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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FDA Takes Steps To Regulate Nicotine

Agency Delays E-cigarette, Cigar Compliance Deadlines

The U.S. Food and Drug Administration today announced a new comprehensive plan for tobacco and nicotine regulation that will serve as a multi-year roadmap to better protect kids and significantly reduce tobacco-related disease and death. The approach places nicotine, and the issue of addiction, at the center of the agency’s tobacco regulation efforts. The goal is to ensure that the FDA has the proper scientific and regulatory foundation to efficiently and effectively implement the Family Smoking Prevention and Tobacco Control Act. To make certain that the FDA is striking an appropriate balance between regulation and encouraging development of innovative tobacco products that may be less dangerous than cigarettes, the agency is also providing targeted relief on some timelines described in the May 2016 final rule that extended the FDA’s authority to additional tobacco products. The agency will also seek input on critical public health issues such as the role of flavors in tobacco products.

lung cancer and smoking tobacco

Tobacco use remains the leading cause of preventable disease and death in the United States, causing more than 480,000 deaths every single year.

In addition to the devastating human toll caused mainly by cigarette smoking, tobacco also causes substantial financial costs to society, with direct health care and lost productivity costs totaling nearly $300 billion a year. A key piece of the FDA’s approach is demonstrating a greater awareness that nicotine – while highly addictive – is delivered through products that represent a continuum of risk and is most harmful when delivered through smoke particles in combustible cigarettes.

“The overwhelming amount of death and disease attributable to tobacco is caused by addiction to cigarettes –  the only legal consumer product that, when used as intended, will kill half of all long-term users,” said FDA Commissioner Scott Gottlieb, M.D. “Unless we change course, 5.6 million young people alive today will die prematurely later in life from tobacco use. Envisioning a world where cigarettes would no longer create or sustain addiction, and where adults who still need or want nicotine could get it from alternative and less harmful sources, needs to be the cornerstone of our efforts – and we believe it’s vital that we pursue this common ground.”

The FDA plans to begin a public dialogue about lowering nicotine levels in combustible cigarettes to non-addictive levels through achievable product standards. The agency intends to issue an Advance Notice of Proposed Rulemaking (ANPRM) to seek input on the potential public health benefits and any possible adverse effects of lowering nicotine in cigarettes. Because almost 90 percent of adult smokers started smoking before the age of 18 and nearly 2,500 youth smoke their first cigarette every day in the U.S., lowering nicotine levels could decrease the likelihood that future generations become addicted to cigarettes and allow more currently addicted smokers to quit.

“Because nicotine lives at the core of both the problem and the solution to the question of addiction, addressing the addictive levels of nicotine in combustible cigarettes must be part of the FDA’s strategy for addressing the devastating, addiction crisis that is threatening American families,” said Commissioner Gottlieb. “Our approach to nicotine must be accompanied by a firm foundation of rules and standards for newly-regulated products. To be successful all of these steps must be done in concert and not in isolation.”

quit smoking information

The FDA is committed to encouraging innovations that have the potential to make a notable public health difference and inform policies and efforts that will best protect kids and help smokers quit cigarettes. To make this effort successful, the agency intends to extend timelines to submit tobacco product review applications for newly regulated tobacco products that were on the market as of Aug. 8, 2016. This action will afford the agency time to explore clear and meaningful measures to make tobacco products less toxic, appealing and addictive. For example, the FDA intends to develop product standards to protect against known public health risks such as electronic nicotine delivery systems (ENDS) battery issues and concerns about children’s exposure to liquid nicotine. It also will provide manufacturers additional time to develop higher quality, more complete applications informed by additional guidance from the agency.

The agency plans to issue this guidance describing a new enforcement policy shortly. Under expected revised timelines, applications for newly-regulated combustible products, such as cigars, pipe tobacco and hookah tobacco, would be submitted by Aug. 8, 2021, and applications for non-combustible products such as ENDS or e-cigarettes would be submitted by Aug. 8, 2022. Additionally, the FDA expects that manufacturers would continue to market products while the agency reviews product applications.

Importantly, the anticipated new enforcement policy will not affect any current requirements for cigarettes and smokeless tobacco, only the newly-regulated tobacco products such as cigars and e-cigarettes. This approach also will not apply to provisions of the final rule for which compliance deadlines already have passed, such as mandatory age and photo-ID checks to prevent illegal sales to minors. It also will not affect future deadlines for other provisions of the rule, including, but not limited to, required warning statements, ingredient listing, health document submissions, harmful and potentially harmful constituent reports, and the removal of modified risk claims, i.e., “light,” “low,” or “mild,” or similar descriptors.

“This comprehensive plan and sweeping approach to tobacco and nicotine allows the FDA to apply the powerful tools given by Congress to achieve the most significant public health impact,” said Mitch Zeller, J.D., director of the FDA’s Center for Tobacco Products. “Public input on these complex issues will help ensure the agency has the proper science-based policies in place to meaningfully reduce the harms caused by tobacco use.”

American Heart Association CEO Nancy Brown issued the following comments on the U.S. Food and Drug Administration’s new plan for tobacco and nicotine regulation, announced today:

“FDA’s move today to lower nicotine levels and take a harder look at how flavored tobacco products attract the young is to be commended. However, the Association is disappointed with the agency’s decision to delay certain e-cigarette and cigar compliance deadlines. Altering the deadline for FDA review of e-cigarettes and cigars is a troubling step and one that we will closely monitor.

We are also concerned that the FDA has raised the possibility of exempting premium cigars in the future. Tobacco in any form presents risk. That’s why we have advocated for – and will continue to insist – that FDA oversight of all tobacco products is absolutely essential. Premium cigars are no different. Cigars are a concern because high school-aged males now smoke them at a higher rate than cigarettes. As we have seen in recent Senate legislation, often the definition for “premium cigars” creates a loophole that allows the flavored and cheap cigars that attract youth to qualify as “premium.” Weakening the deeming rule in any way could lead to an increasing number of Americans at risk for heart disease, stroke or even an early death due to tobacco use.

smoke cigar and cancer

In order to further explore how best to protect public health in the evolving tobacco marketplace, the agency also will seek input from the public on a variety of significant topics, including approaches to regulating kid-appealing flavors in e-cigarettes and cigars. In particular, the FDA intends to issue ANPRMs to: 1) seek public comment on the role that flavors (including menthol) in tobacco products play in attracting youth and may play in helping some smokers switch to potentially less harmful forms of nicotine delivery; and 2) solicit additional comments and scientific data related to the patterns of use and resulting public health impacts from premium cigars, which were included in the FDA’s 2016 rule. Additionally, the agency plans to examine actions to increase access and use of FDA-approved medicinal nicotine products, and work with sponsors to consider what steps can be taken under the safety and efficacy standard for products intended to help smokers quit.

As the FDA carries out its new nicotine and tobacco plan, we urge the agency to remember that protecting public health, particularly the health of young people in this country, should be at the very top of its priority list. While we look forward to agency actions that can lower the number of Americans exposed to the harms of combustible tobacco, the FDA must advance all tobacco regulation. We must not take two steps forward and then one step back.”

Nicotine News

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