“Epidemic?” A Perspective of Youth Vaping & Tobacco Use Trends

On Wednesday, September 12, 2018, FDA commissioner Dr. Scott Gottlieb announced enforcement actions to be taken in the wake of unpublished “preliminary data” showing an “epidemic rise” in vaping among young people. Although the new data are not publicly available, Dr. Gottlieb is referencing it as justification for drastic enforcement actions like banning flavors and pulling entire product lines off of retailers’ shelves. In order to avoid these penalties, FDA is requiring manufacturers to submit in writing within 60 days a detailed description of their plans to prevent youth access to the smoke-free vapor products they make and sell.

A numbers game

In his statement, Dr. Gottlieb refers to having “preliminary data” that shows an “epidemic” of vaping among young people. But it is perplexing, if not suspicious, that the FDA is threatening extreme enforcement action (e.g. removing products from the market) without releasing the data. It’s especially curious given that the public data from the annual National Youth Tobacco Surveys (NYTS), 2011 – 2017, clearly shows that youth use of vapor products, cigarettes, and tobacco products as a whole is declining since a peak in 2015. (See graph and chart below.)


The CDC data shows that high school youth use of all tobacco products, including vapor products, dropped 22.5% from 25.3% in 2015 to 19.6% in 2017, and high school youth vaping dropped 26.8% from 16% to 11.7% during the same time period. Similarly, middle school youth use of all tobacco products and vapor products dropped 24.3% and 37.7% respectively. If, as Dr. Gottlieb suggests, there is a 75% increase in youth use of vapor products then the real question is: Has there been a similar rise in other tobacco product use? With the track record of CDC and FDA spinning statistics to hide the decline in smoking behind the rise in vaping, we are skeptical of such a pronouncement – especially when it is made without the data to back it up.

By Dr. Gottlieb’s own admission, it’s smoking that kills, not nicotine. Often overlooked is the fact that available data shows that America’s youth are continuing to gravitate away from smoking or never start to begin with. If the mysteriously undisclosed 2018 data truly reveals a dramatic increase in youth vaping since last year, how meaningful would that rise be if the smoking rates continue to decline?  This is a key point that seems to be lost in the rhetoric. We won’t know the answer until we see the actual numbers, but if the data does reveal an increase in youth smoking, it is strange that Dr. Gottlieb didn’t even hint at what would be far, far more worrisome data.

The public is being misled about “use”

By using figures that include “ever use, even one puff,” the FDA can create the illusion that vaping is vastly more popular among teens than it really is. Any new product will start at zero people trying it and increase as time passes, but that doesn’t mean people will continue using the product.

For example, youth who answer that they’ve tried a vapor product in the past 30 days – even one puff from a friend or family member’s device – are labeled as “current users.” This practice is highly misleading, because a layperson could easily misunderstand “current use” to mean “daily use,” and daily use, to many people, would imply dependance or addiction. Since 2014, the NYTS survey does ask about frequency of use, but neither the CDC nor the FDA reports how many “current users” only experimented with one puff in the past 30 days vs. respondents who described daily use.

Dr Gottlieb describes an “epidemic of addiction” when, according to the National Institutes of Drug Abuse (NIDA) data,  most teens use only flavored products without nicotine. In 2017, an estimated 2.1 million of 26.6 million middle and high school students tried vaping at least once in the past 30 days, yet past NIDA surveys found that only 13% of youth who tried e-cigarettes reported that the devices contained nicotine. This calculates to just 1% of all middle and high school students trying e-cigarettes with nicotine. Even if the number of youth vaping increased in 2018 by an unprecedented 200%, the number of youth using nicotine in vapor products would only rise to 2% of all students. That kind of pronouncement made by FDA, while ignoring data they already have at hand from NIDA, only serves to further panic the public without cause.

Photo Credit: Joe | iwishiwashannah | Flickr

Additionally, young people who answer that they also smoke cigarettes are not asked if they started smoking before or after they first tried vaping. This is leading to many deceptive claims about vaping acting as a gateway to smoking. Researchers and tobacco control groups frequently use the NIDA survey to report that “most youth who use vapor products also smoke, so vaping may be a gateway to smoking,” yet, they are deliberately avoiding asking which product youth are using first. Furthermore, they fail to even consider the possibility that those smoking youth were already at a high risk for smoking even without ever trying vaping.

Dr. Gottlieb’s statements also make it clear that the FDA can not confirm youth “use” is rising, only that they expect their data to validate their suspicion. He also stated: “We must factor in whether these products get kids addicted to nicotine,” clearly indicating that there is a lack of certainty surrounding this issue. And yet, he places these unknown factors above the well-known risks to millions of adult smokers, strongly stating that youth nicotine use and even the slightest possibility of future nicotine addiction – regardless of whether or not they ever gravitate to smoking conventional cigarettes – is an “unacceptable trade-off” for enabling adult smokers access to effective, low-risk alternatives to smoking. Put simply, he’s willing to throw a safer alternative for tens of millions of smokers under the bus, even without evidence of any serious risk to youth.

Someone to blame

Dr. Gottlieb is placing blame for what he calls an “epidemic of addiction” (after earlier stating that nicotine addiction isn’t the greatest danger) squarely at the feet of vapor product manufacturers, for creating products that taste good and have eye-catching advertising; and major retailers and vape shops with lapses in compliance with laws forbidding sales to minors. Inexplicably, the FDA has now tasked five major vapor brand manufacturers with somehow keeping their products out of the hands of youth, although these manufacturers have less control over what happens at a store counter than parents or local law enforcement.

It’s important to note that the FDA’s own “enforcement blitz” data shows that vape shops and major retailers were not the location of most underage store sales, making up only 6.1% and 27% respectively. Furthermore, data on all underage sales including alcohol and tobacco shows that, of 135,509 inspections, fewer than 1% were found to involve sales of vapor products to minors. A whopping 78.1% of the underage purchases were actual tobacco leaf products, not vapor products.

