February 10, 2019
An op-ed in Sacramento Bee recently described the dangers of accidental ingestion of marijuana-laced edibles by children and calling for childproof packaging. It is also accompanied by a video from Fresno County illustrating seizures of unlicensed marijuana edibles and high potency concentrates, many of which are clearly imitating common candies and attractive to children. Both are worth reading/watching.
In the recent regulatory battle, the State proposed initially to drop even the existing requirement for "child-resistant" primary packaging. Fortunately, that was reinstated in the regulations after protests, but many from the industry continue to falsely portray the products as harmless and not requiring child resistant packaging.
Thanks to Matthew Marson and Lynn Silver for sharing this with me so I could pass it along.
February 7, 2019
Tom Wills and colleagues just published “E-cigarette use and respiratory disorder in an adult sample,” documenting the link between e-cigarette use and asthma and chronic obstructive pulmonary disease, controlling for smoking among a large sample of Hawaiians. The found e-cigs increase the risk of COPD by a factor of 2.58, with dual users (people use e-cigarettes and cigarettes at the same time) higher than using cigarettes or e-cigarettes alone. They found similar risks for e-cigarettes, cigarettes, and dual use for asthma.
February 6, 2019
Kaitlyn Berry and colleagues just published “Association of Electronic Cigarette Use With Subsequent Initiation of Tobacco Cigarettes in US Youths” in JAMA Network Open that further strengthens the overwhelming case that e-cigarettes are expanding the tobacco epidemic by bringing low risk kids who are unlikely to start using tobacco with cigarettes. In addition, they show that e-cigarettes are a gateway to cigarettes, with a stronger effect for e-cigarettes than other tobacco products.
The effect of e-cigs as a gateway for cigarettes was very large for low risk kids, an adjusted odds ratio of 8.6, compared to the odds ratio of 3.5 for the intermediate-to-high-risk kids.
They also highlight the importance of other tobacco products as starter products for kids, although the differential effect on low-risk kids seen with e-cigarettes is not present for the other products.
February 5, 2019
Paul M Ndunda and Tabitha M Muutu just presented their paper “Electronic Cigarette Use is Associated With a Higher Risk of Stroke” at the International Stroke Conference. They conducted a cross-sectional analysis using the CDC’s Behavorial Risk Factor Surveillance System data from 2016 to assess the risks of stroke and myocardial infarction in e-cigarette users, controlling for cigarette smoking. They found compared with non-users, e-cigarette users had higher adjusted odds of stroke (OR 1.71 [1.64 - 1.8]), myocardial infarction (OR 1.59 [1.53 - 1.66]), angina or coronary heart disease (OR 1.4 [1.35 - 1.46]).
These risks are similar to what we reported based on the National Health Interview Survey.
The fact that two independent data sources yielded such similar results is strong evidence that the association is real.
February 4, 2019
Peter Hajek and colleagues published “A Randomized Trial of E-cigarettes versus Nicotine-Replacement Therapy” in the New England Journal of Medicine. This is a well-done trial comparing e-cigarettes with nicotine replacement therapy among people enrolled in smoking cessation programs in England. In addition to being randomized to e-cigs or NRT, people in the study had ar least 4 weeks of counselling. At one year the cigarette abstinence rate was 18.0% among patients randomized to e-cigs compared to 9.9% randomized to NRT, nearly a doubling of quitting.
The study is thoughtfully designed and cautiously interpreted. The authors also did a nice set of sensitivity analyses to show that the results are robust to the usual kinds of problems one has in doing a randomized controlled trial.
They conclude that “E-cigarettes were more effective for smoking cessation that nicotine-replacement therapy, when both products were accompanied by behavioural support.” I agree with that conclusion.