TIME E-Cigarettes

Toronto Bans E-Cigarettes From City Workplaces

An e-cigarette on March 05, 2013 in Paris.
An e-cigarette in Paris. Europe is moving faster than the U.S. to regulate. Kenzo Tribouillard—AFP/Getty Images

Mayor Rob Ford reportedly voted against the ban

The Toronto City Council voted 36-2 in favor of banning e-cigarettes from all city workplaces on Monday.

According to a Toronto Sun reporter, Mayor Rob Ford was one of the two votes against the ban.

The vote was part of a marathon session for the city council which could last several days and will address some 400 items from e-cigarettes to traffic lights.

Toronto is not the first major city in North America to issue a prohibition on e-cigarettes. In March, Los Angeles became the third city after New York and Chicago to outlaw e-cigarettes at the office, and Philadelphia followed soon after.

But the L.A. ban extended further than city workplaces with bans in place for bars, restaurants, and parks. In New York, e-cigarette smokers cannot vape anywhere where conventional smoking is also banned, and in Chicago, there’s an indoor smoking ban in place. Smaller cities have also taken up the issue, and it’s expected that more cities will consider similar bans.

Health Canada, the government’s public health department, advised Canadians not to buy e-cigarettes as long ago as 2009, CTV News reports, but there are no formal prohibitions on the sale of e-cigarettes unless they are “expressly intended” for nicotine delivery. That allows many retailers to circumvent a crackdown by regulators.

Earlier this year, the FDA said it would increase its regulation over e-cigarettes, and on Sunday night, the American Heart Association called for stricter oversight, especially when it comes to marketing to kids.

TIME Addiction

E-Cigs Should Only Be “Last Resort” for Quitters, Experts Say

A salesman waits for customers as he enjoys an electronic cigarette at a store in Miami, Florida on April 24, 2014.
A salesman waits for customers as he enjoys an electronic cigarette at a store in Miami, Florida on April 24, 2014. Joe Raedle—Getty Images

E-cigarettes are everywhere—and are reportedly quitters’ favorite tool with some experts claiming it’s a healthy alternative to traditional tobacco. But vaping doesn’t deserve its health halo, says the American Heart Association (AHA) in a policy statement released today in its journal Circulation.

The group calls for an overhaul of how we deal with e-cigs, advocating for stricter laws, industry oversight by the government, and more rigorous research.

Right now, e-cigs are a Wild West industry, with 10 new companies coming to market every month. The FDA doesn’t yet regulate them—though the agency plans to—fueling concerns about possible contaminants, quality control, labeling, and marketing. There’s not much research about the public health impacts of e-cigs. Yet they’re a big business, and sales are expected to rake in $10 billion by 2017, according to predictions by Wells Fargo.

Many people use e-cigs, many of which contain nicotine but not tobacco, to wean themselves off of cigarettes. Their reputation as cigarette-cessation tools is widespread—though more research is needed to see if that reputation is warranted. “We don’t have much data on the efficacy as a cessation aid,” lead author Aruni Bhatnagar, chair of cardiovascular medicine at the University of Louisville, tells TIME. E-cigarettes aren’t approved by the FDA as tools to help people quit, and the AHA says that there’s a lack of evidence that they actually work for that purpose. However, some studies suggest e-cigarettes may perform as well or a bit better than nicotine patches, so they should be viewed as a last resort when other methods fail.

Another concern is marketing to young people. Television ads for e-cigarettes reached an estimated 24 million youth between 2011 and 2013, the AHA report says. And a separate CDC study released today in the journal Nicotine and Tobacco Research found that more than a quarter of a million youth who’ve never tried a cigarette puffed the electronic version in 2013. That’s a three-fold increase from 2011-2013.

“We have grave concerns about industry marketing and advertising of e-cigarettes to children,” Bhatnagar says. The AHA is calling for a federal tax on e-cigarettes, which may help deter young would-be adopters, in addition to a ban on flavorings. (E-cigs come in more than 7,000 flavors like mint and chocolate, which tend to appeal to younger users.) And while many states ban the sale of e-cigarettes to minors, the AHA is calling for a federal ban on the sale to minors.

Walk into any smoke-free area and you’re bound to encounter e-cigarettes—another fact the AHA wants to change by subjecting e-cigarettes to the same laws as tobacco products. On Monday, Toronto joined the growing list of cities banning e-cigs in the workplace.

