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 e-liquid.com, 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.”

Read The Full Story About Vaping and Teen Smoking

public relations and public affairs firm

Crossbow Communications is a full-service advertising agency and public relations firm in Denver, Colorado and Phoenix, Arizona. The PR firm specializes in issue management and public affairs. Write to Gary Chandler to learn more how we can help build your brand, your bottom line and a better world. gary@crossbow1.com

E-Cigarettes Like Selling Candy To Teens

E-Cigarettes Hooking Teenage Smokers

Use of the devices among middle- and high school students tripled from 2013 to 2014, according to federal data released on Thursday, bringing the share of high school students who use them to 13 percent — more than smoke traditional cigarettes.

About a quarter of all high school students and 8 percent of middle school students — 4.6 million young people altogether — used tobacco in some form last year. The sharp rise of e-cigarettes, together with a substantial increase in the use of hookah pipes, led to 400,000 additional young people using a tobacco product in 2014, the first increase in years, though researchers pointed out the percentage of the rise fell within the report’s margin of error.

teen smoking e-cigarette

But the report also told another story. From 2011 to 2014, the share of high school students who smoked traditional cigarettes declined substantially, to 9 percent from 16 percent, and use of cigars and pipes ebbed too. The shift suggested that some teenage smokers may be using e-cigarettes to quit.

Smoking is still the single-biggest cause of preventable death in the United States, killing more than 480,000 Americans a year, and most scientists agree that e-cigarettes, which deliver the nicotine but not the dangerous tar and other chemicals, are likely to be far less harmful than traditional cigarettes.

The numbers came as a surprise and seemed to put policy makers into uncharted territory. The Food and Drug Administration took its first tentative step toward regulating e-cigarettes last year, but the process is slow, and many experts worry that habits are forming far faster than rules are being written. Because e-cigarettes are so new, scientists are still gathering evidence on their long-term health effects, leaving regulators scrambling to gather data.

In interviews, teenagers said that e-cigarettes had become almost as common at school as laptops, a change from several years ago, when few had seen them.

“It’s the healthy alternative taking over my school,” said Tom, a 15-year-old sophomore at a school in Westchester County, N.Y., who started vaping — the term for puffing on an e-cigarette — to kick a smoking habit. He said about 70 percent of his friends now vaped. But opinions were mixed on why the devices had caught on. A significant share said they were using the devices to quit smoking cigarettes or marijuana, while others said they had never smoked but liked being part of the trend and enjoyed the taste. Two favorite flavors of teenagers interviewed were Sweet Tart and Unicorn Puke, which one student described as “every flavor Skittle compressed into one.”

Joe Stevonson, 18, a senior at a high school in Jackson, Miss., said he used e-cigarettes to quit smoking, after the habit started affecting his ability to play sports. He prefers a flavor called Courtroom, endorsed by the rapper Lil Ugly Mane, which is described on websites where it is sold as “a medley of things you might want while waiting for the jury to convict.”

As for whether he still craved cigarettes, “the only thing that’s really missing is feeling like your entire mouth is coated in dirt,” he said. “I’ve seen a lot of people who don’t smoke pick them up because it looks cool. But for every person I’ve met like that, I’ve met another using it like it’s a medicine against cigarettes.”

James, 17, the senior in Virginia, said he and his friends started using e-cigarettes when he was 13, after his father abandoned the devices in a failed effort to quit smoking.

“It was something for us to do that was edgy and exciting,” said James, who asked that his last name not be used because he did not want his smoking habits to be on public display. He liked the smoke tricks that his friends had become good at, like blowing out the vapor so that it spun like a tornado. His favorite flavor is called Hawk Sauce, which he described as “a berry menthol kind of thing.”

He has never smoked cigarettes and said he could not imagine ever starting. “There’s a harshness to cigarettes,” he said. “Girls think they’re gross.”

E-cigarette use had grown exponentially in previous years, but from such a low base that the numbers had been relatively small. But last year’s rise, which was captured in the Centers for Disease Control and Prevention’s annual youth tobacco survey of about 20,000 schoolchildren, lifted e-cigarette use above that of traditional cigarettes, prompting an outcry from anti-tobacco advocates. They warned that e-cigarettes were undoing years of progress among the country’s most vulnerable citizens by making the act of puffing on a tobacco product normal again, and by introducing nicotine, an addictive substance, to a broad population of teenagers.

“This is a really bad thing,” said Dr. Thomas R. Frieden, the director of the C.D.C., who noted that research had found that nicotine harms the developing brain. “This is another generation being hooked by the tobacco industry. It makes me angry.”

But the numbers had a bright side. The decline in cigarette use among teenagers accelerated substantially from 2013 to 2014, dropping by 25 percent, the fastest pace in years.

The pattern seemed to go against the dire predictions of anti-tobacco advocates that e-cigarettes would become a gateway to cigarettes among youths, and suggested they might actually be helping, not hurting. The pattern resembled those in Sweden and Norway, where a rise in the use of snus, a smokeless tobacco product, was followed by a sharp decline in cigarette use.

“They’re not a gateway in, and they might be accelerating the gateway out,” said David B. Abrams, executive director of the Schroeder Institute for Tobacco Research and Policy Studies, an anti-tobacco group.

Some teenagers described vaping as an entirely different culture from cigarette smoking, and scoffed at the idea that it could be a way into cigarettes. Kenny, the senior from Florida, said students liked the mix-and-match accessories that a user could “personalize and call your own.”

“E-cigarettes appeal less towards the stereotypical longhaired stoners, and more towards sweatshirt-blue-jeans Silicon Valley programmer,” said Kenny, who asked that his last name not be published to keep his vaping habits private. “You can compare them to Apple computers.”

Selling e-cigarettes to minors is banned in many states, and the rule the F.D.A. proposed last year would ban it nationally.

But the proliferation of vape shops and equipment for sale online has made access easy, and some teenagers said they simply clicked a button to indicate they were over 18 to be able to order a starter kit. (E-cigarette equipment includes batteries that can be shaped like cigarettes or a cellphone; liquid reservoirs, known as tanks; cartridges; and battery chargers.)

Ethan deLehman, 17, a junior at a private school in Pennsylvania, said he used to ask seniors who were 18 to buy him e-cigarettes at convenience stores, but now he has equipment and buys his liquids on the Internet.

“You can just go online and click yes,” he said. He has used e-cigarettes to quit smoking, a habit he picked up to relieve the pressure over getting into college. His favorite flavors are Caramel Tobacco and Creamsicle.

A starter e-cigarette kit can begin around $40 and go up to $200 or more, with the fluid costing from $7 to $20 a bottle. That can be less expensive than smoking over the long run, particularly in states like New York where the cost of a pack of cigarettes is high, young people said. Alexander Wilson started smoking cigarettes when he was 15. He said that e-cigarettes helped him cut down and save money. “It’s cheaper over all for how much I smoke,” said Mr. Wilson, who lives in Frederick, Md.

Teen Smoking News via http://www.nytimes.com/2015/04/17/health/use-of-e-cigarettes-rises-sharply-among-teenagers-report-says.html?_r=0