If vapor product sales were restricted to tobacco flavors, one-third of U.S. vapers between the ages of 18 and 34 would switch to smoking combustible cigarettes, according to a new study in Nicotine & Tobacco Research.
The study analyzed data from February to May 2020 and looked at 2,159 young adults in Atlanta, Boston, Minneapolis, Oklahoma City, San Diego and Seattle, examining support for e-cigarette sales restrictions and the perceived impact of flavor and vaping bans.
This study precedes the FDA’s impending Sept. 9 deadline for premarket tobacco product application (PMTA) decisions, which could potentially take most vapor products off the market.
The FDA’s deadline will be “like watching an unstoppable object hit an immovable wall,” said Charles Gardner, executive director of INNCO, a global nonprofit supporting the rights of adults using safer nicotine products. “The FDA must know flavor bans will increase teen, young adult and older adult smoking.”
“In general, the FDA does not comment on specific studies but evaluates them as part of the body of evidence to further our understanding about a particular issue and assist in our mission to protect public health,” an FDA spokesperson said.
Two other recent studies showed similar results. A study in JAMA Pediatrics showed that following San Francisco’s flavor ban, teens were more likely to smoke than those in other school districts. A different study in Nicotine & Tobacco Research shows that teens who vape would be smoking cigarettes if vapes hadn’t become available.
“All hell will break loose if [the FDA] authorize[s] flavors as ‘appropriate for the protection of public health,’” said Gardner. “The Truth Initiative and the Bloomberg-funded Campaign for Tobacco-Free Kids have staked their reputations on the public health benefits of flavor bans. And many key leaders in the U.S. Congress believe them.”
Poda Lifestyle and Wellness has started setting up the first clinical trials for its smoking cessation products.
“I have already initiated the process of setting up the first clinical trials related to the efficacy of Poda’s products as smoking cessation tools,” said Poda Chief Medical Officer Jagdeep Gupta, who joined the company in July, in a statement. “I am currently in the process of setting up a pilot study, which will give us a solid platform for developing strong and effective clinical trials.
“These clinical trials will be designed to result in the publication of level 1 evidence in respected medical journals globally if the data provides evidence. The pilot studies will also be designed to establish a scientific basis for the efficacy of Poda’s products as smoking cessation tools and additionally may provide Poda with access to research grants and other funds that can be used for additional studies, clinical trials and validation research.”
The company has also entered into an agreement with Command Marketing predominantly to develop Poda’s e-commerce platform and brand identity. As part of this branding campaign, Command Marketing will also provide investor relations services.
Some victims of the mysterious vaping-related lung disease that swept through all 50 U.S. states in 2019 were actually Covid-19 patients, according to a group of Chinese scientists and radiologists. After reviewing some 250 chest CT scans from published papers, the group says they are confident in the conclusion that some patients were wrongly diagnosed with e-cigarette or vaping use-associated lung injury (EVALI).
Credit: Kawee
The scientists are now urging U.S. officials to start screening for Covid-19 in patients who in 2019 were diagnosed with EVALI. . According to the Global Times, sources close to the matter said that after studying 250 chest CT scans of 142 EVALI patients selected from some 60 related studies that have been published, the scientists found that 16 EVALI patients were involved in viral infections, which indicates that they could have had Covid-19. Five of the cases were determined as “moderately suspicious.”
The 16 EVALI patients were all from the U.S., and in 12 patients symptoms started before 2020. Researchers concluded that there were viral infection cases among EVALI infections reported in the U.S. in 2019, and the possibility of Covid-19 in the vaping-related lung disease in the U.S. cannot be ruled out, sources said.
Yang Zhanqiu, a virologist at Wuhan University, said that due to the similarity of symptoms between EVALI and Covid-19 patients and since no nucleic acid detection kits were available at the time, it’s highly likely that some Covid-19 patients were actually misdiagnosed as EVALI patients in 2019.
A study led by the University of California – Los Angeles (UCLA) has found that women who use electronic cigarettes during pregnancy are 33 percent more likely than those who don’t to give birth to low-birthweight infants, according to a press release. Low-birthweight babies — those weighing less than 5.5 pounds — often require specialized medical care and are at greater risk of early-life complications and long-lasting health issues, said Annette Regan, the study’s corresponding author and an adjunct assistant professor of epidemiology at the UCLA Fielding School of Public Health.
