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E-Cigarettes at the Office: What’s the right protocol?

In the salad days of the e-cig boom, nearly every vaper and vaping company boasted about our rights to “smoke wherever you want, whenever you want.”

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Electronic cigarettes help smokers quit in ‘real world,’ study finds

A new study based on real-world data from England lends support to the idea that electronic cigarettes can help smokers quit using regular cigarettes.Among a sample of 5,963 adults who tried to kick the habit without prescription medications or counseling, those who turned to e-cigarettes were about 60% more likely to succeed than those who used nicotine replacement therapy or went cold turkey. Researchers from University College London published their results online Tuesday in the journal Addiction.Electronic cigarettes are battery-powered devices that burn a nicotine solution to create a vapor resembling the smoke from a tobacco cigarette. Advocates say they promote health by providing an alternative to traditional cigarettes and the poisonous tars and carbon monoxide that come with them. Critics – including Dr. Tom Frieden, director of the Centers for Disease Control and Prevention – counter that e-cigarettes get people (especially kids) to get hooked on nicotine, increasing the risk that they will move on to regular cigarettes. Scientists and public health officials are eager to sort out the pros and cons of e-cigarettes, which are lightly regulated and increasingly popular. Surveys and clinical trials designed to measure the effectiveness of e-cigarettes as a smoking cessation tool have produced mixed results.For the new study, researchers turned to data from the Smoking Toolkit Study, an ongoing survey of English smokers. They examined survey responses gathered between July 2009 (when e-cigarettes were relatively new) and February 2014 from smokers who said they tried to quit at least once in the previous year. For the sake of simplicity, they focused on three groups of would-be quitters: Those who used only e-cigarettes (8% of the sample); those who used only non-prescription nicotine replacement items like gum or patches (33% of the sample); and those who didn’t use any kind of smoking cessation treatment (59% of the sample). The raw data were strongly in favor of e-cigarettes, with 20% of those who used them saying that they had quit smoking. That compared with 10% of those who used non-prescription nicotine replacement therapy and 15% of those who went cold turkey.But the people who opted for electronic cigarettes were not the same as other smokers, so the researchers controlled for factors like age, gender, socioeconomic status and the degree of their nicotine dependence. With these factors taken into account, the researchers found that people who used electronic cigarettes were 1.63 times more likely to to quit smoking than those who opted for nicotine replacement therapy. In addition, they were 1.61 times more likely to succeed than people who didn’t use any smoking cessation aids.The study participants did not have to verify their nonsmoking status by taking a urine test or anything else, the researchers noted. But they said that given the survey’s design, people would have had little incentive to lie.The findings provide reliable information on the value of e-cigarettes “in the real world,” the study authors concluded.“E-cigarettes may prove to be both an efficacious and effective aid to smoking cessation,” they wrote. “Insofar that this is true, e-cigarettes may substantially improve public health because of their widespread appeal and the huge health gains associated with stopping smoking.”The study was funded in part by Pfizer, which makes the smoking cessation drug varenicline (sold under the trade names Chantix and Champix). In addition, four of the five researchers disclosed that they had received grants and other fees from “companies that develop and manufacture smoking cessation medications.” None of the five has a financial relationship with a company that makes electronic cigarettes.Senior author Robert West, a professor of health psychology and director of tobacco studies at University College London, is the editor in chief of Addiction. Copyright © 2014, Los Angeles TimesOriginal author: Margrett
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E-Cigarette Users May End Up Paying More For Insurance

hide captionA customer holds the electronic cigarette he purchased at a store in Miami.Joe Raedle/Getty ImagesA customer holds the electronic cigarette he purchased at a store in Miami.Joe Raedle/Getty ImagesPeople may think that e-cigarettes are a safer alternative to tobacco, but insurers might not agree.Tobacco use is one of just four things that insurers that sell health plans on the individual market can take into account when determining someone's premium: age, geographic location, and family size are the other three. People who use tobacco can be charged up to 50 percent more than nonsmokers.Under the rules, use of any tobacco product four or more times a week on average in the past six months could subject someone to the tobacco surcharge.But 10 states prohibit or restrict insurers from applying the tobacco surcharge in the individual market, according to the Centers for Medicare and Medicaid Services.So the big question will be if insurers end up classifying e-cigarettes as tobaco products. The battery-powered devices simulate cigarette smoking, producing a smoke-like vapor that usually contains nicotine and flavoring agents.The Food and Drug Administration moved toward deeming e-cigs tobacco products in April when it proposed regulating e-cigarettes, although the proposed regulations aren't as strict as those for regular cigarettes.The Centers for Medicare and Medicaid Services also is looking into the use of e-cigarettes and the tobacco surcharge, according to an agency official.But a lot of this will rest on the science, and the jury is still out the health effects of e-cigarettes.In a recent review of research on e-cigarettes, researchers at the University of California-San Francisco found that although the long-term health effects of e-cigarettes are still largely unknown, they emit potentially harmful substances into the air and can be a source of indoor pollution.The researchers also found that e-cigarettes actually reduce the likelihood that people will quit smoking, in contrast to advertising claims that firing up an e-cig will help people kick the habit.The potential role of e-cigarettes as a smoking cessation tool has insurance coverage implications too. The health law requires most health plans to cover FDA-approved smoking cessation products and counseling without any out-of-pocket cost to consumers. The federal government recently released guidance clarifying which services and products must be covered.Since e-cigarettes aren't FDA-approved for quitting smoking — and in fact are on the brink of being labeled by the agency to warrant regulation like cigarettes — they aren't covered as a free preventive benefit under the law.Clearly more specific guidance will be needed. "The Affordable Care Act does not specify e-cigarette use for purposes of cessation coverage or tobacco surcharge application," says Catherine McMahon, policy principal at the American Cancer Society Cancer Action Network. "The lack of clarity may allow health plans to try to add the surcharge for e-cigarettes."Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.Original author: Daren
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Formaldehyde release in e-cigarette vapor The New York Times story explained in detail

