TIME Addiction

E-Cig Use Triples Among Middle and High Schoolers in One Year

TIME.com stock photos E-Cig Electronic Cigarette Smoke
Elizabeth Renstrom for TIME

More students use e-cigarettes than the conventional kind

E-cigarette use among middle school and high school students tripled in one year, reported the U.S. Centers for Disease Control and Prevention on Thursday. The new data shows that e-cigarette use has surpassed the use of all tobacco products, including regular cigarettes, among young people.

The data, published in the CDC’s Morbidity and Mortality Weekly Report, shows that e-cigarette use among high schoolers increased from 4.5% in 2013 to 13.4% in 2014. That’s a rise from about 660,000 students to 2 million, the CDC says. Use among middle schoolers rose from 1.1% to 3.9% in the same time period.

MORE: E-Cig Flavors May Be Dangerous, Study Says

The study looked at all forms of tobacco use and found that hookah use doubled for middle and high schoolers, and other smoking methods like cigarettes and cigars declined.

“We want parents to know that nicotine is dangerous for kids at any age, whether it’s an e-cigarette, hookah, cigarette or cigar,” said CDC director Dr. Tom Frieden in a statement. “Adolescence is a critical time for brain development. Nicotine exposure at a young age may cause lasting harm to brain development, promote addiction and lead to sustained tobacco use.”

Tobacco sources like cigarettes and smokeless tobacco are regulated by the FDA, and the agency is currently in the process of finalizing rules that would give it jurisdiction over other products including e-cigarettes. In hopes of discouraging use among kids and teens, several states have passed laws that enlist a minimum age for purchasing e-cigarettes, and many states have extended traditional cigarette bans to include e-cigarettes.

TIME Addiction

E-Cig Flavors May Be Dangerous, Study Says

TIME.com stock photos E-Cig Electronic Cigarette Smoke
Elizabeth Renstrom for TIME

Why you might want to reconsider that cotton candy e-cig

The chemicals used to flavor e-cigarettes may surpass safe levels, a new study says.

The study, which is published in the journal Tobacco Control, reveals that high exposure levels of these chemicals could spur respiratory irritation. The chemicals used to flavor e-cigarettes are the same flavors often added to foods, so the FDA has determined them to be generally recognized as safe in food. However, the authors of the new study say the high levels raise concern for safety and need for regulation and that these chemicals may be more dangerous when inhaled than when they are ingested in food.

“Chronic inhalation of these ingredients has not really been studied much at all,” says study author James F. Pankow, a professor of chemistry and civil & environmental engineering at Portland State University.

In the study, Pankow and his colleagues assessed the levels and types of flavor chemicals used in 30 different e-cigarette refill bottles, including a wide variety of flavors like tobacco, menthol, vanilla, cherry, coffee, chocolate, grape, apple, cotton candy and bubble gum. In 13 of the 30 products, the flavor chemicals made up more than 1% of the refill liquid volume, the researchers found, and the chemical levels were higher than 2% in seven of the liquids. Two of the liquids had levels of flavor chemicals higher than 3%.

The researchers found that some of the flavor chemicals used were benzaldehyde and vanillin, which are known to be respiratory irritants and have exposure limits for the workplace. However, when Pankow and his colleagues estimated consumption rates, they found that an e-cigarette liquid consumption rate of about 5 ml per day puts users at an exposure of twice the recommended occupational limits. “That’s probably not a good thing,” says Pankow.

The study authors point out several concerns about flavoring, including the fear that flavored e-cigarettes might attract young people and the fact that flavored e-cigarettes don’t usually list the levels of specific chemicals that are present in the liquids.

“The point is that when e-cigarettes manufacturers talk about these things as being food grade or food-like, they are sort of suggesting that use of flavors is equivalent to using them in foods,” says Pankow. “Never mind the fact that these things have not really been tested for safety, but in food FDA requires labeling ingredients. If they are going to say these are food-like, then why don’t they list the ingredients? It’s also not food-like product because you are inhaling it not ingesting.”

The researchers note that the small sample size doesn’t necessarily represent the entirety of the growing e-cigarette market. But they conclude that the results are likely what a broad survey would have revealed and that their findings suggest high levels of certain chemicals are likely present in many products.

