Tobacco Kills When Used As Intended

Tobacco Kills Millions Every Year

Tobacco is the only legal drug that kills many of its users when used exactly as intended by manufacturers. WHO has estimated that tobacco use (smoking and smokeless) is currently responsible for the death of about six million people across the world each year with many of these deaths occurring prematurely. This total includes about 600,000 people are also estimated to die from the effects of second-hand smoke. Although often associated with ill-health, disability and death from noncommunicable chronic diseases, tobacco smoking is also associated with an increased risk of death from communicable diseases.

Under a UN mandate to address four noncommunicable diseases (NCDs), the World Health Assembly established in 2013 a global voluntary tobacco target to help reduce prevent premature avoidable mortality from NCDs. The agreed global tobacco target is a 30 percent relative reduction in prevalence of current tobacco use in persons aged 15+ years.

smoking rates and trends global

The setting of this target not only provides a context for the development of policies and programs of actions to attain the target, it also provides an opportunity for policy makers to monitor progress towards achievement of the target over time.

To address the global burden of tobacco, the World Health Assembly in 2003 unanimously adopted the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). In force since 2005, the main objective of the WHO FCTC is to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure. Ratified by 180 Parties as at March 2015, the WHO FCTC currently covers about 90 percent of the world’s population. It is a legally binding treaty which commits Parties to the Convention to develop and implement a series of evidence-based tobacco control measures to regulate tobacco industry marketing activities and sales reach, reduce the demand for tobacco, and provide agricultural alternatives for those involved in growing and producing tobacco.

To assist countries to fulfil their WHO FCTC obligations, in 2008 WHO introduced a package of six evidence-based tobacco control demand reduction measures that are proven to reduce tobacco use. These measures known as the MPOWER package measures reflect one or more provisions of the WHO FCTC. MPOWER refers to M: Monitoring tobacco use and prevention policies; P: Protecting people from tobacco smoke; O: Offering help to quit tobacco use; W: Warning about the dangers of tobacco; E: Enforcing bans on tobacco advertising, promotion and sponsorship, and R: Raising taxes on tobacco.

The ability to monitor change in any indicator rests on the availability of data to measure the indicator adequately over time. The NCD tobacco target refers to tobacco use which includes both tobacco smoking and smokeless tobacco. The quality and quantity of data on tobacco smoking is enough to allow for an attempt to draw trends in tobacco smoking by country. Smokeless tobacco data, although improving rapidly, are still too scant to allow for derivation of meaningful underlying trends for many countries. For this reason, the work presented in this report focuses only on tobacco smoking.

After a careful analysis of data quality and completeness of data availability, WHO aims to undertake a similar exercise for smokeless tobacco, most likely only for a limited number of countries.

To generate the trends, WHO worked with a team of epidemiologists and biostatisticians from the University of Newcastle (Australia) and University of Tokyo to generate the underlying trend in tobacco smoking. The trend is based on fitting a Bayesian meta-regression using a negative binomial model. A full description of the method used has been published in The Lancet.

The data for the analysis were obtained from the following WHO databases: WHO FCTC Implementation Database, WHO Comprehensive Information Systems for Tobacco Control, WHO Infobase and from other sources.

The resulting trend lines are projections not predictions of future attainment. A projection indicates a likely endpoint if the country maintains its tobacco control efforts at the same level that it has implemented to date. Obviously the impact of recent interventions or new interventions that are undertaken as a result of the projection will most likely alter the expected endpoint. Countries like Ireland or Vietnam who have reported taking strong tobacco control measures will not capture the impact of their efforts until completing a new survey. The success or otherwise of these actions will only be reflected in the trends once the surveys are completed.

quit smoking campaign

This report contains country specific estimates for four indicators: current and daily tobacco smoking and current and daily cigarette smoking, for males and females for the years 2000, 2005, 2010, 2015, 2020 and 2025.

It also contains information on age-specific prevalence estimates by sex for current tobacco smoking for 2000, 2010 and 2025, as well a short history of recent surveys undertaken by the country. The report also provides an assessment of the next survey due for the country based on the WHO advice to undertake a survey at least once every five years (acknowledging that some countries undertake surveys on a more regular basis).

If the 194 WHO Member States collectively achieved a 30% reduction from the 2010 level of 22.1%, they would be expected to reach a prevalence level of 15.4% in 2025. At this stage, it is projected that the prevalence level in 2025 will be 18.9%, or 3.5 percentage points above the target. This would represent a 14% relative reduction overall.

Read the full report about tobacco consumption trends

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Countries That Smoke The Most Tobacco

European Nations Consume The Most Tobacco

By Oliver Smith, The Telegraph

To mark World No Tobacco Day, we’ve mapped the planet according to cigarette consumption.

As with alcohol consumption, Eastern European nations dominate – with a couple of exceptions. Andorra tops the table, compiled by Tobacco Atlas, with an estimated 6,398 legally-sold machine-made and roll-your-own cigarettes consumed per person per year. However, the country is a haven for duty-free shopping, which may well be skewing those figures. Next up is another of Europe’s littlest nations, Luxembourg.

lung cancer and smoking

Belarus, the country that consumes the most alcohol per capita, comes third, followed by Macedonia and Albania. Belgium, Czech Republic, Jordan, Russia and Syria complete the top 10.

The 20 countries that smoke the most

  1. Andorra
  2. Luxembourg
  3. Belarus
  4. Macedonia
  5. Albania
  6. Belgium
  7. Czech Republic
  8. Jordan
  9. Russia
  10. Syria
  11. Slovenia
  12. Greece
  13. Hungary
  14. China
  15. Lebanon
  16. Armenia
  17. Mongolia
  18. Cyprus
  19. Austria
  20. Georgia

Jordan, Syria and China are the most tobacco-dependent non-European countries. Few regular visitors to Greecewill be surprised to see it at 12th. Other popular summer holiday destinations not far from the smokers’ summit include Austria (19th), Turkey (24th) and Croatia (35th).

Britons, conversely, consume far fewer cigarettes – just 827.66 per adult per year – placing it 79th on the list. The US is slightly higher, at 68th.

Residents of Brunei should be proud of the fact that they smoke the least of all those countries to feature in the Tobacco Atlas list. India, Ecuador, Peru, Ghana, and Antigua and Barbuda are also near the bottom of the table.

smoke cigar and cancer

There also appears to be a clear relationship between wealth and tobacco consumption. Many of the world’s poorest countries can be found in the lower reaches of the rankings. Those with no data appear in grey on the map above. The data does not take into account tobacco sold illegally. 

The 20 countries that smoke the least

  1. Brunei
  2. Guinea-Bissau
  3. Mauritania
  4. Ghana
  5. Antigua and Barbuda
  6. India
  7. Swaziland
  8. Ecuador
  9. Rwanda
  10. Peru
  11. Guatemala
  12. Ethiopia
  13. Niger
  14. Zimbabwe
  15. Democratic Republic of Congo
  16. Eritrea
  17. Haiti
  18. Zambia
  19. Togo
  20. Dominica

Six facts about global smoking

  1. Globally, 942 million men and 175 million women ages 15 or older are current smokers.
  2. Tobacco kills more than half of those who regularly use it and has a two trillion-dollar economic cost to society each year.
  3. In many countries, farmers clear forested land that is agriculturally marginal to grow tobacco—often by burning —and/or harvest wood for curing. Typically, the land is quickly abandoned and becomes unusable, often leading to desertification.
  4. Three quarters of male daily smokers live in countries with medium or high-HDI (Human Development Index), whereas half of female daily smokers live in very high-HDI countries.
  5. The number of smokers is declining only in very-high HDI countries; in the rest of the world, the number of smokers is increasing.
  6. More than 6 million people per year die from tobacco use across the globe, and in 2016 alone, second hand smoke caused 884,000 deaths.