A study to be published in Nicotine and Tobacco Research was featured in the New York Times and has generated a lot of interest. The article mentioned that e-cigarette vapor can be the source of carcinogens, depending on the heating process.

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E-cigarettes more effective than patches to help quit smoking, says study

E-cigarettes are more effective than nicotine patches and gum in helping people to quit smoking, according to a study that challenges the negative views of some public health experts.

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Tobacco Control Legal Consortium Supports Deeming Regulation Changes that Would Take Almost All Electronic Cigarettes Off the Market

The Tobacco Control Legal Consortium (TCLC) is urging the public to write to the FDA and encourage the agency to strengthen the proposed deeming regulations on electronic cigarettes. In a set of talking points provided by the TCLC, the Consortium attacks the 24-month grace period for the submission of substantial equivalence or new product applications by electronic cigarette products, calling for the removal of this grace period:"The FDA proposal would significantly delay the implementation of premarket review for newly covered products. Most egregiously, the proposal creates a twenty-four month provisional period for the submission of tobacco product marketing applications. Applications received during the provisional period enable the continued marketing of the product until the FDA acts on the application which may be well beyond the twenty-four month period. A similar loophole was established during the passage of the Act to apply to cigarettes and smokeless products. The FDA received 3,517 applications but three years later has only issued an order removing four products from the market. After the withdrawal of 117 applications, the tobacco companies are still able to market the unapproved products represented by the 3,396 outstanding applications."The Rest of the StoryAs a public health advocate, the position of the Tobacco Control Legal Consortium is perplexing to me. The Consortium appears to be calling for the removal of the 24-month grace period for submission of substantial equivalence or new product applications by electronic cigarette products. If this advice were to be implemented, then the only electronic cigarettes that could remain on the market are those which were actually marketed as of February 15, 2007. This means that 99.9% of the electronic cigarettes currently on the market would have to be taken off the market.In other words, the TCLC is calling for a virtual ban on electronic cigarettes. The upheaval created by this ban would destroy all but the largest of the electronic cigarette companies, and would essentially deliver the industry to the tobacco companies. However, even the tobacco companies would have to remove their electronic cigarettes from the market until their applications were approved, a process that would likely take many years.The effects of such a regulation would be to force thousands of ex-smokers back to cigarette smoking. It would also result in thousands of dual users who have substantially cut down on their smoking to return to their pre-vaping cigarette consumption levels. Of course, the net effect of such a policy would be to substantially harm the public's health.It's not clear to me whether the TCLC has simply not considered the impact of its recommendations or whether the Consortium actually wants to see a de facto e-cigarette ban. Either way, if the FDA adopts these recommendations, it would be a total disaster for the public's health and a great victory for the cigarette market.Original author: Michael Siegel
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Special report: Clouded youth

