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

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 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

TIME Addiction

It’s Really Easy for Teens to Buy E-Cigs Online

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

Most popular e-cigarette sites fail to verify the age of their clients, finds a new study

Young people under age 18 can buy e-cigarettes online, even in states where it’s illegal, a new study shows.

North Carolina researchers asked 11 teens between ages 14 to 17 who didn’t smoke to try to buy e-cigarettes online from 98 of the most popular Internet vendors. The sale of e-cigarettes to minors in North Carolina is illegal—but of the 98 orders, only five were rejected based on a failed age verification. Eighteen orders failed for problems unrelated to age, like website issues. Overall, the minors made 75 successful orders.

The teens were also asked to answer the door when deliveries were made. None of the companies attempted to confirm age at delivery, and 95% of the time, the orders were just left at the teens’ doors.

The findings are concerning for any state trying to regulate youth access, the authors say. Currently, there’s no federal law forbidding the sale of e-cigarettes to minors, despite the fact that they contain nicotine, which is addictive. In 2014, the U.S. Food and Drug Administration (FDA) proposed that e-cigarettes fall under their regular tobacco regulation jurisdiction, but the proposal is still not a codified law. “It may be several years before federal regulations are implemented,” the study authors write.

Some states have stepped in and banned the sale to minors within their borders. So far 41 states and the U.S. Virgin Islands forbid such transactions, or have pending legislation to do so.

But as the new study suggests, young people can easily get e-cigarettes online if they want them. “Without strictly enforced federal regulations, online e-cigarette vendors have little motivation to decrease profits by spending the time and money it takes to properly verify customers’ age and reject underage buyers,” says study author Rebecca S. Williams, public health researcher at the University of North Carolina at Chapel Hill.

None of the vendors complied with North Carolina’s e-cigarette age-verification law. The majority of U.S. carriers, including USPS, UPS, FedEx, and DHL, ban the delivery of cigarettes, only allowing the delivery of tobacco products from a licensed dealer or distributor to another licensed dealer or distributor. If these rules were extended to e-cigarettes, the study authors argue it would essentially shut down a major loophole in access.

Getting proposed rules like the FDA’s passed takes time, but when it comes to the safety of children, the researchers argue there needs to be more urgency. Prior data has shown that from 2011 to 2013, the number of young Americans who used e-cigarettes but not conventional cigarettes more than tripled, from 79,000 to over 263,000. The study authors conclude that the ease with which teens can get e-cigarettes online—in a state that forbids the practice—stresses the need for more regulation, and fast.

TIME Health Care

California Says E-Cigarettes a Health Risk

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

Department of health advises Californians to stay away from e-cigs

The California Department of Public Health (CDPH) has come out against electronic cigarettes (e-cigarettes), releasing a new report on Wednesday outlining their risks.

“E-cigarettes contain nicotine and other harmful chemicals, and the nicotine in them is as addictive as the nicotine in cigarettes,” CDPH director and state health officer Dr. Ron Chapman said in a statement about his report. “There is a lot of misinformation about e-cigarettes. That is why, as the state’s health officer, I am advising Californians to avoid the use of e-cigarettes and keep them away from children of all ages.”

The news comes as the California state legislature considers a ban on the devices in public places, as well as new measures against selling them to minors.

According to CDPH, e-cig use among Californians aged 18 to 29 has gone up from 2.3% in 2012 to 7.6% in 2013 and young adults in California are three times more like to use e-cigs than people over age 30. California poison centers are also seeing an increase in calls related to exposures to the liquids inside e-cigarettes. Calls increased from 19 in 2012 to 243 in 2014.

MORE: What to Know About the Science of E-Cigarettes

Nationwide, similar increases are being observed, with data from the 2013 National Youth Tobacco Survey showing that the percentage of middle school and high school students who have tried e-cigarettes doubled from 3.3% in 2011 to 6.8% in 2012.

The new report touches on the harm to brain development from exposure to nicotine during adolescence; dangerous chemicals found in some e-cigarette aerosol; and the fact that e-cigs are not FDA-approved devices for smoking cessation.

The report can be added to a growing amount of data on the risks and potential benefits of e-cigarettes. Earlier this month, a study published in the New England Journal of Medicine showed that e-cigarettes may be producing harmful chemicals known to cause cancer in humans.

You can read the full report, here.

TIME Research

What to Know About the Science of E-Cigarettes

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

A guide to understanding conflicting and ongoing research

Two Columbia University professors warned in a new study Thursday that the health fears over electronic cigarettes are hindering research. The very same day, another new study showed that smoking e-cigs, or “vaping,” can produce cancer-causing formaldehyde.

Clearly there’s some disagreement among scientists about the risks and benefits of a product that’s growing in popularity. Here’s what you need to know about the latest science.

What’s with the latest disagreement?