Adult smokers like appealing flavors, too

Dr. Gottlieb stated that he firmly believes “that new innovations that don’t use combustion, like the electronic cigarettes, offer an important opportunity for adults to transition off combustible tobacco.” He also believes in the “concept of modified risk products” and is committed to “the purpose of harm reduction.” It’s his goal to save lives by changing the trajectory of death and disease from tobacco. Yet, his actions continue to demonstrate a willingness to remove one of the most appealing and effective aspects of these products, flavors other than tobacco.

One of the essential points is that flavors play a key role in switching from smoking to a vastly reduced harm product. Thousands of consumer testimonials bear this out and are confirmed by results from a recent survey submitted to the docket for FDA’s advance notice of proposed rule-making on a flavors standard. If cherry, fruit, cinnamon, and orange flavors did not appeal to adult smokers, nicotine gums and lozenges would be sold only in mint and unflavored as they were originally introduced. Indeed, if adults didn’t like candy and dessert flavors, adult products would not be sold in flavors such as cotton candy, toaster pastry, chocolate milk, root beer or grape. Given that youth will experiment with adult behaviors as part of their normal growth and development, and that there is no significant flavor preference that differentiates youth from adults, the entire argument that flavors specifically target youth is a straw man argument.

What “epidemic”?

The use of the word “epidemic” is meant to convey rapid and widespread growth, or the extent of youth use of vapor products. We believe that even if youth use were increasing, it is still a public health benefit – provided that use of smoking products continues to fall. Replacing something as harmful as smoking with a product the FDA recognizes as significantly safer than smoking is a net positive for public health.

The word “epidemic” also carries with it strong, negative bias. One would not, for example, describe an increased, widespread use of condoms by teens, occurring along with a decline in overall teen sexual activity, as an “epidemic.” Ideally, teens would remain abstinent from all risky behavior, whether it’s sex, drugs, drunk driving, or smoking. However, as a society, we have generally accepted that some kids will inevitably experiment, and we shouldn’t express the same moral outrage over experimentation with lower risk activities.

In his unrealistic “zero-tolerance policy” on youth using nicotine, Dr. Gottlieb fails to see, or fails to admit, that smoking youth who switch to vapor products – and youth who would have otherwise started smoking conventional cigarettes, but choose vapor products instead – are also practicing harm reduction. He is also ignoring the consequences of such an unrealistic prohibition – namely that an unregulated, criminal black market will grow to fill the void. This is well documented in the prevalence of youth use of age-restricted products like alcohol and illegal drugs. No amount of prohibition has moved the prevalence among youth over decades of costly effort. While teen use of vapor products is certainly not ideal, the alternative is a an uptick in smoking initiation whose risks are at least 2,000% higher.

The fact is, while adult smoking rates have declined, there are still nearly 38 million adult smokers exposed to real, tangible health risks. Any risks attributed to teen vaping are largely speculative, and those risks should be weighed against the very real likelihood that most teens experimenting with vapor products, if we’re being honest, would otherwise be experimenting with smoking.

Faced with youth choosing products that, in Dr. Gottlieb’s own words, “would pose a lot less harm than smoking cigarettes,” or choosing to smoke, is there really an “epidemic” that needs fixing?

This article was originally published at CASAA
Author: KNoll-Marsh

Posted in All posts, e cigarettes, Epidemic, FDA, News, Smokeless Tobacco, Vaping, Vaping News, Youth Tobacco Survey | Comments Off on “Epidemic?” A Perspective of Youth Vaping & Tobacco Use Trends

Vaping Cancer, Heart Disease Risk Overstated By Recent Research

Photo Credit: Max Pixel

Two recent study findings that were released to the media this month are just wild speculation, and possibly intentional misrepresentation, according to analysis by The Consumer Advocates for Smoke-free Alternatives Association (CASAA).

In an as-yet-to-be-published (or peer reviewed) preliminary study, researchers looked at the saliva of just 5 vapers, testing for the presence of carcinogenic chemicals. Researchers found increased levels of formaldehyde, acrolein and methylglyoxal. They reportedly found “increased DNA damage” in the mouths of 4 of the participants.

Senior investigator Silvia Balbo, an assistant professor with the University of Minnesota Masonic Cancer Center, told reporters that, while she agrees that vaping is reasonably considered to be safer compared to combustible cigarettes, she doesn’t believe that being safe by comparison is “good enough.”

Balbo admitted that her study doesn’t prove that vaping causes cancer, only that it produces chemicals that damage DNA in ways that can possibly lead to cancer.

“This study cannot determine whether e-cigarettes are carcinogenic or are causing a risk for cancer,” she said. Balbo did not elaborate to the extent of the DNA damage, only that it was “higher” than in those who do not vape.

Of note, Dr. Norman Edelman of the American Lung Association commented on this study: “It’s quite clear there are chemicals in aerosol people inhale when they vape that are carcinogenic, but whether they’re going to cause cancer and to what degree is something we don’t know.”

“Dr. Balbo may feel that vaping being safe by comparison to combustible cigarettes ‘isn’t good enough,’ but we strongly disagree,” said Bruce Nye, RN, President of The Consumer Advocates for Smoke-free Alternatives (CASAA). “Harm reduction is a widely accepted practice, even when the risks are reduced only by a small amount,” he said.

“Seat belts in cars, bike helmets, “safe” sex using condoms and even clean needles for intravenous drug use are all examples of harm reduction,” Nye explained, “yet none of them reduce risks by more than half. For example, when used correctly, wearing a seat belt reduces the risk of fatal injury to the front seat passenger in a car by only 45 percent, and reduces the risk of moderate-to-critical injury by only 50 percent, yet no one would be silly enough to suggest that seat belts not be worn because they aren’t 100% safe. With the science known today, vaping poses much less than 5% of the risk of smoking combustible cigarettes, but even if it is found to reduce the risks associated with smoking by just 25 percent, that still means potentially saving millions of lives!”

“Additionally,” Nye continued, “recent studies have shown that the vast majority of adult vapers are current or former smokers, so a comparison to smoking conventional cigarettes is just plain, good science.”

