Kids Are Not Just Substituting E-Cigs for Cigs; E-Cigs Are Expanding the Tobacco Epidemic

September 26th is World Environmental Health Day. The theme this year is “Tobacco Control… a response to the global tobacco pandemic”, and so we offer this commentary, shared with the author’s permission. The original post is available on his blog.

stantonglantzwritten by Stanton Glantz, PhD
Professor of Medicine and Truth Initiative Distinguished Professor of Tobacco Control at the University of California, San Francisco

Jessica Barrington-Trimis and her colleagues have published two important papers in Pediatrics on the link between e-cigarette and cigarette use, both based on a large longitudinal sample of Southern California youth who have been followed for many years.

Their paper “E-cigarettes, Cigarettes, and the Prevalence of Adolescent Tobacco Use” showed that, contrary to assertions of e-cigarette cheerleaders, the large increase in e-cigarette use observed in several national studies in recent years are not simply reflecting kids taking up e-cigarettes instead of e-cigarettes. While some kids who are using e-cigarettes are also smokers, kids are being attracted to e-cigarettes who would otherwise not be attracted to tobacco products.

Here is the abstract:

BACKGROUND: Adolescent e-cigarette use has increased rapidly in recent years, but it is unclear whether e-cigarettes are merely substituting for cigarettes or whether e-cigarettes are being used by those who would not otherwise have smoked. To understand the role of e-cigarettes in overall tobacco product use, we examine prevalence rates from Southern California adolescents over 2 decades.
METHODS: The Children’s Health Study is a longitudinal study of cohorts reaching 12th grade in 1995, 1998, 2001, 2004, and 2014. Cohorts were enrolled from entire classrooms in schools in selected communities and followed prospectively through completion of secondary school. Analyses used data from grades 11 and 12 of each cohort (N = 5490).
RESULTS: Among 12th-grade students, the combined adjusted prevalence of current cigarette or e-cigarette use in 2014 was 13.7%. This was substantially greater than the 9.0% adjusted prevalence of current cigarette use in 2004, before e-cigarettes were available (P = .003) and only slightly less than the 14.7% adjusted prevalence of smoking in 2001 (P = .54). Similar patterns were observed for prevalence rates in 11th grade, for rates of ever use, and among both male and female adolescents and both Hispanic and Non-Hispanic White adolescents.
Smoking prevalence among Southern California adolescents has declined over 2 decades, but the high prevalence of combined e-cigarette or cigarette use in 2014, compared with historical Southern California smoking prevalence, suggests that e-cigarettes are not merely substituting for cigarettes and indicates that e-cigarette use is occurring in adolescents who would not otherwise have used tobacco products. [emphasis added]


image from Linsday Fox at Creative Commons

Their second paper, “E-Cigarettes and Future Cigarette Use,” also in Pediatrics, showed that never-smoking kids in the same cohort who start using tobacco products with e-cigarettes had 6.17 times the odds of smoking cigarettes 16 months later than kids who did not use e-cigarettes, adding to the growing consistent evidence that e-cigarettes are a gateway to cigarette smoking. (Of course, having kids inhaling a mixture of hot propylene glycol, nicotine, and other stuff is not a good thing, even if they didn’t go on to cigarettes.)

Here is the abstract:

BACKGROUND: There has been little research examining whether e-cigarette use increases the risk of cigarette initiation among adolescents in the transition to adulthood when the sale of cigarettes becomes legal.
METHODS: The Children’s Health Study is a prospectively followed cohort in Southern California. Data on e-cigarette use were collected in 11th and 12th grade (mean age = 17.4); follow-up data on tobacco product use were collected an average of 16 months later from never-smoking e-cigarette users at initial evaluation (n = 146) and from a sample of never-smoking, never e-cigarette users (n = 152) frequency matched to e-cigarette users on gender, ethnicity, and grade.
RESULTS: Cigarette initiation during follow-up was reported by 40.4% of e-cigarette users (n = 59) and 10.5% of never users (n = 16). E-cigarette users had 6.17 times (95% confidence interval: 3.30–11.6) the odds of initiating cigarettes as never e-cigarette users. Results were robust to adjustment for potential confounders and in analyses restricted to never users of any combustible tobacco product. Associations were stronger in adolescents with no intention of smoking at initial evaluation. E-cigarette users were also more likely to initiate use of any combustible product (odds ratio = 4.98; 95% confidence interval: 2.37–10.4), including hookah, cigars, or pipes.
CONCLUSIONS: E-cigarette use in never-smoking youth may increase risk of subsequent initiation of cigarettes and other combustible products during the transition to adulthood when the purchase of tobacco products becomes legal. Stronger associations in participants with no intention of smoking suggests that e-cigarette use was not simply a marker for individuals who would have gone on to smoke regardless of e-cigarette use. [emphasis added]