Columbia public health professors Amy Fairchild and Ronald Bayer argue in Science magazine that the staunchest opponents of electronic cigarettes are so concerned about the potential downsides that they advocate for an anti-e-cigarette regulatory and research approach that may be bad for public health. This approach of “deep precaution,” they argue, “has served as a kind of trump argument, hostile to the notion of trade-offs, seeing in them perilous compromise. Such a posture does not serve either science or policy well.”

MORE The Future of Smoking

It “may be years before the disagreements over the evidence” about the effects of electronic cigarettes can be resolved, Fairchild and Bayer wrote. On the one hand, electronic cigarettes may serve as gateway drugs for young people to start smoking cigarettes, and “dual” use of electronic cigarettes with tobacco cigarettes may stop some smokers from quitting. Electronic cigarettes may also carry unknown health consequences of their own. On the other hand, they may provide harm reduction for people who have been unable to quit any other way.

Given these two competing possibilities, the authors argued that the best formula for public health is to acknowledge the possibility for costs and benefits and to push for a regulatory scheme that is flexible enough to account for both outcomes. It is better to make public policy and execute scientific research under the assumption that e-cigarettes could bring good as well as bad.

But also on Thursday, the New England Journal of Medicine published a new study reporting that chemicals inside e-cigarettes—like propylene glycol and glycerol—can produce a type of the cancer-causing chemical called formaldehyde when heated during the vaping process. The researchers report that when testing samples of the aerosol from vaped e-cigs, they found that the e-cigs can contain formaldehyde-releasing agents slightly different from regular formaldehyde, and that the levels are especially high when a user vapes at high voltages. Scientists don’t yet know if formaldehyde-releasing agents carry the same risk as pure formaldehyde, but the researchers said in their report that if they assume the substances do carry the same risks, then long-term vaping could be associated with a significantly higher risk for cancer compared to long-term smoking. The researchers said formaldehyde-releasing agents may actually burrow into the respiratory tract more efficiently than regular formaldehyde, though the observation wasn’t confirmed.

Are there other reasons experts are concerned?

There’s also debate over the safety of the liquid nicotine inside e-cigarettes. In April 2014, the Centers for Disease Control and Prevention (CDC) released a report showing what they called a “dramatic” rise in e-cigarette-related calls to U.S. poison centers. Calls went from one a month in September 2010 to 215 calls a month in February 2014, and more than half of the calls involved children age five and under. Forty-two percent involved people age 20 and older. Symptoms of liquid nicotine ingestion are known to be vomiting, nausea and eye irritation.

Researchers are also wary of the long term effects of inhaling propylene glycol, one of the main ingredients in e-cigarettes. The jury is still out, but some physicians are concerned. “As for long-term effects, we don’t know what happens when you breathe the vapor into the lungs regularly,” Thomas Glynn, the director of science and trends at the American Cancer Society, told ABC News. “No one knows the answer to that.”

Are they really attracting young people?

Several recent—but fairly small—studies say yes. A December 2o14 study in the journal Pediatrics surveyed 1,941 Hawaii high school students and found that about 17% of the high schoolers smoked e-cigarettes only, 12% smoked both e-cigarettes and conventional cigarettes, and only 3% smoked conventional cigarettes. The findings suggested that kids who smoked e-cigarettes scored lower on outside risk factors to pick up a conventional smoking habit. “The fact that e-cigarette only users were intermediate in risk status between nonusers and dual users raises the possibility that e-cigarettes are recruiting medium-risk adolescents, who otherwise would be less susceptible to tobacco product use,” the authors wrote. Numbers released in 2013 from the National Youth Tobacco Survey showed that the percentage of middle school and high school students who have tried e-cigarettes doubled from 3.3% in 2011 to 6.8% in 2012.

What’s the argument in favor of e-cigarettes?

Some smokers use e-cigarettes to help them curb their traditional cigarette habit, or even quit. An August 2014 study that surveyed over 20,000 Americans showed that among adults who used a product to help them quit smoking, 57% chose e-cigarettes. That’s compared to the 39% who used prescription drugs like Chantix and the 39% who used other over-the-counter methods like patches or nicotine gum. Another study from July 2014, which reviewed 80 studies on e-cigarettes’ safety and their effects on users, revealed that not only can e-cigarettes help smokers quit, but they are less harmful to smokers and bystanders’ health compared to regular cigarettes.

What’s the FDA doing about it?

The U.S. Food and Drug Administration (FDA) only regulates e-cigarettes that are marketed for therapeutic purposes, though the agency has proposed a rule that would give it more regulatory power over e-cigarettes but that has not yet been implemented. The FDA has suggested a ban on sale of e-cigarettes to minors, and admits that there is a lot consumers don’t know about the product like whether they attract kids and teens or just how much nicotine is inhaled when a person vapes.

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