Study: Same Nicotine Levels, but lower carcinogens exposure in e-cigs

e-cigarettes

YouSayWHAT.info first reported on vaping and e-cigarettes in late July. We then quoted The Mash, a publication distributed to Chicagoland schools, which declared that “research from institutions like the Roswell Park Cancer Institute (RPCI) suggests that [it] may be true” that, as some users of e-cigs believe, “vaping is a safer alternative to smoking that [using] traditional cigarettes.”

Now, RPCI researchers have declared that, for e-cig users, “nicotine exposure remains the same, while exposure to specific carcinogens and toxicants is reduced,” among smokers who switch from tobacco cigarettes to electronic cigarettes. Their new research was published online ahead of print in the journal Nicotine Tobacco Research.

“To our knowledge, this is the first study with smokers to demonstrate that substituting tobacco cigarettes with electronic cigarettes may reduce exposure to numerous toxicants and carcinogens present in tobacco cigarettes,” says lead author Maciej Goniewicz, PhD, PharmD, Assistant Professor of Oncology in the Department of Health Behavior at Roswell Park. “This study suggests that smokers who completely switch to e-cigarettes and stop smoking tobacco cigarettes may significantly reduce their exposure to many cancer-causing chemicals.”

In a study conducted between March and June 2011, 20 healthy adult daily smokers were provided with electronic cigarettes and 20 tobacco-flavored cartridges. Participants in the study had smoked traditional cigarettes for an average of 12 years, and 95% of them said they planned to quit smoking. All participants were asked to substitute their usual tobacco cigarettes with e-cigarettes for two weeks.

The international scientific team measured participants’ urine levels of seven nicotine metabolites and 17 biomarkers of exposure to carcinogens and toxicants present in cigarette smoke over a two-week period. The biomarkers measured in the study are indicators of the risk of several diseases, including lung cancer. For 12 of 17 measured biomarkers, they found significant declines in exposure to toxicants when participants changed from tobacco cigarettes to e-cigarettes. The decline in toxicant levels was similar to the decline seen among tobacco users who quit smoking. Nicotine metabolites remained unchanged among the majority of study participants, confirming findings from earlier laboratory studies showing that e-cigarettes effectively deliver nicotine to the blood.

“Our findings suggest that e-cigarette use may effectively reduce exposure to toxic and carcinogenic substances among smokers who completely switch to these products,” says co-author Neal Benowitz, MD, Professor of Medicine at the University of California, San Francisco. “Future research will help determine whether e-cigarettes reduce the risk of disease among dual users — those who both smoke and vape — and those who use electronic cigarettes for a long time.”

The study, “Exposure to nicotine and selected toxicants in cigarette smokers who switched to electronic cigarettes: a longitudinal within-subjects observational study,” is available at ntr.oxfordjournals.org.

This work was supported by the Ministry of Science and Higher Education of Poland (grant no. NN404025638) and the U.S. National Institutes of Health (award nos. P30DA012393, National Institute on Drug Abuse, and S10RR026437, National Center for Research Resources). Dr. Goniewicz received a research grant from Pfizer, a pharmaceutical company that markets smoking-cessation medications. He and Benowitz have been consultants to pharmaceutical companies that market smoking cessation medications, and Dr. Benowitz has been an expert witness in litigation against tobacco companies.

Smoking Rates Dropped Significantly During Obama’s Administration

no smoking sign

The steady decline in smoking rates among U.S. adults that began in the early 1960s has accelerated substantially during the 7 years of the Barack Obama presidency. Since 2009, the prevalence of cigarette smoking in the United States has fallen at a rate of about 0.78 percentage points per year — more than double the rates observed during the administrations of Bill Clinton and George W. Bush (mean decreases of 0.28 and 0.36 percentage points per year, respectively, according to a report this week in The New England Journal of Medicine.

If the current rate of decline were to continue, the article said, the prevalence of smoking among U.S. adults would fall from its current level of 15.3% to zero by around 2035. In contrast, at the slower rates of decline observed during the Clinton and Bush years, smoking would not reach zero until approximately 2070 and 2057, respectively.

(Although cigarettes account for most of the combustible tobacco products sold in the United States, sales of non-cigarette tobacco products such as cigars have not decreased at the same rates.)

The recent accelerated decrease in cigarette smoking has not occurred in a vacuum. The striking decline since 2009 is most likely due to the implementation of an array of tobacco-control interventions at the federal, state, nonprofit, and private-sector levels.