These two papers add to the case that e-cigarettes are extending and expanding the tobacco epidemic.

See Dr. Glantz’s blog.

Celebrating 25 Years of Endocrine Disruptors Research

written by Elise Miller, MEd
updated September 19, 2016

Twenty-five years ago “endocrine disrupting chemicals” was hardly a household term. Now at the grocery store or while traveling, I’ve been astonished to hear “endocrine disrupting chemicals” or “EDCs” roll off some people’s tongues as though they were toxicologists, rather than parents with little background in science simply voicing concerns about possible links between chemical exposures and their kids’ health. Even mainstream news outlets refer to EDCs with only the briefest of explanations these days.

How did this happen? I certainly don’t have the space here to detail this remarkable story, but some pioneering researchers in the 1990s were central to bringing these critical issues and a revolution in scientific thinking to national and international attention. Theo Colborn, Pete Myers, Niels Skakkebaek, John McLachlan and Lou Guillette – to name just a few – began publishing and speaking to other scientists, health professionals, health advocates, philanthropists and journalists about the significance of this research. In language accessible to lay audiences, they brought home the point that certain chemicals, pervasive in our environment, could disrupt healthy biological processes at minuscule doses during key windows of development. Most disturbingly, they described how these synthetic chemicals were present in the womb and could contribute to chronic diseases and disabilities across the lifespan.

The publication of the seminal book, Our Stolen Future, in 1996, was particularly catalytic, spawning hundreds more scientific studies as well as nonprofits devoted to bringing attention to the emerging research and translating it into stronger public health policy – CHE being among them.


Click for more about the NIEHS conference.

Next week many colleagues in the environmental health field will attend a conference, “25 Years of Endocrine Disruption Research: Past Lessons and Future Directions”, hosted at the National Institutes of Health’s headquarters in Bethesda, Maryland. Dovetailing with that conference is a meeting for grantees studying chemicals linked to obesity, a burgeoning area of EDC research. That too is particularly timely given September is National Childhood Obesity Month in the US, and among the leaders addressing this massive public health concern, scant attention is yet given to the role EDCs may be playing in the childhood obesity epidemic.

Here’s to all the visionary researchers and others who have put EDCs on the map of public consciousness and to another productive quarter-century of EDC research! CHE looks forward to continuing to feature the emerging EDC science [check out our conference calls organized by the EDC Strategy Group and also the upcoming call on September 28th] and opportunities to reduce exposures towards a healthier future.

Violence: The Connection to Environmental Health and Justice

written by Elise Miller, MEd

Violent events rock families and communities in the U.S. daily. But last week was particularly wrenching as we learned first of two incidents of extrajudicial shootings of black men by police—one in Louisiana, the other in Minnesota—followed by the killing of five police officers by an individual sniper at an otherwise peaceful Black Lives Matter protest in Texas. The complexities and causes of each case may be unique, but at the core is an abiding racism that continues to permeate our country.