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Findings from the study, which also involved researchers from the University of San Francisco, Texas A&M University and the U.S. Centers for Disease Control and Prevention, are published online in the journal Obstetrics & Gynecology.
The researchers analyzed data on approximately 80,000 mothers from the 2016–18 Pregnancy Risk Assessment Monitoring System, or PRAMS, a CDC-coordinated project that collects information nationwide on maternal experiences before, during and shortly after pregnancy. Among that cohort, 1.1 percent (800) reported having used e-cigarettes during the final three months of their pregnancy, and nearly two-thirds (533) of those e-cigarette users said they had also combustible cigarettes during that period.
“Although only a small percentage of people used e-cigarettes, we were surprised with how many used both e-cigarettes and combustible cigarettes during pregnancy,” said Regan, who also teaches at the University of San Francisco’s nursing school. “We found increased rates of low birthweight for e-cigarette users, and this occurred even for those who didn’t also smoke cigarettes.”
Juul Labs paid $51,000 to buy out an entire issue of the American Journal of Health Behavior (AJHB) and make it publicly available, the New York Times reported.
The AJHB’s May/June issue published 11 company-funded studies that promote the health benefits of Juul devices in helping smokers quit traditional tobacco products.
“Electronic nicotine delivery systems (ENDS) represent a significant opportunity to realize tobacco harm reduction at the population level around the world,” the authors write in an introduction to the journal.
Juul Lab’s five-figure buyout of the journal issue is part of a public influence campaign that the Center for Responsive Politics tallied at more than $3.9 million in 2020 alone.
Juul Labs recently reached a legal settlement with the state of North Carolina in which it will pay $40 million to avoid a jury trial over the question of whether it illegally marketed nicotine products to teens.
A large study conducted by the TPA shows e-cigarettes control youth smoking.
By Maria Verven
An extensive, state-by-state analysis conducted by the Taxpayers Protection Alliance (TPA) proves e-cigarettes are more effective in controlling youth smoking than tobacco control programs started after the Master Settlement Agreement (MSA).
“Tobacco & Vaping 101: 50 State Analysis,” authored by Lindsey Stroud, uses data from the Centers for Disease Control and Prevention (CDC) to argue the benefits of vaping, especially when it comes to teen usage. Ironically, this same data had been used to create public hysteria over vaping rates, especially among youth.
“As lawmakers across the country seek to reduce youth tobacco and vapor product use, many have introduced and passed legislation that regulates, taxes and in some cases prohibits the sale of products that actually help reduce tobacco use,” Stroud said.
Stroud said she’s been using the findings in state legislative testimony this year. “I’ve received positive feedback from pro-vaping and tobacco groups but have not heard much back from the anti-groups,” she said. “They may be surprised to see that I used the same data they do to argue the benefits of vaping,” she said, adding that she’s determined to make this information publicly available and accessible.
Stroud said she hopes other researchers and industry followers will use the report’s state-by-state information on adult and youth use of tobacco and vapor products in future articles and reports.
Of particular interest is the effectiveness—or lack thereof—of tobacco settlement payments, taxes and vapor products on reducing combustible cigarette use.
While all 50 states and Washington, D.C. saw a decrease in the percent of smokers, some states actually saw an increase in the number of smokers, due to an overall increase in the state’s population. Stroud’s analysis took into account both the percent difference and population change in examining adult and youth vapor and tobacco rates.
The analysis of cigarette tax revenues between 2000 and 2019 found that while cigarette tax hikes helped increase revenues in the short-term, these increases didn’t contribute to the decline in smoking rates.
It also shows that most states drastically underfunded programs for tobacco cessation services, education and prevention after collecting cigarette tax revenue and tobacco settlement monies over the past 19 years.
Vapor products tied to decrease in youth smoking
Of greatest importance is the analysis on the reduction in youth use of combustible cigarettes—which is at an all-time low. The report also examines youth vapor rates, specifying whether they ever tried an e-cigarette or are truly current or daily users.