These interventions, particularly those at the federal level, were highly intentional, well planned, and well organized. During the first 2 years of the Obama era, several legislative acts provided both the foundation and the essential tools for concerted action on tobacco control. Three of these new laws were particularly influential: the Children’s Health Insurance Program Reauthorization Act of 2009, which increased the federal cigarette excise tax rate from $0.39 to $1.01 per pack; the Family Smoking Prevention and Tobacco Control Act passed in June 2009, which gave the Food and Drug Administration (FDA) the authority to comprehensively regulate thousands of tobacco products for the first time; and the Affordable Care Act (ACA) passed in March 2010, which mandated insurance coverage of evidence-based smoking-cessation counseling and medications without barriers or copayments and expanded Medicare and Medicaid coverage for smoking-cessation treatments. The ACA also established the National Prevention Council and the Prevention and Public Health Fund. Other legislation that contributed included the American Recovery and Reinvestment Act (ARRA), the Prevent All Cigarette Trafficking Act, and the Health Information Technology for Economic and Clinical Health Act; these provided research funding, levied taxes on Internet sales of tobacco products, helped to reduce such sales to children, and incorporated assessment of tobacco use into “meaningful use” requirements for health information technology.

The Obama administration also advanced tobacco control through its leadership choices for the Department of Health and Human Services (HHS), including many senior appointees with extensive tobacco-control experience, such as Deputy Secretary of Health William Corr, Centers for Disease Control and Prevention (CDC) Director Tom Frieden, FDA Center for Tobacco Products (CTP) Director Mitch Zeller, and Assistant Secretary for Health Howard Koh.

All these appointees focused attention and energy on tobacco control. Koh, for instance, led the effort to develop the first HHS comprehensive strategic plan to confront tobacco use in America and created the HHS Tobacco Control Steering Committee, which brought together key HHS agencies each month to coordinate departmental actions designed to reduce tobacco use.

The HHS agencies involved (including the National Cancer Institute, the National Institute on Drug Abuse, the Centers for Medicare and Medicaid Services, and the Substance Abuse and Mental Health Services Administration) capitalized on the tools and opportunities made possible by the new legislation to greatly increase tobacco-control interventions. HHS directed $200 million from ARRA to launch Communities Putting Prevention to Work, a program that encouraged 22 cities and counties to implement evidence-based strategies to reduce tobacco use. In September 2011, the CDC awarded more than $100 million in prevention funding through a new program called Community Transformation Grants to aid states, communities, and tribes throughout the country in implementing tobacco-control programs. Both of these programs provided much needed funds as state and local tobacco-control funding was being reduced.

In March 2012, the CDC launched the first paid national tobacco-education campaign, “Tips from Former Smokers,” which features compelling stories of former smokers living with smoking-related diseases and disabilities. The CDC estimates that the Tips campaign has helped at least 400,000 smokers quit smoking for good since 2012 and is projected to help prevent at least 17,000 premature deaths.

The FDA’s CTP has been central to federal efforts including banning the manufacture and sale of fruit- or candy-flavored cigarettes; prohibiting the use of misleading claims such as “low,” “light,” and “mild”; issuing a final “deeming” regulation that extends its authority over tobacco products to include e-cigarettes, cigars, and pipe and hookah tobacco; conducting more than 600,000 retailer inspections to ensure compliance with laws restricting sales of tobacco products to young people, and issuing warning letters, monetary penalties, and prohibitions of tobacco sales for violations; requiring tobacco manufacturers to report the ingredients and levels of harmful and potentially harmful constituents in their products; and launching “The Real Cost” and other information campaigns warning young people of the dangers of tobacco products.

The cumulative effects of these legislative, regulatory, and policy actions may have resulted in a snowball effect — a decline in smoking that has accelerated over the Obama years. This progress has made the total elimination of tobacco use in the United States seem possible, rather than merely aspirational.

Capitalizing on this progress, the 50th-anniversary Surgeon General’s report, The Health Consequences of Smoking (2014), outlined a series of specific and feasible steps for eliminating tobacco use in America. The progress already made does not argue for future passivity; it argues for continued actions, ranging from sustaining national media campaigns to expanding the provision of tobacco-use counseling and medication treatments.

The path followed to reduce smoking rates during the Obama era provides a road map for the elimination of smoking in the United States. The past seven years have seen substantial progress, which suggests that the policies and programs implemented over this period have meaningfully reduced smoking prevalence. Obviously, there is no incontrovertible evidence linking the observed decreases in smoking with the administration’s actions and policies. However, other secular trends, such as economic changes and use of alternative tobacco products such as electronic nicotine delivery systems, do not seem substantial enough to account for the pronounced changes observed in cigarette smoking.

