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Survey shows less smoking among N.C. teens, more e-cig use
Survey shows less smoking among N.C. teens, more e-cig use

State health officials said Friday that smoking levels among public high-school and middle-school students reached an historic low rate during 2013.

But they also expressed concern that a small, but increasing, number of students are willing to experiment with alternative tobacco products.

The findings come from the N.C. Youth Tobacco Survey that is conducted every two years. The survey included 4,092 high school students and 3,927 middle school students.

Alternative tobacco products included electronic cigarettes, flavored little cigars, clove cigars, flavored cigarettes, snus, hookahs (also known as water pipes) and roll-your-own cigarettes.

The survey determined that 13.5 percent of high school students in 2013 were current smokers, defined as smoking at least once during a 30-day period. That’s down from 15.5 percent in 2011.

The decline in North Carolina mirrors the most recent National Youth Tobacco Survey, which found 14 percent of high school students in 2012 listed as currently smoking.

Among N.C. middle-schoolers, the smoking rate fell to 2.5 percent from 4.2 percent in 2011. The national rate was 3.5 percent in 2012.

By comparison, after decades of decline, the adult smoking rate has stalled at about 20 percent of Americans in recent years.

Dr. Ruth Petersen, chief of the chronic disease and injury section in the state Division of Public Health, said the smoking decline was tempered in part because more youths may be consuming — or are willing to consume — multiple tobacco products. The survey found that 19.1 percent of youth tobacco consumers are using two or more product types.

Current use of e-cigs among high school students rose from 1.7 percent in 2011 to 7.7 percent in 2013.

As a result, the survey determined that 29.7 percent of high school students are current users of a tobacco product.

“This trend toward other tobacco use and dual use of tobacco products is a real cause for concern,” Petersen said. “Nicotine in these tobacco products is highly addictive, and there is evidence that using nicotine during adolescence may harm brain development.”

Measuring the use of alternative tobacco products by youths has become a major hot-button societal issue within the industry and among anti-tobacco advocates. Some groups want e-cigs banned, while others tout e-cigs as potentially less harmful than combustible cigarettes. Although more e-cig health studies are emerging, there has not been a definitive report yet.

“We should be concerned about anyone underage being sold any tobacco or nicotine product,” said Scott Ballin, past chairman of the Coalition on Smoking or Health. “But more importantly, it may be time to also look at ways of further preventing possession and usage comparable to the way alcohol is dealt with.”

Dr. John Spangler, a professor of family and community medicine at Wake Forest Baptist Medical Center, echoed Petersen’s mixed perspective on the survey results.

“Cigarette smoking dropped less than electronic-cigarette use rose,” Spangler said. “So, I worry that some youth might become nicotine addicted to electronic cigarettes — kids who otherwise would not have tried tobacco as a source of nicotine.”

Congress gave the Food and Drug Administration oversight over the tobacco industry in 2009.

In April, the FDA proposed extending current restrictions on cigarette marketing to newly regulated products, including cigars and e-cigs, and prohibiting the use of flavorings that appeal to kids. Among the main recommendations is a ban on sales to underage youths.

However, the FDA did not call for an outright ban of e-cigs, for which some advocates had pushed. The FDA did not curtail Internet sales or current marketing efforts that include television and social media.

There is a growing trend of state legislatures and municipalities to ban the sale of e-cigs to youths. The N.C. General Assembly approved in 2013 adding “vapor products,” which would include e-cigs, to a law prohibiting sales of tobacco to youth under 18 and requiring age verification for Internet sales. At least 24 states have passed similar laws.

Analysts said the surge in popularity in e-cigs over the past six years likely eliminated banning as an option. E-cig manufacturers and marketers warned about an unregulated black market surfacing upon a ban.

“While adolescents need to be educated that all nicotine products should be avoided, it's even more important that teen smokers understand the relative risks of different products,” said Gregory Conley, a research fellow at the right-leaning Heartland Institute.

“Misinforming our youth about the hazards of smoke-free products is a dangerous proposition and can lead to continued smoking or dual use as an adult.”
Study of smoking cancer patients fuels e-cigarette debate

LONDON (Reuters) - The fierce debate over whether e-cigarettes can help people quit smoking took another twist on Monday as a research paper on their use by cancer patients was criticized as flawed.

The study of cancer patients who smoke found that those using e-cigarettes as well as tobacco cigarettes were more nicotine dependent and equally or less likely to have quit than those who didn't use e-cigarettes.

The scientists behind the research, which was published online in Cancer, the journal of the American Cancer Society, said their results raised doubts about whether e-cigarettes had any benefit in helping cancer patients to give up smoking.

But that conclusion was questioned by other tobacco and addiction researchers, who said the selection of patients for the study had given it an inherent bias.

The uptake of e-cigarettes, which use battery-powered cartridges to produce a nicotine-laced vapor for the "smoker" to inhale, has rocketed in the past two years, but there is fierce debate about their potential risks and benefits.

Because they are new, there is a lack of long-term scientific evidence on their safety. Some experts fear they could lead to nicotine addiction and be a gateway to tobacco smoking, while others say they have enormous potential to help millions of smokers around the world to quit.

What few studies there are give a mixed picture, with some concluding that e-cigarettes can help people give up a deadly tobacco habit, while others suggest they may carry health risks of their own.

