FIU ReACH Lab | Michelle Villar
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Author: Michelle Villar

25 Sep 11 Deaths Linked to Vaping Nationwide, While Cases of Severe Vaping-Related Lung Illnesses Climbs to 530

News of vaping has recently inundated the media, seemingly an indication of the uncertain future of e-cigarettes. The latest reports indicate that there have been 11 deaths nationwide linked to e-cigarette use, and the Federal Drug Administration and Center for Disease Control is currently investigating 530 cases of severe lung illness linked to vaping. The eleven deaths reported so far have been in California, Kansas, Illinois, Indiana, Minnesota, Missouri, Oregon, Florida, and Georgia.

The New York Department of Health investigated open cases in their state, testing nicotine and cannabis vape products, and have focused their investigation on vitamin E acetate after discovering extremely high levels of this chemical in “nearly all cannabis-containing vaping products that were analyzed”. According to the department, none of the nicotine-only products contained vitamin E acetate. This finding seems to be extremely relevant in the New York cases, as each person who submitted a product for testing in the state after becoming ill had at least one e-cigarette product containing this product. However, although all the New York cases that submitted their products reported use of at least one cannabis vape device, not all of the 530 severe cases currently being investigated have used e-cigarettes with cannabis products. It is worth noting that in their initial statement, although the FDA and CDC mentioned the potential link between e-cigarettes containing cannabis products and the ongoing investigation into the cases of severe lung illness, they were clear that not all the cases reported using these products. FDA spokesman, Michael Felberbaum, said in an emailed statement that “no one substance, including Vitamin E acetate, has been identified in all of the samples tested. Importantly, identifying any compounds that are present in the samples will be one piece of the puzzle but will not necessarily answer questions about causality.”

The fear behind the escalating cases of severe lung disease is especially magnified concerning teen users, as their age group vapes the most and are continuing to increase their rates of use as the years go on. News stories from Texas, Illinois, and Pennsylvania have put the spotlight on three teenagers who suffered from this grave disease, two of which had to be placed into medically induced comas. For two of the cases, it seems the adolescent boys had been using e-cigarettes for at least a year and a half. As of now, it is still unclear how many of the 530 cases involve underage adolescents, or the length of time each individual had been using these products, but it’s safe to assume we’ll get more information in the weeks to come. 

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18 Sep ACE Project Continues Recruitment Efforts at the Child Expo

The ACE Project took The Children’s Trust Family Exposition by storm! The Children’s Trust Family Expo is a daylong festival held at the Miami-Dade Fair & Expo Center. The ACE Project team stood alongside other programs affiliated with FIU’s Center for Children and Families to provide information on services and opportunities to participate in research. ACE Project Staff members, Nasreen Hidmi and Benjelene Sutherland, alongside research assistants from both the ReACH and NBC Labs, spoke to adolescents and their parents about how they can participate in the ACE Project, an NIH-funded study on risk and protective factors for e-cigarette use. Their recruitment efforts resulted in contact sheets from over 60 families interested in participating in the ACE Project. ACE Project staff and Principal Investigators, Dr. Elisa Trucco and Dr. Matthew Sutherland, are excited to invite more families to participate in the coming weeks.

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11 Sep New Study Finds E-Cigarette Flavors Can Damage Cardiovascular Cells

A new study published in late May found that e-cigarette flavors “can damage the cells that line your blood vessels” and potentially harm your overall heart health over time. The researchers found that these flavored e-cigarettes resulted in “toxic effects” when introduced to a type of cardiovascular cell, including “poorer cell survival and signs of increased inflammation.” The authors say that these effects are known to be a factor in heart disease, and that they were shown even in flavors without nicotine, indicating that any of the other chemicals or ingredients in e-liquids may be playing a role in these toxic results. Dr. Joseph Wu, author of the study and director of the Stanford Cardiovascular Institute, said that it is still unclear which component of the e-liquids is responsible for these effects. This, however, is not the first study to find e-cigarette effects on heart health; a study published last year found that daily e-cigarette users had a higher risk of having a heart attack, although this risk was even higher for daily smokers. 

 

In a different commentary published in the same journal as this study, doctors from the University of Massachusetts Medical School added that “in addition to harm from the nicotine, the additives are a potential source of adverse vascular health and one that is being disproportionately placed on the young.” Wu warned of the recent dramatic uptick in e-cigarette use, saying “the public has this notion that e-cigarettes are safe. As a result of this perception, a lot of kids pick up e-cigarette smoking. There’s so many kids who are smoking e-cigarettes. And these kids are going to become adults. And these adults can become elderly patients that I as a cardiologist will take care of later on.” E-liquids and flavored e-cigarettes have recently been a controversial topic, especially among lawmakers across the nation. Critics of the flavors argue that the fun and fruity options are appealing to younger populations and they therefore attribute the rising number of adolescent vaping rates to youth access to these flavors. Advocates for the flavors say they have been crucial in getting adults to switch from traditional combustible cigarettes to e-cigarettes.
 