Despite this great progress, tobacco use continues to cause substantial harm in the United States, with about 15% of adults, or more than 36 million Americans, continuing to smoke. About half these people will die prematurely unless they can stop smoking.

Although an end to tobacco use in the United States now appears achievable, it will be realized only if we expand on the successful actions begun during the Obama era.

 

 

E-Cigs – ‘Vapes’ – Pose Their Own Risks

e-cigarettes

The past few years have seen a great – somewhat frightening – increase in the number of teens and young adults attracted to the supposedly innocuous practice of smoking electronic cigarettes – ‘vapes’, as they are commonly referred to, because they don’t generate actual smoke, but water vapors laced with nicotine and who knows what else.

Because they deliver lower of doses of known-to-be-harmful nicotine, vapes have, since they were introduced in 2004, appealed to people who wanted to quit smoking regular cigarettes and viewed them as a tempering-off approach, potentially leading to total cessation of smoking.

That sometimes works; often, though, it doesn’t.

But worse than wanna-be ex-smokers taking up vapes is the fact that significant numbers of teens have done so, too. Some just think it’s a cool thing to do. Others see it as a way of sharing an experience with friends, as reported recently by Huffingtonpost.com. (The article, quoted below,was written by teen reporters from The Mash, a weekly publication distributed to Chicagoland high schools.)

“Hinsdale Central senior Cameron Anderson didn’t know what she was getting herself into when she picked up the seemingly harmless device. She said she was at a party at the end of last school year when she decided to try an electronic cigarette out of boredom.

“I really liked vaping at the time because of the intimacy we all had while sharing this one vape,” Anderson said.”

According to the Centers for Disease Control and Prevention, use of e-cigarettes by middle and high school students nearly tripled from 2013 to 2014, creating a “vape culture” among today’s young people. Sherry Emery, a senior research scientist currently examining youth and adult smoking behaviors at the University of Illinois at Chicago, said she thinks that teens are attracted to vaping because it’s a novelty.

“They’re teenagers. They’re going to do stuff,” Emery said. “They think it’s fun and exciting.”

Tricks of the trade

In Emery’s opinion, vaping comes with an “artisanal creativity” that includes everything from flavor combinations and fashionable devices to vape tricks and competitions.

Anderson recalled that at the party, she was initially attracted to the games that involved vaping.

“They looked like they were having a good time doing vape tricks together,” Anderson said.

Popular tricks include blowing smoke into an “O” shape and exhaling smoke through the nose. Social media sites such as Instagram and YouTube can serve as platforms for online vape-trick competitions and publicizing electronic cigarette use.

Amanda Mendez, a senior at Christ The King Jesuit College Prep, also has noticed the obsession with vape tricks.

“It’s crazy­—you will see so many Snapchat stories full of kids in the locker room or even the bathroom showing off tricks,” Mendez said.

Tricks and novelty aside, Dean Kostopoulos, who graduated from Naperville North last spring and has several friends who vape, said the attraction isn’t complicated: Teens think vaping is fun.

“Everyone feels like (vaping) is a more healthy way to smoke, but it’s more for the thrill of it,” Kostopoulos said. “Everybody thinks it’s cool.”

Easy access

Not only do many teens find them cool, but e-cigarettes are also very accessible. In Illinois, a person must be 18 years of age to purchase cigarettes, both traditional and electronic. However, e-cigs easily can be obtained by teens younger than 18 from online vendors.

And e-cigs aren’t just easier for minors to purchase; they’re also easier to conceal. Mendez said that due to the discreet appearance of e-cigs, students rarely get caught at school. Many vaping devices are designed to look like pens: compact, shiny and inconspicuous. In fact, some devices such as Cloud 2.0 and microG are marketed as unnoticeable.

“The pens tend to be made out of the same material as ordinary writing pens,” Mendez said.

According to Naperville North dean Jim Konrad, the consequences for possession of electronic cigarettes are the same as for possession of combustible cigarettes: suspension. But Konrad said he hasn’t run into many issues with student use of tobacco products.

“To be honest, we don’t have a lot of smoking violations here,” Konrad said.

Of the few violations Konrad has witnessed, one student was actually using an electronic cigarette with parental permission as a less harmful alternative to other substances.

“If the kid is going to be using something extreme or a vapor pen, obviously we’re going to choose the vapor pen as the healthier alternative,” Konrad said.

Risky business

Some use e-cigs because they think vaping is a safer alternative to smoking traditional cigarettes, and research from institutions like the Roswell Park Cancer Institute suggests that may be true. But according to Jidong Huang, another senior research scientist at UIC, the comparison shouldn’t be between electronic and combustible cigarettes or other substances, but between teens who vape and teens who don’t.

