC now has 180 Parties and 168 Signatories.
• Guidelines for implementation of 8 Articles of the FCTC were developed and adopted: Article 5.3 (Industry Interference), Article 6 (Tax and Price Measures), Article 8 (Protection from Exposure to Tobacco Smoke), Article 9/10 (Tobacco Regulation and Disclosure), Article 11 (Packaging and Labelling), Article 12 (Communication), Article 13 (Advertising/sponsorship), and Article 14 (Cessation).
• The Protocol to Combat the Illicit Trade of Tobacco Products was negotiated and adopted.
• Many countries have effectively implemented FCTC measures, resulting in millions of humans being protected from tobacco smoke, tobacco advertising, and their associated harms.
• Tobacco was a central aspect of the UN High Level Meeting on the Treatment and Prevention of NCDs, ensuring that addressing the tobacco epidemic was a central element of the Non-Communicable Diseases (NCDs) Strategy.
• ASH and FCA worked together to influence the development of the new UN Sustainable Development Goals (SDGs) that have replaced the Millennium Development Goals (MDGs), resulting in the integration of the FCTC and tobacco control in the Post-2015 Development Agenda.

“I had the privilege to work closely with the FCA through the development of the FCTC and to witness firsthand the expertise they bring to the process of negotiating and adopting complex policy. The importance of having non-government and government agencies work together cannot be underestimated, and FCA understands very well how to influence governments to create the best possible policies,” said President Tábare Vázquez, the Oriental Republic of Uruguay, 2005 to 2010 and 2015 to present.

ASH will continue to work with the FCA and its incoming director with the aim of accelerating the implementation of the life-saving measures of the Framework Convention on Tobacco Control (FCTC).


Action on Smoking and Health (ASH) is the nation’s oldest anti-tobacco organization dedicated to health for all. ASH was formed in 1967 in response to the U.S. Surgeon General Report in order to use legal action to fight tobacco and protect nonsmokers. Today, because tobacco is the leading cause of preventable death worldwide, ASH uses global tools to counter the global tobacco epidemic. Learn more about our programs at

Time to take tobacco dependence treatment seriously

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Labelling of electronic cigarettes: regulations and current practice

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Headlines about e-cigarettes don’t mean they’re ‘not safer than tobacco’

If your New Year’s resolution was to stop smoking, and you were looking for support to help you quit, then recent headlines suggesting e-cigarettes ‘aren’t any safer than tobacco’ might have raised an eyebrow or two.

Since Christmas, we’ve seen three sets of critical headlines about e-cigarettes, each looking at a different aspect of a device now used by millions across the UK.

But how accurately do these stories reflect the scientific evidence? What do we really know about how safe e-cigarettes are? Can they really help you quit? And do candy flavours attract kids?

If you were to go on the media reports alone, you’d be forgiven for being alarmed.

But as is so often the case in the reporting of science and risk, taking a deeper look behind the headlines reveals a very different story.

Just because they’re not “safe” doesn’t mean they aren’t “safer”

The first study to make the headlines suggested that e-cigarettes were ‘as harmful as tobacco’.

After studying cells in the lab, the researchers found some indications of increased levels of DNA damage and cell death in those treated with e-cigarette vapour.

This led one of the researchers to tell the media, “I believe [e-cigarettes] are no better than smoking regular cigarettes.” (More on this statement below).

The most important thing to remember here is that this was a study looking at the effect of chemicals on cells in a lab. Although this can be useful, it obviously can’t give a clear idea of what the impact would actually be in your body. So any claims of impact on health based only on lab studies will always be far-fetched.

The study also looked at an extremely high concentration of vapour. As the researchers admitted at the time, “it was similar to someone smoking continuously for hours on end, so it’s a higher amount than would normally be delivered.”

It boils down to this: the study showed that it might be worse for your cells to be exposed to e-cigarette vapour than the air in a lab. So e-cigarettes might not be 100 per cent harm free. And previous studies have shown there may be some dangerous chemicals present in vapour – so this isn’t a surprise. And there’s little in life that really is ‘safe’ – even drinking too much water can kill you.

But here’s the big caveat. The researchers also treated some cells with tobacco smoke. These died within 24 hours. Those treated with e-cigarette vapour were still alive to experiment on 8 weeks later.

So, contrary to the headlines, this study actually suggests that using e-cigarettes may be far less dangerous than smoking.

You’d never believe that from the headlines though.

There were a few great critiques published shortly afterwards, (notably this one in the Guardian) and the press release was amended (more than a week later) to include the following correction:

“ Contrary to what was stated or implied in much of the news coverage resulting from this news release, the lab experiments did not find that e-cigarette vapor was as harmful to cells as cigarette smoke. In fact, one phase of the experiments, not addressed in the news release, found that cigarette smoke did in fact kill cells at a much faster rate. However, because similar cell-damage mechanisms were observed as the result of both e-vapor and regular cigarette smoke, Dr. Wang-Rodriguez asserts, based on the evidence from the study, that e-cigarettes are not necessarily a healthier alternative to smoking regular cigarettes. As stated in the journal paper and the news release, further research is needed to better understand the actual long-term health effects of ecigarettes in humans. ”

But we’re concerned that, as far as public perception goes, the damage may already have been done.