Monday, May 19, 2014 - 4:16pmEL PASO (KTSM) — The electronic cigarette industry has bloomed into a $2 billion industry. E-cigs are intended for use by adults who are looking for a healthier alternative to smoking, and those who are looking to quit.Abad Garcia, e-cig smoker and employee at The Vape Shop said he's seen many people reduce their nicotine intake by using e-cigs.But studies show they are being picked up by teenagers as well.According to the Centers for Disease Control, the use of e-cigs in high school students more than doubled in a period of year. In 2011, 4.7 percent of high school students said they had tried an e-cig. In 2012, that number was 10 percent.About 90 percent of smokers say they started as teens, which is why many are working to put an end to the rise in e-cig use among teens.The Food and Drug Administration recently announced they will start regulating electronic cigarettes.Something many say, is overdue.The Vape Shop, an electronic cigarette store, says popular flavors include Red Bull, mint lemon, raspberry and strawberry. They have a signed posted on their door that says they do not sell to minors. However, they say they are aware of the growing popularity among teens."They're drawn to things that are new and novel, and also a lot of the solutions have flavors in them, like gummy bear, cotton candy. these are flavors that don't usually appeal to adults. they appeal to children," said Jana Renner, Paso Del Norte associate program officer.She adds, flavoring in banned in traditional cigarettes. The e-cig industry spent $20 million in advertising in 2012. Using flashy ads to capture the attention of potential users."Kids just pulling it out and just smoking and trying to impress other kids in class," said Marco, a high school student."They use them in public and restaurants like everywhere. The odor, sometimes it smells like cherry, it smells good and they think it tastes good too," said Adrian, a high school student.While there are nicotine free options, experts say zero doesn't always mean zero due to the lack of FDA regulations."Zero level to them might be .13 milligrams of nicotine... Since it's not regulated by the FDA, you don't really know what you're consuming and you really don't know what you're buying," said Sarai Garcia, an educator with the Department of Health.Long term effects, and the exact ingredients remain unknown.For the developing adolescent body, any amount of nicotine could be dangerous."The youth that are using it are putting themselves at a potential risk for addiction and since they are at an age where they are developing, that addiction can come a lot stronger and a lot sooner at their age," Garcia said.Garcia visits schools and talks to students about tobacco and other substance use. She said questions regarding e-cigs have become common.The students unfortunately that ask us the most on e-cigarettes are the kindergartners and the first graders and the fifth graders. Mostly because out kindergartners and first graders, they don't really know what the product is, but they see their older sisters using it, their older brothers, their parents, their family members and they're seeing these products being used in public places," Garcia said.This is why districts such as EPISD and YISD have stepped in."The policy that specifically dealt with electronic cigarettes was first put in the 2013-2014 school year which is this first year. We went ahead and felt that since it is a growing trend we wanted to make sure it was officially in the student handbook," said Patricia Ayala, spokesperson with YISD.It's not just on the school level, the City is jumping on it as well.Officials say they are working to change the city ordinance to include e-cigs, banning them on city owned or leased property.  Original author: Barry
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CDC and FDA are Undermining Anti-Smoking Messages and Protecting the Cigarette Industry

Data published last week in the American Journal of Preventive Medicine suggest that the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) are doing an effective job of helping protect the cigarette industry. These data show that despite widespread marketing of electronic cigarettes, half of the adult public still thinks cigarettes are no more hazardous than the fake ones.According to the new study, of adults who are aware of electronic cigarettes, about half (49.3%) believe that cigarettes are no more harmful than e-cigarettes, which contain no tobacco, involve no combustion, and have been shown to have much lower levels of carcinogens and other toxins.The Rest of the StoryIt is remarkable that despite all of the widespread marketing of electronic cigarettes and the claims that these products represent a safer alternative to smoking, the public is still split down the middle as to whether cigarette smoking is any more hazardous than vaping. These results demonstrate that the public health messages regarding the severe hazards of cigarette smoking (and the safer alternative represented by e-cigarettes) being disseminated by e-cigarette companies are being successfully undermined by opposing messages from the CDC, FDA, policy makers, and other health groups.This is an ironic reversal from the past, where it was the public health groups sending the anti-smoking messages and the tobacco industry which was undermining those anti-smoking messages.Instead, in 2014, it is the electronic cigarette companies which are sending the anti-smoking messages and the health groups which are undermining those messages.This irony is bizarre, but also quite unfortunate, as the undermining of anti-smoking messages from the e-cigarette industry by health groups is contributing to an unhealthy and incorrect perception that cigarette smoking is no worse than vaping. This incorrect perception is no doubt deterring many smokers from quitting or cutting down substantially on their cigarette consumption by trying e-cigarettes. Thus, the efforts of the FDA, CDC, and other health groups are actually aiding the cigarette companies by helping to protect cigarette sales from competition from the fake, non-tobacco variety.I find it quite ironic that the health groups, including CDC and FDA, are undermining the efforts of even tobacco companies to develop the non-combustible market and shift a proportion of their sales from combustible to non-combustible products. And the CDC and FDA are completely undermining the efforts of the non-tobacco-related e-cigarette companies to promote e-cigarettes over real tobacco cigarettes.The rest of the story is that in a tragic reversal of the historical functions of public health viz a viz industry, it is now the e-cigarette companies that are attempting to undermine cigarette smoking while the health groups, led by CDC and FDA, are protecting the cigarette market by undermining the anti-smoking messages from the e-cigarette industry.Moreover, the FDA is poised to undermine industry messages even more by prohibiting these companies from continuing to use anti-smoking messages in their product promotion campaigns (by applying section 911 of the Tobacco Act to electronic cigarettes).If the Senate truly wants to reduce cigarette smoking and protect the public's health, it will shift its attack from e-cigarette companies which are trying to get the public off tobacco cigarettes and over to the federal government, which is doing everything it can to protect the cigarette market.Original author: Michael Siegel
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Study: E-cigs increase ‘superbug’ MRSA resistance

[unable to retrieve full-text content]Vapors also hurt immune cells, says study by UCSD, VA researchers.Original author: Reyes
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Hitchman, McNeill, Brose (2014) Addiction paper on ecigs

by Carl V Phillips This recent paper in Addiction by Hitchman, McNeill, and Brose, is a commentary calling for an “accurate and evidence-based debate” about e-cigarettes.  I will admit that my favorite part of it is this reference: 14. Phillips … Continue reading →Original author: Carl V Phillips
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Call to Action Baltimore, MD - Indoor Use Ban

This legislation would prohibit the indoor use of “electronic smoking devices” (aka e-cigarettes, despite the fact that they emit no smoke) in any area where actual smoking is prohibited.  The bill could also regulate the placement of e-cigarettes in retail establishments that sell e-cigarettes with exemptions.  The proposed legislation also restricts the sale of e-cigarettes to minors and imposes civil citations for any violations.