In the second study recently released to the media, senior study author and outspoken anti-vape advocate, Stanton Glantz. PhD, professor of medicine and director of the UCSF Center for Tobacco Control Research and Education, claims to have shown a link between vaping and increased heart attack risk.  The study, published Aug. 22, 2018, in the American Journal of Preventive Medicine, concluded that vaping doubled the risk of heart attack, while dual use (vaping without having yet quit smoking) increased the risk of having a heart attack five-fold.

According to the UCSF press release, the “analysis involved 69,452 people who were interviewed through National Health Interview Surveys in 2014 and 2016, a cross-sectional study in which in-person interviewers asked participants whether they had ever used e-cigarettes and/or cigarettes, and whether they had ever been told by a doctor or other health professional that they had had a heart attack.” However, researchers admitted that “it was not known whether the heart attacks occurred relative to e-cigarette use, and that some of the heart attacks that subjects reported are likely to have occurred before e-cigarettes became available in the U.S.

“Here we have a classic chicken or the egg scenario,” explained CASAA’s Nye. “Cross-sectional studies only give a snapshot of the time that the questions are asked. Researchers did not focus on heart attacks that happened after beginning the use of vapor products, only asking if the participants “ever” had a heart attack. Heart attacks that happened prior to using vapor products are completely irrelevant, yet in this case, those pre-vaping heart attacks are being used to calculate vaping risk. This is an error in temporality that would not be made by a first year student of epidemiology, let alone a distinguished professor on the subject.”

“Additionally,” he continued, “the increased incidence of heart attacks in vapers and dual users compared to never-users makes sense – if having a heart attack is what incentivized the survey participant to try to quit smoking with vapor products. It’s extremely important to note that order of events matters. If it did not, we could conclude that headaches are caused by aspirin, because aspirin is widely used by people with headaches.”

“So, are people having heart attacks because they vape, or – what I believe is more likely – are more smokers turning to vaping to quit smoking because they had a heart attack? The fact is, Dr. Glantz and his colleagues are making a fundamental error by claiming the former. I suspect that an anti-vaping bias has a lot to do with their conclusions.”

This article was originally published at CASAA
Author: KNoll-Marsh

Posted in All posts, CASAA Guidance, e cigarettes, News, news-all, Research, Smokeless Tobacco, Vaping, Vaping News | Comments Off on Vaping Cancer, Heart Disease Risk Overstated By Recent Research

CASAA Files Affidavit in American Academy of Pediatrics v. FDA Lawsuit

The Right to Be Smoke-Free Coalition (RSF) recently submitted a brief to the federal district court of Maryland, opposing a motion for summary judgment filed by various public health groups in American Academy of Pediatrics v. FDA. The public health groups are challenging the pre-market application deadline extensions given by the FDA for tobacco and vapor products. RSF is not a party to the lawsuit, but filed an amicus (or “friend of the court”) brief defending the compliance period so that vapor product manufacturers have adequate time to prepare compliant applications.

Julie Woessner, National Policy Director for The Consumer Advocates for Smoke-free Alternatives Association, filed an accompanying affidavit (here) with the court, testifying how the availability of diverse vapor flavors for adult smokers is a public health benefit. Ms. Woessner noted in the affidavit that  “a significant number of our members use more than one flavor or brand of e-liquid . . . we find those making a complete transition from smoking to vaping most often report that finding a non-tobacco flavor was instrumental in helping them distance themselves from their smoking habit, and sampling a variety of different flavors actually served to make vaping more enjoyable than smoking.”

The law firm of Keller and Heckman, LLP, which represents the Right to Be Smoke-Free Coalition, has written an informative article about the case that can be read in full here.

This article was originally published at CASAA
Author: KNoll-Marsh

Posted in All posts, e cigarettes, legal action, Legal Actions, News, news-all, Smokeless Tobacco, Vaping, Vaping News | Comments Off on CASAA Files Affidavit in American Academy of Pediatrics v. FDA Lawsuit

Researchers Fall Short Examining Effects of Vapor Exposure in Lungs

In a recent study published online Aug. 13 in the BMJ journal Thorax, hoping to discover what happens when e-liquid evaporates and enters the lungs, researchers attempted to recreate vaping using common respiratory suction “traps” and collected the resulting condensation. Using unflavored eliquid both with and without nicotine to conduct the experiment.

They used alveolar macrophage cells (protective cells that fight and eat up debris such as bacteria, dust particles and allergens) from the lungs of eight, healthy non-smokers and grew them in petri dishes, then dosed a third with the raw e-cigarette liquids, and another third with different strengths of the collected vape condensate with or without nicotine. A control group of cells was left untreated.

Based on their findings, the researchers expressed concern that vaping isn’t as safe as some would like to believe.

Dr. David Thickett, lead author of the study and professor of respiratory medicine at the University of Birmingham, said “if you vape for 20 or 30 years and this can cause COPD, then that’s something we need to know about.”

“I don’t believe e-cigarettes are more harmful than ordinary cigarettes,” he continued. “But we should have a cautious skepticism that they are as safe as we are being led to believe.”

            Bruce Nye

Bruce Nye, RN, President of Board of Directors for The Consumer Advocates for Smoke-free Alternatives Association (CASAA), agrees that smokers, vapers and non-smokers alike should be made aware of any possible risks involved with vaping, but disagrees with the authors’ conclusion that what they saw happen in a petri dish and plastic tubing has much relevance in the real world.

“I take issue with several aspects of this study,” said Nye. “the first being that, contrary to what the authors claim, we don’t actually hear that vaping is “safe.” Advocates only ever mention safety in relation to smoking combustible cigarettes, which is something this study fails to acknowledge.”

“Vaping is a harm reduction method intended for smokers, not as a hobby for non-smokers. A recent study published in July found that these products are by and large used by current smokers. Therefore, it’s important to compare the differences between vapor exposure and smoke exposure, not just vapor exposure and no exposure.”