Read The Full Story About Tobacco Consumption By Country

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Lung Cancer Rising Among Younger Women

Lung Cancer Dropping Among Young Men

In a reversal of historical patterns, lung cancer is now more common among young U.S. women than men, a new study finds.

The good news, researchers found, is that over the past two decades, lung cancer rates among 35- to 54-year-old Americans have dropped across the board.

But the decline has been steeper among men so that now, incidence of the disease is higher in white and Hispanic women born since the mid-1960s.

advertising smoking

Among blacks and Asian-Americans, meanwhile, women have caught up with men, according to findings published in the May 24 issue of the New England Journal of Medicine.

The question now is why, said lead researcher Dr. Ahmedin Jemal of the American Cancer Society.

“The higher incidence among women is not fully explained by smoking,” he said.

About 85 percent of lung cancer cases in the United States are related to smoking, according to Jemal. So it’s logical to think that smoking habits would account for shifting patterns in lung cancer.

It’s true, Jemal said, that American women and men have become increasingly similar in their smoking rates. But men still typically smoke more cigarettes per day. And among Hispanic Americans, he said, smoking remains more common among men than women.

Jemal could only guess about why the lung cancer rate has fallen to a greater degree among men. One possibility, he said, is that female smokers who quit have a slower decrease in their lung cancer risk compared male smokers.

He noted that women and men tend to differ in the types of lung cancer they develop. A form called adenocarcinoma is more common in women — and the risk of that lung cancer typically dips at a slower rate among former smokers, compared with other forms of the disease.

smoking tobacco and mental illness

Some research has suggested women might be more biologically vulnerable to the damaging effects of cigarette smoke. But so far, Jemal said, studies have come to mixed conclusions.

Regardless of the explanation, he said, the message for smokers is clear: Quit as soon as you can.

“Smokers should know that those who quit — especially by age 40 — can largely avoid lung cancer,” Jemal said.

And while this study focused on younger adults, he added, it’s never too late to quit smoking. Even people who kick the habit at relatively older ages can lower their disease risks and add years to their life expectancy.

The findings are based on cases of invasive lung cancer diagnosed in Americans ages 30 to 54 between 1995 and 2014.

In general, the study found, the incidence of the disease dipped over time. But men saw a sharper decrease, so that the traditional male-female pattern flipped.

For example, among Americans born in the mid-1960s, the annual rate of lung cancer at the ages of 45 to 49 was about 25 cases for every 100,000 women. That compared with 23 cases for every 100,000 men.

The pattern was a turnaround from what was seen among Americans born around 1950. In that group, the rate of lung cancer among men in their late 40s was about one-quarter higher, compared with women.

“We don’t know why this change has taken place,” said Dr. Norman Edelman, senior scientific adviser for the American Lung Association, which was not involved in the study.

But it will be important to figure it out, according to Edelman. “Anything you can learn about lung cancer could eventually help us better treat or prevent the disease,” he said.

For smokers — or kids who are tempted to start — Edelman said this study highlights a crucial point: Lung cancer can arise at a young age.

“Sometimes young people are immune to messages about long-term health risks that will happen in their 60s,” he said. “If they know this can happen at age 40, that could be a very powerful message.”

Edelman also stressed that many smokers need five or more tries before they successfully quit. But, he said, help is out there, and smokers should keep trying until they find that tactic that works.

In general, Edelman said, a combination of medication and some form of support program is most effective.

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Electronic Cigarettes Targeting Kids

Juul Now A Public Health Threat

Introduced in 2015, Juul electronic cigarettes have quickly skyrocketed in popularity among teens and college students across the United States, according to widespread news reports. Educators and students report an alarming level of Juul use in middle and high schools, making this an urgent public health problem.

JUUL Labs produces the JUUL device and JUULpods, which are inserted into the JUUL device. In appearance, the JUUL device looks quite similar to a USB flash drive, and can in fact be charged in the USB port of a computer. According to JUUL Labs, all JUULpods contain flavorings and 0.7mL e-liquid with 5% nicotine by weight, which they claim to be the equivalent amount of nicotine as a pack of cigarettes, or 200 puffs. JUULpods come in five flavors: Cool Mint, Crème Brulee, Fruit Medley, Virginia Tobacco, Mango, as well as three additional limited edition flavors: Cool Cucumber, Classic Tobacco, and Classic Menthol. Other companies manufacture “JUUL-compatible” pods in additional flavors; for example, the website Eonsmoke sells JUUL-compatible pods in Blueberry, Silky Strawberry, Mango, Cool Mint, Watermelon, Tobacco, and Caffé Latte flavors. There are also companies that produce JUUL “wraps” or “skins,” decals that wrap around the JUUL device and allow JUUL users to customize their device with unique colors and patterns (and may be an appealing way for younger users to disguise their device).

According to data from Wells Fargo, JUUL’s popularity has grown dramatically in the last year, with unit sales increasing more than 600 percent in 2017. In mid-2016, dollar sales share for JUUL products was less than 5 percent, the lowest compared to products sold by the main companies in Nielsen-tracked channels. But by the end of 2017, JUUL sales had surpassed all other companies’ products (see adjacent graph). As a result, JUUL is now more popular than the e-cigarette brands manufactured by the major tobacco companies (blu, Vuse, and MarkTen).

More recently, JUUL has updated its marketing code with the purported goal of limiting youth exposure to its advertising. Its current marketing materials focus primarily on its popular flavors and on messaging that encourages smokers to “make the satisfying switch.”

teen smoking and vaping

E-cigarettes are a diverse group of products containing a heating element that produces an aerosol from a liquid that users can inhale via a mouthpiece, and include a range of devices such as “cig-a-likes,” vape tank systems, and vape mods.  Millions of Americans use e-cigarettes, and e-cigarette use is generally greatest among young adults and decreases with age.  Use varies substantially across demographic groups, including age, gender, race, and ethnicity.  For example, among youth and adults, use is typically greater among males than females.

Juul sales have grown dramatically and now make up more than half of the e-cigarette market. According to the most recent data from Wells Fargo, JUUL sales currently represent 68 percent of the market share. 

Several factors have contributed to Juul’s rising popularity with teens:

  • Juul e-cigarettes are sleek, high tech and easy to hide. They look just like USB flash drives and can be charged in the USB port of a computer. They don’t look like a traditional tobacco product. A Juul is small enough to fit in a closed hand;
  • Juul comes in sweet flavors that appeal to youth, including mango, fruit medley, crème brulee, cool mint and cool cucumber. Research has shown that flavors play a key role in youth use of tobacco products, including e-cigarettes; and
  • Juul appears to deliver nicotine more quickly, more effectively and at higher doses than other e-cigarettes, increasing users’ risk of addiction. The manufacturer claims each Juul cartridge of nicotine liquid (called a “Juul pod”) contains as much nicotine as a pack of cigarettes (about 200 puffs). However, research has found that many Juul users don’t know the product always contains nicotine, and many teens call use of the product “juuling,” indicating they may not realize it is an e-cigarette or tobacco product.