Hopefully, as more research is done on e-cigarettes, these questions will be answered. For now, these types of studies serve as an important warning to the public: although e-cigarettes may be safer than cigarettes, this does not mean they are safe to use. 

If you would like to read more from the journal article, click here. If you would like to read more from the news article, click here

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29 Aug ‘The New Secondhand Smoke’: Adults Living With Children More Likely To Vape

A new study released in early May found that in a sample of American adults, those living with children are more likely to vape than adults who don’t live with children; authors are calling this potential risk “the ‘new’ secondhand smoke.” According to the results, 4.9% of adults living with children or adolescents reported using e-cigarettes, compared to the 4.2% of adults not living with youth that reported vaping. These results ranged across the country, “from 2.3% in the District of Columbia to 7.7% in Oklahoma.” This result, however, may be explained by age. As the authors pointed out, adults living without children also tend to be older, which could reflect ” ‘the relatively young age of e-cigarette users’ and the perception that vaping is safer than smoking combustible cigarettes.” It is also worth mentioning that researchers “could not determine how much adults tended to vape in kids’ presence or additional secondhand exposure from other people, such as siblings and peers” from the data, which came from a nationally representative phone survey conducted in 2016-2017. 

The researchers are also quick to point out that secondhand aerosol exposure is not the only risk; there is also the danger of third-hand exposure, which occurs when residual nicotine from the second-hand vapor remains on surfaces and is absorbed through unintentional ingestion or through the skin via contact. Experts warn parents and caregivers of this risk, as nicotine can be toxic in high doses, especially with young children. 

If you’d like to read more from the news article, please click here. If you’d like to read the journal article, click here

 

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21 Aug US Agencies Pursue Companies That Paid Social Media “Influencers” To Promote Vape Products

The US Food and Drug Administration (FDA) and the Federal Trade Commission (FTC) are officially pursuing companies that paid social media “influencers” in exchange for having their vaping products promoted on social media pages. In early June, the FDA and the FTC sent warning letters to four companies for these infractions, some of which included “omitting a required warning about nicotine’s addictiveness” and, per FTC guidelines, not properly disclosing their relationships with influencers. In a statement released by acting FDA Commissioner Dr. Ned Sharpless, he said, “research shows many youth are mistaken or unaware of the risks and the presence of nicotine in e-cigarettes. That’s why it’s critical we ensure manufacturers, retailers and others are including the required health warning about nicotine’s addictive properties on packages and advertisements — especially on social media platforms popular with kids.” The four companies involved are “Solace Technologies LLC, doing business as Solace Vapor; Hype City Vapors LLC; Humble Juice Co. LLC; and Artist Liquids Laboratories LLC, doing business as Artist Liquid Labs.” Lorenzo De Plano, co-founder of Solace Vapor, released a statement through email saying that his company will be going over and terminating their relationships with any influencer “who may not be compliant with our marketing policies.” He also added that the company’s “internal packaging, marketing and nicotine warnings are compliant with FDA standards.” The four companies had 15 working days to respond to the agencies’ letters with “specific actions taken to address each agency’s concerns. The warning letters also state that failure to correct violations may result in further action such as seizure or injunction.”

 

Companies and brands have long been paying social media influencers to promote their products, as they are able to target their desired audience. “It’s a tactic that most PR agencies have used for years, contacting people of a certain influence in order to shape the market perception of a brand or product,” said Kevin Popovic, director of the Idea Lab at San Diego State University. An investigation led by CNN shed light on a short-lived “influencer program” under vaping giant Juul, but the company claims their program was small-scaled and only lasted a few months. The influence of social media on vaping rates has been highlighted in the past, and Juul specifically took action against adding to any social media influence on adolescents by deleting their own social media accounts. 

