(CNN)The leading maker of e-cigarettes, Juul Labs, attempted to roll out an anti-vaping curriculum in schools earlier this year, offering school districts thousands of dollars and new technologies to implement it, according to documents and emails obtained by CNN.
“Under no circumstance should anybody from the tobacco, nicotine, vaping industries be involved in or implementing tobacco prevention programs,” said Bonnie Halpern-Felsher, professor of pediatrics in Stanford University’s Division of Adolescent Medicine. She published an article last month slamming the curriculum in the Journal of Adolescent Health.
Halpern-Felsher, who is also the founder and executive director of the Stanford Tobacco Prevention Toolkit, had been developing her own curriculum on vaping when she was approached by California education advocates who had gotten wind of Juul’s curriculum in late 2017.
She recalled their message: “You guys need to do something yesterday.”
What’s in it?
Halpern-Felsher said the Juul curriculum was “completely missing the most important pieces” of a bona fide prevention effort.
For example, it didn’t discuss the role of industry and marketing in promoting nicotine use. And it touted mindfulness as a prevention tool, despite what she described as a lack of evidence that it works in this context. Some of the curriculum’s exercises included guided meditation and swinging a pendulum over a piece of paper to discuss the “power of the mind,” she writes in the article.
In a version of the curriculum provided by Halpern-Felsher, teachers are referred to a primer video, which links to an Australian vaping company and says that people vape to “reduce harm” and “save money” over cigarettes. (The Stanford toolkit describes the former as a “misperception.”)
At the end of the video: a popup box that says, “New to vaping? We’ll help you take those first steps.”
The materials rarely mention Juul by name, Halpern-Felsher said.
What they did mention, however, was her own work — the Stanford toolkit — which was referenced as a resource in Juul materials reviewed by CNN.
She became aware of this when a colleague falsely accused her of working with or receiving money from the company.
“That’s when I said, ‘wait, something’s going on here,’ ” Halpern-Felsher said.
On the alert
Also named in Juul documents was the Spokane Regional Health District, which has its own tobacco and vaping prevention programs.
“The Spokane Regional Health District is listed as one of the resources on which they based their prevention initiative, which was of great concern to Spokane,” Frances Limtiaco, program manager for the Washington State Department of Health’s Tobacco and Vapor Product Prevention and Control Program, wrote in an emailed statement.
“However, we were never able to determine how this came to be,” she added.
This prompted Limtiaco and her colleagues to send out an alert in March to Washington schools warning them that “Juul Labs are piloting their prevention program … to middle and high schools.”
“The tobacco industry has a long history of sponsoring youth prevention programming that ultimately undermine evidence-based tobacco control efforts, and JUUL is no different,” the alert said.
No schools or school districts responded to the alert saying they had received offers from the company, Limtiaco noted.
A similar alert was sent by email in February by school health officials with the California Department of Education.
“People have said to me in the schools … ‘I’m concerned because I’m hearing about Juul trying to come to our schools and offering this money,’ ” Halpern-Felsher said.
“There was a lot of confusion.”
Devices for vices
The Stanford and Spokane resources appeared in a December company memo outlining Juul’s plans, which included “designing alternatives to traditional prevention programs” by culling from “best practice resources.”
A Juul Labs spokeswoman, Victoria Davis, confirmed that the memo was a company document.
Also noted in the December memo is the progress the initiative had made: It had contacted 15 school districts in California, committed two schools to the program and engaged “long-time educational leaders Wendell Greer and Bruce Harter to lead the prevention effort in schools and school districts.”
Harter and Greer did not immediately respond to requests for comment. They served together as administrators of California’s West Contra Costa Unified School District; Harter was its superintendent.
“Why would you give this company access to kids like this?” she wrote in the February email.
Similarly, Halpern-Felsher expressed concerns to CNN that the curriculum itself could yield important insights about e-cig marketing to the industry.
For example, one student questionnaire asks, “What’s appealing about using e-cigarette or JUULs? Why do students use them?” Schools were to be instructed to submit these forms to “JUUL consultants,” documents show.
“We in the public health world … got very nervous that that’s how they’re gathering data,” Halpern-Felsher said.
The company’s strategy also included developing technology that might disable the vapes, including “wireless nodes that alert school staff to use in schools,” and an age-verification process that would require an adult’s smartphone, according to the December memo.
In a February email that Halpern-Felsher shared with CNN, Harter said that Juul would be piloting these devices by the end of March. He promised that it would not only disable a vape, it would tip off school administrators as to where and when vapes were being used.