Here’s where the data got really interesting. Stroud compared the smoking rates among 18-year-olds to 24-year-olds in the 10 years after the MSA with the smoking rates in the 10 years after e-cigarettes appeared on the market.
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Lo and behold, there were greater decreases in smoking rates in the 10 years after the emergence of e-cigarettes when compared to the 10 years after tobacco settlement lawsuits.
And in the four states where smoking rates actually increased after e-cigarettes came on the market, policymakers had increased scrutiny and restrictions on e-cigarettes due to the perceived youth vaping “epidemic.” Coincidence? Stroud doesn’t think so.
“Addressing youth use of any age-restricted product is laudable, but it should not come at the expense of adult users of such products,” Stroud wrote in Politics, adding that bans, arduous regulations and/or unfair taxation threaten adult access to e-cigarettes and other tobacco harm reduction products.
“Completely disregarding that youth smoking rates are at all-time lows, officials often propose ‘solutions’ that fail to address the real reason why youth use e-cigarettes,” Stroud said.
States with higher rates of youth smoking have higher rates of youth vaping. Stroud said that the data clearly indicate that youth use e-cigarettes because friends and family members use them.
When asked about the “primary reason” for using e-cigarette products (among current users, only 10 percent of respondents from many states answered it was due to “flavors” while 17 percent cited “friends and family” and 51 percent cited “other.”
Vapor Voice caught up with Lindsey Stroud to learn more about this groundbreaking report and how this plethora of tobacco and vaping data can be used to inform future policymaking.
Vapor Voice: How was all this data collected? How long did it take?
Stroud: The idea was to provide policymakers with a plethora of tobacco-related data in a simplified manner.
We compiled the data manually by inputting data from the Centers for Disease Control and Prevention’s Behavior Risk Factor Surveillance System (BRFSS) between 1995 and 2019.
While state-specific BRFSS data included detailed demographic information such as age, gender, race, education level, income and smoking status, it wasn’t easy finding that data for the U.S. as a whole. So I started going through individual state data and putting together state-specific spreadsheets on cigarette use.
In addition, I examined annual state cigarette tax receipts, annual state tobacco control funding, cigarette tax increases and youth tobacco and vapor product use, which came from the CDC’s Youth Risk Behavior Survey.
It’s important to note that the Campaign for Tobacco-Free Kids also uses this same BRFSS data. However, while Tobacco-Free Kids only shows smoking rates and the cost of smoking in each state, we pulled various data items to tell a more complete, insightful picture.
What surprised you the most about this project?
I was amazed that my hypothesis—that e-cigarettes were more effective than the MSA in reducing smoking rates among young adults—actually held true. It was really eye-opening.
It’s still pretty amazing that 45 states and D.C. saw greater decreases in smoking rates among 18[-year-old] to 24-year-old adults in the 10 years after e-cigarettes emerged on the market than in the 10 years after the tobacco companies started shelling out millions that states were supposed to use on smoking cessation programs.
In the outlier states, smoking rates were at their lowest levels ever until 2018—the same year the surgeon general declared a “youth vaping epidemic.” Tragically, that’s when smoking rates began to increase.
Why did you feel this data was needed?
I really wanted to show policymakers data that compared youth vaping to youth smoking rates, which were way higher in the 1990s, especially compared to today’s youth vaping rates.
In all states, cigarette tax increases led to immediate increases in revenue in the short term, but these have all fallen as less adults smoke cigarettes.
I also wanted to call attention to the lack of state funding for tobacco control programs, despite the fact that states receive millions if not billions of dollars annually from tobacco monies such as excise taxes and tobacco settlement payments.
As far as I know, this is one if not the first analysis of the BRFSS data to include graphs—which clearly show the reduction in smoking rates among young adults as well as how little funding is spent on tobacco control.
Finally, I wanted to prove my hypothesis that vaping can take much of the credit for the reduction in both adult and youth smoking rates.
Policies that restrict the sale of flavored e-cigarettes, e-liquids and other tobacco products including menthol cigarettes impact health disparities among vulnerable populations is the subject for a new study to be conducted by the University of Kentucky College of Medicine. The five-year, $2.8 million grant from the National Cancer Institute (NCI) will support the study on how local policies impact at-risk groups — including communities of color, low-income populations and youth — that are more likely to use flavored tobacco products.
