April 7, 2019
AD Osei and colleagues just published “The association between e-cigarette use and cardiovascular disease among never and current combustible cigarette smokers: BRFSS 2016 & 2017” in American Journal of Medicine. While they did not find a statistically significant increase in risk of cardiovascular disease (coronary heart disease, myocardial infarction, or stroke) among e-cigarette only users, they did find a statistically significant increase in risk for dual users (i.e., people who added e-cigarettes to conventional cigarettes). This finding is consistent with our findings, using the National Health Interview Survey and PATH, that dual use is more dangerous than just smoking. This is an important finding because most adult e-cigarette users continue to smoke (i.e., are dual users).
The fact that the authors did not find an effect of e-cigarettes alone may be because they stratified the sample on e-cig and cigarette use, which reduces the sample size for each comparison, and so the power to detect an effect.
April 7, 2019
YN Chien and others, including me, recently published “Electronic Cigarette Use and Smoking Initiation in Taiwan: Evidence from the First Prospective Study in Asia” in International Journal of Environmental Research and Public Health. We used the 2014 and 2016 waves of the Taiwan Adolescent to Adult Longitudinal Study to enroll junior high school students (mean age 13) and follow them up two year later. We found, among youth who had never smoked a conventional cigarette, that any e-cigarette use at baseline more than doubled the odds that they would have initiated cigarettes two years later (Odds Ratio = 2.14, 95% CI (1.66, 2.75), p < 0.001). This odds ratio is lower than has been found in the USA, perhaps because in Taiwan e-cigarettes remain de facto illegal.
Here is the full abstract:
March 22, 2019
On March 20, 2019, San Francisco City Attorney Dennis Herrera and Supervisor Shamann Walton announced plans to introduce legislation prohibiting the sale of e-cigarettes in San Francisco until they are approved by the FDA.
I see this as a brilliant move to force the companies to follow federal law and demonstrate that the sale of these products would be “appropriate for the public health” as the law requires.
Not surprisingly, some, including, unfortunately, the San Francisco Chronicle editorial board, have labeled this action as “grandstanding” and raised the question of why not ban cigarettes.
This criticism ignores the reality of the federal law that gave the FDA jurisdiction over tobacco.
That 2009 law, the Family Smoking Prevention and Tobacco Control Act, granted the FDA authority over tobacco products contained a political compromise: Any product on the market as of 2007 – including cigarettes – would be allowed to remain but new products would require that the FDA certify that marketing them was “appropriate for public health” before they could be sold.
March 21, 2019
We just submittted this public comment to the FDA on its proposed guidance change to cut a year after the grace period it is providing ecigs before it starts enforcing the law. The tracking number on Regulations.gov is 1k3-98wh-3mjb and a PDF of the comment is available here.
The material in this comment is also relevant to San Francisco's recent decision to introduce a law prohibiting the sale of ecigs that have not yet been approved by the FDA.
FDA’s proposed modifications to its compliance policy for e-cigarettes leaves millions of youth at risk for starting to use e-cigarettes; FDA needs to remove these products from the market now and clamp down on illegal therapeutic and modified risk claims in Juul and other e-cigarette advertising
Lauren Kass Lempert, JD, MPH; Bonnie Halpern-Felsher, PhD; Matthew L. Springer, PhD; Stanton Glantz, PhD
UCSF TCORS
Docket No. FDA-2019-D-0661
March 21, 2019
March 20, 2019
As I have written before, the battle for a ban on flavored tobacco products (including ecigs and menthol cigarettes and little cigars) before the Sacramento City Council is a strategic fight that is likely to affect the fate of a similar law being considered in the California State Legislature. The legislature is just a few blocks from City Hall and the mayor of Sacramento is Darryl Steinberg, the former President Pro Tem of the State Senate, so a strong flavor ban in Sacramento City could help pave the way for state legislation. Conversely, an ineffectual bill (as promoted by Juul and other tobacco industry interests) could have become the model for bad state legislation.
Despite the industry pulling out all the stops, the City Council’s Law and Legislation Committee voted 4-0 to reject he industry proposal and stay with the strong ordinance.
The Sacramento Bee has a good story on what happened. It talked to a colleague in Sacramento who was at the meeting reported that the industry put on an impressive show, vastly outnumbering the health forces in the audience and at the podium.