In August, Bloomberg also reported the rollout of Bluetooth-enabled Juuls that might verify vapers’ ages and shut down in schools due to “geofences” surrounding the premises.
In an e-mailed statement, Davis told CNN, “We actively evaluate new technologies and features to help keep JUUL out of the hands of young people.”
At the time of the December memo, the pilot program aimed to launch in February. But it was ultimately abandoned by mid-May, according to Davis.
Halpern-Felsher said she learned of at least one school that used materials from Juul after a student’s mother contacted her.
“The discontinued curriculum guide was a short-lived initiative designed to provide educators with current information on vaping products in general to supplement existing tobacco prevention education,” Davis said.
“We stopped distribution in response to feedback from those who thought our efforts were being misunderstood,” she added.
According to emails obtained by CNN and dated in February, stipends in the amount of $10,000 had been offered to a number of school districts. In at least one case, a district said it had declined an offer of $20,000 plus “nodes” that could “jam the JUUL devices and render them useless.”
Another school is quoted in these emails, shared by Halpern-Felsher,as saying that it had been offered gadgets that could locate Juuls being used on school premises and that Juul anticipated that the technology would be ready for use during the following school year.
Davis said stipends were offered in varying amounts “depending on their needs and complexity of programs.” She said that receiving those funds was not contingent upon implementing the curriculum.
CNN also reviewed a template of Juul’s memorandum of agreement, which promised 75% of the funding up front, with the remaining 25% contingent upon receiving a final report from the principal, which would contain details like how many students attended and when. Schools would also agree to allow Juul “consultants” to sit in on sessions, though not to participate.
Davis said fewer than 10 schools received stipends, which “were intended to cover the costs associated with operational expenses, resources, or training/material for teachers with the programs the school or district chose to employ.” She did not comment on which schools received stipends.
In the months since Juul’s program came to a halt, federal authorities have toughened efforts to crack down on underage vaping.
The US Food and Drug Administration will announce a “new action plan” this month to “firmly confront and reverse the youth addiction trends that are at epidemic levels,” Commissioner Dr. Scott Gottlieb said in a statement Wednesday.
In another statement Friday, Gottlieb announced a public hearing next month that will “focus on the potential role of drug therapies to support cessation among youth, and the issues impacting the development of such therapies for children.”
The agency recently expanded its investigation into e-cigarette companies, sending letters to 21 companies last month — including Juul — in an effort to uncover whether they are marketing products illegally and outside the agency’s compliance policy.
That move came less than two weeks after the agency conducted a surprise inspection of Juul’s corporate headquarters in San Francisco, seizing thousand of documents, many of which relate to its sales and marketing practices.
On Wednesday, Gottlieb said e-cig companies have acknowledged in meetings that flavored products play a role the products’ appeal to kids. Beyond the FDA’s own regulations, he has invited these companies to take voluntary steps to address what he described as a mutual goal to keep e-cigs out of kids’ hands.
“For the e-cigarette industry, my message was simple: Step up,” Gottlieb said.
Altria Group, one of the companies Gottlieb met with, announced last week that it was pulling a number of flavored vaping products from shelves until it receives FDA authorization or “when the youth issue is addressed,” according to a statement by company Chairman and CEO Howard Willard.
The rapid spread of e-cigarettes, which work by heating a liquid until it vaporizes, was flagged in a 2016 report by the US surgeon general that cited a 900% increase in e-cigarette use by high school students from 2011 to 2015. E-cigarette use declined for the first time in 2016 but held steady the following year.
Halpern-Felsher said consumers and health experts have been locked in a contentious debate; while some see it as a smoking cessation tool for adults, others say “there’s no good evidence there, period,” she added.
“There’s never been … something so divisive in the public health world as vapes,” she said.
London’s High Streets were not considered in the report, as they have been ranked separately in the city.
Each business was scored on the basis of whether it encouraged healthy lifestyle choices, promoted social interaction and greater access to health services.
The UK’s 10 unhealthiest High Streets are:
The UK’s 10 healthiest High Streets are:
Brighton & Hove
The report paints a picture of the rapidly changing British High Street dominated by cafes and coffee shops, convenience stores, off-licences, vape shops and boarded-up premises.
Vape shops were counted as a “healthier” business, because of their role in discouraging smoking. However, the report added the “precise long-term effects of vaping are unknown”.
Shirley Cramer, RSPH chief executive said: “When our time and money are converted into a loss at the bookmaker, a tan from a sunbed, a high-cost loan or a bucket of fried chicken, the High Street is enabling and supporting poor health behaviours.
