Tobacco Center Faculty Blog

November 23, 2019

Stanton A. Glantz, PhD

Jacob George and colleagues recently published “Cardiovascular Effects of Switching From Tobacco Cigarettes to Electronic Cigarettes” in Journal of the American College of Cardiology.  This nicely-done study measured changes in blood vessel function in cigarette smokers before and a month after they switched from cigarettes to e-cigarettes and found that vascular function improved after switching.

A particularly interesting result is that the improvement was seen in women but not men.  There are gender differences in heart disease mechanisms and risks (especially before menopause).  This paper highlights the importance of considering gender effects when assessing effects of e-cigarettes on the cardiovascular system.

Like other studies of the effects of e-cigs on vascular function, the effect was independent of nicotine.

This paper does differ from most of the literature, which shows that e-cigs have similar effects on blood vessels as cigarettes (some recent examples are here), but, as noted above, this study is well done and the results contribute to the overall evidence base on ecigs and cardiovascular function.

Here is the abstract:

November 22, 2019

Stanton A. Glantz, PhD

Earlier this week the State of California sued Juul, alleging a wide range of efforts to addict kids and violate a range of California laws.

Every one of these law suits adds more details to our understanding of how Juul made its billions.  The thing that struck me in the California case is the detailed explanation about how Juul's "state of the art" online agre verification system let a ton of kids buy Juul and collected informationn that could be used to email marketing materials to kids.

Beginning on page 41, the case explains the purposeful holes in the online verification system and how Juul gamed the system to allow kids to get through.  In addition to incomplete verifications, the system allowed -- indeed, encouraged -- multiple attempts for kids who did not get through.

November 19, 2019

Stanton A. Glantz, PhD

I am just catching up on my reading after being on the road for a while and want to highly reccomend Chris Kirkham's extensive story, published by Reuters on November 5, 2019, "Juul disregarded early evidence it was hooking teens."  Kirkham meticulously follows the development of Juul's nicotine salt system and highlights how and why the company's leaders not only ignored intenal warnings that Juul would be hightly addictive to teens, but used this fact to line up retailers.

The stody also has an excellent discussion about nicotine delivery and how that relates to addiction.  They also report the fact that I had met with the two Juul inventors,  Monsees and Bowen . years ago and warned them that getting kids addicted would be a big problem with their product.  As Krikham reports that " Juul declined to comment on whether Glantz and other researchers warned the company about the danger of addicting teenagers."

This story is a must read.

November 19, 2019

Stanton A. Glantz, PhD

LA Times reporter Emily Baumgaertner dug through documents that the FDA obtained from Juul as part of its investigation of the company to write an excellent article, "Juul wanted to revolutionize vaping. It took a page from Big Tobacco’s chemical formulas."  She shows how James Monsees and Adam Bowen, the two guys who came up with Juul, used the UCSF Truth Tobacco Industry Documents Library, RJR patents and other materials to come up with the idea of using nicotine salts to develop their highly addictive product.

Lauren Lempert and I put in a FOIA for the material that the FDA obtained from Juul.  While the FDA only released a tiny fraction of the material they have -- citing the need to protect Juul's trade secrets for witholding the rest -- Baumgaertner found a lot of important material in what was released.

November 17, 2019

Stanton A. Glantz, PhD

Christopher Russell and colleagues recently published “Factors associated with past 30-date abstinence from cigarette smoking in adult established smokers who used a JUUL vaporizer for 6 months” in the Harm Reduction Journal.  Their primary conclusion was “More frequent use of a JUUL vaporizer and primary use of JUUL pods in characterizing flavors, particularly mint and mango, appeared to be important to smokers' chances of quitting.”  They added that, “The impact of suspending retail sales of flavored JUUL pods on adult smokers' likelihood of quitting should be closely assessed.” 

In other words, cities, states and even the FDA should keep mint and mango pods – which are popular with kids – on the market to help adults quit smoking.

The paper is based on a large sample of 15,456 adult established smokers, which sounds pretty impressive until you look at how the sample was generated.  It came from 37,536 people who bought Juul online from Juul directly or responded to one of 500,000 flyers included in Juul packs inviting people to participate.   Judged against this universe of 514,456 possible respondents, the investigators only had a 2.9% response rate, well below what is considered reliable in survey research.