TIME States

Indiana Moves to Regulate E-Cig Liquids

Man demonstrates an e-cigarette at Vape store in Chicago in 2014.
Nam Y. Huh—AP Man demonstrates an e-cigarette at Vape store in Chicago in 2014.

States are moving on electronic cigarettes where the feds aren't

Indiana moved closer this week to regulating the liquids that are used in electronic cigarettes, a regulatory focus that goes beyond the measures states and municipalities have been enacting for months.

The bill advanced by a state Senate committee and already passed by the state House would establish requirements for manufacturing safety standards, a ban on the sale of e-cig liquid to minors, and child-proof safety caps, the Associated Press reports. The movement comes as local governments increasingly look to regulate a cigarette alternative that is growing in popularity in the absence of federal rules.

The bill in Indiana would not extend a smoking ban to so-called vaping, something health advocates and the state attorney general had sought. But electronic cigarette business owners told lawmaers that the regulations could force businesses to close.

MORE: The Future of Smoking

The Food and Drug Administration has proposed a regulatory blueprint for regulation that would subject electronic cigarettes to the same regulations that apply to new tobacco products, and require disclosure of ingredients in the liquids used, among other things. But it could be many months, or even years, before these rules are enacted.

[AP]

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 Cancer

Taking Medication May Make It Easier to Quit Smoking

74076298
Getty Images

A Pfizer-funded study suggests the anti-smoking drug Chantix could be used to slowly help smokers quit

According to the results of a new trial published in JAMA, an anti-smoking medication may make it easier for smokers who aren’t yet ready to quit to do so later on.

Nearly seven out of every 10 current U.S. adult cigarette smokers want to quit completely, according to data from the Centers for Disease Control and Prevention. But some smokers who aren’t yet ready to quit for good want to lower their consumption and increase their chances for success at kicking the habit down the line. That’s possible with the help of a drug called varenicline, which is sold under the trade name Chantix and is manufactured by Pfizer, finds the new study, which was also funded by Pfizer.

The researchers conducted a two-year trial with 1,510 cigarette smokers who weren’t willing to quit within the next month, but who were willing to try to quit within the following three months. The men and women were split into two groups: some received Chantix, and others received a placebo for 24 weeks. The goal for all the volunteers was to reduce smoking by at least 50% by week four, and then continue to ease up on the habit until a quit attempt at week 12.

The volunteers who were taking Chantix were significantly more successful at quitting by the end of the study compared to the people on the placebo, and the effect stuck at one year.

Developing smoking cessation strategies that allow smokers to quit gradually could attract many more smokers to the method, a Pfizer spokesperson said in an e-mail.

Chantix is not without side effects and controversy. Some data has suggested the drug is linked to serious psychiatric side effects and heart problems.

The authors disclose several conflicts of interest, including the fact that Chantix manufacturer Pfizer was involved in the design, data collection and analysis of the study, and many of the study authors received fees or grants from Pfizer. However, the findings highlight a new potential strategy for curbing smoking and possibly allowing more people to be successful. According to the American Cancer Society, only around 4% to 7% of people are able to quit smoking without medication or other means, and about 25% are able to quit smoking for over six months with the help of medicine.

TIME Television

Watch John Oliver Burn Big Tobacco

The HBO late night host sets his sights on the tobacco industry's big business in overseas markets

Last week on Last Week Tonight John Oliver called the pharmaceutical industry to task for marketing to doctors and hard-hitting advertising and then controversially announced that we are all like Radio Shack.

This week, Oliver took on an equally controversial topic: Big Tobacco. To kick off his take-down, Oliver rolled out a vintage ’70s video clip of a Philip Morris CEO saying (with a straight face) that while it’s true that women who smoke have smaller babies, “some women prefer to have smaller babies.”

Since then the U.S. government has restricted tobacco advertising and sales, which according to Oliver, has resulted in falling adult smoking rates, going from about 43% in 1965 to about 18% today. Yet despite the decline in smokers in the U.S., a 2008 report found that tobacco is more profitable than ever — a phenomenon that Oliver compares to the continuing popularity of the band U2.

According to Oliver, the tobacco industry has managed such a feat by targeting developing nations and using the legal system to block restrictions on advertising and health warnings. He illustrates his point through a jaw-dropping array of clips from around the world (a Marlboro sponsored smoking kiosk outside a school!) and the mind-boggling attempts by Big Tobacco to stop an Australian law that slapped gruesome and graphic health warnings on cigarette packages.

According to Oliver, Philip Morris International itself is suing the country of Uruguay, a battle so expensive that Uruguay has had to seek help paying their legal fees from such unlikely sources as former New York City Mayor Michael Bloomberg. The tobacco industry has sent legal letters to countries like Togo, Namibia, and even the Solomon Islands, which Oliver points out has a population of 600,000.

To help the fight, Oliver has offered a new advertising campaign free of charge to Big Tobacco: Jeff the diseased lung. He even paid for ads in Uruguay and sent t-shirts emblazoned with Jeff to Togo. If Big Tobacco wants to remain profitable, they may want to take him up on the free advertising.

Watch the full clip below.