“Our Health on the High Street rankings illustrate how unhealthy businesses concentrate in areas which already experience higher levels of deprivation, obesity and lower life expectancy.
“Reshaping these High Streets to be more health-promoting could serve as a tool to help redress this imbalance.”
The rise in online retail is linked to the growing numbers of empty premises, which have increased from 7% in 2007 to 11% in 2017.
This year the High Street has seen several big name closures including Toys R Us and Maplin and, in this week’s Budget, Chancellor Philip Hammond cut the business rates for small retailers, and proposed a new tax on online retailers in an effort to boost physical shops.
However industry bodies said the changes didn’t go far enough.
The RSPH is calling for further measures including urging local authorities to make vacant properties publicly accessible for what is known as “meanwhile use” – pop-up art galleries or community centres.
The London rankings showed that the borough of Haringey boasted both the most unhealthy street, West Green Road in Seven Sisters, and the healthiest one, in Muswell Hill.
Santa Clarita, California (CNN)Donald Trump’s presidency has sparked revolt among large swaths of young Americans.
Typical midterm elections tend to draw out an older, whiter electorate and fewer single women than presidential years. But because of the deep disdain for Trump among the younger generation, this midterm cycle appears supercharged by younger voters who were stung by the outcome in 2016, and cognizant that their generation could have made the difference for Hillary Clinton.
Strong turnout within that age group could tip some of the closer House races into the Democratic column.
There’s “an embarrassment that comes with having not voted, or having not cared about voting in the past,” said Jessica Cohen, a 30-year-old product manager for a software company in California.
“(People) are realizing how many consequences there have been since 2016,” she added.
“That apathy has gotten us into some serious trouble.”
New polling this week confirms that the energy among youth voters on the ground isn’t a mirage.
A new poll from Harvard Institute of Politics this week found that 18-to-29-year-olds are far more likely to vote in Tuesday’s midterm election than they were in 2010 and 2014. Forty percent of those polled said they would “definitely vote” in the midterms.
President Trump’s job approval rating among those under 30 was 26%. If he runs for re-election in 2020, 59% of those polled said they “will never” vote for him.
In one striking finding, 65% of likely voters in the 18-to-29 age group said they were more fearful than hopeful about the future. Immigration and refugees topped the list of concerns, followed by jobs, President Trump (or leadership issues), and health care.
The energy among the younger generation has also resulted in a crop of candidates in their late 20s and early 30s.
One of those candidates is 31-year-old Katie Hill, the Democrat running in California’s 25th District against incumbent Republican Rep. Steve Knight. Clinton won this district in 2016.
Hill is one of the youngest Congressional candidates running this November, along with Abby Finkenauer in Iowa’s First District, and Lauren Underwood in Illinois’s 14th District.
Every weekend morning in recent months, dozens of young voters have shown up at Hill’s campaign headquarters in Santa Clarita. The office is wedged in a strip mall between a gun armory and a vape shop, underscoring the political diversity of this partly-suburban, partly-rural district north of Los Angeles.
The line of canvassers spilling out the door is decidedly youthful: Echo Park hipsters, Berniacs sporting 2020 T-Shirts, athletic young moms pushing jogging strollers, and large contingents of USC and UCLA students who are competing over who can make the most voter contacts in California’s competitive House districts.
Hill, a first-time candidate who filmed one of her campaign commercials while free-climbing a hundred-foot rock wall in nearby Texas Canyon, blends in easily in her purple campaign T-shirt and aqua skinny jeans.
But she steps up on the staircase to rally this fresh crop of doorknockers, warning that national Republican groups are pouring last-minute money into the race because it is polling within the margin of error.
“You can tell people when you’re knocking on those doors that this election could come down to a few hundred votes,” Hill tells the group as they ready the lists on their clipboards. “So their vote really will matter more in this election than probably any election that they’ll ever vote in – and that there’s no path to flipping the House and holding Donald Trump accountable or making any real progress across the country if we don’t flip this seat.”
At Hill’s headquarters, 30-year-old Caitlin Carlson said she was relieved that people in her generation finally “want to step up and do something.”
“We have been coasting a little bit. We just always kind of assumed that things would work out,” Carlson said. “Taking the House back is the first step to getting our country back on the rails. It just feels like we’re on this crazy train right now where logic and facts don’t matter.”
She views Tuesday’s election as “the first real big test for millennials to have faith that the system works.”