“The question is, ‘Is vaping better than not using any products?’ “ Huang said. “And the answer is no.”

Some consequences of adolescent vaping are obvious. The morning after vaping with friends at a party, Anderson said she woke up with chest pain and a sore throat. For the next month, her laugh came out as a wheeze.

“I promised myself I would never do it again in hopes that my laugh would return back to normal so I didn’t sound like a broken tuba,” Anderson said.

But some of the effects of adolescent vaping aren’t as noticeable. According to Emery, electronic cigarettes renormalize smoking, an act that has become less and less socially acceptable over the past 20 years. In actuality, electronic cigarettes have the potential to act as a gateway to combustible cigarettes.

“It makes the act of smoking less unappealing,” Emery said. “A lot of people report that while they enjoy vaping, they find themselves needing a certain level of nicotine. Vaping isn’t always going to satisfy their needs.”

Aside from nicotine, Emery explained that the products don’t have clear standards and may contain heavy metals.

“There’s a lot of variability in the safety of the components,” Emery said

Beyond that concern, vaping devices are compatible with marijuana, cocaine, THC liquids and other drugs, making substance abuse easier and less publicly recognizable for teens and young adults. The devices’ lack of transparency creates a danger for users who may not be completely aware of what’s inside the electronic cigarette.

Despite these concerns, Emery said fewer people are worried about vaping because it seems like the least problematic of many dangerous options.

“You could kind of throw your hands up in the air and say, ‘Well if (teens) are going to do something, it might as well be this,’ because it is less harmful (than other drugs), probably,” she said. “It’s all appealing to the things teens want to do. Be creative and experiment and be a bit edgy.”

In May of this year, the U.S. Food and Drug Administration finalized a rule extending its authority to all tobacco products, including e-cigarettes, cigars, hookah tobacco and pipe tobacco, among others. This historic rule helps implement the bipartisan Family Smoking Prevention and Tobacco Control Act of 2009 and allows the FDA to improve public health and protect future generations from the dangers of tobacco use through a variety of steps, including restricting the sale of these tobacco products to minors nationwide.

“We have more to do to help protect Americans from the dangers of tobacco and nicotine, especially our youth. As cigarette smoking among those under 18 has fallen, the use of other nicotine products, including e-cigarettes, has taken a drastic leap. All of this is creating a new generation of Americans who are at risk of addiction,” said HHS Secretary Sylvia Burwell. “Today’s announcement is an important step in the fight for a tobacco-free generation – it will help us catch up with changes in the marketplace, put into place rules that protect our kids and give adults information they need to make informed decisions.”

A recent survey supported by the FDA and the Centers for Disease Control and Prevention shows current e-cigarette use among high school students has skyrocketed from 1.5 percent in 2011 to 16 percent in 2015 (an over 900 percent increase) and hookah use has risen significantly. In 2015, 3 million middle and high school students were current e-cigarette users, and data showed high school boys smoked cigars at about the same rate as cigarettes. Additionally, a joint study by the FDA and the National Institutes of Health shows that in 2013-2014, nearly 80 percent of current youth tobacco users reported using a flavored tobacco product in the past 30 days – with the availability of appealing flavors consistently cited as a reason for use.

Before this new rule, there was no federal law prohibiting retailers from selling e-cigarettes, hookah tobacco or cigars to people under age 18. Today’s rule changes that with provisions aimed at restricting youth access, which go into effect in 90 days, including:

  • Not allowing products to be sold to persons under the age of 18 years (both in person and online);
  • Requiring age verification by photo ID;
  • Not allowing the selling of covered tobacco products in vending machines (unless in an adult-only facility); and
  • Not allowing the distribution of free samples.

The actions being taken by the FDA will help prevent misleading claims by tobacco product manufacturers, evaluate the ingredients of tobacco products and how they are made, as well as communicate their potential risks.

The rule also requires manufacturers of all newly-regulated products, to show that the products meet the applicable public health standard set forth in the law and receive marketing authorization from the FDA, unless the product was on the market as of Feb. 15, 2007. The tobacco product review process gives the agency the ability to evaluate important factors such as ingredients, product design and health risks, as well as their appeal to youth and non-users.

Under staggered timelines, the FDA expects that manufacturers will continue selling their products for up to two years while they submit – and an additional year while the FDA reviews – a new tobacco product application. The FDA will issue an order granting marketing authorization where appropriate; otherwise, the product will face FDA enforcement.