TIME Addiction

Teen E-Cigs Smokers More Likely to Turn to Cigarettes: Study

New research suggests e-cigarette use among young people could be a gateway to conventional smoking

Teenagers who use e-cigarettes may be more likely to report using conventional tobacco products like cigarettes, hookah and cigars, new research suggests.

Researchers looked at 2,530 students from 10 Los Angeles public schools. They asked the teenagers about their smoking and vaping activities and found that teens who had used e-cigarettes were more likely to report using tobacco products over the next year compared to teens who had never used e-cigarettes. The findings were published Tuesday in the journal JAMA.

The researchers cannot conclude from their data that using e-cigarettes leads a teen to use other tobacco products. More research is needed to determine if the link is causal. However, they suggest it’s unlikely that the number of teens who use both e-cigarettes and other tobacco products can be entirely attributed to teens already smoking and then trying e-cigarettes later on. “These results raise the possibility that the association between e-cigarette and combustible tobacco use initiation may be bidirectional in early adolescence,” the authors write.

MORE: E-cigs Are the New Cool Thing for Teenagers

Some view e-cigarettes as a healthier alternative to tobacco. However, both e-cigarettes and tobacco products contain nicotine, which is addictive, and some research shows that e-cig flavors are dangerous and that the devices, too, produce potentially dangerous byproducts when heated. Since data suggests that teenagers are increasingly using e-cigarettes, some public health experts are worried.

“Adolescents may be especially susceptible to develop nicotine addiction after e-cigarette exposure because their brains are still developing and are particularly sensitive to nicotine,” writes Dr. Nancy A. Rigotti of Massachusetts General Hospital and Harvard Medical School in a corresponding editorial.

The researchers also note teens may be more likely to use e-cigarettes before other combustible tobacco products due to a perception that they are not harmful or addictive. The fact that e-cigarettes are sold in different flavors can be attractive to young people, the authors argue, and in some cases it remains easy for teens to get access to them due to a lack of regulation.

 

TIME E-Cigarettes

E-Cigarettes May Be Just As Addictive As Cigarettes

e-cigarette-nicotine-vaping-smoking-cigarette
Victor de Schwanber / Getty Images A person "vapes," or smokes an e-cigarette.

The most addictive form of nicotine commonly found in cigarettes is often the same as the one found in cigarettes.

Vapers—or e-cigarette smokers—aren’t any safer from developing addiction, finds a new study released Thursday.

The basis of the pro-vaping argument has been that e-cigarettes don’t contain the harmful chemicals in and byproducts of tobacco cigarettes. There’s nicotine, to be sure, but not all nicotine is the same. Vaping proponents have said that the type found in cigarettes is a highly addictive form, and the type of nicotine in e-cigarettes is less addicting.

“This perception [of e-cigs being safer] stems from the fact that e-cigs are electrically powered devices that heat and vaporize a nicotine-containing flavored liquid to produce an inhalable aerosol, without involving combustion and presumably much of the exposure to combustion-related toxicants,” such as carbon monoxide and nitric oxide, the authors wrote.

But a new study, published in the American Chemical Society’s Chemical Research in Toxicology, indicates that nine out of 17 common, commercially available e-cigarettes contained the most addictive kind of nicotine.

Critics have long held that e-cigs contain ingredients that make them essentially a cigarette in terms of addictive power. There is also evidence that e-cigs may not be an effective means to quitting (some research shows that 75% of Americans who vape also smoke).

TIME Research

4 Weird Health Effects of E-Cigarettes

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

Banana pudding-flavored ecigs disturbed the lungs, one study found

E-cigarette research is heating up, and scientists are starting to show that using e-cigarettes can have some surprising health effects, according to new findings presented at the meeting of the American Thoracic Society.

“Millions of people around the world that are puffing e-cigs,” says Peter Dicpinigaitis, professor at Albert Einstein College of Medicine and one of the authors of new e-cigarette research, “but when you look at the scientific literature about the effects of e-cigs, there’s nothing out there.”