Nationally, Democrats have engaged in a forceful effort this fall to convince younger voters that flipping control of the US House could serve as a check on Trump administration policies that they don’t agree with.
They have enlisted many of the potential 2020 Democratic candidates — including Bernie Sanders, Elizabeth Warren, Cory Booker and Kamala Harris — to deliver that message.
On Friday night in Oceanside, Sanders drew hundreds of cheering, foot-stomping young fans to a rally organized by California Young Democrats for down ballot candidates, including Mike Levin, the Democrat who is vying for the open seat of retiring Republican Congressman Darrell Issa in Orange and San Diego counties.
Levin, an environmental attorney, delivered an even more pointed message than Sanders — telling the crowd that the 2018 midterm election will be “won or lost” by people between the ages of 18 and 35.
“In 2016, 31 million voters in that age group, all very much eligible to vote, decided not to,” Levin told the rally crowd gathered in a gymnasium. “The result was Donald Trump — and Charlottesville, and a tax cut designed to benefit the wealthiest 1% of Americans, and Justice Neil Gorsuch, and Justice Brett Kavanaugh.” (Kavanaugh’s name alone drew the loudest boos of the night).
“You stay home on Election Day, and Republicans stay in charge,” Levin continued. “Your healthcare gets taken away, your student loans become more impossible to pay off, and places like Pulse (the nightclub in Orlando) and Parkland are joined by many more preventable tragedies.”
Resa Barillas, a 30-year-old in the crowd who came to see Sanders, said she had just sent in her ballot – the first she has ever cast in a midterm election.
“My friends are way more involved in voting now,” said Barillas, a single mom who tutors at MiraCosta College where the rally was being held. “Even in the midterms. I never really remember them posting about them, and now they’re on Facebook every day talking about it.”
When Barillas thinks about Democrats retaking the House, she said she hopes they will advance Sanders’ agenda for universal health care and free college tuition.
“That’s still a pipe dream, but it’s something that we’re moving towards,” Barillas said.
She also believes divided government could force more compromise and bring more unity to America. “Right now there’s so much polarization going on. I feel it; I feel it even at school…. Before people were always Democrats or Republicans or something else, but you didn’t have that hatred. Now it’s like you’re afraid to talk about politics, even with people in your own family.”
Perhaps no one has more faith in the power of the youth vote this cycle than Hill herself.
The former head of a non-profit that was focused on the region’s homeless crisis, Hill often reminds her audiences that she never expected to fill this role — but decided she needed to step up if her perspective was going to be heard.
“We have to turn out young people, and I believe that we can this time,” Hill said in an interview. “I had so many people tell me that’s a losing strategy, and I just don’t believe that’s true. This is a campaign, and this is a moment in history, when people are going to show up.”
“We have too many of them, doing exactly the same – the same range of stores and products – and basically that’s not attractive,” he said.
“New data suggests over 200 shopping centres in the UK are in danger of falling into administration, unless their owners secure fresh funding.”
He added the growth of online retail in the UK – on sites such as Amazon – had been faster than in almost any other retail market in the world.
“If the major anchor store moves out, that has a halo effect on other stores in that centre. It’s a downward spiral and you can’t fill shopping centres with nail bars and vape shops.”
Mr Blackley, who is based at Nottingham Trent University’s Nottingham Business School, pointed to research in the Financial Times that suggested about £2.5bn worth of shopping centres and retail parks are up for sale in towns and cities across the UK.
“Some of this marketing is unofficial and not in the public domain,” he said.
“It’s a trend that’s moving very quickly. You don’t necessarily want to be in the business of owning shopping centres at the moment.
“People are suggesting a number of leading national retailers are on the edge and may close and that would bring shopping centres down with them.
“The collapse of BHS, two years ago, left empty units in around 200 shopping centres and more than half of those large, empty units have not yet been filled.”
Residents have spoken to the BBC about their concerns regarding a number of shopping centres up and down the country, where they feel empty units and an apparent lack of investment have led to stagnation.
Kettering’s Newlands Centre, which is backed by private equity, has seen the closure of a number of outlets including names like WH Smith. “It’s a sad scene at the moment,” said Paul Ansell, chair of the town’s civic society. “There is a cycle of shops opening and closing and I’m not sure what they can do to improve it.”
The Guildhall in Stafford, also backed by a private equity group, has seen many retailers vacate the centre in favour of the town’s new Riverside complex. “We are concerned it’s not as vibrant and active as it was,” said William Read, of the Stafford Historical and Civic Society. “I walked through there the other day and about 15-20% of the units are empty.” Both private equity groups have been contacted for a comment.