“As for the study itself,” he continued, “it’s important to note that in-vitro studies do not correlate well with in-vivo studies. This is well-documented in cancer cure studies,” he explained, “where a reaction from isolated cells in a lab doesn’t happen the same way in the human body.”

Nye also explained that the methods used by the researchers to produce the vapor, and the length of exposure, were not realistic.

Graphic from “Pro-inflammatory effects of e-cigarette vapour condensate on human alveolar macrophages,” Aaron Scott, et al., Thorax, BMJ Journals

“They used a new and unproven collection method and a dry ice, methanol bath to create a condensate of the vapor that passed through the chambers. This is quite different than what the human body actually does,” Nye explained. “In effect, the experiment is the equivalent of inhaling and never exhaling!”

“Additionally, they gave the cells a continuous 24 hour exposure. Time of exposure is a huge factor in determining dosing, as well. Average vapers inhale 2.5 – 3 seconds of vapor then exhale. At a 30 second cycle over 5 minutes, that would represent at most less than 1 minute of actual potential exposure. In the experiment, they used the equivalent of 3 – 4 times that exposure. This is significant, because no matter how hard one tries, there is no way to expose yourself to e-cigarette vapor continuously, let alone at the concentrations used for this study.”

He also pointed out that, in general, a pro-inflammatory response is not a bad thing – it is evidence that the body is doing what it is supposed to do with foreign substances – so the presence of inflammation is not a conclusive indication that a disease will develop. It could just as easily be true that the inflammatory response is protecting the body from becoming diseased.

“And one key bit of information mentioned then completely glossed over in the paper,” Nye added, “is that n-Acetyl cysteine (a drug that is used to treat COPD) reverses or reduces the negative effects! This compound is also a part of the body’s natural defense mechanism (made from your own amino acids in small quantities) and would likely help mitigate any potential effects, further reducing the resulting toxicity.”

While this particular study was lacking in many ways, Nye agrees with the study authors that further research is needed to fully understand the effects of e-liquid exposure in humans.

“Most of these studies are lacking the basic, fundamental, validation needed to make their results meaningful to the population,” he said. “There is much work to be done to properly characterize the true respiratory exposure profile before real risk analysis can be conducted.”

Photo Credit (Featured social media image of man vaping): Vaping360.com

This article was originally published at CASAA
Author: KNoll-Marsh

Posted in All posts, CASAA Guidance, e cigarettes, e-cigarette research, lung study, lungs, News, news-all, Smokeless Tobacco, Vaping, Vaping News | Comments Off on Researchers Fall Short Examining Effects of Vapor Exposure in Lungs

CASAA Newsletter – August 2018

Dear CASAA Members,

June and July saw us involved in a lot of activity with the FDA. In early June, CASAA and other advocacy groups filed a 90-day extension request for the comment period for the advance notice of proposed rulemaking (ANPRM) regarding a product standard for flavored vapor and tobacco products. The FDA only extended the period for 30 days, but this did not stop CASAA from submitting a comprehensive comment on behalf of our members. (See link below.) Additionally, CASAA worked collaboratively with the Vapor Technology Association (VTA) to encourage consumers to submit declarations regarding your experiences with vapor products to the flavors ANPRM docket. The campaign generated more than 9,000 comments.

Because CASAA is a tobacco harm reduction organization and our focus is on promoting smoke-free alternatives, we generally do not take a position on regulation of combustible products. But, since CASAA also represents current smokers who may in the future choose to use Tobacco Harm Reduction (THR) products, we also submitted a comment to the FDA regarding the development of a potential nicotine product standard for combustible tobacco products. The FDA claims that “lowering nicotine to a minimally or non-addictive level could potentially save millions of lives, both in the near and long-terms.” CASAA is concerned that the unintended consequences of dramatically reducing nicotine levels in combustible cigarettes may actually harm smokers instead of reducing their risks. That comment to the FDA is also linked in the newsletter below.

Even numbered years tend to be lighter in terms of workload from state legislatures, but local governments never rest. Milwaukee, WI was the latest major U.S. city to irrationally include vaping in its anti-smoking ordinance, and Massachusetts–where 178 municipalities have raised the minimum legal purchase age for all tobacco and vapor products to 21–was the latest state to pass a Tobacco 21 law that takes away access to safer alternatives from 18 to 20 year old smokers. And even as surveys show youth smoking and vaping rates continue to decline, more and more states and municipalities attempt to use flavored tobacco, mythical “gateway” effects, and youth access to pass laws further restricting smokers’ access to safer alternatives.

In better news, the San Ramon City Council elected to have staff research and review a proposal to expand San Ramon’s smoking ordinance to include electronic cigarettes, as well as potentially ban the sale of flavored nicotine products, rather than “making a decision based on ‘cherry-picked’ information.” And a new study entitled “Characterisation of the Spatial and Temporal Dispersion Differences between Exhaled e-cigarette mist and Cigarette Smoke,” which is a collaboration between Kaunas University of Technology in Lithuania, EMPA (Swiss Federal Laboratories for Materials Science and Technology), ETH Zurich (Swiss Federal Institute of Technology) and Fontem Ventures (vapor product company), added to the growing body of evidence that vaping indoors is unlikely to pose an air quality issue.

It’s important that CASAA members remain vigilant, reporting proposed laws to CASAA, acting quickly on Calls to Action, and getting friends and family to join CASAA. The more members CASAA has – the greater its strength!

