TIME Addiction

WHO Urges Tighter Regulation of E-Cigarettes

A woman smokes an "Blu" e-cigarette in Washington, D.C., on Sept. 25, 2013.
A woman smokes an "Blu" e-cigarette in Washington, D.C., on Sept. 25, 2013. Jim Watson—AFP/Getty Images

The United Nations agency acknowledged both the "promise and threat" of the $3 billion industry

The World Health Organization recommended countries adopt a raft of tighter regulations over the sale and use of e-cigarettes Tuesday, including a ban on sales to minors, a ban on “vaping” indoors and tighter controls over advertising and flavored products.

The United Nations agency released a report on Tuesday that acknowledged both the “promise and threat” of the e-cigarette market, Reuters reports. The authors cast doubt on e-cigarette makers’ claims that the devices could help smokers kick the habit. Until those claims had been substantiated by a stronger body of scientific evidence, the U.N. health agency recommended that countries adopt regulations that would “minimize content and emissions of toxicants.”

Suggested regulations include restrictions on advertisements promoting e-cigarettes as a healthy alternative to smoking, prohibitions on sales to minors and sweetened flavors that might appeal to minors and a ban on using the devices indoors. The Food and Drug Administration proposed similar restrictions on sales to minors and advertising of e-cigarettes in April, but stopped short of banning television advertising or sweetened flavors.

The report comes amid a widening divide in the scientific community as to whether e-cigarettes constitute a help or a hindrance in the battle to stop people smoking. A group of 53 scientists signed an open letter to the WHO earlier this year urging officials to resist any measures that might suppress sales of e-cigarettes, calling them “part of the solution” in the fight against smoking.

[Reuters]

TIME E-Cigarettes

Toronto Bans E-Cigarettes From City Workplaces

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

Mayor Rob Ford reportedly voted against the ban

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

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

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

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

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

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

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

TIME Addiction

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

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

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

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

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

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

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

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

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

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

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

TIME 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.

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