A World Health Organization (WHO) report last month called for stiff regulation of e-cigarettes as well as bans on indoor use, advertising and sales to minors.

But that report itself was also criticized by experts who said it contained errors, misinterpretations and misrepresentations.

For the Cancer journal study, researchers led by Jamie Ostroff of the Memorial Sloan Kettering Cancer Center in New York City studied 1,074 cancer patients who smoked and who were enrolled between 2012 and 2013 in a tobacco treatment program at a cancer center.

They found a three-fold increase in e-cigarette use from 2012 to 2013 - rising from 10.6 percent to 38.5 percent.

At enrolment onto the program, the researchers' analysis found, the e-cigarette users were more nicotine dependent than non-users, had more prior quit attempts, and were more likely to be diagnosed with lung or head and neck cancers.

By the end of the study period, the researchers said, e-cigarette users were just as likely as non-users of e-cigarettes to be smoking.

But Robert West, director of tobacco research at University College London, said the study was not able to assess whether or not for cancer patients who smoke using an e-cigarette to try and quit is beneficial "because the sample could consist of e-cigarette users who had already failed in a quit attempt, so all those who would have succeeded already would be ruled out".

Peter Hajek, director of the Tobacco Dependence Research Unit at Queen Mary, University of London, agreed that the study's data did not justify the conclusions.

"The authors followed up smokers who tried e-cigarettes but did not stop smoking, and excluded smokers who tried e-cigarettes and stopped smoking," he said.

"Like smokers who fail with any method, these were highly dependent smokers who found quitting difficult. The authors concluded that e-cigarette (use) was not helpful, but that would be true for any treatment however effective if only treatment failures were evaluated."
E-cigarettes contain up to 10 times carcinogens: Japan research

E-cigarettes contain up to 10 times the level of cancer-causing agents in regular tobacco, Japanese scientists said Thursday, the latest blow to an invention once heralded as less harmful than smoking.

The electronic devices -- increasingly popular around the world, particularly among young people -- function by heating flavoured liquid, which often contains nicotine, into a vapour that is inhaled, much like traditional cigarettes but without the smoke.

Researchers commissioned by Japan's Health Ministry found carcinogens such as formaldehyde and acetaldehyde in vapour produced by several types of e-cigarette liquid, a health ministry official told AFP.

Formaldehyde -- a substance found in building materials and embalming fluids -- was present at much higher levels than carcinogens found in the smoke from regular cigarettes, the official said.

"In one brand of e-cigarette the team found more than 10 times the level of carcinogens contained in one regular cigarette," said researcher Naoki Kunugita, adding that the amount of formaldehyde detected varied through the course of analysis.

"Especially when the... wire (which vaporises the liquid) gets overheated, higher amounts of those harmful substances seemed to be produced."

Kunugita and his team at the National Institute of Public Health, who submitted their report to the ministry on Thursday, analysed several cartridges of e-cigarette fluid using a machine that "inhaled" 10 sets of 15 puffs.

One brand, the name of which was not revealed, showed a more than 10-fold level of formaldehyde on nine out of every 10 sets.

Another brand showed similar levels on several sets, but was not consistently that high.

Kunugita said the research showed e-cigarettes are not the harmless products many people assume them to be.

"We need to be aware that some makers are selling such products for dual use (with tobacco) or as a gateway for young people" to start a smoking habit, he warned.

**So where are all the concerns by Capitol Hill now? Remember in the 1990's when Congress intervened when cigarettes were being marketed toward young people?

In common with many jurisdictions, Japan does not regulate non-nicotine e-cigarettes.

- 'Serious threat' -

Nicotine e-cigarettes, or so-called Electronic Nicotine Delivery System (ENDS), are subjected to the country's pharmaceutical laws, but they can be bought easily on the Internet, although they are not readily available in shops as they are in some Western countries.

"You call them e-cigarettes, but they are products totally different from regular tobacco," the ministry official said.

"The government is now studying the possible risks associated with them, with view to looking at how they should be regulated."

In August, the World Health Organisation called on governments to ban the sale of e-cigarettes to minors, warning they pose a "serious threat" to unborn babies and young people.

Despite scant research on their effects, the WHO said there was enough evidence "to caution children and adolescents, pregnant women, and women of reproductive age" about e-cigarette use, due to the "potential for foetal and adolescent nicotine exposure (having) long-term consequences for brain development".

The UN health body also said they should be banned from indoor public spaces.

US health authorities said earlier this year that the number of young people there who have tried e-cigarettes tripled from 2011 to 2013.

More than a quarter of a million young people who had never smoked a cigarette used e-cigarettes last year, the US Centers for Disease Control and Prevention said.

Supporters of e-cigarettes say the devices are a safer alternative to traditional tobacco, whose bouquet of toxic chemicals and gases can cause cancer, heart disease and strokes -- among the leading causes of death in many countries.

But opponents say the devices have only been around for a few years, and the long-term health impact from inhaling their industrial vapour is unclear.

Big tobacco companies are snapping up producers of e-cigarettes, wary of missing out on a snowballing global market worth about $3 billion.

Earlier this month, Oxford Dictionaries picked "vape"-- the act of smoking an e-cigarette -- as their new word of the year. Forum Index -> HEALTH and Medical NEWS
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