Alex Clark
CEO, CASAA


POLICY


CASAA Tobacco 21 policy statement: “Including low-risk alternatives in T21 laws is unwise, misleading”

Tobacco 21 Idaho logo

Proposals to raise the legal age to purchase tobacco products have been working their way through cities and municipalities for roughly ten years. In 2013, New York City– known for its aggressive tobacco control policies–was the first major US city to raise the minimum age to purchase tobacco and vapor products to 21. In 2015, Hawaii became the first state …

Read More » 


FROM CASAA


Batteries & Bottles: Traveling Safely This Summer

With the summer travel season here, many consumers are wondering about traveling on vacation with their vapor devices and liquids. Lithium batteries are often the most concerning aspect. Headlines appear almost every week of a cell phone, laptop, headphones, hoverboards and even vapor devices overheating or even exploding. The next most common concern is having liquids confiscated by the Transportation Security …

Read More »


FDA NEWS


CASAA’s Comment to FDA on Flavors

The Food and Drug Administration (FDA) issued an advance notice of proposed rulemaking (ANPRM), Regulation of Flavors in Tobacco Products, to obtain information related to the role that flavors play in tobacco products. Specifically, FDA is seeking comments on, among other things, how flavors attract youth to initiate tobacco product use, and about whether and how certain flavors may help …

Read More »


CASAA Submits Comment to FDA Regarding Nicotine Limits

The U.S. Food and Drug Administration (FDA) has issued Tobacco Product Standard for Nicotine Level of Combusted Cigarettes, an advance notice of proposed rulemaking (ANPRM) seeking public comment for consideration in developing a potential nicotine product standard for combustible tobacco products. The FDA claims that “lowering nicotine to a minimally or non-addictive level could potentially save millions of lives, …

Read More »


TOBACCO 21


NY – Monroe County – Stop Tobacco AND Vapor 21!

ENDED: Monroe County’s Agenda/Charter Committee voted against the proposed local law that would raise the age to purchase all tobacco and vapor products to 21-years-old. Although the proposal may be dead for this year, there is clearly interest among county lawmakers to restrict access to all tobacco and nicotine products as if they are just as harmful as cigarettes.

CASAA encourages our Monroe County members to remain vigilant and reach out to county legislators who voted against the measure to thank them.   . . .

Read More »


INDOOR BANS


Milwaukee, WI – VETO the indoor vaping ban! (ENDED)

ENDED: This ordinance was signed by Mayor Barrett and took effect on July 10, 2018. An ordinance (file #180354) which bans vaping in the same places where the state of Wisconsin prohibits smoking has unanimously passed Milwaukee’s Common Council and is headed to the mayor’s desk for signing. Please take action NOW and urge Mayor Tom Barrett to veto the …

Read More »

AK – SB 63 Keep Vaping OUT of Smoking Laws! (ENDED)

ENDED: SB 63 was signed into law on 7/18/18. While this bill amended Alaska’s smoking law to include vaping in the definition of smoking, the bill also includes several exemptions. Notably, the prohibition on “smoking” does not apply to retail tobacco or “e-cigarette” stores that are freestanding or, if connected to a neighboring business, have a separate entrance (vape shops …

Read More »


TAXES


NJ – Gov. Murphy is proposing a MASSIVE tax on vaping starting in FY 2019

(Update – 06.16.18) Two versions of the vapor tax are reportedly racing toward floor votes. A 4132 – Would enact a tax of 10c/mililiter on e-liquid containing nicotine. S 2731 – Would enact a tax of 20c/milliliter on e-liquid containing nicotine. Both of these bills are likely to be heard in their respective budget committees on Monday, June 18th. NOW …

Read More »


TESTIMONIAL OF THE MONTH


Howard Lenow

“My wife and I stopped smoking on the same day we started vaping. I had been a pipe and cigar smoker for over 35 years, my wife was a cigarette smoker. Our doctors were thrilled and we both feel the benefits from having stopped smoking. Vaping is amazingly effective at providing smokers with the feeling and pleasure we got from smoking. I don’t even use nicotine in my vaping liquids, my wife uses 6 mg. I believe allowing the vaping industry to flourish is a public health issue—meaning it benefits the public health enormously. I have no problems regulating access to under age children (I think 18 and under is a fine cut off) but to use the argument that vaping leads to smoking, I believe, is a false agenda. Vaping leads away from smoking. I am a progressive Democrat and I often find myself among a more conservative vaping community. On this issue, I am against restricting vaping in the United States other than for children.”

Be sure to share your own testimonial here.


Did you find this newsletter informative? Please consider making a donation to CASAA. We rely on contributions to provide timely information and engagements to help protect everyone’s access to life-saving, low-risk nicotine and tobacco products.

CASAA is 501(c)(4) tax-exempt organization. While CASAA is a non-profit organization and pays no income taxes on the donations it receives, contributions or gifts to CASAA are not deductible by the donor as charitable contributions for federal income tax purposes.

This article was originally published at CASAA
Author: KNoll-Marsh

Posted in All posts, CASAA Newsletter, e cigarettes, News, news-all, Smokeless Tobacco, Vaping, Vaping News | Comments Off on CASAA Newsletter – August 2018

CASAA’s Comment to FDA on Flavors

The Food and Drug Administration (FDA) issued an advance notice of proposed rulemaking (ANPRM), Regulation of Flavors in Tobacco Products, to obtain information related to the role that flavors play in tobacco products. Specifically, FDA is seeking comments on, among other things, how flavors attract youth to initiate tobacco product use, and about whether and how certain flavors may help adult cigarette smokers reduce cigarette use and switch to potentially less harmful products. In addition to encouraging individual consumers to submit comment, CASAA has submitted a thorough and comprehensive comment to the FDA.