There’s still a lot we don’t know about e-cigarettes, including how chemicals and nicotine interact with the environment and bystanders, and normalizing smoking behavior undoes years of anti-smoke crusading, the AHA says. So the group recommends that e-cigs be classified as tobacco products to subject them to the same smoke-free air laws.

“We don’t have much data on what their long-term health impact is going to be,” Bhatnagar says. “It will be five to seven years before we know what happens to cardiovascular health.”

TIME Research

Ice Bucket Challenge Nears $80-Million Mark

Supporters of Michael Brown, Kalisha Gilmore (L) and Recorida Kennedy (R), pour ice water on Kevin Ephron as he takes the ice bucket challenge in remembrance of Brown along Canfield Drive, where he was fatally shot by a police officer in Ferguson, Missouri August 24, 2014.
Supporters of Michael Brown, Kalisha Gilmore (L) and Recorida Kennedy (R), pour ice water on Kevin Ephron as he takes the ice bucket challenge in remembrance of Brown along Canfield Drive, where he was fatally shot by a police officer in Ferguson, Missouri August 24, 2014. Joshua Lott—Reuters

The funds have come from 1.7 million donors

The ALS Association has raised $79.7 million to combat Lou Gehrig’s Disease since July 29, as the Ice Bucket Challenge continues to encourage people around the world to dump ice over their heads and send in money.

The organization raised just $2.5 million during the same period last year.

The Ice Bucket Challenge, which began last month and has become a viral Internet sensation, has attracted 1.7 million contributors. Political figures like George W. Bush and celebrities like Ben Affleck and Jennifer Garner have taken the challenge.

The ALS Association, which raised $64 million in all of 2013, has described the influx in funds as “a game changer” for the organization’s efforts.

Other groups outside the ALS Association have benefited from the challenge, too. The Project ALS, which also raises money for ALS research, said earlier this month that the challenge has attracted donations.

TIME Heart Disease

E-Cigs Should Be Last Resort for Quitters, Heart Group Says

A salesman waits for customers as he enjoys an electronic cigarette at a store in Miami, Florida on April 24, 2014.
A salesman waits for customers as he enjoys an electronic cigarette at a store in Miami, Florida on April 24, 2014. Joe Raedle—Getty Images

The American Heart Association calls for tighter e-cigarette regulations, but gives the OK for a small amount of smoking cessation use

Electronic cigarettes should be used to help smokers quit only if proven cessation methods like nicotine patches fail, the American Heart Association said late Sunday.

The AHA acknowledged that e-cigs haven’t yet been proven to be good tools for quitting smoking, though some research has suggested they may be about equal to or slightly better than nicotine patches. The new recommendation is part of the AHA’s policy statement on e-cigarettes. The AHA calls for more regulation of e-cigs, which is something the FDA has promised in the past. The AHA says it fears any further delay in these regulations could have serious public health consequences.

Specifically, the AHA calls for new and stronger regulations for how e-cigarettes are marketed, especially to young people. It recommends a ban on sales to minors, since some research has shown that young people consider using e-cigarettes as a convenient method for smoking. Public health experts have long worried that e-cigarettes could serve as a gateway to other tobacco products, like the much unhealthier conventional cigarettes.

The group says some research suggesting e-cigarettes could normalize smoking are troubling, especially data showing youth exposure to e-cigarette advertising has spiked 250% from 2011 to 2013. “These disturbing developments have helped convince the association that e-cigarettes need to be strongly regulated, thoroughly researched and closely monitored,” AHA CEO Nancy Brown said in a statement.

Whether e-cigarettes are just another vector for nicotine exposure to American youth is a hotly debated topic among public health experts. Some hold the belief that pushing smokers toward lower-level nicotine carriers could ultimately help people quit, while others say there’s no space for more addictive products in the U.S. market.

TIME Obesity

Parents Think Their Overweight Kids Are Healthy, Study Finds

New research shows parents often think their overweight kids are a healthy size

Parents are increasingly viewing their overweight kids as “healthy.”

Between 2005 and 2008, parents—mostly mothers—were more likely to say they viewed their overweight child as healthy, compared to parents surveyed between 1988 and 1994, according to a new study published in the journal Pediatrics. The largest increases were seen among low income parents, followed by African Americans. These also happen to be groups at a higher risk for obesity.

What’s troubling is that parents often judge their child’s weight based on how he or she measures up to their peers, suggesting that overweight is increasingly the norm, the researchers say. As Americans get heavier, the new study suggests, perceptions of what’s healthy becomes distorted.