According to the National Youth Tobacco Survey, 11.7 percent of high school students and 3.3 percent of middle school students—over 2.1 million youth—were current e-cigarette users in 2017. However, a study from Truth Initiative found that a quarter of youth and young adult JUUL users don’t refer to JUUL use as “e-cigarette use” or “vaping,” but rather as “JUULing.” Therefore, it is possible that existing surveys may not be capturing the full spectrum of youth e-cigarette use. News articles, letters from school officials, and anecdotal evidence indicate that JUUL has gained popularity among youth and young adults across the country, from middle schools to college campuses. A 2018 study found that nearly one-fifth of youth (ages 12-17) surveyed reported having seen JUUL used in their school.

While smoking cigarettes among high school students has dropped, vaping nicotine continues to increase–in some states more than others. For example, according to the 2017 Healthy Kids Colorado Survey, only 7 percent of high school students currently smoke cigarettes, while 27 percent said they vape nicotine. The statewide school survey shows 87 percent of Colorado high school students think cigarette smoking is risky, but only 50 percent think those risks apply to vaping nicotine.

teen vaping

The availability of flavors may also contribute to JUUL’s popularity among youth. A national survey found that that 81 percent of youth aged 12-17 who had ever used e-cigarettes had used a flavored e-cigarette the first time they tried the product, and that 85.3 percent of current youth e-cigarette users had used a flavored e-cigarette in the past month. Moreover, 81.5 percent of current youth e-cigarette users said they used e-cigarettes “because they come in flavors I like.”

The number of youth using e-cigarettes, including JUUL, is alarming and raises serious concerns that E-cigarettes could be an entryway to nicotine addiction and use of regular cigarettes for some kids. Though there is insufficient research on the long-term effects of using e-cigarettes in general, and certainly not specific to JUUL, the use of such products still raises concerns because they contain nicotine. The company claims that the nicotine in JUUL is from “nicotine salts found in leaf tobacco, rather than freebase nicotine,” which they claim “accommodate cigarette-like strength nicotine levels.” 12 The health impact of that specific form of nicotine is yet unknown.

Juul is putting kids at risk of nicotine addiction and threatens to undermine decades of progress in reducing youth tobacco use:

The alarming increase in youth use of Juul requires strong and immediate action by the Food and Drug Administration to protect kids. The FDA is responsible for regulating tobacco products, including e-cigarettes, and the FDA must take action to address the skyrocketing youth use of Juul.

A congressionally mandated report from the National Academies of Sciences, Engineering, and Medicine takes a comprehensive look at evidence on the human health effects of e-cigarettes. Although the research base is limited given the relatively short time e-cigarettes have been used, the committee that conducted the study identified and examined over 800 peer-reviewed scientific studies, reaching dozens of conclusions about a range of health impacts.

Whether e-cigarettes have an overall positive or negative impact on public health is currently unknown, the report says. More and better research on e-cigarettes’ short- and long-term effects on health and on their relationship to conventional smoking is needed to answer that question with clarity.

“E-cigarettes cannot be simply categorized as either beneficial or harmful,” said David Eaton, chair of the committee that wrote the report, and dean and vice provost of the Graduate School of the University of Washington, Seattle. “In some circumstances, such as their use by non-smoking adolescents and young adults, their adverse effects clearly warrant concern. In other cases, such as when adult smokers use them to quit smoking, they offer an opportunity to reduce smoking-related illness.”

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Tobacco-Free Kids Campaign Celebrates 20 Years

Tobacco Addiction A Key Marketing Strategy

Tobacco use is the world’s leading cause of preventable death, according to the World Health Organization. Increasingly, the burden of tobacco use is greatest in low- and middle-income countries that have been targeted by the tobacco industry with its deadly products and deceptive marketing practices. The result: A global tobacco epidemic of preventable death, disease and economic harm to countries and families.

smoking cigar and cancer


  • There are more than one billion smokers in the world.
  • Globally, 21% of adults are current smokers (men 35%; women 6%).
  • More than 80% of the world’s smokers live in low- and middle-income countries.
    • 29% of men in high-income countries, 37% in middle-income countries, and 24% of men in low-income countries are smokers.
    • 18% of women in high-income countries, 4% in middle-income, and 3% of women in low- income countries smoke.
  • Globally, the number of youth aged 13-15 years who smoke cigarettes is estimated to be around 25 million, with almost 13 million using smokeless tobacco products.2
  • Cigarette smoking and use of other tobacco products is increasing in many low- and middle-income countries due to population growth and tobacco industry marketing.

teen smoking statistics


The Campaign for Tobacco-Free Kids has fought to protect children and save lives from the top cause of preventable death: tobacco use. Our vision is a future free of the death and disease caused by tobacco. Tobacco has killed enough.

We are the leading advocacy organization working to reduce tobacco use and its deadly consequences in the United States and around the world. Through strategic communications and policy advocacy campaigns, we promote the adoption of proven solutions that are most effective at reducing tobacco use and save the most lives.

We are passionate and experienced public health advocates with a more than 20-year track record of leading and supporting successful policy advocacy campaigns:

  • In the United States, we work at the national, state and local levels.
  • Around the world, we are active in low- and middle-income countries facing the greatest threat from tobacco.
  • In addition to our work fighting tobacco use, our Global Health Advocacy Incubator applies our broad range of advocacy experience to supporting organizations working to address other critical public health challenges.

teen vaping

We’re making progress against tobacco

  • In the U.S., our work has helped drive smoking rates to record lows.
  • Around the world, we’re helping to turn the tide of a global tobacco epidemic that would otherwise kill one billion people this century.

The battle against tobacco is far from over

  • Tobacco still kills nearly half a million Americans and more than 7 million people worldwide each year.
  • The tobacco industry relentlessly peddles its deadly products, targeting kids and other vulnerable populations.

Our remarkable progress shows that we can win the fight against tobacco. The Campaign for Tobacco-Free Kids is unyielding in our resolve and committed to finishing the job.

Since 1996, the campaign has contributed to:

  • 70% decrease in youth smoking
  • 39% decrease in adult smoking
  • 185 million Americans protected from secondhand smoke
  • Millions of lives saved by reducing cancer, heart disease and other tobacco-related conditions

As part of the Bloomberg Initiative to Reduce Tobacco Use, we have helped:

  • Pass new tobacco control laws in 59 countries since 2007
  • Save 30 million lives in low- and middle-income countries
  • Reverse the steep growth in cigarette sales worldwide
lung cancer and smoking tobacco