The Broadmarsh in Nottingham is owned by Intu – currently the subject of a takeover bid – which operates shopping centres across the UK. While it does not face the same issues as private-equity backed centres, Mr Blackley said it offers “about as bad a retail experience as you can get without the centre physically closing”. Nigel Wheatley, the centre’s general manager, said preparations were under way for its “exciting transformation”.
The research to identify “at-risk” centres was carried out by asset management firm APAM, which said it had found many of the affected centres had been the subject of short-term speculative deals.
Executive director Simon Cooke said: “We think these shopping centres have been hit with the perfect storm of defaulting retail markets, weaker consumer spending, the impact of the internet and rising rents and rates, making it very difficult for retailers to trade and make a profit.
Mr Cooke said most of the centres “in crisis” were the subject of deals that are due to be refinanced.
“They have to return money to their investors,” said Mr Cooke. “That’s not looking very likely. Frankly, the centres are either going to have to be sold at a lower price or have capital injected in order to regenerate and we don’t see banks having an appetite for that.”
Without reinvestment, Mr Blackley said the impact on communities – particularly small towns – could be stark.
Mr Cooke agrees: “These are big tracts of land, occupying a central space in towns,” he said.
“You could see increasing vandalism, increasing crime, with a knock-on impact on infrastructure.
“I’m not suggesting every town is going to face these problems but we need to stop the rot.”
He called on the government to address the situation.
“Politicians need to come up with a plan to kick-start the regeneration of shopping centres,” he said.
A government spokesperson said: “It’s true that high streets are changing, like they always have, and we’re committed to helping communities adapt.”
The spokesperson said the government had assembled an “expert panel” to “diagnose the issues currently affecting the high street and develop recommendations that will help them thrive”.
The future of shopping centres
The trend of closing shopping centres is fairly well-known in the US, where “dead mall” or “ghost mall” is the term that describes the decaying edifices left when mainstream department stores have moved out.
“Many of the challenges facing shopping centres in the UK are mirrored in the USA,” said Mr Blackley.
Centres that have prospered, he said, have been canny about expanding their offer.
“UK shopping centres must change if they are to survive,” according to Mr Blackley.
“They need to think like a hospitality brand. There has been a marked shift to the ‘experience economy’, and an increase in spend on food and beverage, which is now accounting for over 20% of total spend in some of the newest schemes.
“Some of the big centres in the UK are incorporating Sea Life Centres, ice rinks, indoor ski slopes. These are the shopping centres that, in my view, will survive.
“There’s no doubt that if shopping centres don’t deliver an experience consumers want, they will fall by the wayside.”
Some of the other visions for the future are similarly radical.
Daniel Mead, head of shopping centre asset management at APAM, said community facilities such as libraries, medical centres and even schools could all sit within retail complexes.
“What people like about shopping centres is that they are centrally located with good transport links. The NHS has expressed interest in having a presence in some centres. With a chemist and other retailers already located there, it would be like a one-stop shop in the town centre.
“The problem is, these centres are run by investors who have a short-term approach and haven’t the skill-sets or investments to embrace the kind of changes required. There needs to be a joint venture created with local communities to fix the problem.”
In recent months, some local authorities have bought unloved shopping centres from investors keen to offload them.
“In February 2018, Canterbury City Council struck one of the largest shopping centre deals involving a council on record, taking full control of Whitefriars Shopping Centre in the city,” said Mr Blackley.
“The local authority bought out global fund manager TH Real Estate’s 50% stake for £75m.”
In Shrewsbury, Shropshire County Council bought three neglected centres to “support economic growth and regeneration” in the town centre.
Whether such schemes will work depends on the passion and vision of the authorities concerned and whether they are able to secure private investment.
In Coventry, the city council’s plan to work with private investors to redevelop its post-war shopping precincts is seen as a good example of how to revive a shopping centre.
“But such investments by councils do risk public money,” said Mr Blackley.
“In too many cases, councils are trying to plug a gap and I don’t think that is sustainable long term.”
A TSA officer is receiving praise after moving quickly to remove a piece of smoking luggage from a checkpoint area.
OneTransportation Security Administration security officer is being praised for his quick thinking during a recent scare at Savannah-Hilton Head International Airport. TSA Lead Officer Lead Officer Darrell Wade grabbed a smoking piece of luggage from a checkpoint and ran it away from the terminal, protecting everyone nearby.