Here are some of the newest findings:

Using e-cigarettes suppresses your ability to cough

Smoking an e-cigarette makes you less likely to cough, even when coughing would benefit your health, according to research by Dicpinigaitis. Researchers asked 30 nonsmokers to puff an e-cigarette 30 times in a 15-minute period. After puffing, people in the study were less sensitive to capsaicin, a component of chili peppers that induces coughing. You might think stopping a cough would be a positive side effect, but coughing keeps you from choking and removes agents that may cause infection, says Dicpinigaitis. He presumes that those the effects would continue throughout the day for someone who uses an e-cigarette frequently.

E-cigarette temperature may affect how many chemicals you’re exposed to

People tend to think about the effects of cigarette smoke or e-cigarette vapor when they consider how the products harm their health. But the mechanics of e-cigarettes may also contribute to how much smoking harms your health, according to new research from University of Alabama School of Medicine professor Daniel Sullivan. His research found a correlation between coil temperature and the creation of harmful chemicals like acrolein, acetaldehyde and formaldehyde in the e-cigarette. There are no configuration standards for e-cigarettes, and Sullivan’s research suggests that the lack of consistency makes it hard to assess uniformly the health effects of smoking e-cigarettes.

E-cigarette flavors may have different effects

Researchers tested the effects of flavored e-cigarette liquid on calcium in the lungs and found that not all flavors had the same effect. Five of 13 flavors tested caused changes to calcium signaling in the lungs, according to a study by University of North Carolina at Chapel Hill researcher Temperance Rowell. Hot cinnamon candies, banana pudding and menthol tobacco were among the flavors that disturbed the lungs.

Evidence is growing that e-cigarettes probably aren’t an effective way to quit smoking

E-cigarettes are a popular tool people use to stop smoking, but they may not be the best way, suggests one research review. Using e-cigarettes improved the likelihood that a smoker would quit smoking cigarettes for the first month on the new technology, but the effect dissipated at 3 and 6-month followups, according to a meta-analysis of four studies by University of Toronto researcher Riyad al-Lehebi. He recommended that people who want to quit smoking consider “other more well-established options.”

TIME medicine

The Best Way to Quit Smoking Isn’t E-Cigs

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Peter Dazeley—Getty Images

In the latest in-depth review of studies investigating which smoking cessation methods work best, experts say there isn’t enough evidence to support using e-cigarettes to kick the habit

The U.S. Preventive Services Task Force, a government-convened group of experts, says that if you want to quit smoking, you’re better off with drug-based methods, behavior modification programs or a combination of both—not puffing on e-cigarettes. There isn’t enough evidence to support claims that e-cigs, which have been touted as the latest way to wean people off tobacco, can actually help people quit.

The task force focused on studies that investigated how effective various smoking cessation methods are, for both adults and pregnant women. Drugs that address nicotine’s effects on the body, as well as nicotine replacement options, are better ways to quit, and the data suggest that they are even more effective if used together. In addition, behavioral interventions, including support groups and counseling sessions, can boost quit rates from 7-13% compared to rates of 5-11% among those who don’t use them.

MORE: E-Cigs Are Smokers’ Favorite Quitting Tool

“We have an embarrassment of riches in terms of a menu of things to offer patients who want to quit smoking,” says Dr. Francisco Garcia, director and chief medical officer of the Pima County Health Department in Arizona and member of the task force. “But every individual is different; some might respond better to behavioral therapy, some might respond better to varenicline, some might feel nicotine replacement is important to bridge them away from tobacco use.” For most people, it’s a matter of discussing with the smoker which method has the most appeal, and which one they are more likely to stick with long enough to go smoke-free.

But for certain populations, there isn’t enough data to support one strategy over another. Among pregnant women, for example, there haven’t been many studies to show how drug-based methods might affect the developing fetus, so it’s hard to determine if the benefits of quitting outweigh he risks represented by the medications. So for now, the task force advises that pregnant women rely on behavioral, non-drug strategies to help them stop smoking.

MORE: This Is The New Best Way to Quit Smoking, Study Finds

And for e-cigarettes, the data is sparse. The panel concluded that there was “insufficient” evidence to determine whether e-cigarettes improve or hinder quit rates.