Racism is perpetuated in multiple and insidious ways, such as the widening income gap, toxic stress, poor nutrition, lack of access to healthcare and to nature. Another factor intimately interconnected with these, but often overlooked, is exposure to pollutants and other toxic chemicals. We know that being exposed to heavy metals and neurotoxic chemicals can lead to cognitive deficits and developmental delays that in turn have been linked to juvenile delinquency and violent behavior. We know that many kids of color and low-income families are more likely to live in housing stock with lead paint and pipes and close to polluting industries. We know that during pregnancy poorer women are disproportionately exposed to harmful chemicals associated with learning and developmental disorders. We know that working-class parents often have to take the lowest-paying jobs, many of which require regular contact with contaminants linked to cognitive and behavioral problems. We know for most of these families the only food they can afford comes pre-packaged and contains toxic chemicals that can impact neurodevelopment.

image by Ingrid Taylar
image by Ingrid Taylar

Though we are well aware of these concerns based on the best available science, our collective response perpetually fails to address this component of the many upstream drivers of health. If the implementation of a comprehensive, prevention-oriented intervention strategy to help mitigate violence doesn’t include reducing environmental pollutants, then we are missing a significant opportunity to improve public health and safety. We can’t have justice if we don’t have environmental justice. We can’t have healthy communities if we don’t have environmental health. Of course reducing exposures to pollution won’t stop racism, but it will give kids a far better chance to reach their full potential and live more meaningful lives, rather than being impeded from the get go and more easily caught in a downward spiral of fear and violence.

Our hearts go out to the latest victims of these hateful actions. CHE joins millions around the country to call for an end to all violence—and to all conditions that give rise to violence.

Unprecedented Alliance of Scientists, Health Professionals, & Advocates Agree Toxic Chemicals Are Hurting Brain Development

written by Ted Schettler, MD, MPH
Science Director

Ted SchettlerAn unprecedented alliance of leading scientists, health professionals, and children’s health advocates has come together to publish a consensus statement concluding that scientific evidence supports a causal link between exposures to toxic chemicals in food, air and everyday products and children’s risks for neurodevelopmental disorders. The alliance, known as Project TENDR, is calling for immediate action to significantly reduce exposures to toxic chemicals to protect brain development for today’s and tomorrow’s children.

Neurodevelopmental disorders include intellectual disability, autism spectrum disorder, attention deficits, hyperactivity, other maladaptive behaviors, and learning disabilities.  Project TENDR’s consensus statement is available on the Project TENDR website.

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Cell Phones, Cancer and Precaution

written by Elise Miller, MEd

The National Toxicology Program’s study on the potential health impacts of cell phone radiation published at the end of May has been called a potential “game-changer” by some leading researchers in the field. The preliminary findings of this study, the largest of its kind ever conducted, indicate that male rats exposed to radio-frequency (RF) radiation emitted from wireless devices have an increased risk of developing brain cancer (malignant glioma) and tumors on the heart (schwannomas). This affirms the World Health Organization’s International Agency for Research on Cancer (IARC) decision in 2011 to classify RF radiation as “possibly carcinogenic” in humans. It also suggests that if IARC were to assess the emerging research from the last five years, it might have good reason to raise that classification to “probably carcinogenic.”
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Waste More, Want More: The Adage of the Age of Electronics

written by Elise Miller, MEd

NOTE: While CHE primarily highlights emerging environmental health science, we also occasionally bring attention to how this new research is being applied (or not) to decision-making in the marketplace and regulatory policies. 

Every day new mountains are being born—not because of shifting plate tectonics but due to electronic waste, the fastest growing source of waste in the world. This is not news to most people, but what may be surprising is that many of the old computers and phones you thought you were being responsibly recycled are actually being shipped thousands of miles overseas. This is according Basel Action Network, which partnered with MIT to put geo-tracking devices in old electronics to see where they actually ended up. In their investigation, reported Monday, it was found that almost a third of old electronics taken in by even a couple of the most reputable electronic recycling companies in the US went to other countries—despite these companies stating explicitly that they did not allow this practice.

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Scientific Consensus Statements on the Role of Environmental Chemicals in Diabetes, Obesity, and Metabolism

written by Sarah Howard
Coordinator of the Diabetes-Obesity Working Group

Sarah Howard

Two worldwide gatherings of experts have published consensus statements on the role of environmental chemicals in diabetes, obesity, and metabolism:

The Parma Statement was based on a workshop held in Parma, Italy, in May 2014, and the Uppsala Statement was based on a workshop held in Uppsala, Sweden, in October 2015.

Both focus on guiding future scientific research in the field, but also contain recommendations for policy makers, health care providers, and other professionals. Both call for reducing environmental chemical exposures, especially in early life, to help prevent the development of metabolic problems later in life.

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