“We rarely compare our weight status against an absolute scale or a number recommended by doctors,” says study author Dr. Jian Zhang of Georgia Southern University. “Instead we compare to what our friends, neighbors, and coworkers look like. If we look like most of others, we of course perceive that we are just fine. As the prevalence of pediatric obesity has tripled within decades, the socially accepted ideal body weight may also be shifting accordingly.”

As more children become overweight, the trend shows that more parents will not think their child is unhealthy, and will be less likely to take action. That could lead to a vicious cycle, the researchers warn. “At a certain point, if no effective strategies are taken now to reverse this trend, all kids are obese, and they continuously carry the extra weight and the risk of various health problems into adulthood,” says Zhang.

The researchers call on pediatricians to talk to their patients—and their patients’ parents—about a healthy weight.

TIME Research

School Should Start Later So Teens Can Sleep, Urge Doctors

The American Academy of Pediatricians (AAP) says there’s strong scientific evidence to support later school start times for middle and high schoolers

+ READ ARTICLE

When it comes to the importance of sleep, it’s all about the biology, say pediatric experts. And in a report released Monday, the American Academy of Pediatrics supports pushing back start times for older kids, particularly teens, because it’s better for their mental and physical health.

“The evidence is clearly mounting both in terms of understanding the repercussions that chronic sleep loss has on the health, safety and performance of adolescents, and there is also really solid compelling data supporting the fact that delaying school start times is a very important intervention that can mitigate some of the impact of sleep loss,” says Dr. Judith Owens, director of sleep medicine at Children’s National Medical Center and lead author of the report.

In a statement published in the journal Pediatrics, the Academy’s Adolescent Sleep Working Group reviewed the studies to date involving how inadequate sleep among teens—which means anything less than 8.5 hours to nine hours a night on school days—can contribute to health issues such as obesity, diabetes, mood changes and behavior problems. They even analyzed studies linking poor sleep to increased reliance of substances like caffeine, tobacco and alcohol and the effect of sleep deprivation on academic performance. The evidence, they concluded, supports giving teens more time in bed by pushing back the time they have to be at school to at least 8:30am. Even a half-hour delay, some studies showed, can have dramatic effects on improving children’s health and academic performance.

MORE: The Most Well-Rested and Sleep-Deprived Cities in the World

The AAP committee studied the issue of adolescent sleep for nearly four years to come up with this policy statement, says Owens, and that data show that puberty may biologically wire teens to stay up late and wake up late—which means that forcing them to bed earlier won’t do much good. Something about the hormonal changes occurring during that period of development shifts their body clocks, which regulate the balance between sleeping and waking, later, like daylight savings in reverse. Puberty also pressures kids to stay up later because the normal sense of tiredness that builds up during the day is slower to develop among teens, so they can’t fall asleep earlier even if they wanted to. ”It doesn’t change how much sleep they need, but it makes it easier for them to stay awake longer,” says Dr. Mary Carskadon, a professor of psychiatry and human behavior at Brown University Medical School and director of sleep and chronobiology at Bradley Hospital.

That’s why delaying school start times may make more sense than enforcing earlier bedtimes. According to a 2006 National Sleep Foundation poll, 87% of high school students don’t get the recommended 9 to 10 hours of sleep they need to function at their best and promote healthy mental and physical development; most average around seven hours of sleep on weeknights. And the effects of that deprivation may show up in their grades; about 30% of students report falling asleep in class at least once a week, and studies consistently connect less sleep with lower grades in school and on standardized tests. Students who don’t get the recommended amount of sleep also tend to have higher rates of anxiety and mood disorders, including depressive symptoms.

But in the 70 school districts involving more than 1,000 schools that have adopted later start times for high school students, teachers, parents and the students themselves are seeing substantial benefits. In one district that pushed back start times by one hour, half of the students reported getting eight or more hours of sleep, compared to 37% who had prior to the shift.

MORE: Less Sleep Pushes Your Brain to Age Faster

Owens and her colleagues also conducted a study among students at an independent school that delayed start times by 30 minutes. That was enough to shift bed times earlier, by an average of 18 minutes, something that surprised her and her team. They also found that the delay increased the percentage of students getting eight or more hours of sleep a night. “Anecdotally, a lot of the students said they felt better with the extra half hour of sleep they got in the morning, and that motivated them to go to bed earlier as well,” she says. “They said they could focus better and concentrate better and that it took them less time to get their homework finished so they could go to bed earlier.”