 

TIME States

Kentucky Mulls Statewide Smoking Ban

146242512
Shui Ta Shan—Flickr RF/Getty Images

But measure unlikely to become law

Kentucky lawmakers voted Friday to ban smoking in all public buildings and workplaces, but the measure faces a steep uphill battle to become law.

The vote was seen as a landmark move in Kentucky, which ranks among the states with highest tobacco yield. The sponsor of the bill, state Rep. Susan Westrom, said secondhand smoke kills about 950 Kentuckians each year.

The bill passed 51-46 in the Democratic-controlled state House of Representatives, WLWT reports, but will face harsher odds in the Republican-controlled state Senate.

[WLWT]

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.

MONEY health

Smoking Can Cost You $1 Million to $2 Million in a Lifetime

smoking cigarette wrapped in money on ashtray
John Knil—Getty Images

Your pack-a-day habit isn't just destroying your lungs, but your bank account as well—more than you ever imagined.

According to the American Lung Association, tobacco kills nearly half a million Americans annually and costs the nation $333 billion per year in health-care expenses and lost productivity to boot. But it’s hard for the average person—specifically, the average smoker—to wrap one’s brain around such an enormous figure.

Coming to the rescue, timed to coincide with the CDC’s Tobacco Awareness Week, is a new state-by-state analysis from WalletHub detailing the lifelong financial costs of smoking for an individual. Because the average price of a pack of cigarettes varies widely around the country—$5.25 in Virginia, $8 in Michigan, $12.85 in New York—the lifetime outlay varies greatly from state to state as well. In all cases, though, the data gathered by WalletHub show that smoking is incredibly costly in addition to being potentially deadly.

The total cost per smoker is estimated at $1,097,690 in South Carolina—and it’s the least expensive state in the nation. A Kansas City Star headline noted that the “cost of smoking is cheap in Missouri … relatively,” as the state ranks as the eighth least expensive on WalletHub’s list, with the total cost for a lifetime of smoking running “only” $1,177,230. At the high end of the spectrum, there’s Rhode Island, Massachusetts, New York, and Connecticut, where the habit costs more than $1.9 million per person in a lifetime. Priciest of all is Alaska, which crosses the $2 million mark.

For a little perspective, federal data estimates that the cost of raising a child to age 18 is about $250,000—a big chunk of change, but only a small fraction of expenses reportedly incurred by smokers.

Right about now, the average smoker (or just the average reader with a healthy degree of skepticism) is probably thinking: hogwash. The process of coming up with such wild figures must involve a fair amount of smoke and mirrors, so to speak, right?

Let’s have a look at what WalletHub did, exactly. By far, the largest expense incorporated into the per-person total is the “tobacco cost per smoker,” measured at $786,346 in South Carolina, up to roughly $1.5 million in Alaska. WalletHub came up with that figure by multiplying the average price of a pack of cigarettes in each state by the number of days in 51 years. Fair enough. There are cheaper ways to go about buying cigarettes, like buying smokes by the case, but many people purchase by the pack.

What’s trickier is the way that WalletHub pumped up its tobacco cost estimates by calculating “the amount of return a person would have earned by instead investing that money in the stock market over the same period. We used the historical average market return rate for the S&P 500 minus the inflation rate during the same time period to reflect the return in present-value terms.” In other words, the assumption is that money not spent on cigarettes would have been dutifully and wisely invested over those same 51 years.

Similar assumptions have also been used in the now (mostly) discredited “latte factor,” which is the theory that holds that people can wind up with millions in the bank by cutting back on everyday expenses like a daily latte. Among other reasons, this line of thinking is questionable because people don’t necessarily invest money that they don’t spend on some product or service—they’re more likely to simply spend that money on something else.

WalletHub also includes other costs that many smokers never think about, factoring in added health care expenses (with state-by-state data from the CDC) and an 8% hit on income due to smoking, as determined in a study by the Federal Reserve Bank of Atlanta.

Add up all of these and a few other estimated expenses, and over the course of a half-century, the cost to the pack-a-day smoker runs $1 million to $2 million, according to WalletHub. Are the figures overblown? Well, perhaps a bit. There’s a good argument to be made that the data were construed to come up with totals that are as big and headline-worthy as possible. (After all, they got our attention.)

Nonetheless, even if the figures are on the inflated side, it’s an undeniable reality that the smoking habit costs big bucks over a lifetime. And oh yeah, it can make your lifetime a lot shorter. Let’s not forget that.

TIME Addiction

The Best Way to Kick Your Smoking Habit

Getty Images

The more techy interventions, the better

If you’re really committed to quitting smoking for good, it’s time to get tech-savvy.

A new study published in the Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report shows that people who use both phone hotlines and online cessation services to help them quit are much more likely to say they’ve abstained from smoking compared to people who opt for just one or the other.

In general, smoking quitlines are proven to be successful interventions for smokers who want to kick the habit. They offer guidance, support and resources to keep quitters on track. Most quitlines also offer a web version of their services, but until now, it hasn’t been clear that more information really is better.

