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 Addiction

E-Cigs Are Smokers’ Favorite Quitting Tool

A patron demonstrates an e-cigarette at Vape store in Chicago, April 23, 2014.
Nam Y. Huh—AP

"The fact that there isn't industry-wide, definitive proof that e-cigs help all smokers quit for good may be irrelevant to smokers"

Electronic cigarettes are a more popular tool for smokers trying to quit than nicotine gums and patches, according to a new study of consumer behavior from Kantar Media. As e-cigarettes have exploded from niche product to $2 billion-plus industry, big tobacco isn’t the only industry facing disruption. E-cigarettes are shaking up the pharmaceutical business too.

Of the adults who used a product to help them quit smoking in the past 12 months, 57% chose e-cigarettes, compared with 39% who used a prescription drug like Chantix and 39% who used other over-the-counter methods including nicotine gum and patches, according to the study. The study’s results are based on more than 20,000 responses to a questionnaire about health-related behavior mailed to a random sample of about 50,000 American households. The results do not show whether or not e-cigarettes are effective at helping people quit — just that people are trying them.

E-cigarette makers are legally prohibited from making claims that their products can help smokers quit. Among scientists, the question of whether or not e-cigs can really help smokers quit remains unanswered. A highly publicized study of almost 6,000 smokers trying to quit in England, published in the journal Addiction in May, showed that they were more likely to successfully quit if they used e-cigarettes than products like nicotine patches and gum. But the quit rate, while better than other options, was still relatively low — and this was among a group of smokers highly motivated to quit. The health effects of electronic cigarettes are also largely unknown.

But the Kantar Media study results show that right now, for smokers, the science on e-cigs may not matter. “The fact that there isn’t industry-wide, definitive proof that e-cigs help all smokers quit for good may be irrelevant to smokers,” reads Kantar Media’s summary of the findings. And, whether or not the science supports it, e-cigarettes make their users feel better about their health. E-cigarette users are 35% more likely than all adults to say their current health is much or somewhat better than it was a year ago, according to the study. Cigarette smokers were, unsurprisingly, less likely than most adults to think their health had improved. Interestingly, e-cig users were more likely to report feeling healthier than were people using other smoking-cessation methods.

The study also offers a window into the typical e-cigarette consumer. According to the study, almost 6 million adults in the U.S. use e-cigs, compared with the 44 million who use a tobacco or nicotine product (including cigarettes). E-cig users tend to be young and male and have lower household incomes than the national average and are more likely than other adults to play video games and poker, more likely to watch reality TV, and go to bars and nightclubs. E-cig users are also more likely to live in the South. In the region including Alabama, Kentucky, Mississippi and Tennessee, the ratio of electronic-cigarette users to traditional cigarette smokers is nearly 2 to 1, according to the study.

In light of the demographic findings, it maybe isn’t surprising that so many e-cigarette users prefer them to other methods of quitting. For young guys having fun, it’s more fun to “vape” than to do nothing at all.

TIME tobacco

E-Cig Benefits Outweigh Their Harms, New Research Says

A patron demonstrates an e-cigarette at Vape store in Chicago, April 23, 2014.
Nam Y. Huh—AP

That doesn't mean you should hop on the bandwagon

The debate over e-cigarettes—now a$2 billion industry in the U.S. and growing—is constantly up in smoke.

The primary problem is that we simply do not know what e-cigarettes’ long-term health impacts are, with some people heralding it an effective smoking cessation while others say it’s just more nicotine products on the market—and not smoking, no matter what you inhale, is your best bet. Some early research found that adolescents smoking e-cigarettes will also smoke regular tobacco products, and that there’s an increase in e-cigarette related calls to poison centers around the nation.

But this week, a new paper looking at over 80 studies on e-cigarettes’ safety and their effects on users plays devil’s advocate.