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In Senate Testimony, CDC Lies in Order to Obscure the Issues Surrounding Electronic Cigarettes

In 1994, so many of us in the tobacco control movement, including myself, castigated the chief executive officers of the tobacco companies who testified before Congress that nicotine is not addictive. In fact, some of us went so far as to suggest that these executives should be prosecuted for perjury.Clearly, those of us in tobacco control believe it is essential that testimony before Congress be accurate, honest, truthful, transparent, and not at all misleading.Unfortunately, CDC's testimony yesterday before the Senate Health, Education, Labor, and Pensions Committee fell way short of that mark. Specifically, in describing the benefits of switching from tobacco cigarettes to electronic cigarettes, the CDC called such benefits "hypothetical," thus casting doubt on whether such benefits actually exist.The CDC stated: "It is not fair to our children to ask them to pay a price for that for a hypothetical benefit for adult smokers." [emphasis is mine]The Rest of the StoryIn characterizing the benefits of switching to electronic cigarettes as merely "hypothetical," the CDC has misled the Senate and the American public about the clear science on this issue. There is no question that vaping is much safer than smoking. There is therefore no question that smokers who quit smoking by switching to electronic cigarettes are improving their health. In addition, there is clear evidence that smokers who become dual users are also improving their health. Just this week, a study demonstrated that dual users experience substantial improvements in their asthma symptoms. Moreover, there is abundant clinical evidence, both anecdotal and published, that smokers who switch to electronic cigarettes experience substantial improvement in their respiratory health.Ironically, the truth is actually the opposite of what the CDC suggests. The benefits of switching to electronic cigarettes for adult smokers are quite clear. In contrast, the harms to youth of trying electronic cigarettes are hypothetical because there is no evidence that e-cigarette use leads to cigarette smoking among adolescents. In fact, the present evidence suggests that e-cigarettes may be serving as a partial deterrent to real cigarette use, as the overwhelming proportion of youth regular e-cigarette users are adolescents who have previously experimented with tobacco products and are therefore at high risk of becoming addicted smokers.There is an abundance of information about electronic cigarette use that we do not know. However, there is one thing that is clear: electronic cigarettes are much safer than the real ones, and smokers who switch to e-cigarettes or even who cut down substantially on their cigarette use by taking up vaping are greatly improving their health. In other words, the benefits of electronic cigarettes for adult smokers are not hypothetical, but well established.Why would the CDC deceive Congress and the public in this way? Why misrepresent the nature of the scientific evidence on this issue? Why throw dirt in the face of every vaper who has quit smoking and is proud of himself or herself for having improved their health and perhaps saved their life? Why give ex-smokers throughout the country pause about their switch to vaping and perhaps cause them to return to smoking because of doubt over whether they are experiencing any health benefits?If the benefits of a switch from smoking to vaping are only "hypothetical," then why should vapers continue to vape? Why not just return to cigarette smoking, since there is no proven benefit to their vaping?The CDC's misinformation to Congress is therefore not only deceptive, but potentially harmful and destructive as well. It certainly undermines the public's well-established appreciation of the severe hazards of cigarette smoking. If there are no known benefits to smokers of switching to electronic cigarettes, then it appears that smoking isn't as bad as we thought. The rest of the story is that the tobacco executives are not the only ones who have pulled the wool over the eyes of Congress and the public. Sadly, the CDC has added itself to that shameful category.Am I equating the lies of the tobacco executives with that of the CDC? Of course not. The nature of the deception was very different and so was the motivation beyond the deception (the tobacco companies lied for profit; the CDC is lying because of an apparent underlying ideology, although its ultimate intentions are good ones). However, misinformation is misinformation and if we are going to attack the tobacco companies for deceiving Congress, then we cannot stand by and allow public health groups to mislead Congress without being willing to also criticize them. In fact, public health should be beyond reproach in providing accurate and scientifically supported information to Congress and the public.AddendumThis may be the most difficult blog post I have ever written. I was deeply saddened to see the CDC completely obscure the critical issues surrounding electronic cigarette use by arguing that the harms being done to adolescents are definite, while the benefits to adult smokers as being merely hypothetical. In fact, it is exactly the opposite. In contrast, I thought Mitch Zeller presented a well-balanced and evidence-based perspective.I hope my readers understand how difficult it is for me to see this. It literally pains me to see, especially since I once worked at CDC, in the Office on Smoking and Health, and have a very deep attachment to that office. However, I also can’t stand the idea of a public health agency deceiving the Congress and that has to take precedence over my deep affections for the office that I love.Second AddendumI want to emphasize that this position of the CDC's - that the benefits of e-cigarettes are hypothetical but the harms are real - is not new. Dr. Frieden has been saying this for some time and the CDC testimony yesterday merely reflected this long-standing (but wrong) summary of the scientific evidence.For example, in a CNN interview, Dr. Frieden concluded that while the reported benefits of electronic cigarettes -- aiding smoking cessation -- are merely "possible," the speculated and undocumented potential harms -- such as hooking kids to smoking -- are "definite": "I think what we can say basically is they might or might not be able to help you quit, but there are definite harms that they can cause. And those definite harms are in different environments. So, if they get kids hooked on nicotine, that's a really bad thing. If they get a smoker who would have quit smoking to continue smoking, that's a bad thing. If they get a smoker who stopped mo smoking and going back to nicotine addiction and then smoking, that's a bad thing. And if they re-glamorize the act of smoking, that's a bad thing. So, we have possible benefits and definite harms."Original author: Michael Siegel
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Call to Action! North Carolina Bill would Impose a Separate "Sin" Tax on "Vapor Products"