TIME Addiction

FDA Panel Votes Against Smokeless Tobacco Safety Claims

Swedish Match Targets Wall Street Smokers With Snus Tobacco
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The panel's vote was split on some important points

An FDA advisory panel voted on Friday that it does not agree with the evidence and claims put forward by smokeless tobacco manufacturer Swedish Match regarding its application to change warning labels on its tobacco product, called snus.

Snus, pronounced snoose, is a cloth baggie with moist tobacco powder which users stick under their upper lip for a nicotine buzz. As TIME reported on Thursday, Swedish Match wants to remove the required warnings that say snus causes mouth cancer, gum disease and tooth loss, arguing that there isn’t sufficient scientific evidence to support them. The company also wants to change the warning to read: “No tobacco product is safe, but this product presents substantially lower risks to health than cigarettes.”

On Thursday and Friday an advisory committee to the FDA met about the company’s application and voted on a series of questions related to the application. The FDA will use the committee vote as a recommendation that it may or may not adopt. On Friday, the committee largely voted against many of Swedish Match’s claims, with some exceptions.

On certain claims, the panel’s vote was clear cut. The committee unanimously voted that there was not evidence to suggest that snus products do not pose risks to gum disease or tooth loss. The committee was, however, split on the question of whether snus products do not pose risks for oral cancer. Three members voted yes, three members voted no, and two abstained from the vote.

The committee was split on the question of whether there’s evidence to support the statement that the health risks for people who exclusively use snus products are “substantially lower” than the health risks from smoking cigarettes. Four members voted yes and four voted no.

The vote suggests the committee is still unconvinced that solely using the smokeless tobacco product is indeed safer than using cigarettes. A large part of Swedish Match’s argument is that snus has contributed to what’s called the “Swedish experience.” Sweden has similar tobacco consumption rates as other European countries but has the lowest smoking-related mortality rate. Many say that’s because Swedish men tend to choose snus over cigarettes (the product is less popular among women). Members of the public health community watching the vote have been largely divided on whether harm reduction has a place in tobacco control and whether pushing people toward products with lower levels of nicotine is good for public health.

The committee also voted that the proposed warning statement from Swedish Match does not adequately communicate the potential health risks from using snus.

“I am very happy with the vote,” says Shyam Biswal, a professor in the department of Environmental Health Sciences at the Johns Hopkins Bloomberg School of Public Health. “My main concern is [snus attracting] new users who would otherwise not smoke. Saying snus is significantly less harmful [than cigarettes] is a very broad claim.” Biswal adds that he thought the evidence presented by Swedish Match was weak, including studies with small sample sizes. Biswal was not involved in the vote, but has studied modified risk tobacco products.

Swedish Match did not respond to requests for comment by time of publication.

TIME Addiction

How a Big FDA Decision Could Change Tobacco Control

Swedish Match Targets Wall Street Smokers With Snus Tobacco
Ramin Talaie—Bloomberg/Getty Images

A Swedish Company that manufactures snus wants to change its label to indicate it's safer than cigarettes

An upcoming decision from the U.S. Food and Drug Administration (FDA) could have significant implications on U.S. tobacco control.

On Thursday and Friday, an advisory committee to the FDA is meeting to review an application from the smokeless tobacco company Swedish Match. The Stockholm-based company wants to be permitted to legally claim that their tobacco product, called snus (pronounced “snoose”) is safer than cigarettes. The company disagrees with some of the warnings required for its label, and instead wants to use a warning that says “No tobacco product is safe, but this product presents substantially lower risks to health than cigarettes.”

Snus is a small cloth baggie that contains moist tobacco powder. They’ve been described as looking like mini tea bags. Users tuck the small pouches under the upper lip to get a buzz from the nicotine. It’s sort of similar to dip or chew, but without all the spitting.

The company’s argument is that snus is behind what’s called the “Swedish experience.” Sweden has a similar tobacco consumption rate compared to other European countries, but has the lowest smoking-related mortality rate. Snus has credited itself for offering Sweds (it’s used primarily by men) a safer alternative to cigarettes, becoming the country’s predominant product. The company wants to remove the required warnings that say the product causes mouth cancer, gum disease and tooth loss arguing there isn’t evidence to support that for their product and they would like to make the claim that the product safer than conventional cigarettes.

