TIME

Here’s Why Bacteria Like E-Cigs

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Barbara Rich—Getty Images/Flickr Open

The vapor from e-cigarettes is supposed to be safer than cigarette smoke, but not when it comes to fighting bacteria

There’s quite a bit that we still don’t know about e-cigarettes when it comes to how safe they are — if they cause lung cancer like traditional cigarettes do, whether they are as addictive as cigarettes, and more. That’s reflected by the fact that fewer smokers believe that e-cigs are safer for their health than traditional cigarettes; in 2010, 85% did, but that percentage dropped to 65% in 2013, according to a study published in the American Journal of Preventive Medicine.

But for bacteria, e-cigs may not be so bad. Dr. Laura Crotty Alexander, from the University of California at San Diego and the VA San Diego Healthcare System, found that the vapor from e-cigs prompts bacteria to become more resistant to antibiotics. In the presence of e-cig vapor, for example, methicillin resistant staphylococcus aureus (MRSA) became more resistant to the natural anti-microbial agents that the body makes. Cigarette smoke also produces the same effect, but Crotty Alexander was surprised that the e-cig vapors did as well, given that they were not supposed to contain the health-harming carcinogens that tobacco smoke does.

MORE: The FDA Plans to Ban E-Cigarette Sales to Minors

“I was hoping that maybe e-cigarettes would be safer and that they would not stress the bacteria as much as cigarette smoke,” she says of her findings, which she presented at the American Thoracic Society International Conference. “But we found that the e-cig vapor also made bugs become more resistant to killing by antimicrobial peptides.”

Other studies show that these peptides, known as the body’s natural antibiotics, are structurally similar to antibiotic drugs, so while Crotty Alexander did not test bacteria exposed to e-cig vapor against antibiotics, she expects they would be resistant to the medications as well.

MORE: Study: E-Cigarettes Do Not Help People Quit Smoking

How did the bugs fight back? When stressed by the e-cig vapors to defend themselves, the bacteria produced copious amounts of biofilm, a sticky, slimy polymer that acts as their armor against things like antibiotics.

But the vapors may be doing much more than disturbing the bacteria. Earlier studies showed that traditional cigarette smoke, with its tar and tobacco-burning byproducts, can also weaken the ability of the body’s immune cells to defend against the insult, making it harder to fight off infections. Crotty Alexander is starting to analyze human cells to see if e-cig vapors have the same effect. She’s narrowing down which components of e-cigs contribute to the antibiotic resistance – some e-juices are made with propylene glycol, while others contain a vegetable-based glycol, and not all contain nicotine.

MORE: E-Cigs Still Produce Carcinogens, Study Shows

So far, it looks like the nicotine may be driving the MRSA biofilms, but Crotty Alexander is doing more research to determine how e-cigs are affecting human immune cells. As the survey of smokers shows, however, they may already know the answer.

TIME Smoking

The Weird Link Between E-Cigarettes and Mental Health Disorders

US-HEALTH-TOBACCO-E CIGARETTE
This September 25, 2013 photo illustration taken in Washington, DC, shows a woman smoking a "Blu" e-cigarette (electronical cigarette). PAUL J. RICHARDS—AFP/Getty Images

A new study finds elevated rates of depression, anxiety and other mental disorders among users of e-cigarettes

A new study has found that people suffering from depression, anxiety and other mental disorders are more than twice as likely to spark up an e-cigarette and three times as likely to “vape” regularly than those without a history of mental issues.

Researchers at the University of California, San Diego drew their findings from an extensive survey of American smoking habits. Among 10,041 respondents, 14.8% of individuals suffering from mental health disorders said they had tried an e-cigarette, compared with 6.6% of individuals who had no self-reported history of mental disorders.

The e-smokers’ elevated rates of mental disorders reflected the elevated rates of mental illness among smokers in general. The authors note that by some estimates, people suffering from mental disorders buy upwards of 50 percent of cigarettes sold in the U.S. annually.

Many respondents said they switched to e-cigarettes as a gateway to quitting. The FDA has not yet approved e-cigarettes as a quitting aide.

“People with mental health conditions have largely been forgotten in the war on smoking,” study author Sharon Cummins said in a university press release. “But because they are high consumers of cigarettes, they have the most to gain or lose from the e-cigarette phenomenon.”

The study will run in the May 13 issue of Tobacco Control.