Highlights

    • Comments being submitted by CASAA and thousands of individual consumers should be given serious and primary consideration, given that consumers are in a very real sense the most important stakeholders. It is our lives and our health that are most profoundly impacted by the decisions FDA makes in connection with Tobacco Harm Reduction (THR) products. In fact, we consider the right of consumers to obtain honest information about the full range of THR products (and access to those THR products) to be a human rights issue.
    • THR products are indisputably low risk as compared with smoking. It is therefore self-evident that extraordinary care should be taken to regulate THR products lightly and to do nothing that would make them less accessible, less affordable, less effective, or less enjoyable to adult consumers.
    • The “problem” of youth use of THR products is not nearly the crisis that it is being portrayed as in the media and by public health activists. Far from youth tobacco use being a public health crisis, we are seeing a very steady decline in use. And even though there is a modest uptick in use of low-risk THR products, use of the most dangerous products is decreasing.
    • The collateral harm of making THR products less attractive and less available to adult consumers is that the most risky tobacco products, combustible cigarettes, remain the most popular and visible products to young people. Parents and close family friends, in turn, act as unknowing sources of both product and marketing for smoking.
    • The goal of reducing youth use of tobacco products generally (and of THR products specifically) should not outweigh the critical need to provide effective and satisfying low-risk smoking alternatives to adults.
    • There has not been a serious exploration of just how “addictive” nicotine is for various methods of delivery beyond FDA-approved nicotine replacement therapies (NRT), and there is substantial evidence that vapers (those who use vapor products) exhibit less dependence on vapor product use than they did as compared to smoking.
    • Contrary to notions that THR products might serve as a gateway to the most harmful combustible products, the declining smoking rates would suggest low-risk products are acting as a path away from smoking.
    • It is important to empower young people with truthful, accurate information, and it would be public health malpractice to mislead youth to believe that all tobacco products carry similar risks.
    • Federal law requires age verification and prohibits sales of all tobacco products, including low-risk THR products, to anyone under the age of 18. It is within FDA’s power to strictly enforce these laws in order to reduce youth access.
    • The definition of “flavors” is far from simple. Because vapor products contain no tobacco, even “tobacco-flavored” vapor products contain added flavorings. Moreover, “tobacco-flavored” vapor products, while in many cases reminiscent of some tobacco notes, do not replicate the taste of smoking a cigarette since there is no combustion to impart the taste, sensation, and aroma of smoke. Even completely unflavored liquids designed for use with vapor products impart a flavor since vegetable glycerin and propylene glycol (common ingredients) have a slightly sweet taste.
    • Non-tobacco and non-menthol flavors in and of themselves do not constitute marketing to children. If this were a genuine issue, the pharmaceutical industry would be under fire for producing NRT gums and lozenges (which can be used without detection in schools and other places in order to circumvent smoking bans) that come in trendy flavors like Fruit Chill™, Cinnamon Surge™, White Ice Mint® and Spearmint Burst™, to name a few.
    • Of those who quit smoking entirely (87% of the CASAA Survey respondents), 72% credited interesting flavors with helping them quit. This response very clearly demonstrates that among the CASAA Survey respondents who have been successful in completely replaced their smoking habit with vaping, flavors were instrumental in helping them quit. Of those who still smoke, 53% credited interesting flavors as helping them move towards quitting entirely.
    • Reducing flavor choices will reduce overall enjoyment of THR products for many consumers. This loss of enjoyment is not only detrimental to consumers, it will inevitably lead to fewer smokers successfully reducing or eliminating their smoking habit by switching to THR products.
    • There are now thousands of brick and mortar vapor shops across the United States which sell a wide variety of products. As discussed in more detail below, these shops play a vital role in the fabric of the vaping community and are instrumental in helping smokers who are interested in reducing or eliminating their smoking habit. Anything but a relatively trivial intervention by FDA in connection with flavors will have a devastating impact on those vapor shops and on the consumers who rely on them to become or remain smoke-free.
    • Given the low-risk nature of vaping as compared to smoking, there is nothing misleading in informing consumers that vaping poses fewer risks than smoking. Yet vapor companies are prohibited from even suggesting to consumers that vaping is likely less hazardous than smoking. From a consumer rights standpoint, it is simply indefensible that the government would prohibit consumers from receiving this basic, truthful information from vapor companies.
    • Limiting the supply will not eliminate the demand. Any non-trivial restriction on flavors will result in an increase in consumers seeking out black market sources and engaging in Do It Yourself (DIY) activities in order to be able to use the flavors they enjoy.

CASAA’s full comment to the FDA can be read below or here.

07.19.18 – CASAA comments – FDA-2017-N-6565 – Regulation of Flavors in Tobacco Products

This article was originally published at CASAA
Author: KNoll-Marsh

Posted in All posts, e cigarettes, FDA, flavors, News, news-all, Smokeless Tobacco, Vaping, Vaping News | Comments Off on CASAA’s Comment to FDA on Flavors

CASAA Submits Comment to FDA Regarding Nicotine Limits

   Image from FDA.gov

The U.S. Food and Drug Administration (FDA) has issued Tobacco Product Standard for Nicotine Level of Combusted Cigarettes, an advance notice of proposed rulemaking (ANPRM) seeking public comment for consideration in developing a potential nicotine product standard for combustible tobacco products. The FDA claims that “lowering nicotine to a minimally or non-addictive level could potentially save millions of lives, both in the near and long-terms.”

Because CASAA is a tobacco harm reduction organization, we generally do not take a position on regulation of combustible products. However, since CASAA also represents current smokers who may in the future choose to use Tobacco Harm Reduction (THR) products, we submitted a comment on this ANPRM because we are concerned about the unintended consequences of dramatically reducing nicotine levels in combustible cigarettes and how that may actually harm smokers instead of reducing their risks.

CASAA’s concerns regarding lowering nicotine levels include:

  • An increase in compensatory smoking
  • Perpetuation of the myth that nicotine is what causes smoking-related diseases
  • Increase in black market sales
  • Lack of a clear regulatory path forward for low-risk products so that smokers have acceptable alternatives
  • FDA hinting of the possibility of even greater prohibition on other low-risk tobacco products by, for example, eliminating the sale of higher nicotine content liquid for e-cigarettes to prevent potential use in low-nicotine combustible cigarettes

CASAA’s full comment can be viewed below or here.

CASAA – Comment on FDA-2017-N-6189 – Tobacco Product Standards for Nicotine Level of Combusted Cigarettes (07.16.18)

This article was originally published at CASAA
Author: KNoll-Marsh

Posted in All posts, e cigarettes, FDA, News, news-all, nicotine, Policy analysis (THR), Smokeless Tobacco, Vaping, Vaping News | Comments Off on CASAA Submits Comment to FDA Regarding Nicotine Limits

CASAA Tobacco 21 policy statement: “Including low-risk alternatives in T21 laws is unwise, misleading”

Graphic from the Tobacco 21 web site, which falsely claims that vapor products are designed and advertised to be an addictive “gateway” for youth to using tobacco, therefore, they only support T21 laws that include vapor products.

