February 24, 2019
Three more epidemiological studies demonstrating increased risk of lung disease in e-cigarette users were presented at the Society for Nicotine and Tobacco Research meeting from Feb 20-23, 2019. While they use different end points (respiratory disease generally, asthma, or COPD), they all show elevated risks associated with e-cigarette use, either by using people who are only using e-cigs or accounting for smoking in the statistical analysis.
These epidemiological changes are precisely what you would predict based on the pathological changes that e-cigs cause in the lungs.
Here are the abstracts:
POS2-146
ELECTRONIC CIGARETTE USE IS ASSOCIATED WITH RESPIRATORY DISEASE AMONG ADULTS IN THE UNITED STATES POPULATION ASSESSMENT OF TOBACCO AND HEALTH: A LONGITUDINAL ANALYSIS
Dharma N. Bhatta, PhD, Stanton Glantz, PhD. University of California San Francisco, San Francisco, CA, USA.
February 24, 2019
There were several interesting scientific presentations at the Society for Research on Nicotine and Tobacco meeting held from February 20-23, 2019 in San Francisco dealing with the biology of how e-cigarettes cause disease. It is becoming clearer and clearer that e-cigarettes are not just cigarettes that deliver less of some bad things, which is how everyone, including me, used to think about them. The reality is that e-cigarettes are different from cigarettes. While they damage the body through some mechanisms in common with cigarettes, it is now clear that e-cigarettes also have adverse effects through channels not affected by cigarettes (and vice versa). The effects even transcend generations; exposure while pregnant compromises blood function in adult offspring.
These effects occur at the levels of exposure that real-world e-cigarettes generate and can be substantial. Evidence is also appearing demonstrating that e-cigarettes are implicated in cancer, something most people, including me, previously did not think was a substantial risk.
February 16, 2019
Pawan Sharma and colleagues recently published “IQOS exposure impairs human airway cell homeostasis: direct comparison with traditional cigarette and e-cigarette” in which they measured a wide range of effects of cigarette smoke extract (from Philip Morris’ Marlboro cigarettes, Philip Morris International’s heated tobacco product IQOS, and an e-cig using Blu liquid) on human lung cells. All three products adversely affected lung cells with a dose-response (i.e., bigger effects at higher doses).
In this study they exposed lung from the lining of the bronchi (big air pipes) and airway smooth muscle cells in vitro (i.e., cells in “test tubes”) to solutions made from the aerosols from all three products.
Here is my simplified version of their summary:
February 11, 2019
It’s no secret that I was initially skeptical of Tobacco 21; I saw it as another supply-side effort that wouldn’t work. What changed my mind was research that Dorie Apollonio and I did using the tobacco industry documents that revealed that many states had age limits for selling tobacco older than 18 and the tobacco companies worked hard to reduce the age in order to make it easier to market cigarettes to kids. Even since then, I have supported Tobacco 21.
My view that Tobacco 21 was important was reinforced when I saw how hard the cigarette companies fought the issue here in California.
There is now clearly momentum behind this idea and so, now, Altria and Juul are taking a page from their playbook on smokefree policies and starting to sponsor their own weak and unenforceable laws.
They got a lot of these bad (nominally) smoking restriction laws passed with the assistance of well-meaning but naïve health groups who, tired of getting nothing, decided to support flawed laws as a “first step” toward high-quality legislation (beginning with Florida in 1985). The problem is that it takes a median of 17 years to get these weak laws fixed.
February 11, 2019
The full release of the 2018 National Youth Tobacco Survey by the CDC in its paper, “Vital Signs: Tobacco Product Use Among Middle and High School Students — United States, 2011–2018” (summarized in non-technical terms here) in the Morbidity and Mortality Weekly Report (MMWR) has generated a lot of concern.
E-cigarette use, driven primarily by Juul, by youth continues to accelerate (see figure provided by Tom Eissenberg), as does multi-product use, led by dual use of e-cigarettes and cigarettes. In addition to the rapid growth in e-cig use, the historic decline in cigarette smoking has stopped. This is exactly what one would expect if e-cigarettes were bringing new low-risk kids into the market and acting as a gateway for cigarette smoking.
Of course, even if the kids did not go on to smoke cigarettes, addicting a new generation of kids to nicotine e-cigs is a bad thing.