TIME

E-Cigs Still Produce Carcinogens, Study Shows

New research suggests that some e-cigarettes get hot enough to produce cancer-causing compounds

Vaping may not be the benign drug-delivery system some have thought. E-cigarettes are touted by some to help people curb smokers’ conventional cigarette habit, but new research suggests e-cigs can still produce carcinogens.

E-cigarettes are considered healthier than conventional cigarettes, since smokers are inhaling vaporized nicotine instead of carcinogen-filled smoke. But soon to be published research shows that some popular e-cigarettes can get so hot that they produce some of the same carcinogens as traditional cigarettes. The study looked at higher-voltage e-cigarettes—referred to as “tank-style”—which are heated with larger batteries compared to smaller disposable brands. The new study, which will be published in the journal Nicotine and Tobacco Research, found that tank e-cigarettes can produce the carcinogen formaldehyde when the liquid nicotine is heated at high temperatures, which users can inhale. “This finding suggests that in certain conditions, [e-cigarettes] might expose their users to the same or even higher levels of carcinogenic formaldehyde as tobacco smoke,” the Roswell study says, according to the New York Times.

In April, the U.S. Food and Drug Administration (FDA) announced that it extended its regulatory jurisdiction over more tobacco products, including electronic cigarettes. The agency said it plans to crack down on e-cigarettes by proposing a ban of their sale to people under 18 and by requiring health warnings on packaging.

The trouble with e-cigarettes is that their risks and benefits are still unknown. It remains uncertain whether they help people quit, or if they’re servings as a gateway to regular cigarettes for young people. According to data from the National Youth Tobacco Survey, 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. There are also questions over whether liquid nicotine is dangerous when put in the wrong hands, given that some tobacco control agencies have seen an uptick in poisonings.

There’s an overall lack of research on e-cigs, but researchers are beginning to fill that hole, and lately, the findings haven’t looked good for e-cigarettes.

 

TIME

E-Cig Execs Are Actually Thrilled With New FDA Regulations

Customers at Henley Vaporium in New York, Dec. 2013.
Customers at Henley Vaporium in New York, Dec. 2013. Timothy Fadek—Redux

E-cigarette makers have hailed the Food and Drug Administration's proposed regulations for new tobacco products—including electronic cigarettes, pipe tobacco and hookah, among others—as fair and moderate and a sign of a business-friendly approach

“It’s a great day,” says Christian Berkey, CEO of Johnson Creek, a leading maker of electronic cigarette liquid based in Wisconsin.

Berkey was referring to the FDA’s issuance Thursday of proposed federal regulation of electronic cigarettes, a nascent industry that has grown to nearly $2 billion a year in U.S. sales. The move extended the FDA’s authority to regulate new tobacco products, including electronic cigarettes, pipe tobacco, and hookah, among others.

The FDA will take comments from various stakeholders on the rules over the next 75 days, and it could be a year or more before the regulations take effect, but today’s proposed rules were a big step toward bringing the e-cig wild west under control. Currently, there are no federal rules governing e-cigarettes (though many states prohibit the sale to minors).

“People worried the regulations would be unreasonable and onerous,” says Berkey. “What we are seeing is they are not.” Upon seeing the FDA’s proposed rules today, the businesses are cheering. They see the proposal as a signal that the agency plans to take a business-friendly approach.

Craig Weiss, the President and CEO of NJOY, a popular e-cigarette maker, was even more ecstatic in a press statement: “By resisting calls to regulate ahead of – and indeed in opposition to – the science and data, today the FDA has brought NJOY a giant step closer to achieving its corporate mission of obsoleting cigarettes.”

“I would say that there were certain people that went into this thinking the FDA would be a foe — an irrational, illogical opponent to these devices,” says Miguel Martin, president of Logic Premium Electronic cigarettes, another top e-cigarette manufacturer, “[But] they’ve hit the ball right down the middle of the fairway. It is early, I might change opinion,but the original set up on the process seems extremely fair.”

The proposed regulations would ban the sale of e-cigarettes to minors and in vending machines where minors are allowed, require labels that list the ingredients and warn of the addictive properties of nicotine, and require companies to register new products with the FDA with a rigorous application process before they can put them on the market.

The FDA has not yet proposed to ban flavors, which some anti-smoking advocates say appeal to kids, nor have they banned internet sales or advertising of e-cigarettes. And the FDA has given electronic cigarette companies a two-year window after the regulations go into effect to keep their products on the market while they apply to register new products.