 

Sharpless continued his statement, saying, “under my leadership, the FDA will continue to tackle the troubling epidemic of e-cigarette use among kids. This includes limiting youth access to, and appeal of, flavored tobacco products like e-cigarettes and cigars, taking action against manufacturers and retailers who illegally market these products or sell them to minors, and educating youth about the dangers of e-cigarettes and other tobacco products. We cannot and will not risk a generation of youth to a lifetime of nicotine addiction.”
If you’d like to read more from the article, click here
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15 Aug FDA Approves Sale Of New ENDS Product

A new “tobacco heating system” called the IQOS from Philip Morris International has been approved for sale in the United States by the US Food and Drug Administration (FDA). This new device is not like e-cigarettes that are currently on the market; “rather, it’s a noncombustible device that heats, without burning, ‘tobacco-filled sticks wrapped in paper to generate a nicotine-containing aerosol.’ ” The FDA approved the product for U.S. sale following a “rigorous science-based review,” after which the agency believed the product could benefit public health due to the device containing “fewer toxic chemicals than cigarette smoke” and that “many of the toxins identified are present at lower levels than in cigarette smoke.” The product is expected to hit U.S. shelves sometime between July and August, starting in Atlanta. The FDA made it clear, however, that their approval for sales does not mean the agency has decided that the IQOS is safe for use. 

Not surprisingly, controversy about this new device has already stirred. Critics are concerned about the fact that research behind the product was “widely company-funded”. The director of the FDA Center for Tobacco Products shot down this thought, saying that “ensuring new tobacco products undergo a robust premarket evaluation by the FDA is a critical part of our mission to protect the public, particularly youth, and to reduce tobacco-related disease and death.” Additionally, critics are concerned that use of this product will spread among teens similarly to how vapes like Juul did. Matthew L. Myers, president of the Campaign for Tobacco-Free Kids, says his organization has repeatedly “raised concerns with the FDA that Philip Morris International has marketed IQOS in other countries in ways that clearly appeal to kids, including through social media, sponsorships of events like beach parties and fashion shows, and slick stores and kiosks that look like they’re selling tech gadgets, not addictive tobacco products.” Myers continued, saying “there is a serious risk that IQOS will become the next Juul and worsen the current youth epidemic.” Robin Koval, president and CEO of the Truth Initiative, believes the timing of the approval of the IQOS is suspect, saying that “the introduction of another nicotine delivery device to the U.S. market while we are in the midst of a youth e-cigarette epidemic is concerning.” The FDA claims it will carefully observe the reception of this new device, saying that if they notice an increase in sales among youth the agency could potentially reverse the IQOS’s approval. 

If you want to read more from the article, click here

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07 Aug Senate Majority Leader Unveils Bill To Raise Tobacco/ENDS Purchase Age To 21

A bill to raise the age for buying nicotine products, including traditional and electronic cigarettes, to 21 years old was formally introduced by Senate Majority Leader Mitch McConnell and Senator Tim Kaine in late May of this year. The legislation was proposed during a controversial climate for the U.S. concerning nicotine use; adolescent vaping rates having risen dramatically in previous years, and legislators across the nation are attempting to fight against this recent uptick. “Youth vaping is a public health crisis. It’s our responsibility as parents and public servants to do everything we can to keep these harmful products out of high schools and out of youth culture,” McConnell said. Kaine, co-sponsor of the legislation, added to these thoughts, saying “We’re backsliding…recent increases in youth tobacco use demonstrate we need to do more.” Both senators referenced recent data from the Centers for Disease Control that showed a giant spike in adolescent vaping rates. 

This bill sponsored by the two senators is actually the second one this year introduced to raise the legal buying age to 21. The first was introduced earlier this year and was co-authored by four senators: Mitt Romney, Todd Young, Dick Durbin, and Brian Schatz. While McConnell mentioned this bill during his speech without specifically voicing his support, Kaine pledged to work directly with the four senators. Somewhat surprisingly, Altria, one of the largest manufacturers of nicotine products in the world, voiced their support for both bills. Supporters of the bill favor the simplistic nature of the legislation; controversial issues such as banning specific flavors were avoided in order to ensure the bill could pass through the Senate without issues. According to the article, McConnell actually “dropped from his legislation an exemption he had previously announced it would include for members of the military, something Schatz had called a non-starter.” The head of Tobacco Free Kids, a campaign group that fights against tobacco use, issued a statement of support for the bill proposed earlier this year from the four senators; the group says they are still reviewing this new bill before issuing their support. 