RJ Reynolds is at it again.  Last year, they introduced a tax on e-cigarettes in Oklahoma, and we beat them back.  This year, they managed to get a tax on "vapor products" introduced in North Carolina. (See HB 1050, p. 51)  Their idea is to get a separate tax on the books that isn't particularly onerous in hopes of preempting efforts to tax e-cigarettes at some of the draconian rates suggested by other states (like the tax we beat back in Washington State earlier this year).

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Fewer smokers believe e-cigarettes are a safer alternative to cigarettes

Fewer smokers believe e-cigarettes are a safer alternative to cigarettesPUBLIC RELEASE DATE:15-May-2014[| E-mail ] ShareContact: Angela J. This email address is being protected from spambots. You need JavaScript enabled to view it.-8775Elsevier Health SciencesInvestigators find rise in overall e-cigarette awareness, but note decline in the perceived safety of the devices, according to new data published in the American Journal of Preventive MedicineAnn Arbor, MI, May 15, 2014 – E-cigarettes are gaining mainstream attention as a competitor to traditional cigarettes. Researchers from the University of Pennsylvania and the University of Illinois at Urbana-Champaign wanted to examine changes in e-cigarette awareness, how harmful people believe them to be, and if those attitudes have any connection to smoking cessation attempts. They found that while awareness of e-cigarettes has increased significantly, smokers are less inclined to consider them safer than cigarettes. Also, investigators discovered that awareness did not show evidence of promoting smoking cessation. Their findings are published in the August issue of the American Journal of Preventive Medicine.It is predicted that e-cigarette sales will soon reach 1.7 billion dollars, which represents roughly 1% of current regular cigarette sales in the U.S. This is due in part to the surge in marketing and increasing availability of e-cigarette products in the last few years. E-cigarettes are perceived as an invention that competes with tobacco cigarettes. While some people and advertisements even go so far as to refer to them as cessation aids, they are not currently approved by the FDA for that purpose.In this new study, researchers set out to examine the prevalence of e-cigarette awareness and perceived harmfulness. Using data collected from the Health Information National Trends Survey (HINTS), they discovered that national awareness of e-cigarettes has risen from 16.4% in 2009 to 77.1% in 2013. Young people, more educated respondents, and current and former smokers were more likely to be aware of e-cigarettes, while Hispanics and older survey participants were less likely to be aware of e-cigarettes."Compared with earlier national surveys among U.S. adults, this study found a notable increase in public awareness of e-cigarettes since 2009," explains co-investigator Andy Tan, MBBS, MPH, MBA, PhD, Center of Excellence in Cancer Communication Research, Annenberg School for Communication, University of Pennsylvania. "In the beginning of 2013, more than three in four respondents were aware of this novel product. The rise in awareness of e-cigarettes could reflect sharp increases in advertising expenditures by manufacturers, availability in retail stores across the country, and presence in popular media."The study also looked at the perceived harmfulness of e-cigarettes among current smokers. In 2010, 84.7% of smokers surveyed believed e-cigarettes were less harmful than traditional cigarettes, but according to this new study in 2013, that number dropped to just 65%."This apparent decline in smokers' beliefs about reduced harm of e-cigarettes compared with regular cigarettes is perplexing against the background of advertising and media messages touting e-cigarettes as safer alternatives and cessation aids," adds co-investigator Cabral Bigman, PhD, College of Liberal Arts & Sciences, University of Illinois at Urbana-Champaign. "One possible explanation is that the increased media attention over the lack of FDA approval and regulation of this emerging tobacco product, injuries arising from e-cigarette-induced fires, and health concerns from toxic chemicals in e-cigarettes in recent years may have conveyed conflicting information about the relative safety of e-cigarette use."Another important aspect of the new study was to examine if there are possible links between e-cigarette awareness or beliefs they are less harmful and current smokers' quit attempts. After data analysis, investigators found no association between increased awareness or perceptions of lower harms and smokers' attempts to quit. There was also no evidence at the population level that widespread knowledge about e-cigarettes or beliefs they are less harmful is associated with current smokers being more likely to think about quitting."The current analyses showed that there were no significant associations between e-cigarette awareness or perceived harmfulness and smokers' intentions to quit or past-year quit attempts," comments Dr. Tan. "One potential interpretation is that adult smokers have not yet accepted e-cigarettes as a means to quit smoking."While levels of awareness have increased rapidly, use percentage is still very low with only 6% of U.S. adults reporting ever using e-cigarettes. This small number means that e-cigarettes may not yet be a threat to tobacco control programs, but at the same time, means any claim that e-cigarettes are helping to reduce the harm done by regular cigarettes is probably premature."There is an ongoing debate within the public health community about whether e-cigarettes are a viable alternative for harm reduction and whether smokers are merely supplementing or truly replacing their smoking with e-cigarettes and achieving smoking cessation," concludes Dr. Tan. "It is uncertain whether increased population e-cigarette awareness and perceptions about reduced harm might play a role in encouraging smoking-cessation behaviors. However, public health professionals should systematically scrutinize the nature of marketing activities and media coverage of e-cigarettes, their impact on population awareness and perceptions of e-cigarettes, and how these factors may influence e-cigarette use and smoking prevalence in the U.S. population."### [| E-mail Share]AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.Original author: Irving
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Call to Action! Missouri Vapers, Ask Governor Nixon to Sign SB 841, Common-Sense Ban on Sales to Minors