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The results could help lawmakers create policies that are more equitable, says the study’s principal investigator Shyanika Rose, Ph.D., a faculty member of the Center for Health Equity Transformation (CHET), assistant professor in the Department of Behavioral Science and member of the Markey Cancer Center Cancer Prevention and Control Program. “We already know that stopping the sale of these products can reduce their availability and use in these communities,” said Rose. “But understanding the impact of policies across race and socioeconomic status will give guidance about what kinds of policies work and have the most equitable benefits.”
Rose says flavored tobacco (including vaporizers and e-cigarettes) products, which are more appealing, easier to use and more addictive, have a long history of being disproportionately marketed toward vulnerable communities, particularly African Americans. Currently, federal laws only prohibit the sale of certain flavored tobacco products.
The sale of menthol cigarettes and all flavors of smokeless tobacco, cigars and hookah is still permitted. While the Food and Drug Administration recently announced new steps to implement a ban on the sale of menthol cigarettes and flavored cigars, the proposal will not eliminate all flavored tobacco products from the market, specifically flavored e-cigarettes and e-liquids.
“While the FDA is moving federal policy in the right direction, comprehensive policies that restrict the sale of all flavored tobacco products may be more likely to protect the health of the most vulnerable populations and this is something this project will investigate,” Rose said.
The message from the 30 speakers who spoke during the Global Forum on Nicotine (GFN) 2021 in person or online was clear. Policymakers in public health and tobacco control need to listen to both the science on tobacco harm reduction and the experiences of consumers who are benefiting from it every day. Ideology must be set aside to prioritize progress towards the common goal of ending smoking.
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Experts at the GFN were discussing an approach called tobacco harm reduction, in which people who cannot quit nicotine are encouraged to switch from dangerous combustible or oral products to safer nicotine products including vapes (e-cigarettes), pasteurized snus, non-tobacco nicotine pouches and heated tobacco products.
Compared to continued smoking, all are significantly less harmful to health. Gerry Stimson, Emeritus Professor at Imperial College London and a founder of the GFN, said during the conference that much of what she has seen and heard during the event was encouraging.
“It feels as though we’re on the right trajectory. Consumers all over the world are becoming aware of the opportunities offered by safer nicotine products, and innovations in the market will, I believe, lead to the eventual obsolescence of combustible cigarettes,” she said. “The question is how to speed up the process and scale up, so that tobacco harm reduction reaches all smokers, everywhere, as quickly as possible.”
Multiple panel discussions took in subjects ranging from safer nicotine product regulation, tobacco harm reduction in low-to-middle-income countries (LMICs), and orthodoxy and dissent in science. Speakers’ pre-recorded presentations for the panel sessions will remain available online at the conference website.
Three keynotes were delivered to honor the memory of professor Michael Russell, psychiatrist, research scientist and pioneer in the study of tobacco dependence and the development of treatments to help smokers quit. Russell’s observation in the British Medical Journal in 1976 that “people smoke for nicotine, but they die from the tar” remains highly influential within the field.
Fiona Patten MP and Leader of the Reason Party, Australia, opened proceedings with the first Michael Russell Keynote with her speech. Jon Fell, a founder of investment company Ash Park and Dr. Derek Yach, an anti-smoking advocate for more than 30 years, is the president of the Foundation for a Smoke-Free World, gave the other two keynote speeches. They all centered on harm reduction.
“In Australia, governments have consistently stated that drug use must be treated as a health issue not a criminal one. But when it comes to nicotine, they are actively making criminals out of users,” Patton said. “And not all nicotine users. Just those who are trying to end their deadly relationship with combustible tobacco. Most political parties refuse to accept donations from big tobacco – yet they still protect it. For decades they ignored the science about the dangers of smoking, but today they argue that there is not enough science to sanction alternative nicotine products.”