TIME Addiction

Health Experts Angry FDA Still Doesn’t Regulate E-Cigarettes

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

Prominent medical groups are asking the government to hurry up

A year has passed since the U.S. Food and Drug Administration (FDA) proposed new regulations for e-cigarettes, cigars and waterpipe tobacco, to prevent them from being sold to minors and to require manufacturers to add health warnings to labels—but the new rules still haven’t gone into effect.

Now, public health experts are urging action, arguing it’s unacceptable that it’s taken so long given data shows use of these products among minors has spiked.

Earlier this week, 31 health and medical groups including the American Academy of Pediatrics, the American Academy of Family Physicians and the American Heart Association wrote a letter to President Obama asking for the federal government to finalize the “long-overdue” regulation. The medical groups say cigar and e-cigarette brands are using marketing tactics that they feel appeal directly to young people, like promoting candy and fruit-flavored products, and they want regulations to put an end to it.

“It’s no wonder use of e-cigarettes by youth has skyrocketed,” the letter reads. “This process has already taken far too long. We cannot afford more delays that allow tobacco companies to target our kids with a new generation of tobacco products.”

Health experts are concerned over a recent U.S. Centers of Disease Control and Prevention (CDC) report that showed e-cigarette use among middle school and high school students tripled between 2013 to 2014 and hookah use doubled. The report showed that e-cigarette use among high schoolers increased from 4.5% in 2013 to 13.4% in 2014, which is a rise from approximately 660,000 students to 2 million.

“My concern is always the first-time users,” says Shyam Biswal, a professor in the department of Environmental Health Sciences at the Johns Hopkins Bloomberg School of Public Health. “It’s bad it took so long to make a dent in [conventional] tobacco users, and we are now starting something else, and we are just waiting and waiting and waiting. We don’t have the data that e-cigarettes are a gateway [to other tobacco products], so we just wait. It should not be like that.”

In a statement sent to TIME, the FDA said it “remains concerned about the significant increase in e-cigarette and hookah usage among youth.” The agency wrote:

These staggering increases in such a short time underscore why FDA intends to regulate these additional products to protect public health. Rulemaking is a complex process, and this particular proposed rule resulted in more than 135,000 public comments for the agency to review and consider. FDA is committed to moving forward expeditiously to finalize the rule that will extend its authority to additional tobacco products such as e-cigarettes, cigars, pipe tobacco, and other currently unregulated tobacco products.

Stanton Glantz, a professor of medicine at the University of California, San Francisco Center for Tobacco Control Research & Education, said he hopes that when the regulation is finalized there are no loopholes. “Given that the White House has blocked eliminating menthol from cigarettes for years despite strong evidence—including from the FDA’s own analysis that doing so would protect public health—I am not holding my breath,” he said.

Several states and local governments have regulated items like e-cigarettes on their own. Data shows at least 42 states and 1 territory currently prohibit the sale of e-cigarettes or vaping/alternative tobacco products to minors.

“I just hope that the final FDA rule does not do anything to make that process more difficult,” said Glantz.

The medical groups concluded in their letter that “further delay will only serve the interests of the tobacco companies, which have a long history of using product design and marketing tactics to attract children to harmful and addictive products.”

When asked for a comment about the letter, the White House’s Office of Management and Budget referred TIME to the FDA.

TIME Addiction

Hawaii Set to Become First State to Raise Smoking Age to 21

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

The bill covers both cigarette and e-cigarette use

Hawaii is set to become the first state to pass a law banning the sale, use and possession of cigarettes and e-cigarettes to people under the age of 21.

If a bill approved by Hawaii lawmakers on Friday is signed into law by Governor David Ige, adolescents will be prohibited from smoking, buying and possessing both conventional cigarettes and e-cigarettes. First-time offenders will be fined $10, and after that they can be charged a $50 fine or be required to complete community service, the Associated Press reports.

Some local governments have raised the smoking age to 21 in certain counties and cities — New York City among them — but if the bill becomes law, Hawaii will be the first state to do so.

Though the rates of high-school-age smokers have dropped in recent years, some 2.3 million children and young adults started smoking in 2012. In addition, a recent report from the U.S. Centers for Disease Control and Prevention revealed that e-cigarette use among middle-school and high school students tripled in one year.

If the Hawaii bill passes, it will go into effect Jan. 1, 2016.

[AP]

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

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

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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.

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