  • 100 million people died from tobacco use in the 20th century. If current trends continue one billion people will die from tobacco use in the 21st century.
  • Tobacco use kills up to half of all lifetime users. On average, smokers lose 15 years of life.
  • Tobacco kills more than 7 million people each year. By 2030, the number of tobacco-related deaths will increase to 8 million each year.
  • Smoking is estimated to cause about 1.4 trillion USD in economic damage each year.
  • Health care costs associated with tobacco-related illnesses are extremely high. Economic costs associated with smoking represent 1.8% of global GDP, and smoking-attributable health expenditure represents 5.7% of total health spending.
    • In the United States, annual tobacco-related health care costs amount to 170 billion USD; in China, 28.9 billion; in Vietnam, 0.6 billion USD; in Brazil, 5.8 billion USD.9
  • Tobacco-related illnesses and premature mortality impose high productivity costs to the economy because of sick workers and those who die prematurely during their working years. Lost economic opportunities in highly-populated low- and middle-income countries will be particularly severe as tobacco use is high and growing in those areas.
    • Global indirect costs of smoking are estimated to be about 1 trillion USD, nearly two thirds of which are due to premature mortality.
    • In Ukraine, the productivity loss due to premature smoking-related mortality is at least 3 billion USD annually.
  • Tobacco production damages the environment:
    • Tobacco plants are especially vulnerable to many pests and diseases, prompting farmers to apply large quantities of chemicals and pesticides that harm human health and the environment.
    • Clearing of land for cultivation and large amounts of wood needed for curing tobacco cause massive deforestation at a rate of about 200,000 hectares per year.
  • Tobacco kills over 480,000 people in the U.S. and over 7 million worldwide each year.
  • 5.6 million kids alive today in the U.S. will ultimately die from smoking — unless we act now to prevent it.
  • In the U.S. alone, tobacco companies spend $9.1 billion a year — $1 million every hour — to market their deadly products.


  • Raise the price of tobacco products;
  • Make all workplaces and public places smoke-free;
  • Require graphic health warnings on tobacco products;
  • Conduct tough anti-smoking ad campaigns;
  • Invest in programs that prevent kids from smoking and help smokers quit;
  • Raise the tobacco sale age to 21; and
  • End the tobacco industry’s harmful manufacturing and marketing practices.
 Read More About Tobacco-Free Kids
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Studies Linking Vaping To Health Impacts

Vaping Helps Adults Quit Nicotine, While Helping Kids Start Habit

By Erin Brodwin, Business Insider

Smoking kills. No other habit has been so strongly tied to death.

In addition to inhaling burned tobacco and tar, smokers breathe in toxic metals like cadmium and beryllium, as well as metallic elements like nickel and chromium — all of which accumulate naturally in the leaves of the tobacco plant.

It’s no surprise, then, that much of the available evidence suggests that vaping, which involves puffing on vaporized liquid nicotine instead of inhaling burned tobacco, is at least somewhat healthier. Reaching for a vape pen instead of a conventional cigarette might also be helpful for quitting smoking, though the evidence is somewhat limited.

teen smoking and vaping

We don’t have a ton of research on how vaping affects the body and brain. But a handful of studies published this year have begun to illuminate some of the potential health effects of e-cigs.

Vaping is linked with twice the risk of a heart attack, while smoking is linked with triple the risk.

One of the most worrisome outcomes of that research is a study linking daily vaping to a significantly higher risk of heart attacks.

It is the very first study to show a long-term health impact of e-cigarettes.

The analysis, presented on Saturday at the annual meeting of the nonprofit Society for Research on Nicotine and Tobacco, suggests that people who vape every day may double their risk of having a heart attack compared with people who do not vape or smoke. In comparison, daily cigarette smoking potentially triples the risk.

But the people most at risk are “dual users,” or people who use both devices, according toStanton Glantz, the lead author on the presentation and a professor of medicine at the University of California, San Francisco as well as its director of the Center for Tobacco Control Research and Education. People who smoked and vaped every day faced five times the risk of a heart attack as those who took up neither habit, Glantz told Business Insider.

Dual users make up a significant proportion of overall vapers, Glantz said.

“E-cigarettes are widely promoted as a smoking cessation aid but for some, they actually make it harder to quit, so most people end up doing both,” Glantz said. “This is the dominant use.”

lung cancer and smoking tobacco

Still, the study has a number of limitations, most notably the fact that it could not conclude that vaping (or even smoking, for that matter) caused heart attacks — only that the two were linked. Also, only the study’s abstract has been peer-reviewed; the full paper is still awaiting publication. Glantz said one of the reasons they decided to make the abstract public was to get the word out about the findings as soon as possible.

“We’re the first people to show a long term impact of e-cigarettes, and given that it’s consistent with what we know biologically about how vaping affects the heart, we wanted to get this out there,” Glantz said.

To arrive at his findings, Glantz looked at national survey data on 70,000 Americans which asked people about their use of e-cigarettes and regular cigarettes. It also asked if they’d ever suffered a heart attack. After controlling for factors that could muddle their results, like hypertension, the researchers found that people who vaped every day were twice as likely to have suffered a heart attack compared with people who didn’t vape or smoke at all. Daily smokers were three times as likely as non-smokers to have suffered a heart attack.

Other studies in animals and cells have suggested that vaping could stiffen the heart and blood vessels, potentially creating an increased risk of heart disease and heart attacks, but this was the first to line up those limited findings with actual health impacts in humans.

The study isn’t the first to suggest that e-cigarettes may come with some important risks.

Some of the same toxic metals that can be found in cigarettes are also found in e-cigs.

In 2015, a group of researchers from medical schools across the globe decided to find out just what was inside the vapors that e-cig users were inhaling.

After recruiting 56 daily e-cig users in Baltimore and testing their devices in a lab at the Bloomberg School of Public Health, researchers found that, trapped deep in the aerosol particles that vapers breathe, lurk some of the same toxic metals and metallic elements found in conventional cigarettes, including cadmium and nickel.

They also found unsafe levels of several other dangerous substances such as arsenic, chromium, and manganese. They published their findings earlier this week in the journal Environmental Health Perspectives.

“These heating coils, as currently made, seem to be leaking toxic metals — which then get into the aerosols that vapers inhale,” Ana Maria Rule, an assistant scientist at the Johns Hopkins Bloomberg School of Public Health who led the study, said in a statement.

Despite these findings, it remains unclear what inhaling these levels of substances does. Still, consistently inhaling high levels of these metals has been tied to health problems in the lungs, liver, immune system, heart, and brain, as well as some cancers, according to the US Department of Labor’s Occupational Health and Safety Administration.

“We’ve established with this study that there are exposures to these metals, which is the first step, but we need also to determine the actual health effects,” Rule said.

The largest report on the health effects of vaping found that e-cigs could help adults quit smoking — but may encourage teens to start.

A large recent report on the health effects of vaping from the National Academies of Sciences, Engineering, and Medicine found that e-cigarettes may be helpful for adults looking to quit smoking. One of the reasons may be that vaping not only exposes people to fewer of the cancer-causing substances in conventional cigarettes but may also be less addictive.

But while adults sometimes use e-cigs as a tool to quit smoking, young people may end up using them to start, the authors of the newest report concluded.

As a result, “e-cigarettes cannot be simply categorized as either beneficial or harmful,”David Eaton, a vice provost at the University of Washington at Seattle who led the committee that wrote the report, said in a statement.

Eaton said that in certain circumstances, such as when teens use them and become addicted to nicotine, e-cigarettes “adverse effects clearly warrant concern.” But in other cases, like when adults turn to e-cigs to quit smoking, “they offer an opportunity to reduce smoking-related illness.”

Read The Full Story About The Health Effects Of Vaping

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Vaping Contributing To Smoking, Addiction Among Teens

Report Fails To Call Vaping Safe

By Sheila Kaplan, New York Times

A national panel of public health experts concluded in a report released on Tuesday that vaping with e-cigarettes that contain nicotine can be addictive and that teenagers who use the devices may be put at higher risk of switching to traditional smoking.