The researchers found that based on the evidence, e-cigs are much less harmful to smokers and bystanders compared to conventional cigarettes. They are becoming more popular, but the numbers—so far—don’t suggest that they are being regularly used by non-smokers or kids. Finally, the researchers found that e-cigs can help some users cut down on their use of regular cigarettes and even quit. As regulating bodies around the world make decisions about how to deal with e-cigs, the researchers conclude that letting e-cigarettes compete with traditional tobacco on the market might actually decrease smoking morbidity and mortality.

“Health professionals may consider advising smokers unable or unwilling to quit through other routes to switch to [e-cigarettes] as a safer alternative to smoking and a possible pathway to complete cessation of nicotine use,” the Queen Mary University of London researchers write in their study, published in the journal Addiction.

When it comes to the question of what’s safer, e-cigs or cigarettes, no one is in disagreement. E-cigarettes win. While they still provide smokers with nicotine, which is highly addictive, users do not inhale the toxic smoke and chemicals from regular cigarettes.

Public health experts are split on what role e-cigarettes will play in the nation’s health, but more evidence and further research from both sides of the debate will hopefully keep policy members informed about where the current science stands.

TIME Law

White House Softens Proposed E-Cigarette Regulations

A patron demonstrates an e-cigarette at Vape store in Chicago, April 23, 2014.
Nam Y. Huh—AP

The long-awaited regulations on electronic cigarettes go through a review phase before they become final.

Newly published documents show that the White House watered down restrictions on electronic cigarettes proposed by the Food and Drug Administration.

The White House’s Office of Management and Budget regularly analyzes proposed regulation for its potential economic impact. A Reuters review of the documents published in the Federal Register on Tuesday shows that the OMB weakened language detailing concerns over e-cigarettes and nixed a clause that could have been used to ban online sales.

The FDA proposed the long-awaited regulations in April, banning their sale to minors and requiring that makers of e–cigarettes register their ingredients within the next two years. The proposal also would ban “non-face-to-face sales,” which would have prohibited vending machine sales but also could have targeted online sales.

But the proposal was open to comment and review, and OMB edited that sentence to refer specifically to vending machines, Reuters reports.

The OMB’s review of the proposal aimed “to ensure that the regulations through which agencies implement policies are efficient, well-designed to achieve their objectives, and based upon the best available evidence,” spokeswoman Emily Cain told Reuters. “It is routine for agencies to make changes to their draft rules during the course of OMB review.”

[Reuters]

TIME E-Cigarettes

Snuff and E-Cigs Are Not Harmless, Say Scientists

New research casts doubt on nicotine's safety—even if you aren't smoking

New research from the American Heart Association journal Circulation shows that patients who stopped using smokeless tobacco after a heart attack had improved life expectancy—similar to that of people who quit smoking. The finding offers new information about the dangers of smokeless tobacco, the risks of which are not as well understood as cigarettes’.

“That was a big surprise for us,” said Dr. Gabriel Arefalk, lead researcher and a cardiologist at Uppsala University Hospital in Uppsala, Sweden. “For smoking, it has been known for decades now that people benefit from discontinuation, especially after having suffered a heart attack, but for snus we had no idea what to expect.”

The researchers reviewed data on 2,474 heart attack survivors under 75 in Sweden who used snus (oral snuff) from 2005 to 2009. About 675 quit. During the two years of follow-up, 69 of those who continued using snus died, compared with only 14 quitters. Based on this data, researchers determined that those who quit snus had almost half the mortality risk of those who didn’t quit, which is similar to the benefit of smoking cessation, according to a release from the American Heart Association

Dr. Arefalk, who is also a clinician, said the researchers wanted to study the problem because they didn’t know what to tell patients about the risks of using snus after a heart attack. He cautioned that the study was small and far from enough to determine a causal relationship, but added “It’s the best evidence we’ve got so far, so from our perspective at our clinic, [the advice to patients] is probably that you should discontinue all kinds of tobacco,” if you’ve had a heart attack, Dr. Arefalk told TIME.