MORE: Here’s the Best Way to Get Someone to Quit Smoking

The new study suggests that it is. Researchers looked at 7,901 people who reported using either phone-only interventions, internet interventions only, or a combination of both. People who used both methods were significantly more likely to report they hadn’t smoked in 3o days when researchers followed up with them. The researchers speculate that dual usage may improve a quitter’s likelihood of succeeding, possibly because they’re strongly committed to their goal.

“Although telephone and Web-based interventions are effective in tobacco cessation, providing access to multiple types of cessation services might improve the odds of users in achieving long-term cessation,” the researchers write. The hope is that physicians will counsel patients on considering both interventions.

Our ever-connected climate may make this easier, and many public health initiatives are seeing success in sending educational text reminders. The National Institutes of Health (NIH) is paying particular attention to how social media and cell phones can best be used to help break addiction. In October, the NIH pledged $11 million to studying the use of social media to help understand, prevent and treat substance use and addiction.

So if you’re ready to accept the challenge of going cigarette-free in 2015, set yourself up for success and log in.

TIME Addiction

E-cigs Are the New Cool Thing for Teenagers

505196337
Getty Images

High schoolers are more likely to smoke e-cigs than regular cigarettes

Electronic cigarettes are hugely popular with teenagers all across the United States, new government data shows, but fewer teens are smoking regular cigarettes—suggesting that e-cigs may attract young people who wouldn’t otherwise smoke.

Researchers surveyed 1,941 Hawaii high school students about their smoking behaviors as well as their relative risk for picking up smoking. Risk was assessed based on factors like sensation-seeking and prevalence of smoking among peers, parent support and academic involvement.

They found, in their study published in the journal Pediatrics, that about 17% of the high schoolers smoked e-cigarettes only, 12% smoked both e-cigarettes and conventional cigarettes, 3% only smoked conventional cigarettes, and 68% said they did not smoke.

MORE: Debate Over E-Cigs Lights Up

Students who smoked tobacco cigarettes, or who smoked both cigarettes and e-cigs, fell within the highest risk category for picking up the habit. E-cigarette users were lower on the risk threshold than those two groups, suggesting it’s attracting young people who wouldn’t necessarily be interested in conventional smoking. E-cigarette users and dual smokers were also more likely that nonsmokers to believe e-cigarettes are healthier than regular cigarettes.

“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 write.

Part of this perception and attraction to e-cigs could be the fact that they are heavily marketed in public places the authors suggest.

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

The trouble with e-cigs is that there’s still not enough research to make any definitive conclusions on their risks or benefits. Some experts argue that since e-cigarettes have fewer unhealthy components than traditional cigarettes, they are a better option. They have even been trumpeted as a possible quitting device. Other experts argue that e-cigarettes are just another gateway to nicotine use, and are therefore unacceptable. Whether young people can access them and get hooked is of great concern.

Currently, the U.S. Food and Drug Administration (FDA) only regulates e-cigarettes marketed for therapeutic purposes, and many products continue to be marketed and sold with little FDA interference. The agency has proposed a rule that would give it more regulatory power over e-cigarettes that would look similar to other tobacco products, but nothing has been finalized. The FDA has also suggested a ban on sale of e-cigs to minors. The agency admits there’s a lot that consumers don’t know about e-cigs, like if they lead young people to smoke other tobacco products or how much nicotine is actually inhaled in each use.

TIME Cancer

U.S. Smoking Rate Hits Historic Low

186025671
Getty Images

And the number of people who say they smoke every day has dropped, too

Cigarette smoking among American adults has hit at an all-time low, health officials said Wednesday.

The percentage of smokers over the age of 18 dropped from 20.9% in 2005 to 17.8% in 2013, according to a new Centers for Disease Control and Prevention (CDC) report. That’s the lowest rate of smoking adults since the CDC started tracking the numbers via its National Health Interview Survey in 1965. Over the course of eight years, the number of U.S. smokers dropped from 45.1 million to 42.1 million, the report reveals.

Still, the CDC worries too many Americans still smoke, and a Nov. 13 report from the agency showed that a high number of young people still smoke, putting millions at risk for premature death.

The good news for health officials is that people seem to be cutting back, if not quitting. The number of people who smoke every day has dropped nearly 4% from 2005 to 2013, and the proportion of smokers who smoke only some days has increased. Of course, smoking less habitually still poses tremendous danger for the health.

“Though smokers are smoking fewer cigarettes, cutting back by a few cigarettes a day rather than quitting completely does not produce significant health benefits,” said Brian King, a senior scientific adviser with the CDC’s Office on Smoking and Health, in a statement.

Cigarette smoking continues to be the leading cause of preventable death among Americans, reportedly racks up $289 billion a year in medical costs and productivity loss.

Around 70% of all cigarette smokers want to kick the habit, and if a smoker quits by the time they turn 40, they can gain almost all of the 10 years of life expectancy they lose by smoking.

Americans who want to quit smoking can call 1-800-QUIT-NOW for free counseling and resources, or visit the CDC’s antismoking tips site here.

Your browser, Internet Explorer 8 or below, is out of date. It has known security flaws and may not display all features of this and other websites.

Learn how to update your browser