Whether teenage use of e-cigarettes may lead to conventional smoking has been intensely debated in the United States and elsewhere. While the industry argues that vaping is not a stepping stone to conventional cigarettes or addiction, some anti-smoking advocates contend that young people become hooked on nicotine, and are enticed to cancer-causing tobacco-based cigarettes over time.

The new report by the National Academies of Sciences, Engineering and Medicine is the most comprehensive analysis of existing research on e-cigarettes. It concluded the devices are safer than traditional smoking products and that they do help smokers quit, citing conclusive proof that switching can reduce smokers’ exposure to deadly tar, numerous dangerous chemicals and other carcinogens.

teen smoking e-cigarette

But it stopped short of declaring e-cigarettes as safe, noting that there are no long-term scientific studies of the devices’ addictive potential or their effects on the heart, lungs or on reproduction.

The panel found evidence among studies it reviewed that vaping may prompt teenagers or young adults to try regular cigarettes, putting them at higher risk for addiction, but that any significant linkage between e-cigarettes and long-term smoking has not been established. It said it was unable to determine whether young people were just trying cigarettes or becoming habitual smokers.

“When it got down to answering the questions about what the impacts on health are, there is still a lot to be learned,” said David Eaton, of the University of Washington, who led the committee that reviewed existing research and issued the report. “E-cigarettes cannot be simply categorized as either beneficial or harmful.”

The report was commissioned in 2016, after the F.D.A. gained the authority to regulate tobacco products that had previously been outside its jurisdiction, such as e-cigarettes, cigars and other goods.

Mitch Zeller, head of the agency’s tobacco division, said the committee was assigned to assess the existing science, and to point out where research gaps suggest more study was needed. The report will aid the agency in its review of applications for lower-risk tobacco products and the potential harm or benefits those pose to individuals and the public.

On Wednesday, an F.D.A. advisory panel will review an application from Philip Morris International for iQOS, an electronic device that unlike e-cigarettes, contains tobacco in a stick that the company says heats it but does not burn it. It releases nicotine vapor the company says is less hazardous than smoke. If approved, it would be the first company allowed by the government to claim its product is less harmful than cigarettes.

lung cancer and smoking tobacco

Also this week, on Friday, the agency’s new nicotine steering committee will hold a public hearing on over-the-counter therapeutic products, among them gums, patches and lozenges, designed to help smokers quit.

Cessation was one area where the committee’s report did give the booming e-cigarette industry some good news. It pointed out the benefits for smokers of tobacco-based cigarettes who are trying to quit. and. But people who continue to smoke cigarettes, alternating with e-cigarettes, do not gain the same health benefits, the committee said. That’s especially important given that most adults who vape also still smoke or use other tobacco products.

While there is no evidence at this time that e-cigarettes or their components cause cancer, the committee recommended more long-term research. Some e-cigarettes do contain chemicals and metals whose long-term effects — including on pregnancy — also require additional research, the committee said.

Smoking rates among adults and teenagers have declined significantly over the last few decades. In 2015, the last year for which the Centers for Disease Control and Prevention has statistics, about 37 million Americans, 15 percent of adults aged 18 and older, smoked cigarettes. The number has declined from nearly 21 percent of every 100 adults in 2005; and 42 percent in 1965.

healthcare costs and smoking

With that decline, the e-cigarette industry has emerged as a potential substitute and Big Tobacco has been among the device developers enjoying new profits from the tobacco alternatives. Bonnie Herzog, a well-known Wells Fargo tobacco analyst, predicted the industry will grow about 15 percent to $5.1 billion in retail sales in the United States, in 2018. Of that, she noted that $1.6 billion will be spent on the pre-filled cartridges sold mostly by the big tobacco companies, and $3.5 billion on open vapor systems; the liquid refill products, most of which are sold at vape shops.

The vaping industry, as well as traditional tobacco companies, are also gearing up for a lengthy fight with the F.D.A. over the campaign by the agency’s commissioner, Dr. Scott Gottlieb, to slash levels of nicotine in traditional cigarettes to nonaddictive or minimally addictive levels.

Dr. Gottlieb is expected to issue an initial proposal, calling for public comment on lower nicotine levels, in the near future.

The new report reflects the complexity of the issues surrounding e-cigarettes and the balancing act tobacco regulators face over the pros and cons of the many alternatives to conventional cigarettes. The notion of e-cigarettes as a gateway to conventional cigarettes for youths has been a sticking point.

Adam Leventhal, a professor of preventive medicine at the University of Southern California, and an author of the report, said his group did an exhaustive literature search, reviewing all studies on youths and e-cigarette use from around the world. Of those, they found 10 studies that they deemed strong enough to address the question. But these studies did not show that using e-cigarettes caused teens to move on to tobacco, only that the use of e-cigarettes was associated with later smoking of at least one traditional cigarette. The report noted that more than 11 percent of all high school students had used e-cigarettes within the past month, a total of nearly 1.7 million youths.

“The evidence was substantial that this association was consistent across a number of research methodologies, age ranges, locations, and research groups in and outside the U.S.,” Mr. Leventhal said.

More intriguing was the report’s finding of moderate evidence that youths who use e-cigarettes before trying tobacco, are more likely to become more frequent and intense smokers.

Critics have long contended that the flavored liquids for the devices are luring adolescents to the habit, at a time when nicotine is especially hazardous for their brain development. Three of the top-selling flavors at, a large online retailer, include “Unicorn Milk” (strawberries and cream), “TNT” (strawberry, apple and peach) and “I Love Donuts” (blueberries and pastry).

The authors of the new report cite conclusive evidence that vaping can be addictive, and that exposure to nicotine from e-cigarettes is highly variable, depends on the characteristics of the device, as well as how it is used. They also cited conclusive proof that in addition to nicotine, most e-cigarettes also contain and emit numerous potentially toxic substances.

In terms of second hand vapor, the committee said there was conclusive evidence that e-cigarette use increases airborne concentrations of particulate matter and nicotine indoors.

The report concluded that much of the current research on e-cigarettes is lacking by scientific standards and that many important areas have not yet been studied. Dr. Eaton, in an interview, said that the authors did not distinguish between industry-funded, and independent research.

Many of the existing studies were also flawed, either in methodology or because of industry-financed bias. In addition, the levels of nicotine and other chemicals, including metals, vary in e-cigarettes from brand to brand, which has complicated some research findings.

Mr. Zeller praised the report and stressed its strong findings that youths who start on e-cigarettes are more likely to become heavier users of tobacco.

“And for kids who initiate on e-cigarettes, there’s a great chance of intensive use of cigarettes. As the regulator, we’ve got to factor all that in,” Mr. Zeller said.

In July, the F.D.A. delayed the deadline at least four years for e-cigarette companies to submit applications for currently marketed products to demonstrate that their public health benefit warrants agency approval. The agency did not delay other aspects of its tobacco control work, including requirements for mandatory age and photo-ID checks to prevent illegal sales to minors and the banning of free samples.

Public health advocates who objected to the July delay, said this report gave them further concern.

“What the report demonstrates is that despite the popularity of e-cigarettes, little is known about their overall health effects, and there is wide variability from product to product,” said Matthew L. Myers, President of Campaign for Tobacco-Free Kids. “That makes the case even stronger for F.D.A. regulation. This report makes very real the concern that e-cigarettes may well increase the use of combustive tobacco products.’’