Proposals to raise the legal age to purchase tobacco products have been working their way through cities and municipalities for roughly ten years. In 2013, New York City– known for its aggressive tobacco control policies–was the first major US city to raise the minimum age to purchase tobacco and vapor products to 21. In 2015, Hawaii became the first state to pass legislation that raises the minimum purchase age to 21.

Advocates of Tobacco 21 (T21) claim these laws will significantly reduce smoking initiation for adolescents and young adults. However, these laws also ban the sale of vapor products and other safer alternatives to smoking. CASAA’s position is that including low-risk alternatives in T21 laws is unwise and likely to hamper the general public health goal of reducing the use of combustible tobacco products.

Consistent with CASAA’s mission, we support the principles of tobacco harm reduction as the most effective and humane means for reducing the harms attributed to smoking. We believe if consumers are provided accurate information about the relative health risks of these products, in concert with their individual freedom to choose, many will opt for safer, low-risk alternatives to smoking. Empowering consumers presents a significant opportunity to vastly improve public health without resorting to coercive methods of control such as punitive taxation, comprehensive place bans, and excessively restrictive regulations.

In contrast, advocates of T21 legislation have as their guiding principle the eventual elimination of tobacco and nicotine products from the marketplace. To this end, they promote the view that all tobacco and vapor products, in spite of considerable evidence to the contrary, are equally harmful. We believe it is never appropriate to mislead consumers about product risks in order to achieve a policy goal. Furthermore, as most youth obtain their tobacco products from a grey market, such prohibition only serves to amplify this problem without adequately addressing, or funding, enforcement efforts – efforts that often result in misdemeanor convictions that hinder young adults from achieving economic independence.

Accordingly, T21 legislation, which treats all tobacco and vapor products equally under the law, sends the misleading message to consumers that e-cigarettes, snus, and other low-risk products pose risks equivalent to traditional cigarettes. It treats young adults, who are capable enough to serve in the military, sign contracts, and elect decision-makers to public office, as incapable of making the distinction between risky and less risky behavior. And finally, T21 laws represent a prohibitionist approach, which in the past has often been met with limited success compared to the harmful unintended consequences.

Although CASAA takes no position on regulations regarding combustible tobacco products, we strongly oppose this legislation. We believe this policy will cause far more harm than it prevents, and we urge our members to oppose it.

This article was originally published at CASAA
Author: KNoll-Marsh

Posted in All posts, CASAA Guidance, e cigarettes, News, news-all, policy, Smokeless Tobacco, T21, Tobacco 21, Vaping, Vaping News | Comments Off on CASAA Tobacco 21 policy statement: “Including low-risk alternatives in T21 laws is unwise, misleading”

Batteries & Bottles: Traveling Safely This Summer

With the summer travel season here, many consumers are wondering about traveling on vacation with their vapor devices and liquids. Lithium batteries are often the most concerning aspect. Headlines appear almost every week of a cell phone, laptop, headphones, hoverboards and even vapor devices overheating or even exploding. The next most common concern is having liquids confiscated by the Transportation Security Administration (TSA).

Read below about policies and practices that will safely and successfully get you to your destination!

TSA Rules Apply
– The FAA prohibits these devices in checked bags. Battery-powered E-cigarettes, vaporizers, vape pens, atomizers, and electronic nicotine delivery systems may only be carried in the aircraft cabin (in carry-on baggage or on your person). Check with your airline for additional restrictions. Remove all electronic cigarette and vaping devices from carry-on bags if checked at the gate or planeside.1

– You are allowed to bring a quart-sized bag of liquids, including e-liquids, in your carry-on bag and through the checkpoint. These are limited to travel-sized containers that are 3.4 ounces (100 milliliters) or less per item. Placing these items in the small bag and separating from your carry-on baggage facilitates the screening process. Pack items that are in containers larger than 3.4 ounces or 100 milliliters in checked baggage.2

– Amtrak prohibits use of devices on its trains, Thruway buses and stations. Vaping is allowed in designated smoking areas.3

Packing Safety
– Do not place batteries in pockets, pouches or bags that contain coins, keys or other metallic objects. These things may come into contact with the batteries, complete an electrical circuit and could cause the battery to overheat. Many shops will provide free battery cases to customers with a battery purchase. Don’t throw those cases away!

– Remember to pack the original charger. Never use a phone or laptop charger to charge your device.

– If traveling to a foreign country, be sure to check what type of electrical outlets are common there. U.S.-style plugs may not work in the outlets of some countries and a special charging plug may be needed.

– If leaving your device in a purse or carry-on bag, remove the batteries or lock the firing button. If your device doesn’t have a locking mechanism, consider getting a device for travel that has safety features, such as the firing button lock, vent holes and overcharging protection.

Hotels and Motels
– Some hotels and motels still have smoking rooms, except in states and cities where smoking is prohibited.  Check the hotel web site for smoking policies, as many now include vaping. You can also look up many state and local vaping laws on CASAA’s Find My State Info pages.

– Vaping is typically allowed in smoking rooms. However, use caution when exhaling large amounts of vapor, as excess vapor is known to have triggered hotel smoke alarms.

– Do not assume vaping is allowed in non-smoking rooms simply because vapor products do not create smoke. There have been several reports of hotel staff reporting vapers as smoking in their room, resulting in financial penalties for the guest.

Other Safety Considerations
– Never charge your batteries or rechargeable device overnight or unattended.

– Do not use batteries with peeling wrappers, are nicked, dented, bulging, or have been dropped.

– Do not expose your device or batteries to extreme temperatures, such as in a hot or freezing vehicle.

– Only use batteries recommended for your device.

– Do not mix old and new batteries or different brands.

