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Articles of Interest: Electronic Nicotine Delivery Systems

...the FDA has attempted to balance the public health concerns related to youth use of ENDS products with considerations regarding addicted adult cigarette smokers who may try to use ENDS products to transition away from combustible tobacco products.
FDA Finalizes Enforcement Policy on Unauthorized Flavored Cartridge-Based E-Cigarettes That Appeal to Children, Including Fruit and Mint
HHS Press Release

2020

Amid the epidemic levels of youth use of e-cigarettes and the popularity of certain products among children, the U.S. Food and Drug Administration (FDA) today issued a policy prioritizing enforcement against certain unauthorized flavored e-cigarette products that appeal to kids, including fruit and mint flavors. Under this policy, companies that do not cease manufacture, distribution and sale of unauthorized flavored cartridge-based e-cigarettes (other than tobacco or menthol) within 30 days risk FDA enforcement actions.

2019

Maloney, Jennifer. "U.S. Raises Tobacco-Buying Age to 21." Wall Street Journal, December 19, 2019.

New restriction, which also includes e-cigarettes, is part of spending bill passed by Senate and would take effect in September 2020.

Steinbuch, Yaron. "Over 20 percent of US high school seniors vaped marijuana in 2019: study." New York Post, December 18, 2019.

The number of teens using marijuana by vaping has increased dramatically in the past two years — with more than 20 percent of US high school seniors reporting the activity this year, according to a study.

This week Discovery Education, the leading provider of digital content and professional development for K – 12 classrooms nationwide, in partnership with CATCH Global Foundation, a public charity dedicated to the development and dissemination of evidence-based health programs, and the CVS Health Foundation, the philanthropic arm of CVS Health, launched Be Vape Free, a nationwide initiative to provide standards-aligned, no-cost, e-cigarette prevention resources for educators teaching grades 5 – 12. Be Vape Free will serve to expand the use of CATCH My Breath, a proven effective vaping prevention program, to combat the growing vaping epidemic by arming educators, parents, and communities with easy-to-use tools that will help students make smart, informed, and healthy choices for life. The CVS Health Foundation is providing a $3 million commitment to fund this multi-year collaboration.

Researchers from Queen’s University Belfast have discovered that bacteria often found in the lungs became more harmful and caused increased inflammation when they were exposed to e-cigarette vape.

The results of the three-year study, published today (Wednesday 18 December) in Respiratory Research, show that  this increase in lung inflammation is due to  bacteria made more virulent by exposure to e-cigarette vapour.

Dr Deirdre Gilpin, researcher and lecturer from the School of Pharmacy at Queen’s University and lead author of the research explains: “There is currently a knowledge gap about whether vaping is harmful, or less harmful than smoking tobacco.

Rawson, Jeff. "I nearly died from vaping and you could too." The Boston Globe, December 16, 2019.

It seemed like food poisoning.

All weekend, I lay in bed with such abdominal pain that I cried, moaned, even yelled. It was the worst stomach bug I had experienced in my 40 years. By Sunday, I began to improve. I held down fluids, I ate a banana. But that night I grew sicker. No matter how much water and sports beverage I drank, my mouth dried out and my fever rose. Instead of immersive fever dreams, my dreams were of a single object, receding into the distance, emptiness all around me.

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.

Raeke, Meagan. "E-cigarettes: Understandardized, under-regulated, under-studied - safety unknown." MD Anderson Cancer Center, November 4, 2019.

The recent outbreak of lung injury and death associated with e-cigarettes and vaping has led to a renewed scrutiny of electronic nicotine delivery systems (ENDS). While the Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA) are leading an investigation into e-cigarette, or vaping, associated lung injury (EVALI), available data on the short- and long-term health effects of ENDS are limited, says Ernest Hawk, M.D., division head and vice president of Cancer Prevention & Population Sciences.  

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.

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