The vaping industry was cautiously optimistic about the influence of the report. Gregory Conley, president of the American Vaping Association, a nonprofit that advocates for vapor products, said it was good news. He said the findings were consistent with those reached by the Royal College of Physicians and other institutions in Britain that have issued reports indicating e-cigarettes are less dangerous than traditional smoking and help with cessation.

“The committee’s findings also fall in line with F.D.A. Director Scott Gottlieb’s nicotine strategy, a key element of which involves adult smokers switching to lower risk products,” he said. “In the wake of this report, it is more apparent than ever that true leadership is needed in public health to ensure that adult smokers have access to truthful information about the benefits of switching to smoke-free products.”

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Cigar Use Rising Among Young Adults

Flavored Tobacco Products Fueling Demand

Though fewer young people are smoking cigarettes these days, cigar smoking is increasing among youth and young adults.

Cigars include a range of products, from large traditional cigars to little cigars and cigarillos (LCCs), many of which come in flavored varieties. To better understand the market and usage pattern for each type of cigar, from 2011 to 2015 Truth Initiative® researchers surveyed more than 26,000 people between the ages of 18 and 35. Researchers asked participants if they used traditional cigars and LCCs in the last 30 days and, if so, what flavor.

smoking cigar and cancer

The results, published in Tobacco Regulatory Science, show that almost half—47 percent—of cigar smokers preferred to smoke flavored products, and nearly twice as many LCC smokers preferred flavored products compared to traditional cigar smokers. Use of flavored LCCs was more common among younger adults (18-24 years), women and those with less education.

Industry documents show that cigar manufacturers explicitly target young people by adding flavors to make their products more palatable.

For example, a 2014 study revealed internal industry studies that confirmed “menthol and candy-like flavors (e.g., vanilla and cherry)” increased the appeal of LCCs to new smokers “by masking the heavy cigar taste, reducing throat irritation and making LCC smoke easier to inhale.”

Researchers found that traditional cigar use was most common among male and Hispanic respondents. Conversely, those who preferred little cigars and cigarillos were more likely to be younger (18-24) and black. LCC smokers also smoked the products more often—nearly eight days per month on average, compared to five-and-a-half days a month for traditional cigar smokers.

“Greater frequency of tobacco use may lead to sustained use into adulthood and subsequent negative health effects,” said Allison M. Glasser, senior project manager at the Schroeder Institute® for Tobacco Research and Policy Studies.

Flavored cigar smokers were also more likely to use multiple tobacco products (poly-use).

“Poly tobacco users are at risk for increased nicotine dependence due to increased nicotine exposure,” Glasser said. “The popularity of cigars among poly tobacco users could be related to the products’ similarities to cigarettes or their availability as cheaper products sold in smaller units than cigarettes.”

Evidence also shows that tobacco companies manufacture LCCs to resemble cigarettes. Last year, four tobacco manufacturers received warnings from the Food and Drug Administration for illegally selling flavored products labeled as LCCs that the agency says are actually cigarettes.

“This study supports closing those regulatory loopholes by standardizing cigar products through the creation of a tax parity with cigarettes and requiring minimum packaging, in addition to a flavor ban,” Glasser said.

The FDA’s 2009 Family Smoking Prevention and Tobacco Control Act banned characterizing flavors, except menthol, in cigarettes. It did not address flavors in any other tobacco products. Truth Initiative has repeatedly called on the FDA to issue a rule banning the sale of all flavored tobacco products.

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Health Concerns Explode Over Vaping

Oral Lesions Drawing Attention Among Vapers

By Lindsey Konkel, Science News For Students

When Irfan Rahman talked to young vapers, some complained of bleeding mouths and throats. And these bloody sores seemed slow to heal. Such reports concerned this toxicologist at the University of Rochester in New York. So he decided to investigate what the vapors inhaled from electronic cigarettes might be doing to mouth cells.

Last October, his team showed those vapors inflame mouth cells in ways that could potentially promote gum disease. That gum damage can destroy the tissues that hold teeth in place. So severe gum disease could lead to tooth loss.

teen smoking and vaping

Vapers inhale those same gases and particles into their lungs. Rahman wondered what effects those vapors might have on cells there. One gauge would be to test how long any lung-cell damage took to heal. And his latest data confirm that e-cigarette vapors also make it hard for lung cells to repair damage.

Students as young as 12 or 13 are now more likely to vape than to smoke. Many are under the impression that because e-cigs don’t contain tobacco, they pose little risk to health. Wrong.

Over the past few months, research has turned up evidence that vaping can pose many brand new risks. The vapors mess with immunity, some studies show. “Smoker’s cough” and bloody sores have begun showing up in teen vapers. The hotter a vaped liquid gets, the harsher its effects on human cells. And a relatively new vaping behavior called “dripping” ups the heat. This threatens to intensify a teen’s risks from those vapors.

Some new data even suggest that e-cig vapors may contain cancer-causing chemicals.

“There are a lot of potentially harmful substances in e-cigarettes. If you’re a teen with your whole life in front of you, why take that risk?” asks Rob McConnell. He’s an internal medicine specialist at the University of Southern California (USC) in Los Angeles.

The newly emerging data suggest that adolescents ignore these risks at their peril.

Cells in the body face constant damage from foreign substances, infections and injury. Most times, nothing bad happens to their host. That’s because the body has a system in place to heal itself. Most major organs have special cells — fibroblasts (FY-broh-blasts) — that repair damaged or injured tissue.

Fibroblasts make up the connective tissues that keep organs in place. But when injured, these cells morph into wound-healers. “If you cut your hand, fibroblasts are the guys that are going to come in and help heal it,” explains Rahman.

In their wound-healing form, fibroblasts at the edges of a cut will shrink. This causes the wound to close up. This squeezing or contraction of the skin takes a lot of energy. Fortunately, fibroblasts are powered by cellular engines. Called mitochondria (My-toh-KON-dree-uh), these tiny powerhouses turn food (sugar) into fuel.

In the lab, Rahman and his colleagues grew lung fibroblasts in Petri dishes. Then they cut into the community of growing cells to mimic a wound. Afterward, they exposed the growing cells to e-cigarette vapors.

As expected, the fibroblasts morphed into wound-healing cells. But unexpectedly, they didn’t close up the cut. Curious, Rahman looked more closely at the cellular machinery. Some mitochondria had been destroyed. The fibroblasts simply had run out of the energy they needed before they could successfully squeeze the wound closed.

Rahman’s team described its findings March 3 in Scientific Reports.

It’s not clear yet if the fibroblast damage that Rahman showed in the lab signals that wounds will heal more slowly in people who vape. After all, in the lab, scientists can manipulate one variable at a time while holding other factors constant. But in the body, many processes will be at work all at once. This can make it harder to tease out whether such lab tests mimic well what would happen to an otherwise healthy person.

And that’s why Rahman now hopes to compare rates of wound healing in people who vape to rates in those who don’t. For now, however, he’s worried that what he saw in the lab may indeed mimic risks to people.

Inhaling pollution can irritate the lungs. And when the assaulting particles are breathed in regularly, the lungs tend to respond by triggering a cough that won’t go away, explains McConnell at USC. He has been studying the effects of air pollution in kids. Inhaling irritating particles or gases may lead to bronchitis (Bron-KY-tis). That’s when the airways that channel oxygen to the lungs become irritated and inflamed.

