As ‘Vaping’ Rockets in Popularity, Will It Help Smokers Quit Tobacco, Hook Young Addicts or Mask Marijuana?

Southern California’s first electronic cigarette expo promised to be “epic.” And like any good party, it briefly got shut down by authorities.  How epic was it? So many thousands puffed away — or “vaped” — that the steamy haze set off fire alarms and forced the evacuation of the Anaheim Convention Center. Throngs of sellers and users swiftly returned to the bustling trade show that had a festival vibe with DJs pumping out hip-hop, sofa lounges and tasting bars. Looking like a Wild West bartender in his handlebar moustache and bowler hat, Vince Sottile surveyed the scene from behind the Five Pawns counter, where lines formed all day. “I quit smoking with this device, and we’re here hoping others will quit, too,” Sottile said, gripping what looked like a jumbo metal pen filled with liquid. The flavor was “Gambit,” and one click heated it by battery. Sattile inhaled on it, a misty vapor momentarily cloaking his head. “It simulates the smoke going in your lungs without being harmful …. it dissipates quickly, and you don’t stink.” And, he added with a grin, “My girlfriend will kiss me.” Created as a way to wean smokers off nicotine and free them from carcinogenic tobacco chemicals, electronic cigarettes were almost unheard of when they hit the U.S. five years ago. They’ve now rocketed into a nearly $2-billion industry that is forecast to eclipse traditional cigarette smoking globally within a decade, according to Bonnie Herzog, Wells Fargo Securities’ senior tobacco industry analyst. With the market entrance of Big Tobacco and its huge money, distribution systems and branding horsepower, industry growth may accelerate even faster, her team has told investors. Lorillard, the third-largest manufacturer of cigarettes in the U.S. and owner of Blu, the largest e-cigarette brand in the country, has seen a fourfold increase in revenue in the third quarter of this year over the same quarter one year ago. Additionally, Reynolds American and Altria Group, the largest cigarette producer in the country, are test-marketing their own e-cig brands. However, the unfettered sales and access of the nicotine-loaded e-cigarette may soon change. Because the health impacts of e-cigarettes are unknown, the U.S. Food and Drug Administration is poised to announce first-time proposed regulations over the sale of electronic cigarettes. An FDA spokeswoman said the agency is seeking to regulate the devices by defining them as a tobacco product, on the grounds that they often contain nicotine, derived from tobacco. This comes fresh off this fall’s report by the Centers for Disease Control and Prevention that e-cigarettes had been tried by double the number of middle and high school students in 2011-2012. Despite the overall percentages being relatively low, and even lower among non-smoking youth, the fact that any juveniles were experimenting with a potential nicotine delivery system fueled widespread calls, including by more than 40 state attorneys general, for FDA action.

Effect on Adolescent Brains

“[There were] an estimated 1.78 million students having ever used e-cigarettes as of 2012,” the CDC report stated about youths who were asked if they had used such a device in the prior 30 days. “Moreover, in 2012, an estimated 160,000 students who reported ever using e-cigarettes had never used conventional cigarettes. This is a serious concern because the overall impact of e-cigarette use on public health remains uncertain. In youths, concerns include the potential negative impact of nicotine on adolescent brain development as well as the risk for nicotine addiction and initiation of the use of conventional cigarettes or other tobacco products.” E-cigarettes had been mostly curiosities when they arrived in the U.S. These days you may seem them popping up at mall kiosks or shopping centers, certainly around college campuses around the country. The mostly metal devices sell for about $50 or more. The small bottles of liquid, or “juice,” are sold separately and may or may not have nicotine in varying amounts, and in flavors ranging from berry and menthol to apple pie and bacon. A cartridge inside is filled, and a lithium battery heats it to create vapor that is inhaled. Hence the name “vaping,” the term used as noun and verb in the vast online marketplace and social media. Any view of e-cigarettes has to include traditional cigarettes, which kill an estimated half a million people yearly, according to the CDC. For every death, 20 more people suffer at least one or more serious or chronic illnesses, the American Lung Association reports. The addictive power of nicotine and the estimated 4,800 chemicals added to traditional tobacco cigarettes results in a dishearteningly low quit rate, according to Michael Siegel, professor of public health at Boston University and a vocal supporter of e-cigarettes’ potential promise. Of every smoker who tries to quit, only 3% will remain non-smokers by year’s end, he said.