On August 8, footage was released of Wade’s brave actions at the Georgia air hub on July 20, which potentially prevented a major mishap, Fox 30 reports.
“I just really wanted everyone else to be safe. At that moment I can honestly say I wasn’t thinking of me getting injured, or anything else,” Wade recalled of the scene, in footage obtained by Fox News. “I just wanted everyone else at the checkpoint and all the other officers to be safe, passengers to be safe.”
Upon examination, the cause of the smoke was revealed to be a malfunctioning vape battery, Fox 30 reports. Wade’s actions also prevented damage to the TSA security equipment, as well as a potential showdown of the airport. The checkpoint also remained open.
“Battery-powered E-cigarettes, vaporizers, vape pens, atomizers, and electronic nicotine delivery systems may only be carried in the aircraft cabin (in carry-on baggage or on your person). Check with your airline for additional restrictions,” the site states.
Janine Puhak is an editor for Fox News Lifestyle. Follow her on Twitter at @JaninePuhak
Despite continued national and local efforts, progress in minors’ e-cigarette use has stalled.
The vapor from e-cigarettes may boost the production of inflammatory chemicals in the lungs, while disabling key cellular defenders against infection, a new study suggests.
In a series of laboratory experiments, researchers found that e-cigarette vapor impairs the activity of cells called macrophages, which normally remove allergens, bacteria and other particles that have made their way into the lungs, according to the report published in Thorax.
For the cultured cells, exposure to e-cigarette vapor induced many of the same changes in lung macrophages that have been seen in cigarette smokers and patients with COPD, the researchers note.
The concern is that long-term vaping might lead to breathing problems. E-cigarettes “are safer in terms of cancer risk, but if you vape for 20 or 30 years and this can cause COPD, then that’s something we need to know about,” senior study author Dr. David Thickett of the University of Birmingham in the UK, said in a statement.
Earlier studies looked just at the effect on cells of the liquid that goes into an e-cigarette rather than at the vaporized chemicals.
To determine what effect vaporizing might have, Thickett and his colleagues extracted macrophages from lung tissue samples from eight non-smokers who had never had asthma or COPD. One third of those cells were exposed to e-cigarette fluid, another third to vaporized liquid and the remaining third to nothing.
After 24 hours, the researchers saw cells dying in the groups exposed to fluid and vaporized e-cigarette liquid. But the vaporized liquid killed cells at lower doses than the unvaporized liquid.
The researchers also noted that when macrophages were exposed to doses too low to kill, the cells spewed out 50-fold higher amounts of oxygen-free radicals, the “rust” of the biological world, compared to unexposed cells. The cells exposed to vaped liquid also secreted a host of inflammation-inducing molecules.
Cells exposed to vaporized liquid also were not as good at battling bacteria, suggesting that e-cigarette users’ lungs might have more trouble fighting off infections.
The macrophages examined by the researchers are important cell defenders deep within the lungs, said Dr. Daniel Weimer, a pediatric pulmonologist at the Children’s Hospital of Pittsburgh of UPMC who was not involved in the study.
“They do a bunch of things,” he said. “One thing they can do is eat up foreign things, whether they be bacteria or viruses or just particles that have drifted down into the lungs. They can act as scavengers that present these particles to the immune system to activate an immune response.”
It’s important to keep in mind that the study was done on cells in a culture, not in an animal or a human being, Weimer said. Things might be different in vivo.
Nevertheless, this study, taken along with some earlier ones, suggests that we may need to worry a bit more about the use of e-cigarettes, especially among the young, Weimer said.
“Many people think of COPD as an older person’s disease,” he added. “But we’re seeing younger and younger kids vaping. And that may cause a loss of long function at a more accelerated pattern because they’re starting it in their teens.”
Research on e-cigarettes has been a bit of a moving target, said Dr. Michael Blaha, a professor of medicine and director of clinical research at the Ciccarone Center for the Prevention of Heart Disease at Johns Hopkins Medicine in Lutherville, Maryland. That’s because every aspect of the devices and the fluids used in them has been changing at a rapid pace, he said.
The idea that vaporized e-cigarette liquid might be more toxic than the liquid itself, “is highly plausible,” Blaha said. “And there are some early studies that suggest that people using e-cigarettes have more respiratory symptoms, such as coughing and wheezing, than those using nothing at all.”
Initially public health experts were not that concerned about e-cigarettes because they were being marketed as a way to help smokers quit, Blaha said. “When the field was originally thinking of these as cessation devices, then some toxicity could be tolerated,” he added. “But now we’re looking probably at a couple million users in the United States who are being exposed to e-cigarette vapors who potentially wouldn’t have been exposed to any tobacco product.”