The study is one more piece of evidence that ads to our understanding that smokeless tobacco carries its own risk. Though the study was about snus, it has implications for other kinds of nicotine delivery systems, including e-cigarettes.

The FDA is currently taking comment from experts over the next few weeks as the agency tries to determine the best rules to regulate the nascent e-cig industry, which is approaching nearly $2 billion in U.S. annual sales. And though there isn’t yet enough information or scientific research to back this up, common sense says that e-cigs, which do not burn and contain fewer chemicals than regular tobacco cigarettes, must be better for a smoker’s health. Yet, some cardiologists, as TIME learned, are reluctant to see electronic cigarettes as harm-reduction tools.

For starters, nicotine is not a benign substance, especially when it comes to cardiovascular health. As Dr. Steven Nissen, Department Chair of Cardiovascular Medicine at the Cleveland Clinic, put it, nicotine has “profound effects on the heart.” The highly addictive drug can lead to surges in heart rate, constriction in the blood vessels, and spikes in blood pressure—the very effects that heart medications are designed to counteract.

“To come up with new diabolically clever way to addict Americans to nicotine is a terrible idea,” says Dr. Nissen. “[E-cigarette companies] are pitching very hard that they can make smoking safer. [But] nicotine is an addictive drug, no matter if you smoke it or ‘aerosolize’ it. Why you would want to addict another generation to nicotine is beyond me. Public health suggests we should fight electronic cigarettes the same way we fought tobacco.”

Another concern, beyond the possible impact of nicotine, are concerns about small, potentially toxic, particles and what they can do to the sensitive cardiovascular system, says Dr. Aruni Bhatnagar, a professor of medicine at the University of Louisville and spokesperson on electronic cigarettes for the American Heart Association.

Dr. Bhatnagar is studying the toxic effects of e-cig vapor on mice. Like all doctors, he is careful to point out that we don’t know enough about these devices. But he says that wishful thinking about harm reduction could be especially problematic when it comes to cardiovascular health. The risk of cardiovascular disease for a person who smokes only 2-3 cigarettes a day is already 80 percent of the risk to a pack-a-day smoke. “Very low levels of smoke are very dangerous for cardiovascular tissues. Cancer is more linear—you have to smoke a large amount for a very long period of time to get lung cancer,” he says. “But reducing harmful levels is not going to mitigate the cardiovascular risk. That is why we are greatly concerned about e-cigarettes when it comes to the high sensitivity of cardiovascular tissues to a low level of these pollutants.”

Electronic cigarette manufacturers and their customers often point to the low levels of particles in electronic cigarette smoke as compared to the appropriate levels of air pollution determined by agencies like OSHA. But, Dr. Bhatnagar says, these claims can be misleading because the thresholds take into account the necessity of polluting the air to some degree—they aren’t an endorsement of a safe level of pollution. From a cardiovascular perspective, he says: “There is no threshold, there is no level of these particles that you can say is safe.”

For now: Smokers—and snuffers, and e-cig smokers—beware.

TIME Companies

Dutch Company Rolls Out ‘E-Joints’ Modeled After E-Cigarettes

This company is high off innovation

First e-cigarettes, now “e-joints”: the Dutch company E-Njoint B.V. is introducing a new, “100% legal” product that allows “people to enjoy a variety of flavors, relaxing, while expressing themselves in a unique way.”

Designed to look like a marijuana cigarette, the E-Njoint, as it’s called, has an image of a marijuana leaf on its tip that lights up when in use, the International Business Times reports. The fake joints don’t have nicotine or THC in them, but rather vegetable glycerin, propylene glycol and flavoring. After the E-Njoints vaporize the original contents, however, consumers can load the reusable products with liquid forms of marijuana and “vape” those — a way of getting high that’s already inspired some entrepreneurs.

“Holland is well known in the world for its tolerant and liberal attitude toward soft drugs, and the introduction of this new product clearly makes a statement,” said Menno Contant, the CEO of E-Njoint B.V., which is manufacturing 10,000 E-Njoints a day. “As long as you don’t bother or disturb other people and stay within the legal boundaries, all is well.”