If you’d like to read more from the article, click here

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31 Jul ReACH Lab’s ACE Project Creates Online Webinars For The Parent Academy

In collaboration with Miami-Dade County Public Schools (M-DCPS) Family Support Services, the ACE Project team created an English and Spanish online presentation for The Parent Academy. Dr. Elisa Trucco (ReACH Lab Director, ACE Project Co-PI) and Benjelene Sutherland (Post-Bac Research Assistant) presented on the most recent information regarding electronic nicotine delivery system (e.g., e-cigarette) use among teens. In addition, the online presentation was also translated by The Parent Academy into Haitian-Creole. The Parent Academy is a free, parent engagement initiative from M-DCPS that includes providing educational workshops and classes monthly for both parents and children. The Parent Academy aims to inform parents “about the importance of their roles, uniting families and schools, and giving parents a fuller sense of their rights, responsibilities, and the educational opportunities available. “

Follow the links if you’d like to watch the webinar in English, Spanish, or Creole

 

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26 Jul ReACH Lab Director Featured On Podcast Episode “Planet Of The Vapes”

Dr. Elisa Trucco, director of the ReACH Lab, continues to educate the public on the truth behind vaping, this time being featured on “The Forum” podcast where different scientific topics are discussed bi-weekly. Additionally, Dr. Linda Bauld was featured, with both her and Dr. Trucco providing the most up-to-date information on e-cigarettes, including a quick introduction of the devices, marketing and advertisements, international restrictions, and the recent dramatic uptick of adolescent vaping rates. Some recent studies were also discussed, attempting to answer the question: “are e-cigarettes safe to use?”

If you’d like to learn the answer to that question and more, be sure to listen to the episode below. 

 

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22 Jul San Francisco Passes Ban On E-Cigarette Sales, A US First

Following a unanimous vote from San Francisco’s board of supervisors in late June, the city will become the first in the U.S. to ban e-cigarette sales. The ordinance states that ” ‘no person shall sell or distribute an electronic cigarette to a person in San Francisco’ unless that product has undergone premarket review by the US Food and Drug Administration.” As of yet, no ENDS product on the market has undergone premarket review. This ban includes sales both in physical stores in San Francisco, as well as online sales shipped anywhere in the city, and also applies to flavored tobacco products; this measure, however, does not ban overall use of vapes among those 21 and older. Following the vote, City Attorney Dennis Herrera said “this is a decisive step to help prevent another generation of San Francisco children from becoming addicted to nicotine.” San Francisco Mayor London Breed signed the ordinance in late June, and expressed her support for the measure in a statement released ahead of her vote, saying “I support the legislation authored by City Attorney Dennis Herrera and Supervisor Shamann Walton to suspend the sale of e-cigarettes in San Francisco until the Food and Drug Administration concludes a review of the impacts of vaping on public health. There is so much we don’t know about the health impacts of these products, but we do know that e-cigarette companies are targeting our kids in their advertising and getting them hooked on addictive nicotine products. We need to take action to protect the health of San Francisco’s youth and prevent the next generation of San Franciscans from becoming addicted to these products.” Now that Mayor Breed has signed the ordinance, it will become an effective policy 30 days after her signing date and will be fully implemented six months following that. 

 

Not surprisingly, this vote is being regarded with controversy; after this measure passes, San Francisco will be both the first city to ban e-cigarette sales and the home of Juul Labs headquarters. Following the vote, Juul spokesman Ted Kwong released a statement saying that “this full prohibition will drive former adult smokers who successfully switched to vapor products back to deadly cigarettes, deny the opportunity to switch for current adult smokers, and create a thriving black market instead of addressing the actual causes of underage access and use.” Kwong also described the company’s plan to support “new strict regulation and enforcement, instead of prohibition,” some of which include “electronic age verification technology, limiting the amount of the product that can be purchased at one time, and city permits for online sellers of vaping products.” According to the statement, Juul has already gathered the required signatures to move forward with this proposal.

 

This move by San Francisco does not come as a big surprise; the city teamed up with officials from New York and Chicago for a letter written in March that criticized the FDA’s “failure to act” following the e-cigarette boom among adolescents, and for “allowing these products to temporarily remain on shelves without undergoing premarket review for their impact on public health.” In a statement released by Herrera after the measure passed its initial vote, he says that “e-cigarettes are a product that, by law, are not allowed on the market without FDA review. For some reason, the FDA has so far refused to follow the law. Now, youth vaping is an epidemic. If the federal government is not going to act to protect our kids, San Francisco will.” While the FDA would not specifically comment on this measure, spokesman Michael Felberbaum said in a statement before the ordinance passed that “the FDA has and will continue to tackle the troubling epidemic of e-cigarette use among kids. This includes preventing youth access to, and appeal of, flavored tobacco products like e-cigarettes and cigars, taking action against manufacturers and retailers who illegally market or sell these products to minors, and educating youth about the dangers of e-cigarettes and other tobacco products.” A federal judge actually ordered the FDA to “speed up its review of thousands of vaping products now on the market” following a lawsuit filed against the agency by multiple health groups claiming the FDA has been acting “illegally by allowing e-cigarettes to remain on the market until 2022 before requiring companies to apply for that [official] authorization.”

 

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