Bronchitis may cause wheezing, too, and coughs that bring up thick mucus known as phlegm (FLEM). The germs that cause colds, flu and bacterial infections can sometimes trigger bronchitis. So can breathing in heavily polluted air, tobacco smoke or certain chemical fumes.

When these symptoms don’t go away, the bronchitis is called chronic (KRON-ik). And cigarette smoking is its most common cause. That’s why chronic bronchitis is typically referred to as “smoker’s cough.”

McConnell’s team decided to look for signs of bronchitis in vaping teens. After all, he explains, “There are a lot of these irritants in e-cigarette vapor.”

teen vaping

The researchers asked 2,000 students in the Los Angeles, Calif., area about their vaping habits. All were in their last two years of high school. The researchers also asked the teens about any respiratory symptoms. These could include coughs or phlegm.

Anyone who reported a daily cough for at least three straight months was judged to have chronic bronchitis. A student with persistent phlegm or congestion for three months or more that was not accompanied by a cold or flu also was suspected of having chronic bronchitis.

About 500 of the students said they had vaped at some point. And about 200 had vaped within the past 30 days. Those recent vapers were about twice as likely to have chronic bronchitis as were kids who had never vaped, the researchers report. Students who had vaped in the past, but not in the last month, also were about as likely as current vapers to have chronic bronchitis.

The researchers looked for other possible causes of the teens’ persistent coughs and phlegm. One of these was local air pollution. They also looked at the teens’ exposure to triggers for allergic asthma. Such triggers can include molds and pet dander. Yet even accounting for all of that did not erase the link between vaping and chronic bronchitis.

The findings, first announced in November, will appear in an upcoming issue of theAmerican Journal of Respiratory and Critical Care Medicine.

These data also support what has been seen in studies conducted in human and animal cells, Rahman notes.

It worries McConnell that vapers show some of the same lung symptoms as cigarette smokers. It also worries him that more teens are taking up vaping. E-cigarette use grew an astounding 900 percent among high school students between 2011 and 2015.

Cigarette smokers with chronic bronchitis often develop permanent lung damage as they get older. Researchers don’t know yet whether long-term vapers will too.

“People haven’t been using e-cigarettes long enough to answer that question,” observes McConnell. E-cigarettes have been available in the United States only since 2007.

Teens lured by fruity flavors

A third new study investigated the role of flavor in e-cig use, especially by teens.

E-cigarettes don’t burn tobacco as true cigarettes do. Yet they still are considered tobacco products. That’s because the liquids that are vaporized in e-cigarettes usually contain nicotine. It’s the addictive substance found in tobacco leaves — one that also gives cigarettes their stimulant effect, or “buzz.”

A team of researchers led by Li-Ling Huang at the University of North Carolina (UNC) in Chapel Hill wanted to know whether the e-liquid’s flavor affected how safe people thought vaping was. To do this, they reviewed 40 studies on flavored tobacco products. These included flavored e-cigs. Most of the studies had been conducted between 2010 and 2016.

Both tobacco users and non-users said tobacco products were more appealing when the products had pleasing flavors. Younger people were particularly interested in fruity and candy-flavored products. In fact, this is one reason the U.S. Food and Drug Administration in 2009 banned cigarettes flavored with anything but menthol. It was to limit their appeal to kids.

“It turns out that an interest in flavors is one of the main reasons that youth try e-cigarettes,” says Adam Goldstein of UNC. An author of the new study, his past work had focused on tobacco use.

Teens also tended to perceive pleasantly flavored products as less harmful than tobacco-flavored ones, his team’s data show. Their findings are due to appear in an upcoming issue of Tobacco Control.

Goldstein says it’s important to note that just because something doesn’t taste like tobacco doesn’t mean it is safe. Studies have shown that some flavor compounds in e-liquids (such as cinnamon extract) appear to become harmful when heated in an e-cigarette.

Review studies like this one point to potentially important trends. Such studies may help shape new policies, Goldstein says. (Policies are actions taken by government, companies or other large groups.)

Goldstein believes that removing flavorings would be one way to discourage kids from experimenting with e-cigs. “Research suggests that if you remove the flavors, far fewer youth around the country would use any tobacco product,” he says. And that would put fewer kids at risk for vaping-related damage to the mouth and lungs.

Toxic metals in e-liquids

At the heart of every e-cigarette is a metal coil used to heat up the flavored e-liquid that will become a vapor. Scientists have found a number of harmful chemicals in e-cigarette vapors. Some can cause cancer. Among these are formaldehyde (For-MAAL-de-hide) and acetaldehyde (Ass-et-AAL-de-hide). Previous studies had shown that some e-liquids that were considered harmless could become toxic — but only after they were heated by an e-cig’s especially hot coil.

smoking rates global

Now Catherine Hess of the University of California, Berkeley, and her colleagues have turned up traces of toxic metals in the e-liquids used in five different brands of e-cigarettes. Those liquids came packaged from the manufacturer in non-refillable e-cigs. The scientists chose to look at these “first-generation” e-cigarettes because they are inexpensive, which can make them especially attractive to teens.

The most concerning of these metals were nickel, chromium and manganese. The amounts of them varied between brands. All three metals occur naturally in rock formations all over the planet. Inside the body, though, they can cause trouble. Research suggests that nickel and certain forms of chromium may cause cancer. Manganese can harm the nervous system.

The researchers measured only the amount of toxic metals in the e-liquids, not how much ended up in the vapor. “More research is needed to see whether e-cigarette users are being exposed to these chemicals when they inhale — and what the long-term effects of those exposures might be,” says Rahman, who was not involved in this study.

Hess’s team published its results in the January Environmental Research.

Another new study turned up benzene in e-cig vapors. This chemical is known to pose a cancer risk to people. Chemist James Pankow and his team at Portland State University in Oregon don’t know the chemical’s source. Benzene is, however, a toxic component of cigarette smoke. The levels in e-cig vapors were not as high as in cigarette smoke. Still, Pankow argues, that does not mean that vaping poses little benzene risk.

“The fact that vaping can deliver benzene levels many times higher than those found in the ambient [air] — where it’s already recognized as a cancer risk — should be of concern to anyone using e-cigarettes,” he says. Higher-power e-cigs, which burn hotter, produced the most benzene in the Portland State tests. So, Pankow now urges, “Please stay away from high power if it’s available on your device.”

His team published its findings March 8 in the journal PLOS ONE.

Concerns About Dripping

Newer-generation e-cigs allow users to choose — and change — what flavorings they heat up in their devices. Most vapers choose a liquid with nicotine (that addictive, stimulant found in tobacco). To get the biggest nicotine hit from each puff, some vapers take the outside cover off of their e-cigarette and use an eyedropper to “drip” the liquid directly onto the device’s coil.

E-liquids reach higher temperatures when dripped directly onto the coil. This also creates a bigger vapor cloud and provides a bigger throat hit. A new study now raises special concerns for teens who drip.

Allowing the liquid to get superhot can transform harmless chemicals in the e-liquid into toxic ones. (Note: At least one recent study showed that the hotter the vaped liquid became, the more likely it was to undergo such a toxic transformation.) And dripping makes this super-heating likely. Some people even use attachments, called atomizers, to do this more effectively.