We need Missouri vapers toimmediately contact Governor Jay Nixon’s office and ask him to sign SenateBill 841. 

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FDA Regulation: Defining E-Cigarettes As Tobacco Products

The FDA released a proposed rule to regulate “products that meet the statutory definition of ‘tobacco products’ …such as certain dissolvables, gels, hookah tobacco, electronic cigarettes, cigars, and pipe tobacco.” Media reports have primarily focused on the rule’s impact on e-cigarettes. The FDA would ban sales to youths, allow flavorings and set a two-year timeframe for approval of existing products. The proposed regulation, a complex 241-page document, raises fundamental questions, including: What e-cigarette components are subject to regulation as tobacco products? Page seven of the draft rule states that the “Tobacco Control Act…defines the term ‘tobacco product’ to mean ‘any product made or derived from tobacco that is intended for human consumption, including any component, part, or accessory of a tobacco product.’”Is the entire e-cigarette, including the liquid cartridge, heating element, battery and mouthpiece/switch, subject to regulation, or only the liquid and only if it contains nicotine? I believe the FDA could exert regulatory authority over e-liquids containing nicotine, but not over other e-cig components. There is language in the draft rule supporting this: “Therefore, items such as hookah tongs, bags, cases, charcoal burners and holders, as well as cigar foil cutters, humidors, carriers, and lighters would be considered accessories and would not fall within the scope of this proposed rule.” The most relevant accessory named in this list is “lighters.” The FDA does not regulate matches or butane lighters as tobacco products. These accessory items are necessary in order to consume cigarettes, cigars or pipe tobacco, but they are not tobacco products per se. The case could be made that all of the e-cig hardware – minus the liquid – is the equivalent of a match or lighter, and thus not subject to FDA regulation as a tobacco product. What about the Tobacco Control Act’s reference to “any component, part, or accessory of a tobacco product”? I don’t believe that applies to e-cig hardware, but rather to the water, propylene glycol or glycerin, and any flavoring in e-cig liquids. Again, language in the draft rule supports this interpretation: “Such examples would include air/smoke filters, tubes, papers, pouches, or flavorings used for any of the proposed deemed tobacco products (such as flavored hookah charcoals and hookah flavor enhancers) or cartridges for e-cigarettes.” These components are used or consumed along with the tobacco. This might appear to be splitting hairs, but defining precisely what parts of e-cigarettes are subject to regulation under the Tobacco Control Act has huge implications. If nicotine e-liquids are regulated tobacco products, manufacturers will be able to file market approvals based on substantial equivalence to liquids that were on the market in 2007. In addition, they would have considerable flexibility to continue innovation and product development of hardware components, subject only to less-burdensome consumer safety standards. Finally, nicotine-containing e-liquids are the only component of e-cigarettes that would qualify for tobacco excise taxes.Defining nicotine e-cigarette liquid as a tobacco product will bring clarity to the FDA deeming regulation, provide a basis for implementing unambiguous tobacco excise taxes, and promote innovation and product development.Original author: Gwen
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Hamburg letter helps clarify FDA’s naivety regarding e-cigarettes

by Carl V Phillips The great mystery of the proposed FDA regulation of e-cigarettes is what benefit they think the proposed regulations would have.  As we have pointed out (here and here), the proposed regulations seem to impose costs — … Continue reading →Original author: Carl V Phillips
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CASAA Submission to U.S. Senate Committee on Health, Education, Labor, and Pensions Regarding 5-15-14 Hearing on E-Cigarettes

Our mission is to ensure the availability of effective, affordable and reduced harm alternatives to smoking by increasing public awareness and education; to encourage the testing and development of products to achieve acceptable safety standards and reasonable regulation; and to promote the benefits of reduced harm alternatives.