How can you tell if something helps people quit?

So the scientific evidence on e-cigarette vapour to date suggests it’s far safer than tobacco smoke.

But can e-cigarettes actually help you quit?

Here we come across the second set of unfortunate stories, after a systematic evidence review and meta-analysis published last week claimed that those using e-cigarettes seemed to be less likely to quit smoking than those not using the devices.

But, again, there are a number of serious problems with the review.

Systematic reviews and meta-analyses are usually extremely useful, because they pull together all the evidence in one area, to paint a fuller picture than one study alone.

However the relationship between this picture and reality depends entirely on the quality and relevance of the original studies that are included. In this case, since there haven’t been many high-quality trials exploring whether e-cigarettes help people quit smoking, the researchers included a range of different types of studies.

The gold standard of evidence is the randomised control trial, which, in this case, would compare a group of smokers trying to quit using a nicotine-containing e-cigarette, to a similar group using nothing (or an e-cigarette without nicotine). But here’s the problem – there have only been two published studies like that.

A 2014 meta-analysis of these found people using nicotine via an e-cigarette were more likely to successfully quit than those using e-cigarettes without nicotine.

Last week’s review included both of these randomised trials alongside a range of other ‘realworld’ non-trial studies of e-cigarette use. This is a big problem. Whatever their strengths individually, these studies didn’t use consistent measurements – neither of e-cigarette use, nor of whether people had actually quit – so the studies aren’t necessarily comparable. And so including them together in a meta-analysis is questionable, at best.

Even so, when the analysis only included studies where people were actively trying to quit (as opposed to using e-cigarettes for other reasons) the results became inconclusive – people who said they’d ‘ever’ used an e-cigarette weren’t any more or less likely to succeed.

Furthermore, some of the studies included only looked at current smokers and asked about ecigarette use. This would exclude anyone who had used an e-cigarette but successfully stopped smoking.

Quitting smoking can be incredibly hard. Someone trying an e-cigarette once probably wouldn’t have any better chance than if they hadn’t. Whatever support aid is used it would need to be as part of a concerted quit attempt and used enough to deliver sufficient nicotine to wean yourself off tobacco, and preferably alongside specialist support from a Stop Smoking Service to get the best possible chance of quitting.

E-cigarettes aren’t a magic bullet, but that doesn’t mean they couldn’t be a useful weapon in our arsenal against tobacco. The evidence for quitters using these products both within the Stop Smoking Services and without points towards this being the case in the UK.

The impact of advertising and flavours on kids

Whether or not they’re ‘safe’, or help people quit, another big concern about e-cigarettes is that they could encourage children to start smoking – either by exposing them to nicotine (the ‘gateway’ argument) or by making smoking seem more normal again (the ‘renormalisation’ argument).

The first of these arguments isn’t supported by the evidence to date: surveys across the UK last year found that young people who hadn’t smoked weren’t using e-cigarettes.

But a small study published this week found young people rated printed adverts with flavoured e-cigarettes more appealing than those without flavours, leading to headlines suggesting children are being lured in with sweet flavours.

But when you dig into the detail, again it’s a more complex picture – the young people in this study, including those who saw the flavoured e-cigarette adverts, had negative views about ecigarettes, and said they didn’t intend to buy them. And, perhaps more importantly, it didn’t find any evidence that e-cigarette adverts increase the appeal of regular cigarettes.

There are now measures in place to protect young people (e-cigarettes cannot be sold to under 18s, and further legislation heavily restricting advertising will come into force in May) but it’s still important to continue looking at how e-cigarette adverts might appeal to children, and to track use of both e-cigarettes and tobacco cigarettes to make sure there isn’t a negative impact from these products.

However, Linda Bauld, Professor of Health Policy at the University of Stirling (and our Cancer Prevention Champion), said the study “should provide some reassurance to those who say that e-cigarette advertising will result in a new generation of tobacco smokers.”

Where does this leave us?

When you look at the bigger picture, rather than the headlines, the evidence so far actually points towards a positive role for e-cigarettes in helping combat the biggest preventable cause of cancer. However none of the questions posed here – on safety, effectiveness and impact on children – have full answers.

As we’ve said before we need years of good quality science before we can definitively answer these questions, and at Cancer Research UK we are working towards that. But for now the evidence we have suggests e-cigarettes are far safer than smoking tobacco, they might help you quit and non-smoking children aren’t being lured into using them regularly.

While the evidence on e-cigarettes continues to accumulate, and the media controversy rages on, if you’re looking for evidence-based inspiration to quit smoking in 2016, speak to your GP or local Stop Smoking Service, or check out our website… but maybe keep reading the headlines with an appropriate dose of scepticism.

Nikki Smith is a senior health information officer at Cancer Research UK