“Given all the science we have, it’s clear to me that the current label is misbranded. The label says a lot of things that there simply is no scientific basis for. We would like to be able to communicate that,” says Dr. Lars Erik Rutqvist, an oncologist and Swedish Match’s vice president of scientific affairs. Rutqvist was a cigarette smoker while in medical school (he says at the time that was still common), but wanted to quit when he decided to become an oncologist. He used snus to do so.

“I think it’s problematic that the only message that American smokers are left with today is you should quit,” he says.

The FDA panel is expected to make a vote after the hearing ends on Friday. The panel’s vote will provide a recommendation to the FDA. The agency could follow that recommendation or decide not to adopt it. If the committee agrees with Swedish Match, experts within the tobacco control community believe it could have some major implications for tobacco control regulation.

“This is a critical decision because of the precedent it sets,” says Kenneth E. Warner, a professor of public health focusing on tobacco control at University of Michigan. “It’s precedent setting in the sense that if this goes through it will be the first product to get this reduced risk authorization from the government. It would allow a tobacco harm reduction message to be placed on a product other than an FDA certified treatment such as nicotine replacement products. So it’s pretty important.”

Smokeless tobacco is considered less dangerous than cigarettes, since it doesn’t have toxic smoke. There are members within the public health community that believe that pushing consumers towards lower nicotine-containing products or products that put less harmful chemicals in buyers’ bodies is good for public health.Warner is among them. Others, including the U.S. Centers for Disease Control and Prevention (CDC), have come down hard against such products like e-cigarettes for example, arguing using the products can lead to dual use instead of cigarette smoking cessation.

“Although there’s evidence snus may have reduced harm, reduced harm products are not the same as safe products,” Dr. Michael Steinberg, director of the Tobacco Dependence Program at Rutgers University told NPR.

Warner says the company will have to prove to the FDA that it can back up it’s claims, and the FDA must be confident that the changes wouldn’t have negative consequences. “If information about how snus lowers harms encourages kids to start using it because they don’t think it’s particularly dangerous, and then they graduate to cigarettes because they want the faster nicotine kick, that’s a bad thing,” says Warner. “If snus were to get former smokers to start using it and it has health hazards, that’s not good. It’s hypothetical. The best evidence we have comes from Sweden.”

What the advisory committee will decide and the reverberations of that decision remains unknown, but it it will further fuel the debate over modified risk tobacco products and whether harm reduction has a place in tobacco control.

TIME Addiction

What Binge Drinking During Adolescence Does to the Brain

A new study in rats underlines the consequences of underage drinking

Binge drinking during adolescence may interfere with brain development and have lasting consequences on genes and behavior, a new study in rats shows.

In the study, published in the journal Neurobiology of Disease, the researchers mimicked adolescent binge drinking in a population of rats, in order to see how the alcohol affected their brains. The rats, which were 28 days old, were given alcohol for two days in a row and then abstained for two days, alternating for nearly two weeks. Some of the rats in the study were observed into adulthood.

The researchers discovered that the rats that binge drank when they were younger, preferred alcohol to water when they were older and displayed more anxiety-like behaviors compared to rats that didn’t drink. The researchers also noted epigenetic changes in the brains of the rats (changes to DNA caused by chemicals or environmental substances, like alcohol). The researchers believe that some of the rats’ behavior could be explained by these brain changes.

Though the study was in rats and not in humans, the researchers believe it suggests some of the possible effects of adolescent drinking on growing brains, and underlines the potential lasting consequences.

The researchers also found that a cancer drug was able to reverse some of these effects, which may hint at a possible treatment. One of the study authors has a patent pending related to the drug.

TIME Addiction

A New Government Anti-Smoking Campaign Includes E-Cigs

Past campaigns have increased calls to quitlines by 80%

A new federal ad campaign against smoking features e-cigarettes for the first time.

The U.S. Centers for Disease Control and Prevention (CDC) released its latest ad in its ongoing “Tips From Former Smokers” campaign. The campaign features real Americans who have experienced serious health or social consequences from smoking. Often the ads are explicit. On March 30, the first ad about e-cigarettes, as opposed to traditional tobacco, will air.

The ad features a 35-year-old woman named Kristy who picked up e-cigarettes as a way to quit smoking. She ended up using both products. Eventually she had a collapsed lung and was diagnosed with lung disease. She’s a married mother of three who works as a truck driver.

Kristy's Tip Print Full Page Ad
CDC

“Nationally, about 3 in 4 adult e-cigarette users also smoke cigarettes,” the CDC says in a statement. “If you only cut down the number of cigarettes you smoke by adding another tobacco product, like e-cigarettes, you still face serious health risks.”