Original author: Julie
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V for Vaping: E-cigarettes and the new smoking culture

The method is simple. First flip open the pack charging case. Then pull out the battery and screw on the atomiser. Once the unit is assembled, 25-year-old Ajinkya Bhonsle uses the device to start vaping. For the uninitiated, vaping is the term used for smoking e-cigarettes. And for Bhonsle, the advertised health benefits have been a reason good enough to ito purchase a starter kit in the US. “It’s more clean and healthy,” he says, adding, “There is no staining and after-smell as compared to a regular cigarette, and I have stopped smoking normal cigarettes completely. Vaping is just a cleaner and healthier option for me.”While that’s a belief that many people who use e-cigarettes share, it’s probably pretty far from the truth. As per the United States Food and Drug Administration, the American agency that monitors food safety, tobacco products, medicines and various other health related issues, there have been several adverse events related to e-cigarettes reported by healthcare professionals and consumers. The latest version of its page on e-cigarettes, updated in January 2014, mentions pneumonia, congestive heart failure and hypotension as just some of the events that have been possibly linked to e-cigarettes.Despite this, over the last eight years the number of people switching over to vaping from cigarettes has been huge. This is despite the fact that there is a wealth of contradictory research pointing, one way or the other, to the actual impact that these e-cigarettes have on our bodies.Primarily, an e-cigarette comprises a battery and a screw-on atomiser. The atomiser unit also houses the nicotine-based liquid. When you take a drag, the battery unit heats up, which also signifies the glowing tip. This results in vaporising the liquid which is inhaled by the user, and exhaled as water vapour. Vaping is also being looked upon as a social activity. For instance, Blu cigarette packs come with an inbuilt social-networking feature. On pressing a switch located on the right hand side, next to the charging indicators, it vibrates loudly twice to signify that the device has gone online. What it does is detect other Blu cig users in the vicinity of 50 feet. The idea as the company says is, “Smoking is a social activity, we want to do the same with Blu cigs.” Interestingly, this is another novel method in which the vaping fad has caught up with people.The smokeless smokersE-cigarettes makers have taken at least one leaf from the tobacco industry’s playbook – marketing. A brand like Blu has paid celebrity endorsements on its website and also plenty of celebrity users. The website has images of several actors including Jenny McCarthy, who says ‘Freedom to have a cigarette without the guilt’. Actor Stephan Dorff is also an endorser of the brand. On the other hand actor Leonardo DiCaprio, who had recently sported a Blu cig at the Golden Globe awards, told the Associate Press in a report that he vapes to relieve stress.Celebrity endorsement is one aspect, but the viral marketing also goes a long way in promoting the product. Without getting into the health aspect of the same, the reason why vaping has found an audience is because promoters are portraying it as the ‘next cool thing to do’. Located near Soho in NYC is ‘The Henley Vaporium’. A direct retail outlet of Henleycigs.com, the Vaporium, in addition to selling its products and stocking other batteries and liquids used in vaping, also educates smokers to the concept of Vaping. On its website, the description for the Vaporium reads – Not your father’s smokeshop.The mission of the Vaporium is to educate vapers about the variety of new products on the market. A vaper can come and sample new e-liquid flavours (from a full-list on its menu) as well as interact with the Vapologists. The place is not inexpensive, considering that a flavour like Smoked Custard (on its menu) from Nick’s Blissful Brews can set a user back by as much as $26 (roughly Rs. 1600) for a 30ml bottle. But outlets like these that are trying to educate smokers and convert them to vapers are doing something important – giving a shot in the arm to the number of people joining the bandwagon. The liquids come in 15ml and 30ml packs with varying nicotine strengths on them from 6mg to 18mg.In India, you won’t find any of these products at retail outlets, but many e-commerce sites now stock them. Rupesh Singhania, a 34-year-old Delhi-based freelance writer, says he buys coffee flavoured e-cigarettes regularly from Snapdeal. He says that the price fluctuates, but you can get the equivalent of four packs of cigarettes for under Rs. 500. “It isn’t actually four packs worth, and because I can use it at home without bothering my wife who is a non-smoker, I think I puff a lot more than before anyway. But you can get a lot of different flavours, it’s cheap, and it feels healthier. I know it probably isn’t but it still feels like it.”Singhania was smoking a pack of Classic Milds every three days, he says, and now he’s spending around Rs. 500 every week on e-cigarettes. He says, “I was worried at first that this would be really expensive – as a freelancer I’m usually not overflowing with cash, you know,” he quips, adding, “but even if I wasn’t a smoker, I probably would have wanted to try and smoke an e-cigarette anyway. It’s so cool and high-tech! You inhale a little air and you get your kick and the tip of this plastic cylinder lights up? It’s crazy, I love it.”The rush has hit India in the recent past and has found a growing sense of acceptance. So much so that it is not uncommon to find locally made e-cigarettes retailing for as less as Rs. 300. Software professional Aritra Sarkar, based out of Mumbai, has been a vaper since 2012. A visit to the doctor two