None of the studies show that delaying school start times encourages students to go to bed even later, a concern that some parents and health care workers have raised about the policy.

Having high school students start later may also have domino effects on everything from their extra curricular activities, including sports, which often occur after school, and on child care issues for parents who rely on older children to take care of their younger siblings following school. “Communities and school districts really need to go all in and make a commitment [to it],” says Carskadon. “Where it doesn’t work is where schools just dabble and say they will try it for six months to see how it works.” Adds Dr. Cora Breuner, professor of pediatrics and adolescent medicine at Seattle Children’s Hospital at University of Washington and a member of the committee, “we know that implementation of our recommendations wild be challenging but we stand behind these recommendations and strongly ask that they be considered for the health of our children.”

MORE: Poor Sleep Affects Babies’ Weight Later In Life

And in some districts, efforts to overcome the hurdles are starting to work. Some schools, for example, have created after-school programs where younger children can remain at school in a supervised setting until their older siblings or parents can take them home. And in communities in Minnesota and Massachusetts, where elementary school students are starting school earlier to accommodate bus service for the older students later, community volunteers have manned the stops to ensure younger children are safe while they are waiting to be picked up during early morning hours.

“The hope is that this statement will galvanize communities,” says Carskadon. “Now they have another tool in their tool kit, and another set of evidence and advice to take to school committees and school boards, to get communities moving on addressing adolescent sleep.” Given the state of the data on how poor sleep affects adolescent development, adds Owens, “to do nothing Is really to do harm. The status quo of starting schools at 7:15 or 7:20 is not in the best interest of the students.”

TIME India

India’s ‘Untouchables’ Are Still Being Forced to Collect Human Waste by Hand

World's Dirtiest Job
Devi Lal, a 43-year-old manual scavenger, cleans drains in New Delhi on July 13, 2012 Sagar Kaul—Barcroft Media/Getty Images

They face violence, eviction and withheld wages if they do not take on the hazardous job of emptying private and public latrines

The practice of forcing low-caste people in Indian communities to remove accumulated human waste from latrines is continuing despite legal prohibitions and must be stopped, says a leading advocacy group.

In a report released Monday, the New York City–based Human Rights Watch (HRW) detailed the practice of “manual scavenging” — the collecting of excrement from latrines by hand. The job is done by those considered to be of the lowest birth. These Dalits, or untouchables, often face threats of violence, eviction and withheld wages if they attempt to leave the trade.

“The first day when I was cleaning the latrines and the drain, my foot slipped and my leg sank in the excrement up to my calf,” Sona, a manual scavenger in Bharatpur, a city in the northwestern state of Rajasthan, told HRW. “I screamed and ran away. Then I came home and cried and cried. I knew there was only this work for me.”

Laws exist to curb this form of subjugation, yet it remains widespread across India. Dalit women typically collect waste from private homes, while the men do the more physically demanding, and hazardous, maintenance of septic tanks and public sewers. Many suffer injuries and serious health problems.

“The manual carrying of human feces is not a form of employment, but an injustice akin to slavery,” says Ashif Shaikh, founder of Rashtriya Garima Abhiyan, a grassroots campaign to end manual scavenging. “It is one of the most prominent forms of discrimination against Dalits, and it is central to the violation of their human rights.”

HRW’s 96-page report, Cleaning Human Waste: ‘Manual Scavenging,’ Caste, and Discrimination in India, is based on more than 100 interviews with manual scavengers, and documents how these wretched people are coerced to collect human excrement on a daily basis, carrying it away in nothing more protective than a cane basket.

“People work as manual scavengers because their caste is expected to fulfill this role, and are typically unable to get any other work,” says Meenakshi Ganguly, South Asia director at HRW. “This practice is considered one of the worst surviving symbols of untouchability because it reinforces the social stigma that these castes are untouchable and perpetuates discrimination and social exclusion.”

HRW called on the administration of Prime Minister Narendra Modi to enforce existing legislation aimed at assisting manual scavengers to find alternative, sustainable livelihoods.

“Successive Indian government attempts to end caste-based cleaning of excrement have been derailed by discrimination and local complicity,” adds Ganguly. “The government needs to get serious about putting laws banning manual scavenging into practice and assisting the affected caste communities.”