[IBT]

TIME E-Cigarettes

10 New E-Cig Brands Hit the Market Every Month

A series of studies shows just how prevalent e-cigarettes are, and what that means for smokers, non-smokers and would-be smokers alike

In the most comprehensive look at e-cigarettes to date, from how they are used to how they are marketed and where they are sold, researchers are surprised by how quickly the devices have taken hold worldwide.

In nine studies published in the journal Tobacco Control by the State and Community Tobacco Control Research Initiative (SCTC), scientists looked at where e-cigarettes are sold, the status of state laws regulating e-cig sales and use, and how taxes and pricing may affect the popularity of the devices, among other topics.

MORE: 5 Sketchy Things We Still Don’t Know About E-Cigarettes

When it comes to e-cig marketing, researchers found that about 10.5 new brands appear online every month, touting 242 novel flavors. “The most surprising thing was how quickly they became available across the country,” says Frank Chaloupka, a professor economics at University of Illinois and a co-author of the study. “A few years ago, they were hardly available anywhere, and by 2012, they were available in about a third of the stores we were going into.”

He and his colleagues found that at least initially, e-cigs were targeted in areas with weaker tobacco regulations, including areas with lower taxes and more lenient smoking policies in public places. E-cig makers, says Chaloupka, likely focused their early marketing strategies in areas with the greatest density of smokers.

MORE: Industry Is Winning the E-Cig Regulation Battle

That may be shifting, however, as the latest data suggests that e-cigarettes are now marketed more heavily in higher income communities, and less so in lower income neighborhoods, which traditionally have higher proportions of smokers. That may be because e-cig manufacturers are promoting claims that their products are safer than traditional cigarettes and are also hoping to capture those who may turn to their devices to help them quit smoking. “Groups that are more likely to switch to e-cigarettes in the long run are more interested in the health benefits, and tend to be more highly educated and have higher incomes” says Chaloupka.

That’s supported by evidence from some of the other studies in the series; scientists led by researchers at Harvard University’s School of Public Health conducted the largest study of e-cig use in Europe and found that the bulk of users were young smokers who had tried to kick the habit in the past year. These smokers were twice as likely to try e-cigs as smokers who hadn’t tried to quit.

MORE: Here’s Why Bacteria Like E-Cigs

On the one hand, the quick penetration of e-cigs into nearly every retail outlet, from pharmacies to convenience stores, grocery stores and gas stations may help more smokers to try the devices and try to quit. On the other hand, the ubiquity of the devices, and the unsubstantiated claims about their safety over regular cigarettes, may lead younger smokers to try them and potentially serve as a gateway to tobacco-based cigarettes. “Just the fact that their availability increased so rapidly means that people, especially kids, may see them a lot more in the stores they go into, and perceive them as normative, and that could by contributing to the big increases in use that we are now seeing,” says Chaloupka. The percentage of teens who have ever tried e-cigarettes doubled from 3.3% in 2011 to nearly 7% in just one year, according to the latest data from the Centers for Disease Control and Prevention.

The Food and Drug Administration recently announced its intention to regulate e-cigarettes as tobacco products; although they don’t contain tobacco, the agency says the devices meet the “statutory definition of a tobacco product.” As such, the FDA wants to ban sales to minors, require health warnings and keep e-cigs out of vending machines. The proposal is up for public comment until July, and may take another year before they become enforceable. In the meantime, 34 states have laws addressing e-cigs, but primarily to prevent minors from buying them and to ensure they don’t violate existing smoke-free air laws.

MORE: The Future of Smoking

The safety of e-cigarettes isn’t clear yet, despite claims by some manufacturers that they are less dangerous than traditional cigarettes. While they don’t envelop smokers in the carcinogenic smoke emitted by burning tobacco, they do contain other compounds such as propylene glycol, which the FDA is still studying for its health effects.