In response to widespread alarm by consumer watchdogs and anti-smoking groups about the doubling in youth experimentation or use of e-cigarettes and their rapid popularity, Siegel has called for more study of the products and regulation of advertising to youth. But he noted that the industry doesn’t need youth for sales; there are billions in sales from adults, and they know if juveniles increasingly use them, “Congress would shut them down immediately.” Siegel finds it “ironic” that Congress seems so zealous in going after e-cigarettes. “Congress has done almost nothing to prevent youth smoking,” Siegel said. “The Tobacco Act does virtually nothing to prevent youth smoking. The most telling point is the exemption of menthol from the flavoring ban. If Congress were truly interested in reducing youth smoking, they would have included menthol in the flavoring ban, since that is the one type of flavored cigarette that kids are actually smoking. While there are restrictions on marketing of cigarettes to youth, smoking rates among youth remain high. What is needed are mass media campaigns to discourage tobacco use among youth. Congress needs to allocate money for such campaigns. But it continues to fail to do so. It is indeed ironic how quickly Congress can get mobilized around stopping electronic cigarettes, but how little the Congress is willing to do to actually decrease youth smoking.” As to the potential value of e-cigs, he views the glass half-full.The nicotine quantity is lower, and that right there is the bottom line.

Safer Than Smoking?

“It’s not even a question of whether they are safe, which we want to know, but whether they are safer than smoking,” Siegel said. “Yes the number of 160,000 young [non-smoking] students reporting trying an e-cigarette is of concern, but what that means is that nine out of 10 students haven’t tried them. And if they do help people quit smoking, that would be among the greatest public health success stories of the century.” UC Riverside biology professor Prue Talbot is conducting research into the mostly unknown effects of the liquid used in electronic cigarettes. She and others note that there is no regulation of ingredients in the frontier marketplace of vaping, no way to know for certain if the “juice” is truly free of nicotine. And apart from medical impacts, she noted that the vapor does create a residue. “We’ll be looking at that, too,” Talbot said. In the void of medical research has come growing concern among local governments, and universities around the country are grappling with e-cigarettes. Legislatures in states such as Oregon and Colorado are weighing whether and how they would be taxed. Not all school districts have e-cigarette bans and one of California’s largest, Long Beach Unified, reported that it hadn’t encountered the devices, which would be ruled smoking, a spokesman said. Large cities and small businesses face the question: Do they belong in public parks, coffee houses or restaurants or campuses, where smoking has long been outlawed in most states? On airplanes? While smoking has been banned in most municipal and state jails, administrators of some county jails are selling e-cigarettes to inmates as program fundraisers in the tri-state area of Southern Illinois, Kentucky and Indiana, reports the Quad City Times. Much to the chagrin of the local American Lung Association, disposable e-cigs have been sold via commissaries as a pilot idea to combat illegal smuggling; jail administrators found inmate morale rose, while money was raised for publicly funded facilities. Not all jail administrators jumped on board the idea, reports Southern Illinois 14 News, and opponents argue that inmates should get no such morale perks. And like even sellers and lovers of electronic cigarettes, most have been caught off-guard by their rapid rise in sales “It has just exploded,” said Dimitris Agrafiotis, host of a weekly online show called VapeTeam, where he interviews guests live on the latest products and science around vaping. “I quit tobacco three years ago. I’m now on the lowest nicotine level, and I have the pleasures of smoking,” Agrafiotis said.” What smoker wouldn’t want to keep the good parts while losing the dangers, the 4,000 chemicals and combustion of tobacco?” Talbot hopes to learn some answers. She has research underway into the liquid’s effects on the body, be it from inhaling or second-hand exposure to the mist created by the vaporized ingredients, or so-called third-hand impacts.

Toxic Fluid in E-Cigarettes

Already in her research, Talbot has found that some fluids used in e-cigarettes are toxic to cells. Among her other findings are that the output of e-devices varies widely depending upon how hard a user pulls on the vaper; some of the refill fluids were “toxic to mouse neural stem cells, human embryonic stem cells as well as to adult lung cells,” she told a UC Health reporter. “And at least some e-cigarette components may threaten developing fetuses, as regular tobacco cigarettes do, and also may damage lung tissue.” Talbot’s team has also dissected “cartomizers” — devices used in newer versions of e-cigarettes that combine the flavored fluid and the battery-powered heater in a single unit, the report stated. “The researchers have found that when heated, the aerosol from one brand of cartomizer-style cigarette contained 21 substances, including a number of metals and metal nanoparticles. One metal, tin, appeared to be released from solder joints in the cartomizers “We obviously need to know more about these chemicals and long-term effects,” Talbot said. Beyond that, she anecdotally has seen a mushrooming of retail shops around the Riverside, California, campus and a sizable increase in student use in just one year. “It’s all around the campus now, where a year ago you would have had to search for a place to buy one,” she said.