Currently, it is illegal for e-cigarette companies to make health claims that their products are healthier than regular cigarettes or can help people quit—a question that needs more thanks to a court decision ruling in 2009. But in today’s deeming regulations, the FDA opened a pathway for companies to make health claims by submitting supporting research to the FDA.

“I suspect that many companies are going to take a run at that,” says Martin.

The proposals are really just a starting point. Mitchell Zeller, the director of the Center for Tobacco Products at the FDA, called the proposed rules “foundational” today in a call with reporters, signaling that future regulations could ban or restrict things like internet sales, flavors, or advertising. And after the first two year grace period, e-cigarettes will still be subject to potentially long application processes for new products that might hurt business, say manufacturers.

“It’s not time for a victory lap,” says Martin. “A lot can change.”

TIME Addiction

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

The FDA has cracked down on e-cigs by asserting its regulatory power and proposing a ban on sales to minors

On Thursday, the U.S. Food and Drug Administration (FDA) flexed its regulatory muscles and extended its authority over more tobacco products, including the highly debated electronic cigarettes, or e-cigarettes. In the announcement, the agency said it now has jurisdiction over items that meet the statutory definition of tobacco products—which includes e-cigarettes, pipe tobacco, and hookah tobacco, among others. The FDA says it also plans to crack down on e-cigarettes by proposing a ban of their sale to people under 18 and by requiring health warnings on packaging.

The UK already has stiff regulations on e-cigarettes and some cities in the U.S., like Los Angeles, have banned them in several public places. The trouble with e-cigarettes is that they are so new, and there’s not enough evidence to definitively determine either how effective they are at helping people quit smoking—or the health risks associated with inhaling vaporized nicotine. Here are five things we are still scratching our heads over.

1. Do e-cigarettes actually help people quit—or are they a gateway for new smokers?
Some e-cigarette brands claim that they can help people wean themselves off regular cigarettes by supplying would-be quitters with nicotine (but without the carcinogens in conventional cigarette smoke). However, recent research is questioning whether they really help people quit. A recent study published in the journal JAMA Internal Medicine looked at self-reports from 949 smokers–88 of whom used e-cigarettes at the start of the study–in order to determine if e-cigarettes were helping people kick or cut back on nicotine. Researchers found that e-cigarettes did not help people quit, concluding, for now at least, that the case for e-cigarettes as a cessation tool is flimsy at best. (The study size was small, signaling a need for more research.)

There’s also the worry that e-cigarettes are tempting people into trying the real thing. Another study published in March found that adolescents who use e-cigarettes are more likely to smoke other tobacco products and regular cigarettes, which suggests that e-cigarettes are not always the lesser of two evils, but instead, just another vector for nicotine exposure. According to data from the National Youth Tobacco Survey, 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. Of course, there are still not enough studies to reach a firm conclusion that e-cigarettes make people more likely to smoke tobacco—and the FDA says this is not yet determined.

2. How dangerous is liquid nicotine?
The health risks associated with the liquid nicotine used in e-cigarettes are not fully understood. A recent New York Times article found that the liquid could be linked to poisonings; the number of poisonings linked to e-cigarette liquids rose to 1,351 in 2013, which is a 300% increase from 2012. The CDC also released a report earlier this month that showed what they called a “dramatic” rise in e-cigarette-related calls to U.S. poison centers. The spike went from one call a month in September 2010 to 215 calls a month in February 2014. Over half of the calls involved kids age five and under, and 42% involved people ages 20 and older. Known symptoms of liquid nicotine ingestion include vomiting, nausea, and eye irritation.

3. Are the vaporizers safe?
Though the numbers are small, there have been a few cases of e-cigarettes exploding and harming users and the people around them. E-cigs contain a small lithium battery that heats up the liquid inside. The liquid is made up of nicotine dissolved in a colorless liquid called propylene glycol, with added synthetic flavor and sometimes dyes. When an e-cigarette exploded in a Florida man’s face, Thomas Kiklas, co-founder of the Tobacco Vapor Electronic Cigarette Association, told the Associated Press that the industry does not know of issues with the cigarettes or batteries exploding.

4. Is propylene glycol dangerous?
Propylene glycol is a a clear, colorless liquid that becomes vapor when it’s heated. It can also be found in food, cosmetics, and pharmaceutical products, and the small amounts people are typically exposed to are largely believed to be benign. However, it’s uncertain whether inhaling propylene glycol could come with unique health risks. “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.”