years back convinced him to change his smoking habits and preferences. “I don’t know how healthy it is, honestly, but I have given up smoking normal cigarettes completely. I took to vaping to wean myself off smoking and it helped. People do come up and ask once in a while, as to what I am smoking (when I use my e-cigarette),” he says.Earlier, Sarkar says, he was smoking a pack a day: “I smoked Marlboro Red. And I had been smoking since I was 16. Ten years later, the signs started to show. I went and got myself checked by a doctor, and X-rays revealed that there was a 4mm spot on my lung. That image was an eye opener.”Talking to several people who use e-cigarettes, a picture begins to emerge. Ameetha Prakash, a 28-year-old marketing consultant based in Bangalore, is a fairly typical example. Living in a major metro, most of the buyers we found were young and upwardly mobile; busy at work but still keen on having an active social life. We saw people who were young enough to be comfortable adopting new technology, but old enough to start caring about their health. That’s why the e-cigarette makers ensure that their product is seen as healthy, with or without any scientific evidence to back up their claims.Prakash, who first used an e-cigar while on a business trip to the United States, bought one immediately. She says, “I started smoking when I was 13, thanks to some very stupid friends in school. I was equally stupid considering that I continued to smoke for a dozen years. I had stopped smoking because my throat used to feel very painful but old habits die hard, and between 23 and 25 I must have ‘quit’ a hundred times. But since I started to use the e-cigar, I’ve not picked up a cigarette any more.”Instead, she buys three or four e-cigars every time she travels to the United States, and gets friends to bring them back for her as well. “I have tried some of the local brands available here, but I was never a fan. Some of the ones I’ve tried didn’t produce enough vapour, and in some of the others, the flavour was too weak. And most of them leave a bad aftertaste. So I just get them from the US thanks to work and friends.”At crossroads: The e-cigaretteThe fact that the national airline carrier Air India, too has decided to sell e-cigarettes on board its flights, also shows the tremendous growing popularity of the same. The decision might have not gone down too well with the Ministry of Health but it shows how more and more companies are jumping in to cash in on their popularity. The WHO, in a 2013 report, strongly urged users to stay away from e-cigarettes till a regulatory body approves their usage and consumption. But with more and more smokers and even non-smokers taking to vaping as an alternative to smoking, it looks like as though vaping is here to stay.On the face of it, the biggest selling point for vaping and e-cigarettes is that outside of nicotine the marketing for them suggests that it is completely hygienic and safe to use. However, the actual reports are a lot less positive. Some people also raise concerns that e-cigarettes could be a gateway drug for youngsters, who could then take up smoking regular cigarettes after some time.SKYCIG, which is based out of the UK and has around two lakh customers, writes on its official website, ‘We believe our electronic cigarettes provide a viable, realistic alternative to tobacco, and so do over 200,000 other people who already use SKYCIG.’ Henley cigs on the other hand believes that using e-cigarettes helps to drastically reduce the consumption of cigarettes, and then reduce the nicotine intake to zero eventually. Even though the health aspect is debatable, with all the conflicting reports coming in, there is a fad value to vaping too. Another reason why a lot of smokers convert to vaping is because of another important marketing trait. A lot of e-cigarette brands advertise their products as ‘having nicotine, which is highly addictive, but also free of tar and 4000 other hazardous chemicals found in cigarettes’.And users seem to buy into the idea. Meenakshi Rao, a Mumbai-based interior design consultant, says, “Of course it’s healthier. There’s no tar and there’s nothing being burned. It’s just steam that I’m taking in. What’s wrong with that?” She’s unmoved by the fact that there are a lot of conflicting studies, and says that she isn’t going to stop smoking, and adds, “I don’t think they’re healthy. But I think they are less unhealthy.” Rao spends close to Rs. 5,000 each month on Smokefree brand e-cigarettes, which she buys online. For her, it’s a lifestyle choice, as most of her friends are people who either never smoked, or have quit smoking.”Earlier, if I was spending time with my friends, then I was a pariah, who’d have to go out and stand alone to smoke in the balcony while everyone else was together inside. No one minds when I puff on an e-cig, because there’s no smoke or smell,” she says, and adds in an exasperated voice, “Of course some people still complain, but it’s not like earlier. And I don’t use my Smokefree in public spaces like restaurants or movie halls. There is nothing wrong with using them in those places because it doesn’t affect people, but once, when I tried to take a puff in a restaurant this woman at the next table started to complain really loudly, so it’s just not worth the hassle.”  V for Vaping: E-cigarettes and the new smoking cultureOriginal author: Odis
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Toughest electronic cigarette restrictions won’t advance as House members say they lack votes

[unable to retrieve full-text content]ST. PAUL, Minn. — An attempt to treat electronic cigarettes like regular smokes and curb their use in public stalled Tuesday in the Minnesota Legislature, ending the closely watched debate for the year.Original author: Irving
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