Devices Eliminate Marijuana Odor

Further buzz-killing the allure of the smoking-cessation devices is the reality that they are being used by young people to smoke marijuana openly, because the device renders it odorless. You’ll find YouTube videos on how to camouflage stoner ways.

Although vaping is so new law enforcement has no hard data, even avid users at September’s Electronic Cigarette Expo recognize its potential for misuse. Angelo, an Anaheim truck driver who smoked Marlboro Reds for 27 years until he weaned off nicotine by vaping, recognizes that using them illegally is easy to do. “That culture wrecks it for the rest of us,” he said. Watchdogs point to the fact that smoking portrayed in movies and commercials quickly glamorized what has since been found to be a deadly habit, and it took decades to undo the damage. While smoking has been on the decline, seeing stars such as actor Steven Dorff or “The View” host Jenny McCarthy promoting e-cigarettes in advertising has caused further alarm that the unregulated industry may return us to the 1950s. Christina, 22, of Garden Grove, was born decades after these images were banished. Still, she has been smoking since she was 10 or 11 years old. “I did quit cigarettes just I am still on a 6 mg of nicotine,” she said, demonstrating smoke rings that quickly evaporated. “I figure it’s still better than cigarettes.” Last year the American Lung Association issued a warning about e-cigarettes, advising consumers to stay away. “People are inhaling some vaporized compound into their lungs without really knowing what’s in it,” said Dr. Mike Feinstein with the American Lung Association in West Palm Beach. Yet electronic cigarettes and vaping have plenty of supporters beyond the millions of users, many of whom are smokers trying to kick traditional tobacco. One of the more vocal has been Jacob Sullum, author of books critical of public health “crusaders” and senior editor at Reason magazine and, as well as a fellow at the Knight Center for Specialized Journalism. In his latest piece, headlined, “The Lunatic War on E-cigarettes,” Sullum notes that even the CDC notes that electronic cigarettes “appear to have far fewer of the toxins” than do smoke-creating traditional cigarettes. So where does the opposition lie, he asked, and why? The CDC survey provides no evidence that such experimentation leads to smoking. To the contrary, as Siegel points out, nine out of 10 teenagers who tried e-cigarettes were already smokers, meaning the trend that the attorneys general consider a public health emergency may instead portend successful harm reduction, Sullum wrote. Likewise with adults: Survey data indicate that e-cigarette use is overwhelmingly concentrated about current and former smokers. “It’s in the shift from the former category to the latter that the disease-reducing potential of e-cigarettes lies. “Impeding that transition by imposing arbitrary restrictions on e-cigarette advertising, sales and flavors would be a literally fatal error,” Sullum said. It will take years to fully understand the long-term use of electronic cigarettes, but in the meantime, the trade industry for vaping, The Smoke Free Alternatives Trade Association, will lobby against regulation and classifying electronic-cigarettes as a tobacco product in a Nov. 4 trip to Washington, D.C., the Los Angeles Times reported. Most users we interviewed stressed that vaping absolutely should not be marketed or sold to juveniles. At the Electronic Cigarette Convention in Anaheim last month, identification of every entrant was checked before a lanyard was issued, then ID was checked again at the door of the hall. Beyond vows by the industry to self-police, the Internet sales potential is still an unleashed global market, and sellers accept  that some regulation is needed to prevent children from obtaining liquid nicotine. Skeptics and avid vapers mostly expect the FDA regulations proposed will, at minimum, robustly clamp down on enticements to kids.

‘Greatest Appeal to Young People’

Pamela Ling, a UC San Francisco associate professor of medicine, has done research backed by UC’s Tobacco-Related Disease Research Program. She holds that e-cigarettes have been aggressively marketed to youth. “They are being offered in fruit and candy flavors, and even tobacco-flavored products are given odd names like ‘bombshell,’ which evokes a feminine image,”  according to Ling, who studies the marketing of tobacco products to vulnerable groups. “Earlier studies of cigarette marketing showed that flavored cigarettes have their greatest appeal to young people.” Companies are not allowed to advertise traditional tobacco cigarettes on television, and Ling pointed out there are no such restraints on e-cigarettes, which can now be seen in TV and Internet ads. “The TV and Internet images may subliminally promote tobacco cigarettes,” Ling told UC Health. “If you look at the ads showing people smoking e-cigarettes, they look very much like they are smoking conventional cigarettes.” Ultimately, the American Lung Association cautioned consumers about e-cigarettes: “This is a buyer stay-away, a buyer health hazard, potentially.”

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