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Articles of Interest: Electronic Nicotine Delivery Systems

We know nicotine can cause a variety of health issues, including possibly future tobacco use, so we are supportive of any efforts to prevent children from developing a lifetime addiction to nicotine. - Dr. Ernest Hawk
Surgeon General’s e-cigarette advisory brings necessary attention to ‘epidemic’ in youth
University of Texas MD Anderson Cancer Center

2019

Von Drehle, David. "This vape craze should never have been allowed to happen." The Washington Post, November 29, 2019.

Todd White is superintendent of the Blue Valley School District in Johnson County, Kan. It’s an enviable position. The Blue Valley schools serve a relatively upscale population in the suburbs of Kansas City. On an average day, more than 95 percent of Blue Valley students are in school. The graduation rate is 97 percent. The dropout rate, less than 1 percent. Every student in grade three and above has a computer.

Yet White confessed recently that his prosperous district is in the midst of an epidemic. “In my 35 years in education, I’ve never seen anything that has been so rapid and devastating to the health and well-being of students, nor so disruptive to the daily work of teachers and administrators in educating our students,” he said of the crisis. What wreaks such havoc?

Vaping.

Rupp, Lindsey and Riley Griffin. "Duke University Was Built on a Cigarette Fortune. Now It May Ban Vaping On Its Campus." Bloomberg, November 23, 2019.

At Duke Unversity, at the epicenter of North Carolina’s tobacco country, a tense showdown over college vaping and its health risks is roiling the campus.

Fried, Ina; Mike Allen. "Apple to remove vaping apps from store." Axios, November 15, 2019.

Amid growing health concerns over e-cigarettes, Apple will remove all 181 vaping-related apps from its mobile App Store this morning, Axios has learned.

Why it matters: The move comes after at least 42 people have died from vaping-related lung illness, per the CDC. Most of those people had been using cartridges containing THC, though some exclusively used nicotine cartridges.

Lou, Nicole. "Vaping Worse for Heart than Cigarettes?." MedPage Today, November 12, 2019.

E-cigarette smokers were worse off than conventional cigarette smokers in terms of coronary microvascular vascular function, researchers found in a small study.

A study recently published in the Journal of the Endocrine Society suggests that women who use e-cigarettes may face difficulties in becoming pregnant, and that exposure to vaping could cause permanent health complications for the fetus [1]. Dr. Mark Trolice, Director of Fertility CARE: The IVF Center, notes that smoking regular cigarettes is already contraindicated for women seeking to become pregnant, and that vaping should be as well. "E-cigarettes are probably just as harmful to pregnancy and fertility as traditional cigarettes because they both have similar amounts of nicotine," Dr. Trolice said. "There is a misconception that e-cigarettes are safe to use during pregnancy. Anyone on their fertility journey should avoid the use of nicotine altogether."

Megan Jacobs, MPH. "More companies starting to offer virtual support to parents with kids who vape." The ex Program, October 21, 2019.

As you’ve probably seen by now in the news, vaping rates among teenagers are increasing at an alarming rate. From 2017 to 2018, e-cigarette use among high school students increased a whopping 78%! In 2019, 27.5% of high school students—more than 1 in 4—are vaping.

E-cigarette use among middle school students also jumped 48% from 2017 to 2018. And, according to a study in the Journal of the American Medical Associatione-cigarette use among 18-24-year-olds increased 60% from 2017 to 2018.

NEW ORLEANS—Vaping is not a low-risk substitute for smoking cigarettes, according to researcher Charlie Lin, MD, who authored a case study of a 34-year-old former smoker diagnosed with granulomatosis attributed to two months of electronic cigarette use. Dr. Lin will present his case study at the CHEST Annual Meeting 2019 in New Orleans.

“This case of granulomatosis secondary to electronic cigarette use exemplifies an unintended consequence of ‘vaping,’” Dr. Lin wrote. Granulomas destroy healthy tissue and inflame blood vessels, which can limit blood flow to organs including the lungs.

Electronic cigarettes vaporize liquids for inhalation to simulate the combustion of smoking traditional cigarettes. Until recently, e-cigarettes, with their lack of combustion-produced toxins, were thought to be lower risk than traditional cigarettes. Consequently, e-cigarettes have been heralded as having a perceived role in smoking cessation.