Other ads focus on side effects like vision loss and colorectal cancer.

In 2014, the CDC says the national quit line received 80% more calls when the ads were on the air, and since 2012 the ads have generated more than 500,000 additional calls. The ads will run for 20 weeks on TV, radio, online, billboards, in theaters and in magazines and newspapers. Kristy’s ads will be on the radio and in print.

The ads encourage smokers to call 1-800-QUIT-NOW or visit www.cdc.gov/tips.

Read next: These 4D Ultrasound Photos Show How Fetuses Respond to Their Mothers’ Smoking

Listen to the most important stories of the day.

TIME Addiction

California Launches Campaign Against E-Cigarettes

The new ads are part of a new campaign called "Wake Up"

California rolled out new television and digital ads about the dangers of e-cigarettes on Monday.

The new ads air just two months after the California Department of Health (CDPH) declared e-cigarettes a public health risk, and warned Californians to stay away from them. The new ads are part of the agency’s new campaign called “Wake Up,” which suggests e-cigarettes are just another mass marketed product with serious health consequences.

MORE: California Says E-Cigarettes a Health Risk

Both ads feature songs from the ’50s and ’60s, when traditional cigarette marketing was prevalent. One ad titled “What Could Go Wrong” underlines the fact that Big Tobacco is also involved in the e-cigarette market. The ads call e-cigarettes “a new way to inhale toxic chemicals.”

Another calls out candy-flavored e-cigarette products that California health officials believe market to children.

“California has been a world leader in tobacco use prevention and cessation since 1990, with one of the lowest youth and adult smoking rates in the nation. The aggressive marketing and escalating use of e-cigarettes threatens to erode that progress,” said Dr. Karen Smith, the CDPH director and state health officer, in a statement. “Our advertising campaign is telling the public to ‘wake up’ to the fact that these are highly addictive products being mass marketed.”

In a health advisory released by the CDPH in January, the state reports that e-cigarette use has spiked among California teenagers and young adults.

TIME Smoking

5 Things You Didn’t Know About Tobacco

cigarette pack smoking kills
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Smokers lit up more than 5.8 trillion cigarettes in 2014

Despite killing 6 million people each year, tobacco use is still rampant worldwide, according to the new edition of the Tobacco Atlas, a report from the American Cancer Society and the World Lung Foundation. Drawn from the report, here are five startling tobacco facts worth knowing.

Smokers lit up more than 5.8 trillion cigarettes in 2014.

People have consistently been smoking fewer and fewer cigarettes for the last several decades in Europe and the Americas, but that improvement has been offset by growth of cigarette consumption in China. The average adult there smoked more than 2,000 cigarettes in 2014.

Tobacco kills at least half of its users.

People tend to think that lung cancer is responsible for tobacco-related deaths. It’s true: the disease kills more than a million smokers around the world every year. But lung cancer is just one of many tobacco-related ailments that can kill. Stroke, heart attack, bronchitis and emphysema are other top killers. And even if a smoker doesn’t get a disease caused by tobacco, smoking reduces the chances of surviving other conditions.

The tobacco industry spends billions of dollars annually promoting itself.

From charitable donations to lobbying, the tobacco industry spends heavily to win over users and supporters. In the United States, for instance, the tobacco industry has more than 150 lobbyists in Washington at an annual cost of more than $26 million, the report notes, and companies also donate millions to charities to improve their public image. But all of that pales in comparison to the money spent on traditional marketing campaigns, like billboards and magazine advertisements. The tobacco industry spends $900,000 every hour on advertising in the U.S., the report says—so if you spend five minutes reading this article, the tobacco industry will have spent $75,000 on marketing.

Cigarette manufacturers target the already vulnerable.

As people in developed nations like the U.S. increasingly realize the risks of smoking, the tobacco industry has invested resources in getting people in the developing world to adopt the habit. Faced with less regulation, the report says, marketing feeds the perception that smoking is not only “cool” but also provides health benefits. Smokers often ignore essentials to pay for their cigarette habit, finds the report. In high-income countries like Canada and France, nearly a third of male smokers are spending money on cigarettes and skimping on essentials like food. Nearly three-quarters of male smokers do the same in middle-income countries like Brazil and Thailand.