Vaping hobbyists that do smoke tricks may have popularized dripping, says Suchitra Krishnan-Sarin. A psychiatrist at Yale University in New Haven, Conn., she’s been studying vaping behaviors in teens. Many now drip, she and her colleagues report.

This team surveyed 1,080 Connecticut high schoolers who said they vaped. One in every four teen vapers said he or she had tried dripping.

This is the first time any study has reported on the popularity of dripping in teens. (Researchers don’t yet know how common dripping is among adults.) The new statistics appear in the February Pediatrics.

Most teens who dripped said they had hoped it would let them make thicker vapor clouds or give the vapor a stronger taste. At present, little is known about the health risks of this type of vaping, Krishnan-Sarin notes.

And that worries her. “There’s great concern,” she says, “that kids are being exposed to higher levels of known carcinogens this way.” Researchers don’t yet know if this is true. And that’s because no one has yet studied whether more of these compounds get into the body when people drip instead of vaping normally.

For now, Krishnan-Sarin says a bigger vapor cloud or more flavorful hit probably isn’t worth the risk. “You don’t know what you’re exposing yourself to,” she points out, and no one should assume that the e-liquids and the vapors they generate are harmless.

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The History Of Tobacco Lawsuits

Lawsuits Against Tobacco Companies An Uphill Battle

Smokers, their families, and government entities have been filing lawsuits against tobacco companies for more than half a century. Over the years, tobacco litigation has seen a number of changes — from the theories of liability used by plaintiffs to the legal defenses mounted by cigarette manufacturers. Read on to learn the history of tobacco litigation and to get an idea of the types of smoking-related lawsuits being brought today.

When the first reports emerged linking cigarettes to cancer emerged in the 1950s, plaintiffs began suing cigarette manufacturers. Plaintiffs in these early cases — usually smokers with lung cancer — typically employed several legal theories in their lawsuits:

  • negligent manufacture – the tobacco companies failed to act with reasonable care in making and marketing cigarettes;
  • product liability – the tobacco companies made and marketed a product that was unfit to use;
  • negligent advertising – the tobacco companies failed to warn consumers of the risks of smoking cigarettes;
  • fraud; and
  • violation of state consumer protection statutes (most of which prohibit unfair and deceptive business practices).

lung cancer and smoking

Tobacco manufacturers responded in full force, fighting each lawsuit and refusing to settle out of court. They relied on several defense strategies, arguing that:

  • Tobacco was not harmful to smokers.
  • Smokers’ cancer was caused by other factors.
  • Smokers assumed the risk of cancer when they decided to smoke.

The tobacco companies prevailed in all of these early lawsuits. (To learn more about product liability, negligence, and fraud, see Nolo’s articles Toxic Torts: Legal Theories of Liability andDefective Product Claims: Theories of Liability.)

Litigation Based On Addiction

In the 1980s, a new wave of lawsuits emerged. In the landmark case of that time, Cipollone v. Liggett, the plaintiff and her family alleged that cigarette manufacturers knew — but did not warn consumers — that smoking caused lung cancer and that cigarettes were addictive. Although Rose Cipollone’s husband was awarded $400,000, an appellate court reversed the decision. Other plaintiffs also sued, claiming that tobacco companies knew cigarettes were addictive and caused cancer.

In defending these lawsuits, the tobacco companies argued that smokers had knowingly assumed the risks of cancer and other health problems when they began smoking. The companies also argued that various state laws were preempted by federal laws. That is, that federal laws governing tobacco advertising superseded state laws regarding the same thing, and plaintiff’s couldn’t sue under the state law. For the most part, the tobacco industry was successful in these lawsuits.

smoking and lung cancer

Plaintiff Successes & Lawsuits by the States

In the 1990s, plaintiffs began to have limited success in tobacco lawsuits, partly because some cigarette company documents were leaked showing the companies were aware of the addictive nature of tobacco. The first big win for plaintiffs in a tobacco lawsuit occurred in February 2000, when a California jury ordered Philip Morris to pay $51.5 million to a California smoker with inoperable lung cancer.

Around this time, more than 40 states sued the tobacco companies under state consumer protection and antitrust laws. These states argued that cigarettes contributed to health problems that triggered significant costs for public health systems. In these lawsuits, the tobacco companies could not use the defense that had proven so successful in lawsuits brought by individuals — that the smoker was aware of the risks and decided to smoke anyway.

In November 1998, the attorneys general of 46 states and four of the largest tobacco companies agreed to settle the state cases. Terms of the settlement are referred to as the Master Settlement Agreement.

Highlights include:

  • Tobacco companies agreed to refrain from engaging in certain advertising practices, particularly ad campaigns that marketed cigarettes towards kids.
  • Tobacco companies agreed to pay annual sums of money to the states to compensate them for health-care costs related to smoking (a minimum of $206 billion over the first twenty-five years).
  • The settlement created and funded the National Public Education Foundation, dedicated to reducing youth smoking and preventing diseases associated with smoking.
  • Tobacco companies dissolved three of the biggest tobacco industry organizations.

Recent Developments in Tobacco Litigation

In recent years, several key court decisions have paved the way for a raft of individual lawsuits against tobacco companies and have opened the door for class action lawsuits that focus on light cigarettes.

Individual Lawsuits in Florida

In 2006, the Florida Supreme Court threw out a class action lawsuit brought on behalf of 700,000 smokers and their families against tobacco companies. In its ruling, the court found that tobacco companies knowingly sold dangerous products and kept smoking health risks concealed, but that the case could not proceed as a class action. Instead, the court ruled that each case must be proven individually.

This ruling paved the way for over 8,000 smokers and their families to bring individual lawsuits against the tobacco companies. By 2015, according to RJ Reynolds regulatory filings, the company faced jury verdicts totaling almost $300 million, although many of those cases are in various stages of appeal.

lung cancer and smoking tobacco

Light Cigarettes

Another batch of tobacco lawsuits focuses on light cigarettes. Light cigarettes have special filters designed to dilute the smoke inhaled by smokers. Plaintiffs in these cases allege that tobacco companies advertise light cigarettes as being healthier than regular cigarettes, when in fact they are no safer than non-light cigarettes.

Tobacco companies respond that “light” refers to the taste of the cigarettes, not the amount of nicotine ingested, and that consumers should understand what “light” means. They have also raised federal preemption as a defense against state class action lawsuits, arguing that federal legislation regarding cigarette advertising supersedes state laws that prohibit deceptive advertising practices.

In December 2008, the U.S. Supreme Court threw out the tobacco companies’ preemption arguments in a class action light cigarette lawsuit brought in Maine. In allowing the Maine case to proceed, the Supreme Court ruled that federal legislation does not preempt plaintiffs from suing under certain state unfair business practice laws. This will open the door for similar lawsuits against tobacco companies. The Supreme Court, however, didn’t rule on any of the underlying claims — plaintiffs will still have to prove that the cigarette companies violated Maine’s consumer protection laws.

In a 2014 wrongful death lawsuit against RJ Reynolds, a Florida jury awarded more than $23 billion in punitive damages to the widow of a former smoker, but in 2015 a Florida appeals court shrank that award way down to just under $17 million.

Any type of tobacco litigation involves complex legal theories, detailed and intricate scientific analyses, and often aggressive defendants. If you want to explore whether you or a loved one can bring a claim against a cigarette manufacturer, talk to a lawyer that specializes in this field and knows the status of tobacco litigation in your particular state.

Tobacco, Deceit and Death.

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