TIME E-Cigarettes

Teen Smoking Is Way Down. But What About E-cigs?

Cigarette smoking among high school students has dropped to lowest level in two decades

Rates of cigarette smoking among high school students has dropped to lowest level in 22 years, the CDC reports.

In 2013, the smoking rate among high school students hit 15.7%, which means the U.S. government has already reached its goal of lowing the teen smoking rate to 16% of less by 2020. That’s according to the National Youth Risk Behavior Survey (YRBS), which began in 1991. Another important data set on teen smoking and drug use—Monitoring the Future (MTF)—reports the rate is at 16.3%. Regardless, both surveys show fewer kids are smoking.

That’s good news, and it’s likely thanks to a combination of several factors, the most important being the rising costs of cigarettes. Others include the growing stigmatization of smoking, with half of states prohibiting smoking in places like bars and restaurants. The adult smoking rate is dropping too, which means teens have fewer smoking role models.

If teens are passing around fewer packs of cigarettes, does that mean they’re not smoking other things? Past data has shown a 123% increase in the consumption of other smokable tobacco products like cigars and pipes, though the recent numbers from the larger data sets show no change in smokeless tobacco use since 1999, and a drop in cigar use.

CDC

One question you’re likely going to see is whether teens are switching to e-cigarettes. E-cigarettes is a subject the public health community is uncharacteristically split on. On one side of the spectrum, you have critics arguing that it’s possible e-cigarettes serve as a gateway to regular cigarettes. One vocal critic being the head of the CDC himself. “The increased use of e-cigarettes by teens is deeply troubling,” said CDC Director Dr. Tom Frieden in a statement about teen tobacco use going down. “Nicotine is a highly addictive drug. Many teens who start with e-cigarettes may be condemned to struggling with a lifelong addiction to nicotine and conventional cigarettes.”

Emerging data points to certain trends, but e-cigs are still so new. Earlier this fall, a CDC report showed that e-cig use among teens, while still low, had doubled in a year, from 3.3% in 2011 to 6.8% in 2012.

Dr. Kenneth Warner, a professor of health management and policy at the University of Michigan School of Public Health, looked back through the data and found that among kids who have never smoked a conventional cigarette, only 0.7% have ever tried an e-cigarette within the last 30 days. What this shows is that the same kids who are smoking regular cigarettes are smoking e-cigs.

“Everyone thinks they are right and the logical thing is that nobody knows,” says Warner. “This is a huge-stakes issue, because the proliferation of e-cigs has the potential to either reduce the cigarette problem or increase it over time among kids.”

The reality is we have a long way to go. It took 40 years to get the adult smoking rate down to around 20%, and it won’t be easy to cut it in half again. Warner and his colleague David Mendez have created a smoking-prevalence model that’s been used since the 1990s. Their predictions show that at the rate we are going, we might not be able to hit a 10% adult smoking rate until the middle of the century. But that’s if we don’t try anything radically different.

“I believe we will do better because I don’t think we’ll stick with just status quo tobacco control,” says Warner. “In my judgment, the future lies in how effectively FDA can regulate cigarettes and other [nicotine] products.”

The FDA announced it is expanding its regulatory powers to cover more tobacco products including e-cigs, but anti-smoking advocates are arguing it’s still not enough.

“The data on kids is great, but we have a long way to go before we can pack up and go home and say we solved the problem,” says Warner.

You can read more on the latest CDC numbers here.

 

 

 

TIME E-Cigarettes

Industry Is Winning the E-Cig Regulation Battle

An e-cigarette on March 05, 2013 in Paris.
An e-cigarette in Paris on March 05, 2013 Kenzo Tribouillard—AFP/Getty Images

Correction appended: June 12, 2014

It’s a critical time for the e-cigarette industry. In April, the FDA announced proposed rules to regulate e-cigarettes as tobacco products. The announcement kicked off a period of public comment so that e-cig makers and public health experts can raise concerns and give the FDA the necessary facts to write an appropriate set of final rules. Regulation is just like writing the rules of a new game—on one side there are businesses vying for industry-friendly regs, and on the other are public health advocates.