A statement on the airline’s website reads: “We provide a smoke and vape-free environment inside the airport – at all times and for all substances – and have designated smoking and vaping areas outside the terminal building for public use. Airport users, as a condition of using the airport facilities, must obey smoke-free and vape-free signage at all times and for all substances.”
Passengers are also allowed to fly with up to 30 grams of the substance in their suitcase – however only on domestic flights within the country.
Federal Transport Minister Marc Garneau said: “As long as the flight is domestic, people are allowed to bring up to a certain quantity for their personal use. However, I would remind people if they’re going to a country like the United States – the rules of that country are the rules that apply.”
The airport has put up signage around the airport warning people that “crossing international borders with cannabis is illegal.”
One tweet on Friday morning underlined the frustration of one rail traveller: “No-one on the platform and it’s totally uncovered. I was vaping. A guard walked 100 yards and told me it’s not allowed. I said ‘but it’s open air and there’s no-one about. Rules are rules’ he said!”
On the other hand, some of those who don’t smoke or vape take exception to the idea of being in close proximity to an e-cigarette user.
To quote another tweet: “Not in public places please – I don’t want my world filled with sweet smelling clouds of vapour. All mixed together from different peoples tastes. Yuk!”
People of this persuasion might not be happy to hear that the committee advocates “non-vapers having to accommodate vapers”.
So is vaping safe?
There is no definitive answer to that.
The clinical regulator, NICE, makes the point that as e-cigarettes have only been on the market for about a decade, there is no authoritative research yet available. It may take several more years for such research to emerge which can show beyond doubt that vaping does not affect users’ lungs or other aspects of their health.
This then is a debate about whether clear gains now in terms of getting smokers off tobacco might be outweighed in future by adverse health effects which only emerge after detailed research.
The MPs on the committee, public health authorities and many health campaigners are strongly of the view that fairly certain gains now are more important than a possible long-term risk.
Critics are adamant that it’s too soon to give a clear-cut message to consumers.
The MPs also want to see a clearer lead from the NHS in advocating e-cigarettes. They are disappointed that a third of mental health trusts in England won’t allow vaping on their premises, even though smoking among people with mental health conditions is much higher than for the general population.
At smoking cessation clinics some local authorities suggest vaping, but others don’t.
The committee also wants to see more e-cigarette brands cleared for medicinal use. This would allow GPs to recommend or even prescribe them if they wished, subject to the views of their commissioning groups.
There is one brand, eVoke, which has had such approval from the Medicines and Healthcare Products Regulatory Agency but, curiously, it has not yet been marketed to consumers.
Intriguingly, the company which owns the brand is British American Tobacco. Company sources have indicated that the brand is “not likely” to be taken any further as the vaping market has moved on since eVoke was developed and consumer preferences have changed.
This is still a debate clouded with uncertainty but the select committee report has allowed some of the fog to clear.
It has moved smoking higher up the agenda of important public health issues, with growing pressure on NHS leaders and ministers to think about a way forward.
Health charity Action on Smoking and Health (Ash) also criticised the campaign – which includes a four-page wraparound on Monday’s Daily Mirror – saying it was a way for Philip Morris to get around the UK’s anti-tobacco advertising rules.
Most forms of tobacco advertising and promotion in the UK are banned, and rules introduced last year mean cigarettes and tobacco must be sold in plain green packets.
Deborah Arnott, chief executive of Ash, said Philip Morris was still advertising its Marlboro brand wherever globally it was legal to do so.
“The fact of the matter is that it can no longer do that in the UK, we’re a dark market where all advertising, promotion and sponsorship is banned, and cigarettes are in plain packs.
“So instead Philip Morris is promoting the company name which is inextricably linked with Marlboro,” she said.
Philip Morris has said previously that it wants to achieve a “smoke-free” future.
Like many tobacco firms, Philip Morris is moving towards a focus on new products to replace cigarettes as the number of smokers in the UK continues to decline.
In the UK, it markets several alternatives to cigarettes, including a heated tobacco product, Iqos.
It also owns the Nicocig, Vivid and Mesh e-cigarette brands.
‘It takes time’
The firm’s managing director Peter Nixon said its new advertising campaign was “about supporting smokers in finding alternatives”.
Asked why, if Philip Morris was so keen for smokers to quit, it did not simply stop making cigarettes and focus entirely on alternative products, he said it was because then smokers would then just switch to a rival product.
