April 10, 2019
On March 29, 2019 Jidong Huang and colleagues published “Changing Perceptions of Harm of e-Cigarette vs Cigarette Use Among Adults in 2 US National Surveys From 2012 to 2017“ in JAMA Network Open, reporting that in two nationally representative multiyear surveys of US adults, the proportion who perceived e-cigarettes to be as harmful as or more harmful than cigarettes increased substantially from 2012 to 2017. They conclude that there is a “need for accurate communication of the risk of e-cigarettes to the public is urgent and should clearly differentiate the absolute from the relative harm of e-cigarettes.”
I wrote an accompanying editorial that summarized the consistent epidemiological evidence that e-cigarettes increases the risk of cardiovascular and pulmonary disease and the emerging molecular biological evidence suggesting that e-cigarettes may also increase cancer risk, concluding that The Evidence of Electronic Cigarette Risks Is Catching Up With Public Perception.
April 10, 2019
An annual public health survey of top-grossing US movies, released today, reports that most major movie studios have dramatically cut back on smoking in their kid-rated movies in the past two decades. Against the tide, only Comcast’s Universal and Fox (now owned by Disney) are pushing more tobacco imagery proven to recruit kids to smoke.
Breathe California and the University of California, San Francisco, also report that nearly three-quarters of smoking characters in Hollywood’s smokiest film genre, biographical dramas, are actually invented. Bio-dramas exaggerate the amount of smoking in youth-rated films and have reversed health progress industry-wide.
As a result of both these trends, US youth-rated movies delivered 10.3 billion tobacco impressions to moviegoers of all ages in the US and Canada in 2018, double the number in 2017 (5.1 billion) and triple the number in 2015 (2.9 billion).
Comcast and Fox accounted for 88 percent of audience exposure to onscreen smoking in 2018. Sony, Time Warner, and independent film companies accounted for 12 percent. Kid-rated films from Disney and Viacom’s Paramount were all smokefree last year.
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.