5. Can you get addicted to e-cigarettes?
As the FDA says, nicotine is “highly addictive.” The FDA says they still don’t know how much nicotine or other potentially harmful chemicals are being inhaled during e-cigarette use. Therefore, it’s hard to tell how much or little damage is being done.

 

TIME Law

The FDA Plans to Ban E-Cigarette Sales to Minors

Talia Eisenberg, co-founder of the Henley Vaporium, uses her vaping device in New York, Feb. 20, 2014.
Talia Eisenberg, co-founder of the Henley Vaporium, uses her vaping device in New York, Feb. 20, 2014. Frank Franklin II—AP

The Food and Drug Administration has proposed rules that include requiring the markers of e-cigarettes and other tobacco-related products to register their ingredients in the next two years, marking a first step toward national regulation

Updated 9:41 a.m. ET Thursday

The FDA announced Thursday long-awaited regulations for electronic cigarettes that would for the first time ban their sale to minors and require health warnings on the devices nationwide.

The FDA rules will require that makers of e-cigarettes and other tobacco-related products register their products and ingredients with the FDA within the next two years. The FDA-required warning labels will caution users against the risks of nicotine addiction.

“This proposed rule is the latest step in our efforts to make the next generation tobacco-free,” said outgoing U.S. Department of Health and Human Services Secretary Kathleen Sebelius in a statement. Sebelius announced her upcoming retirement earlier this month.

However, the government will not immediately restrict television advertisements and flavorings that could target younger consumers.

The new regulations will be open to public comment and the possibility of legal challenges before becoming final.

E-cigarettes have been exploding in popularity, recently becoming a multibillion-dollar industry. Cities and states across the U.S. have already begun imposing their own restrictions on the nicotine-delivering devices in the absence of federal regulations.

“I call the market for e-cigarettes the wild, wild West in the absence of regulations,” Mitchell Zeller, director of the FDA’s Center for Tobacco Products, told reporters, the Los Angeles Times reports.

The health impact of the devices remains unclear.

This post has been updated to reflect the FDA’s publication of its proposed rules.

TIME health

New Push to Raise Tobacco Age in Washington State

The King County Alcoholism and Substance Abuse Board says tobacco sales should conform to the same regulations as marijuana and alcohol, barring purchases by anyone under the age of 21. A similar measure in Colorado failed to pass in March

A Washington state group wants the state to keep tobacco out of the hands of those under 21.

The King County Alcoholism and Substance Abuse Board, which recommends substance abuse polices, wants the state legislature to raise the minimum age to purchase tobacco from 18, KOMO News reports. Adults over 21 are legally able to purchase alcohol and marijuana in the state, and the board thinks tobacco should conform to the same standards.

Board chairman Pat Godfrey said a new minimum age would also prevent teens from picking up the habit in the first place. “Our concern is that nicotine is a very powerful addictive substance,” Godfrey told KOMO News in Seattle. “If we can discourage teens from beginning the habit, that’s a better strategy than trying to get adults to stop the habit after they’ve started.”

A similar measure in Colorado, where marijuana can also be legally purchased by adults 21 and up, failed to pass through committee in March. Several states and localities have been considering and passing legislation that restricts tobacco sales to 18 through 20-year-olds.

Keeping tobacco products away from young people is championed by the same groups who worry the influx of electronic cigarettes will promote the habit. Some research supports the idea that e-cigarettes help smokers quit, though the Food and Drug Administration has yet to confirm its effects.

[KOMO News]

TIME health

Lawmakers to E-Cig Makers: Stop Preying on Minors!

Top US Tobacco Companies Enter E-Cigarette Market
A patron enjoys an electronic cigarette at the Vapor Shark store in Miami on Feb. 20, 2014 Joe Raedle—Getty Images

In a 43-page report, a group of congressional Democrats led by Dick Durbin of Illinois stressed the need for federal regulation of e-cigarettes, citing marketing efforts aimed at minors and a need for more information on health risks for consumers

In a report published on Monday, 11 Congress members recommended federal regulations on e-cigarettes that would include banning sales to anyone under 18, halting TV and radio ads, and educating the general public about the risks associated with inhaling nicotine vapors.