So far, it looks like the businesses are winning. When the FDA first announced the start of the rule-making process, Time wrote about the positive reaction to them by e-cigarette executives, who saw them as a reasonable first step that would not greatly interfere with their businesses. Now, a few weeks into the rule-making process, business continues to be optimistic while public health advocates are getting worried.

“The deeming rule that the FDA has proposed is very, very, very limited in its scope,” says Stanton Glantz, a cardiology professor at the University of San Fransisco and one of the most vociferous proponents of strict rules for e-cigs. “It requires a useless warning label and says they can’t be sold to kids under 18, but it doesn’t put any restrictions on internet sales, which means kids under 18 can easily get them. It has no restrictions on marketing at all.” This puzzles Glantz. “You would think that the Obama administration would be supporting tobacco control because it would reduce health care costs.” As far as Glantz is concerned, the administration has erred on the side of the tobacco interests.

Naturally, one of the biggest concerns among health advocates is children’s access to e-cigarettes—and marketing of e-cigs to teens is up 321%, as TIME recently reported. The Centers for Disease Control and Prevention estimates that almost 2 million students in the U.S. have tried e-cigarettes. Policies to address the issue run the gambit from the least controversial—like establishing an age restriction on purchasing e-cigs and child proof packaging—to the more divisive, like prohibiting marketing to teens, prohibiting internet sales, and restricting the use of kid-friendly candy-like flavors.

But even the most basic restrictions—like better product labeling, and child proofing—were absent from the FDA’s initial deeming rules, making other restrictions on advocates’ wish lists seem that much further away. “Any meaningful rules on marketing of e-cigarettes are years, and years, and years away,” says Glanz, pointing out that if restrictions were imposed, e-cog companies would likely sue over marketing restrictions on first amendment grounds.

Craig Weiss, the CEO of NJOY in Scottsdale, Arizona, one of the leading electronic cigarette brands, also thinks the FDA rules will stay fairly restrained. “The FDA are smart people,” he says. “They have to read everything and they will, but I think what you saw in the proposed regulations, that’s what you are going to see in the ultimate regulations as well.”

As for whether any child-marketing restrictions would make sense down the line, Weiss says there are appropriate curbs, but there is no reason e-cigarette marketing should be as strict as tobacco. “You are confusing the arsonist with the firefighter,” he says. “Why would you treat products that are part of the solution as products that are part of the problem?” he says. Though NJOY is careful not to make direct claims that their products can help smokers quit, Weiss is a big believer in the potential for electronic cigarettes to replace cigarettes. Weiss supports limits on the age of actors in ads and rules against e-cigs appearing in cartoons, but he rejects the idea that there is anything wrong with his ads, which do feature young adults.

That’s not good enough for public health advocates. “The best way to market to kids is to market to young adults,” says Glantz, “If you designed marketing to stop smoking in a 50 year old, it could be done. That’s not what they are doing. It wouldn’t be on MTV, it would be on evening news.”

Weiss responds: “I’m interested in converting every adult smoker in the country to these products. I think it would be a tragedy for smokers to be smokers for decades before we advertise in a way that is appealing to them.”

The battle over e-cig regulation isn’t settled, but if what’s going on now is any indication, that battle may have actually been over—and won by industry—before it even started.
Correction appended: The original version of this story incorrectly described which restrictions are absent from the FDA’s initial deeming rules.

TIME Advertising

What to Say to Your Kids About E-Cig Ads

A woman smokes an e-cigarette.
A woman smokes an e-cigarette. PAUL J. RICHARDS—AFP/Getty Images

What parents can do to offset the impact of a steep rise in TV ads for electronic cigarettes aimed at teens and young adults.

If your kids watch “The Bachelor,” “Big Brother” or “Survivor”—and there is a good chance that they do—odds are growing fast that they are seeing ads for one of the most controversial products to hit the market in years: e-cigarettes.