Regulation and public awareness campaigns have worked.

The report found some good news, too: a combination of regulation and public awareness can decrease the prevalence of smoking. Cigarette tax increases, for example, have been shown to improve the odds that smokers will quit and discourage people from picking up the practice in the first place. Other efforts like public smoking bans and restrictions on advertising have also had success, the authors say. In New York City, where these practices have been adopted, the prevalence of smoking has declined by a third.

Read next: Watch John Oliver Burn Big Tobacco

Listen to the most important stories of the day.

TIME Addiction

This Is Not a Good Reason to Smoke Cigarettes

Cigarettes
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But smoking causes weight loss, a new study says

Anyone who’s considered lighting up knows smoking’s skinny-making reputation, and a new study of 80,000 people shows there’s truth to the claim. Researchers found that smokers weighed about 5 pounds less than people who had never smoked, according to new research in the International Journal of Epidemiology. The cause of that lighter weight, the researchers say, is tobacco.

Those findings are a direct contradiction to several observational studies that have linked smoking to just the opposite: higher body weight and BMI. But researchers at Copenhagen University Hospital wanted to look at the link genetically, in a way that wouldn’t be plagued by confounding lifestyle factors that often go along with smoking. They took weight and BMI measurements of 80,342 people, along with blood samples that they analyzed for DNA.

They looked at a genetic variant associated with higher tobacco consumption, close to a gene called CHRNA3—”the smoking craving gene,” says study author Børge G. Nordestgaard, MD, professor at the University of Copenhagen in the department of clinical biochemistry. Smokers with this genotype weighed almost three pounds less than smokers who didn’t inherit this genetic variant. But in people who had never smoked or formerly smoked, there was no link between CHRNA3 and a lower body weight.

“That’s really the proof that smoking causes it,” Nordestgaard says.

That doesn’t mean that smoking will give you a better figure. In the study, smoking only affected total body weight, not body shape or fat distribution.

The weight loss effect may be due to a laundry list of chemicals in cigarettes, the authors say—some studies have found nicotine to suppress appetite and increase resting metabolic rate. “There’s a possibility that many of these chemicals may influence weight in some pathway we don’t know about yet,” Nordestgaard says.

That’s obviously no reason to start—or continue—smoking, the researchers caution. “From what we know so far, the hazards of smoking much overweigh the slight benefit of having a lower body weight,” Nordestgaard says. “But when smokers tell you they won’t stop smoking because they’re afraid of gaining weight, I think it’s important to know that this is real—so we can try at the same time to help them quit smoking and keep a lower body weight.”

Read next: What Diet Soda Does to Belly Fat

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TIME Addiction

Watching E-Cig Ads May Increase the Urge to Smoke, Study Says

TIME.com stock photos E-Cig Electronic Cigarette Smoke
Elizabeth Renstrom for TIME

A new study shows possible consequences of vaping in commercials

Seeing commercials for electronic cigarettes can increase the urge to smoke traditional cigarettes, a new study suggests.

Researchers at the Annenberg School for Communication at the University of Pennsylvania discovered that watching advertisements that showing vaping can increase the desire of current and former smokers to pick up a conventional cigarette.

In the new study, published in the journal Health Communication, the researchers assessed the urge to smoke among 301 daily smokers, 272 intermittent smokers and 311 former smokers. They then had the participants watch three e-cigarette commercials. Some of the commercials showed vaping, and others did not.

After they viewed the advertisements, the men and women were once again asked about their urge to smoke. Their responses showed that the daily smokers who saw vaping ads had a greater desire to smoke a regular cigarette, and a higher likelihood of actually doing so during the experiment.

The former smokers who watched the advertisements with vaping were more likely to report decreased intention to abstain from smoking. Intermittent smokers showed no significant changes.

The researchers say the data suggests that watching the commercials with vaping could lead to actual smoking behaviors or interfere the ability of former smokers to refrain from picking up the habit again.

“The jury is still out on the efficacy of e-cigarettes to reduce tobacco use and tobacco smoking,” says study author and communication professor Joseph N. Cappella in a video about his study. “If it turns out to be the case that e-cigarettes are a good vehicle for reducing tobacco addiction, then we not want to stand in the way of advertising…but it doesn’t mean we couldn’t carry out that advertising without the vaping cues in order to not have these deleterious consequences.”

MORE: The Future of Smoking

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