July 11, 2016
Jessica Barrington-Trimis and her colleagues have published two important papers in Pediatrics on the link between e-cigarette and cigarette use, both based on a large longitudinal sample of Southern California youth who have been followed for many years.
Their paper “E-cigarettes, Cigarettes, and the Prevalence of Adolescent Tobacco Use” showed that, contrary to assertions of e-cigarette cheerleaders, the large increase in e-cigarette use observed in several national studies in recent years are not simply reflecting kids taking up e-cigarettes instead of e-cigarettes. While some kids who are using e-cigarettes are also smokers, kids are being attracted to e-cigarettes who would otherwise not be attracted to tobacco products.
Here is the abstract:
July 9, 2016
While e-cigarettes deliver fewer cancer-causing chemicals than conventional cigarettes, the evidence that e-cigarettes substantially increase heart and lung disease keeps piling up. This is important because heart and vascular disease (including stroke) and non-cancer lung disease account for over 70% of smoking-caused deaths. In addition, unlike cancer, where the dose-response effect for exposure to carcinogens is reasonably linear at the doses tobacco products deliver, the effects on cardiovascular disease are highly nonlinear, with the biggest increases in risk at the lowest doses.
Aruni Bhatnagar recently published a well-written (and cautiously interpreted) review of the evidence, “E-cigarettes and Cardiovascular Disease Risk: Evaluation of Evidence, Policy Implications, and Recommendations,” in which he observes
June 9, 2016
The New England Journal of Medicine just published two alternative views on what to tell patients about using e-cigarettes for smoking cessation, one from Chris Bullen and one from. You can read both at http://www.nejm.org/doi/pdf/10.1056/NEJMclde1602420.
Check it out.
June 6, 2016
Noel Brewer and his colleagues just published an important paper. “Effect of Pictorial Cigarette Pack Warnings on Changes in Smoking Behavior: A Randomized Clinical Trial,” in JAMA Internal Medicine in which they demonstrated that graphic warning labels on cigarette packages will save lives in America. This study, as close to a real-world test that I can imagine, gave smokers their own brand of cigarettes, except with graphic warning labels pasted on them. Brewer and colleagues then followed the smokers for a month and found that the smokers randomized to the graphic warnings had increased intentions to quit, more forgoing of cigarettes, more quit attempts, and more successfully quitting smoking.
The control group got packs with text warnings on the side of the pack, like the US, unlike most of the rest of the world, still has.
I don’t know what more evidence the FDA and, more important, the White House, should need to implement state-of-the art circa 2000 graphic warning labels. (True state of the art is plain packaging.)
Here is the abstract for the paper:
June 6, 2016
FDA courageously stated in its final version of the deeming rule that it submitted to the White House that menthol flavored products would be treated the same as other flavored products (such as chocolate and gummy bear), and therefore all newly deemed menthol products would have been ordered off of the market by November 6, 2016. To market a flavored (including menthol) product after that date, the tobacco and e-cigarette companies would have been required to present evidence to FDA proving that the products were entitled to receive marketing authorization because they protected the public health. As detailed below, the FDA presented overwhelming evidence, supported by comments it received on the proposed deeming rule, that menthol, candy, and fruit-flavored tobacco products attracted youth to tobacco use and deterred quitting.