“Cigarettes still generate 87% of our business. We want to get to [smoke-free] as soon as possible, and we want to be selling alternatives, but it does take time,” he said.
Mr Nixon said the firm had invested over £4bn in developing alternative products to cigarettes.
The campaign suggests four ways to give up cigarettes, including going cold turkey, using nicotine patches, vaping and using heated tobacco products.
In July last year, the government set out a plan to make England, in effect, smoke-free in the next few decades.
The new Tobacco Control Plan aimed to cut smoking rates from 15.5% to 12% of the population by 2022.
There is no evidence e-cigarettes are a gateway into smoking for young people, Public Health England said.
The report on e-cigarettes, by the science and technology MPs’ committee, said they were too often overlooked by the NHS as a tool to help people stop smoking.
For example, it said it was “unacceptable” that a third of the 50 NHS mental health trusts in England had a ban on e-cigarettes on their premises, when there was a “negligible health risk” from second hand e-cigarette vapour.
What else do the MPs say?
In the report they call for:
greater freedom for industry to advertise e-cigarettes
relaxing of regulations and tax duties on e-cigarettes to reflect their relative health benefits
an annual review of the health effects of e-cigarettes, as well as heat-not-burn products
a debate on vaping in public spaces, such as on public transport and in offices
e-cigarettes licensed as medical devices
a rethink on limits on refill strengths and tank sizes
an end to the ban on snus – an oral tobacco product which is illegal in the UK under EU rules
How popular has vaping become?
About 2.9 million people in the UK are currently using e-cigarettes.
It is estimated that 470,000 people are using them as an aid to stop smoking and tens of thousands are successfully quitting smoking each year as a result.
Although the report recognised the long-term health effects of vaping were not yet known, it said e-cigarettes were substantially less harmful than conventional cigarettes because they contained no tar or carbon monoxide.
Norman Lamb, chairman of the science and technology committee, said: “Current policy and regulations do not sufficiently reflect this and businesses, transport providers and public places should stop viewing conventional and e-cigarettes as one and the same.
“There is no public health rationale for doing so,” he said.
“Concerns that e-cigarettes could be a gateway to conventional smoking, including for young non-smokers, have not materialised.
“If used correctly, e-cigarettes could be a key weapon in the NHS’s stop-smoking arsenal.”
Mr Lamb said medically licensed e-cigarettes “would make it easier for doctors to discuss and recommend them as a stop-smoking tool to aid those quitting smoking”.
The debate on e-cigarettes
The report is the latest in a long-running debate about e-cigarettes and how they are used in society.
In fact, to encourage smokers to switch to vaping, Public Health England recommends e-cigarettes should not be treated the same as regular cigarettes when it comes to workplaces devising smoking policies.
“Vaping,” the authority said, “should be made a more convenient as well as safer option”.
But some places have banned vaping. For example, Transport for London forbids the use of e-cigarettes on all buses and the Underground, including at stations.
Big cinema chains such as Cineworld, Odeon and Empire also ban smoking e-cigarettes anywhere on their premises while most theatres also forbid their use.
Most airlines and airports ban vaping, apart from in designated smoking areas.
What is the response to the MPs’ report?
Public Health England estimates that e-cigarettes are 95% less harmful than normal cigarettes.
Duncan Selbie, chief executive of PHE, said: “E-cigarettes are not without harm but are way safer than the harms of tobacco.
“There is no evidence that they are acting as a gateway into smoking for young people.
“We want to see a tobacco-free generation within 10 years and this is within sight.”
The charity Action on Smoking and Health welcomed the report but said it had some concerns over rule changes on advertising, which could mean tobacco companies being allowed to market their e-cigarettes in packs of cigarettes.
George Butterworth, from Cancer Research UK, said any changes to current e-cigarette regulations “should be aimed at helping smokers to quit whilst preventing young people from starting to use e-cigarettes”.
Prof Linda Bauld, professor of health policy at the University of Stirling, said: “This report is a welcome and evidence-based respite from all the scare stories we see about vaping.
“Its recommendations are not likely to be popular with all, and some of them may be difficult or complex to implement. But government, regulators and service providers should take note.”
What do the public say?
There are some strong opinions on Twitter in reaction to the idea of allowing vaping on public transport.
No thanks no public https://t.co/f3Em9ODWky the confinement of a bus, with young children and people who dislike them on?What about the choices of those who dislike them or have other health issues which could make this an issue for them? E cigarettes are still full of chemicals.