The Gateway to Addiction report written by the lawmakers’ staff after surveying e-cig makers finds e-cigarette companies are using marketing tactics that appeal to young people, such as handing out samples at events like music festivals, social-media promotion and offering kid-friendly flavors. The Centers for Disease Control and Prevention estimate 1.78 million children and teens tried e-cigarettes in 2012.

“E-cigarette makers are starting to prey on kids, just like big tobacco companies,” said Congressman Henry Waxman, a Democrat from California. “With over a million youth now using e-cigarettes, FDA needs to act without further delay to stop companies from marketing their addictive products to children.”

Though use is up, the Food and Drug Administration has not fully studied the products — according to its website consumers are not aware of the risks of use, the amount of nicotine or other chemicals being inhaled and whether or not there are benefits to smoking e-cigarettes. A New York Times report from March detailed the potential dangers of the liquid nicotine found in electronic cigarettes, including vomiting, seizures and death.

According to the report, six of the surveyed e-cigarette companies support some regulation.

TIME

In Children’s Hands, E-Cigarettes Can Be Deadly

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

Poison centers are experiencing a spike in calls concerning children exposed to liquid nicotine, from one call a month in September 2010, to 215 calls a month in February 2014. The new findings are just the latest in increasing skepticism over e-cigarettes' safety

Update: Thursday April 3, 2014 4:00 p.m.

E-cigarettes have been criticized for targeting children, since many brands come in bright colors, and candy and fruit flavors. While some worry about tempting kids with an addictive habit, e-cigs can also be deadly for them.

On Thursday, the CDC released a report indicating a “dramatic” rise in e-cigarette-related calls to U.S. poison centers, from one call a month in September 2010 to 215 calls a month in February 2014. More than half of the calls involved children age five and under, while 42% involved people ages 20 and older. The nicotine in e-cigarette comes in a liquid form, which when ingested can lead to vomiting, nausea, and eye irritation.

“E-cigarette liquids as currently sold are a threat to small children because they are not required to be childproof,” said CDC director Dr. Tom Frieden in a statement. “Use of these products is skyrocketing and these poisonings will continue.”

The study follows a New York Times report about the dangers that “e-liquids” pose, where small amounts can cause vomiting and larger amounts can lead to seizures and even death. “A teaspoon of even highly diluted e-liquid can kill a small child,” according to the Times.

The new findings are just the latest in increasing skepticism over e-cigarettes’ safety. The support for these cigarette alternatives is manifold: people argue they are are healthier than conventional ones because they don’t contain tar and tobacco, that pushing people towards lower spectrum nicotine carriers is ultimately better, and that they may help people kick their conventional smoking habit.

But evidence against them is mounting. Just last month, a small study published in the journal JAMA Internal Medicine reported that smoking e-cigs doesn’t help people smoking conventional cigarettes quit. Another study found that young people who smoke e-cigarettes are more likely to smoke regular cigarettes as well. Whether e-cigs are a gateway to the real thing remains unclear.

It’s too early for a definitive conclusion on e-cigarettes’ full spectrum of risks and benefits, but the CDC warns that they may be an emerging public health issue. In response to the study and growing concerns over safety, FDA Commissioner Margaret Hamburg pushed senators at a Congressional budget hearing on Thursday to allow the FDA to establish regulation authority over e-cigarettes, Reuters reports. The FDA’s proposed rule is currently being reviewed by the White House’s Office of Management and Budget.

This post was updated with the latest news from the FDA.

TIME cities

Philadelphia Poised to Regulate E-Cigs

The city council unanimously votes to treat e-cigarettes like traditional smokes and fine businesses that sell them to minors. If the mayor signs the legislation, Philadelphia will join New York City, Chicago and others where similar laws are on the books

Philadelphia is set to join a growing list of city and state governments that are regulating e-cigarettes.

The city council voted unanimously Thursday to ban smoking the electronic cigarettes in public and to prohibit their sale to minors under 18, NBC Philadelphia reports, subjecting the device to the same regulations imposed on traditional cigarettes. The legislation, which imposes $250 fines on businesses that sell e-cigarettes to minors, still has to be signed by Mayor Michael Nutter. A spokesperson for the mayor told NBC that he could not say Thursday whether Nutter would sign the bill.

New York City, Chicago, and the state of New Jersey are among several jurisdictions that have imposed similar restrictions on electronic cigarettes, as local governments respond to reports of growing use, particularly among minors.

[NBC Philadelphia]

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