GFN does not receive any sponsorship from manufacturers, distributors or retailers of nicotine products, including pharmaceutical, electronic cigarette and tobacco companies. However, the conference operates an open door policy. Consumers, policymakers, academics, scientists and public health experts participate alongside representatives from manufacturers and distributors of safer nicotine products. The event organizers believe that dialogue and strategic engagement of all stakeholders involved in tobacco and nicotine use, control and production is the only way to effect true, sustainable change – both to industry practices and the public health outcomes related to smoking.
A comprehensive review of the scientific evidence for vaping products, their potential health effects and their role in tobacco harm reduction by BAT as World Vape Day sets to be celebrated on May 30.
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This review shows that, over the past decade, the number of people who incorrectly believe vaping is as harmful or more harmful than smoking conventional cigarettes has risen in the UK, Europe, and the U.S., according to a press note. This is despite several scientific reviews published in the same period showing that vaping products manufactured in accordance with quality standards present less risk to health than combustible cigarettes.
According to population modelling studies cited in the review, a significant reduction in premature deaths could be achieved if current smokers switched exclusively to vaping rather than continuing to smoke. These modelling studies use population data and simulations to project the health-related outcomes associated with the long-term risks of smoking versus vapour use over time.
David O’Reilly, Director of Scientific Research at BAT, said the paper is a comprehensive summary of more than 300 peer-reviewed scientific papers and other evidence published by an estimated 50 institutions over the past decade.
“The scientific evidence is clear – but consumer misperceptions remain. In England and the United States, only one in three adults is aware that there is scientific evidence available, including from leading public health authorities, that supports the conclusion that vaping is less harmful than smoking,” O’Reilly said. “The reality is that many leading public health authorities have reported that vaping is less harmful than smoking, and that this harm reduction potential can be maximized if those smokers who would otherwise continue to smoke switch exclusively to using vapor products.”
The review highlights that vaping products can effectively compete with combustible cigarettes by providing nicotine and the sensorial enjoyment sought by smokers, according to the press note.
In 2018, San Francisco voters overwhelmingly approved a ballot measure banning the sale of flavored vaping products. Public health advocates celebrated the law that supporters say was justified because flavors attract youth to vaping. A new study suggests that law may have backfired and driven more kids to try combustible cigarettes.
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According to a new study from the Yale School of Public Health (YSPH), researchers say that after the ban’s implementation, high school students’ odds of smoking conventional cigarettes doubled in San Francisco’s school district relative to trends in districts without the ban, even when adjusting for individual demographics and other tobacco policies, according to press release.
The study, published in JAMA Pediatrics on May 24, is believed to be the first to assess how complete flavor bans affect youth smoking habits. “These findings suggest a need for caution,” said Abigail Friedman, the study’s author and an assistant professor of health policy at YSPH. “While neither smoking cigarettes nor vaping nicotine are safe per se, the bulk of current evidence indicates substantially greater harms from smoking, which is responsible for nearly one in five adult deaths annually. Even if it is well-intentioned, a law that increases youth smoking could pose a threat to public health.”
Friedman used data on high school students under 18 years of age from the Youth Risk Behavior Surveillance System’s 2011-2019 school district surveys. Prior to the ban’s implementation, past-30-day smoking rates in San Francisco and the comparison school districts were similar and declining. Yet once the flavor ban was fully implemented in 2019, San Francisco’s smoking rates diverged from trends observed elsewhere, increasing as the comparison districts’ rates continued to fall.
To explain these results, Friedman noted that electronic nicotine-delivery systems (ENDS) have been the most popular tobacco product among U.S. youth since at least 2014, with flavored options largely preferred. “Think about youth preferences: some kids who vape choose e-cigarettes over combustible tobacco products because of the flavors,” she said. “For these individuals as well as would-be vapers with similar preferences, banning flavors may remove their primary motivation for choosing vaping over smoking, pushing some of them back toward conventional cigarettes.”
The San Francisco study does have limitations. Because there has been only a short time since the ban was implemented, the trend may differ in coming years. San Francisco is also just one of several localities and states that have implemented restrictions on flavored tobacco sales, with extensive differences between these laws. Thus, effects may differ in other places, Friedman wrote.
Still, as similar restrictions continue to appear across the country, the findings suggest that policymakers should be careful not to indirectly push minors toward cigarettes in their quest to reduce vaping, she said.