It’s time for parents to strike back.

A study published today in Pediatrics suggests that e-cigarette makers are aiming their products at young people, ages 12 to 24, by increasing advertising during the shows (such as those above) and on the channels (including AMC, Country Music Television, Comedy Central and TV Land) they watch most.

“If current trends in e-cigarette television advertising continue, awareness and use of e-cigarettes are likely to increase among youth and young adults,” says the study, which was conducted by a team from the nonprofit research institute RTI International and the Florida Department of Health.

The impact of e-cigs, devices that vaporize an addictive nicotine-laced liquid solution into an aerosol mist that simulates the act of tobacco smoking, is hotly debated. On one side are those who argue that e-cigs are much safer than conventional tobacco cigarettes and help people addicted to them to quit. On the other side are those who say e-cigs still pose serious risks, including from liquid nicotine.

What can be said, with great certainty, is that we don’t know nearly enough about the long-term health effects of e-cigs to let young people get hooked on them. And as a parent, this is precisely why the study in Pediatrics and other analyses that have shown e-cigarette companies are spending tens of millions of advertising dollars targeting our kids are so alarming.

So, in the absence of any government regulation of e-cig advertising, here are a few things parents can do:

For starters, as always, the best thing we can do is talk to our kids. Let them know that e-cigarette companies have them in their sights and, as I’ve written, are trying to reel them in with fun flavors and sexy ads that are designed to make them feel all grown up. Tell them that these companies have a vested interest in promoting the idea that e-cigs aren’t bad for them—but the fact is, we aren’t really sure. And share that some experts are concerned that because they contain nicotine, e-cigs may be a gateway to real cigarettes.

Second, set clear expectations. We need to make sure that our kids understand that we don’t want them to vape and will be disappointed if they do. The Campaign for Tobacco-Free Kids has found that “parental attitudes, opinions, and feelings about their kids’ smoking status greatly influence whether or not kids will smoke, even when the parents smoke.” Vince Willmore, the organization’s vice president of communications, says the same principle is sure to hold true for vaping.

Third, set a good example. You should certainly express to your kids your own struggles to quit cigarette smoking, if that’s the case, but don’t vape around them. If you do, they may think it’s something to emulate—especially given the onslaught of ads reinforcing that vaping-is-cool message.

The Pediatrics study found that 50% of youth, ages 12 to 17, were exposed to an average of 21 e-cigarette ads from October 2012 to September 2013, and half of young adults, ages 18 to 24, were exposed to an average of 35 e-cigarette ads during the same period.

That’s a sharp rise from just a couple of years earlier, according to the study. In all, youth exposure to e-cigarette ads on TV increased 256% from 2011 to 2013, and exposure for young adults jumped 321%. More than 80% of the advertisements were for the brand blu eCigs.

The tactic seems to be working. The Centers for Disease Control reported last year that 1.8 million middle- and high-school students said they had tried e-cigarettes in 2012—double the number from the previous year.

“When I give talks about e-cigs I call them ‘Back to the Future’ because I feel like I’ve gotten into a DeLorean and gone back in time,” says Stanton Glantz, a professor of medicine at the University of California, San Francisco and the director of the Center for Tobacco Control Research and Education. “E-cig marking today looks a lot like what conventional advertising for tobacco looked like in its heyday.”

That shouldn’t be surprising. Many of the same companies that have long sold tobacco products—including R.J. Reynolds, Philip Morris parent Altria and Lorillard—have now gotten into the e-cigarette business.

Which leads me to the last thing that parents should do: Advocate. You can begin by writing in and supporting the Food and Drug Administration’s proposed new rules that include banning the sale of e-cigarettes to anyone under 18. But we need to go even further. Urge lawmakers and the White House to ban e-cigarette advertising from television—as has been the case with cigarette ads since 1971.

With e-cigs, tobacco companies are clearly taking a page out of their old playbook. It’s time for regulators to do the same.

 

 

 

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