– Do NOT make modifications to your device, including those which could block any ventilation holes or slots. Those holes or slots remove heat and/or allow venting gas to escape safely.

– Keep e-liquids away from the reach of children. It’s highly recommended that e-liquids be stored in bottles with child-resistant caps.


For more information on battery safety read CASAA’s guide: Battery Safety Making Peace with Power: A Guideline to the use and storage of portable power sources for Electronic Cigarette Consumers.

Sources

  1. https://www.tsa.gov/travel/security-screening/whatcanibring/all
  2. https://www.tsa.gov/travel/security-screening/liquids-rule
  3. https://www.amtrak.com/smoking-policy

This article was originally published at CASAA
Author: KNoll-Marsh

Posted in All posts, batteries, CASAA Guidance, e cigarettes, News, news-all, Smokeless Tobacco, travel, TSA, Vaping, Vaping News | Comments Off on Batteries & Bottles: Traveling Safely This Summer

American Cancer Society Acknowledges Reduced Harm for Electronic Nicotine Delivery Systems and Warns About the Dangers of Misleading Consumers

  • On June 11, 2018, the American Cancer Society (“ACS”) released a statement entitled, “The American Cancer Society Public Health Statement on Eliminating Combustible Tobacco Use in the United States’ (“Statement”).[1] The Statement sets forth the ACS’s goal of eliminating exposure to combustible tobacco smoke and provides three strategies for the ACS to enhance its approach in tobacco prevention and control.

    This Statement follows its earlier “Position Statement on Electronic Cigarettes,” released on February 15, 2018, which acknowledged, for the first time, that e-cigarettes, also known as Electronic Nicotine Delivery Systems (ENDS), play an important role in helping certain smokers quit.[2] In that prior position, ACS suggested that physicians should encourage individuals that will not use FDA-approved cessation medicines to switch to using ENDS.[3] This latest Statement takes that position further, as the ACS commits to joining in on efforts to better understand how or whether ENDS might be integrated into evidence-based cessation options, and the organization also warns about the misinformation given to consumers about those products.

     “Rapidly Changing Tobacco Marketplace” and the Consumer Misperception about ENDS

    The ACS’s stated highest priority is to eliminate cancer caused by tobacco use as cigarette smoking is the leading cause of mortality in the U.S.[4] Placing its Statement in the context of what is calls, “the rapidly changing tobacco marketplace today,” the ACS acknowledges that tobacco control has increasingly become a social justice issue, as the percentage of smokers at the greatest risk (e.g. because of their low socioeconomic status, lower educational attainment, etc.) has risen markedly.[5]

    Given today’s landscape, the Statement highlights the need for consumers to receive accurate information about different tobacco products and the role that nicotine plays in disease.[6] Citing numerous studies and reports, the Statement posits that although the “current generation ENDS are markedly less harmful than combustible tobacco products,”[7] “[m]any adults believe, erroneously, that ENDS are as harmful as combustible tobacco products, and the level of public understanding has deteriorated overtime.”[8] The Statements cites the Monitoring the Future study, which reported that as of 2017, “e-cigarettes have one of the lowest levels of perceived risk for regular use of all drugs, including alcohol,” among adolescents.[9] And to contrast e-cigarette use with combustible (burned) tobacco products, the Statement notes that while ENDS delivers nicotine, flavor additives and other chemicals, they do not actually burn tobacco – a process that yields an estimated 7000 chemicals, including at least 70 carcinogens.[10]

    Three Strategies to Eliminate All Combustible Tobacco Use: Lending Support to Further Utilizing ENDS for Tobacco Cessation

    The Statement outlines three separate strategies to eliminate all combustible tobacco use-all of which involve some component linked to ENDS.

    • Promote Increased Access and Utilization of Cessation Options for Smokers, With an Emphasis on Preventing Dual Use

    As part of its first strategic effort, the ACS will work to promote tobacco-cessation strategies and develop health care provider and consumer-facing materials with information on the risks associated with tobacco products and cessation treatment options.[11] As a part of this communications strategy, the ACS notes that it intends to communicate to consumers that current-generation ENDS are less harmful than combustible tobacco products, and it provides that the ACS will contribute to research to determine how or whether ENDS might be integrated into evidence-based cessation options.[12]

    • Prevent Initiation of ENDS by Youth and Other High-Risk Demographic Groups

    Despite noting the lesser risks associated with ENDS relative to combustible tobacco use, the Statement still holds that protecting youth from cigarette smoking and the use of novel tobacco products remains a priority.[13] The ACS will advocate for tobacco-free policies, including ENDS in all cases, as well as for policies to raise the minimum age for sale of all tobacco products, including ENDS.[14] The ACS makes clear that it will continue to oppose what it calls, “the widespread exposure of youth to e-cigarette advertising.”[15]

    • Promote and Support a Comprehensive Tobacco and Nicotine Regulatory Framework

    As part of its broader regulatory strategy, the Statement describes a “continuum of risk” for tobacco products, noting that while science is mixed, ENDS are likely to be much less harmful that combustible tobacco products.[16] Among other proposals, the Statement again commits to conduct further scientific research, including research related to the short-term and long-term risks of using ENDS and the impact of ENDS on tobacco use behavior.[17]

    Conclusion

    Taking its February 15, 2018 statement on electronic cigarettes one step further, this latest announcement by the ACS makes clear that the organization intends to contribute to further research on whether e-cigarettes may be utilized for tobacco cessation strategies. However, the ACS continues to advocate for tobacco-free policies, which include the use of ENDS, and the organization remains concerned about preventing youth initiation of ENDS, which has fallen dramatically since 2015, along with all tobacco use.

Posted in All posts, community, consumers, e cigarettes, e-cigarette, ecig, Harm Reduction, health, modified risk, News, news-all, Smoking Cessation, Smoking/nicotine addiction, Vaping, Vaping News | Comments Off on American Cancer Society Acknowledges Reduced Harm for Electronic Nicotine Delivery Systems and Warns About the Dangers of Misleading Consumers