TIME Education

Pediatricians’ Rx for Schools: Later Start Times

Julian Lopez, Ben Montalbano, James Agostino
From left: students Julian Lopez, Ben Montalbano, and James Agostino listen during their physics class at Woodrow Wilson High School in Washington on Feb. 7, 2014. Charles Dharapak—AP

Evidence on potential dangers for teens who get too little sleep is "extremely compelling"

(CHICAGO) — Pediatricians have a new prescription for schools: later start times for teens.

Delaying the start of the school day until at least 8:30 a.m. would help curb their lack of sleep, which has been linked with poor health, bad grades, car crashes and other problems, the American Academy of Pediatrics says in a new policy.

The influential group says teens are especially at risk; for them, “chronic sleep loss has increasingly become the norm.”

Studies have found that most U.S. students in middle school and high school don’t get the recommended amount of sleep — 8½ to 9½ hours on school nights; and that most high school seniors get an average of less than seven hours.

More than 40 percent of the nation’s public high schools start classes before 8 a.m., according to government data cited in the policy. And even when the buzzer rings at 8 a.m., school bus pickup times typically mean kids have to get up before dawn if they want that ride.

“The issue is really cost,” said Kristen Amundson, executive director of the National Association of State Boards of Education.

School buses often make multiple runs each morning for older and younger students. Adding bus drivers and rerouting buses is one of the biggest financial obstacles to later start times, Amundson said. The roughly 80 school districts that have adopted later times tend to be smaller, she said.

After-school sports are another often-cited obstacle because a later dismissal delays practices and games. The shift may also cut into time for homework and after-school jobs, Amundson said.

The policy, aimed at middle schools and high schools, was published online Monday in the journal Pediatrics.

Evidence on potential dangers for teens who get too little sleep is “extremely compelling” and includes depression, suicidal thoughts, obesity, poor performance in school and on standardized tests and car accidents from drowsy driving, said Dr. Judith Owens, the policy’s lead author and director of sleep medicine at Children’s National Medical Center in Washington, D.C.

The policy cites studies showing that delaying start times can lead to more nighttime sleep and improve students’ motivation in class and mood. Whether there are broader, long-term benefits requires more research, the policy says.

Many administrators support the idea but haven’t resolved the challenges, said Amundson. She said the pediatricians’ new policy likely will have some influence.

Parents seeking a change “will come now armed with this report,” Amundson said.

Amundson is a former Virginia legislator and teacher who also served on the school board of Virginia’s Fairfax County, near Washington, D.C. Owens, the policy author, has been working with that board on a proposal to delay start times. A vote is due in October and she’s optimistic about its chances.

“This is a mechanism through which schools can really have a dramatic, positive impact for their students,” Owens said.

TIME infectious diseases

2 People Die of Ebola in Democratic Republic of Congo

But the deaths are not related to the current outbreak in West Africa, health officials in Congo say

Two people have died of Ebola in the Democratic Republic of Congo, though the cases may be unrelated to the outbreak in West Africa that has killed more than 1,400 people.

Of eight samples taken in the Boende region of Congo’s northwest Equateur province, two came back positive, Health Minister Felix Kabange Numbi said Sunday, the Associated Press reports. Eleven people are sick and in isolation, and 80 contacts are being traced.

“This epidemic has nothing to do with the one in West Africa,” Kabange said.

Ebola has killed 13 people in the region, including five health workers. The current cases are part of the seventh outbreak of Ebola in Congo, where the disease was first discovered in 1976.

[AP]

TIME Infectious Disease

It’s Now Illegal to Hide Ebola Patients in Sierra Leone

SLEONE-HEALTH-EBOLA-WEST-AFRICA
A Sierra Leone government burial team with the coffin of Dr Modupeh Cole, Sierra Leone's second senior physician to die of Ebola, at the MSF facility in Kailahun, Sierra Leone, on Aug. 14, 2014. Carl De Souza—AFP/Getty Images

Perpetrators can get up to two-year prison sentences

In a move meant to help the country more effectively combat a deadly Ebola outbreak, Sierra Leone approved a measure Friday that would impose jail time on anyone caught hiding someone infected with the virus.

The law, an amendment to the country’s 1960 Public Health Act, imposes prison sentences of up to two years for violators, the Associated Press reports.

Sierra Leone has recorded at least 910 cases and 392 deaths as part of the current outbreak, according to the World Health Organization. Many cases, however, go unrecorded when families hide patients out of fear of high fatality rates and the stigma that comes with a positive diagnosis.

[AP]

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