Recently, I was approached on London Bridge by an attractive sales woman with samples of what looked like sweet containers. On closer inspection, they were not confectionary, but instead turned out to be nicotine vape samples. I was not asked if I was over 18 (I look young for someone in their mid-20s), and I was not asked if I was trying to quit smoking or had a previous history of substance abuse. I politely declined.

The marketing for nicotine vapes around the world has been, by and large, poorly regulated, and it is commonplace in London to see teenagers with their hands on vapes blowing pillows of smoke. While 10 years ago it would have been more common to see teenagers experimenting with their first cigarettes under the cover of trees and park benches, the seemingly more accessible nature of vapes has started to replace this underage rite of passage with something more blatant. In the United States, the Federal Court has launched an investigation into Juul, a large nicotine vape producer. The global regulation of vaping, which contains nicotine, a substance found to be nearly as addictive as heroin, should be more common than it is now.

"Outbreak of Lung Injury Associated with E-Cigarette Use, or Vaping." Centers for Disease Control and Prevention, September 19, 2019.
  • There are 530* cases of lung injury reported from 38 states and 1 U.S. territory. Seven deaths have been confirmed in 6 states.
  • CDC has received complete sex and age data on 373 of 530 cases.
    • Nearly three fourths (72%) of cases are male
    • Two thirds (67%) of cases are 18 to 34 years old
    • 16% of cases are under 18 years and 17% are 35 years or older
  • All reported cases have a history of e-cigarette product use or vaping.
  • Based on initial data from certain states we know: Most patients have reported a history of using e-cigarette products containing THC. Many patients have reported using THC and nicotine. Some have reported the use of e-cigarette products containing only nicotine.

Today, the Trump Administration announced that as part of its ongoing work to tackle the epidemic of youth e-cigarette use, the FDA intends to finalize a compliance policy in the coming weeks that would prioritize the agency’s enforcement of the premarket authorization requirements for non-tobacco-flavored e-cigarettes, including mint and menthol, clearing the market of unauthorized, non-tobacco-flavored e-cigarette products. The FDA plans to share more on the specific details of the plan and its implementation soon.

Within days, Alexander Mitchell had gone from being a 20-year-old hiking enthusiast to being kept alive by two machines forcing air into and out of his lungs and oxygenating his blood outside of his body.

Sun, Lena; Lindsey Bever. "Mystery lung illness linked to vaping. Health officials investigating nearly 100 possible cases.." The Washington Post, August 16, 2019.

State and federal health officials are investigating almost 100 cases of mysterious lung illnesses linked to vaping and e-cigarette use in 14 states, many of them involving teens and young adults. A large number of those stricken ill have been hospitalized, with some in intensive care and on ventilators.

Chris Sweeney. "The problem with industry-sponsored vaping research." Harvard T.H. Chan, August 16, 2019.

Use of e-cigarettes and other vaping products including Juul is soaring, especially among youths. Between 2017 and 2018, the prevalence of current e-cigarette use among U.S. high school students increased from 12% to 21%. Andy Tan, assistant professor of social and behavioral sciences, recently co-authored a Lancetarticle examining how Juul is funding scientific research—and why this is problematic.

Frieden, Joyce. "Vaping Companies Marketing to Teens, House Panel Told." MedPage Today, July 24, 2019.

WASHINGTON -- Children and teenagers should not be vaping, House members and witnesses agreed at a hearing Wednesday, but they disagreed on what government should focus on regarding e-cigarettes such as those made by JUUL: their potential as smoking-cessation aids for adults, or their role in creating a new generation of nicotine addicts.

Kempe, Yaabelle. "E-cigarette users seeking help in lonely struggle to quit vaping." Boston Globe, July 7, 2019.

Kyle, a rising senior at BU, has tried to quit vaping. His last attempt was unsuccessful and he found himself switching to Smok Novo (above) instead of Juul.

Connor hated feeling like a slave to the slender metal device in his pocket. That’s why the rising junior at Boston College recently wrote his first-ever Reddit post on the page “QuittingJUUL,” a virtual space populated by more than 800 others who are also battling e-cigarette addiction.

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