E-cigarette News

For years, the U.S. Food and Drug Administration (FDA) has been trying to decide what to do about e-cigarettes -- the electronic gadgets that vaporize nicotine, a process promoters say produces a healthier way of ingesting nicotine.

Apparently tired of waiting on the FDA, five U.S. Senators today introduced the "Protecting Children from Electronic Cigarette Advertising Act" to prohibit the marketing of e-cigs to children and teens. 

“We cannot risk undoing decades of progress in reducing youth smoking by allowing e-cigarette makers to target our kids,” Senator Barbara Boxer (D-Calif.) said. “This bill will help protect our children from an industry that profits from addiction.”

State and local jusidictions have also been stepping into the void left by the lack of action by the FDA. Earlier this week, a committee of the Los Angeles city council passed a measure that would treat e-cigs like tobacco cigarettes and subject them to the same restrictions. Before leaving office last year, ex-New York City Mayor Michael Bloomberg signed a bill outlawing e-cigs and plastic plates. 

Mass marketing techniques

Sen. Dick Durbin (D-Ill.), another sponsor of the Senate measure, said e-cig makers are increasingly adopting mass marketing techniques previously used by tobacco companies to target children and teens.

"With fruit and candy flavors and glossy celebrity ads, e-cigarettes makers are undeniably targeting young people. Unfortunately, it’s working. We must take action now to prevent a new generation from walking down the dangerous path towards nicotine addiction,” Durbin said.

“When it comes to the marketing of e-cigarettes to children and teens, it’s ‘Joe Camel’ all over again," said Sen. Tom Harkin (D-Iowa), chairman of the Senate Health, Education, Labor, and Pensions Committee. "It is troubling that manufacturers of e-cigarettes – some of whom also make traditional cigarettes – are attempting to establish a new generation of nicotine addicts through aggressive marketing that often uses cartoons and sponsorship of music festivals and sporting events.” 

The other senators sponsoring the bill are Tom Harkin (D-Iowa), Richard Blumenthal (D-Conn.), and Edward J. Markey (D-Mass.).

The Protecting Children from Electronic Cigarette Advertising Act would permit the Federal Trade Commission (FTC) to determine what constitutes marketing to children, and would authorize the FTC to work with state attorneys general to enforce the ban.

The health implications of using electronic cigarettes are not yet clear, and the FDA has warned that consumers of e-cigarette products “currently have no way of knowing” if e-cigarettes are safe for their intended use, or how much nicotine or other potentially harmful chemicals are being inhaled during use.

Gateway to tobacco

“E-cigarettes are a gateway to tobacco use by children and teens and should not be marketed to youth, period,” Sen. Markey said. “We’ve made great strides educating young people about the dangers of smoking, and we cannot allow e-cigarettes to snuff out the progress we’ve made preventing nicotine addiction and its deadly consequences."

According to the National Youth Tobacco Survey, 1.8 million middle and high school students said they tried e-cigarettes in 2012, and a study released by the Centers for Disease Control and Prevention (CDC) found that the percentage of high school students who had tried them had more than doubled in just one year – indicating that e-cigarette companies could be targeting youth through advertisements.

More than 76 percent of those users said they also smoked conventional cigarettes, suggesting that for many young people, e-cigarettes could be a gateway to nicotine addiction and smoking of conventional cigarettes, the senators noted.

The bill has been endorsed by the American Academy of Pediatrics, the American Heart Association, the American Lung Association, the American Cancer Society Cancer Action Network and Campaign for Tobacco-Free Kids.

In December, Senators Boxer, Blumenthal, Durbin, Harkin, Markey, and Sherrod Brown (D-Ohio) sent a letter urging the FTC to investigate the marketing practices of e-cigarette manufacturers.

The popularity of e-cigarettes continues to rise for teens across the U.S. Middle and high school students are glorifying habits like vaping, and many still believe that the products don’t pose much of an immediate threat to their health.

While different studies have disagreed over that fact, new findings from the University of Southern California suggest that the health of young users may be at serious risk in the short- and long-term. The reason, the authors say, is that e-cigarette use and vaping can be associated with an increased frequency of smoking and heavier smoking habits overall.

Heavier smoking patterns

Dr. Adam M. Leventhal and his colleagues came to their conclusions after analyzing surveys given to 10^th grade students in ten public high schools in Los Angeles County between 2014 and 2015. Questions focused on the frequency and heaviness of e-cigarette and cigarette use, as well as vaping habits. A follow-up survey was given six months later to gauge any changes.

The analysis found that students that smoked or vaped at the time when they took the first survey were more likely to increase their e-cigarette smoking frequency by the time the second survey was taken. Similarly, the researchers found that adolescents who smoked cigarettes were more likely to increase their smoking frequency and heaviness if they also vaped; this was especially true for infrequent smokers.

The researchers believe these findings speak to the need for stronger tobacco control policies, though they admit that more research will need to be conducted to verify the results. The full study has been published in JAMA. 

Tobacco companies face tough restrictions when it comes to marketing cigarettes. Advertising for e-cigarettes, on the other hand, faces no such regulations. At least not yet.

Not surprisingly, e-cigarette advertising spending in the U.S. tripled in one year, according to a study by RTI International. The researchers found ad spending went from $6.4 million in 2011 to $18.3 million in 2012.

“E-cigarette advertising expenditures are focusing heavily on national markets and TV ads, which will likely increase consumer awareness and use of e-cigarettes,” said Annice Kim, Ph.D., senior social scientist at RTI and co-author of the study.

Most of the ad spending was for television and magazines. Newspapers and the Internet received the lowest share.

Gray area

At the moment, e-cigarettes fall into a regulatory gray area. A federal court has ruled that they are tobacco products, even though they contain no tobacco.

But while cigarettes are barred from television and radio advertising, and face other restrictions, e-cigarettes remain unregulated, even though the Federal Trade Commission (FTC) is reportedly drafting proposed rules.

Many former smokers praise e-cigarettes as a means to quit. They say e-cigarettes provide many of the pleasures of smoking, with nicotine delivered through water vapor that can be inhaled.

While e-cigarettes lack many of the toxins found in tobacco smoke, some health advocates worry that e-cigarettes could have some negative health effects that aren't yet known. Meanwhile, they are being heavily advertised.

“Our results suggest that federal-level efforts are needed to track e-cigarette advertising, as the U.S. Federal Trade Commission (FTC) does not currently require companies to report e-cigarette ad expenditures,” Kim said. “Tobacco companies are required to report their ad expenditures annually to the FTC, but there are no comparable reporting requirements for e-cigarette companies because e-cigarettes are not regulated by the U.S. Food and Drug Administration.”

Congressional push

Eleven members of Congress released their own report this week, not only showing a spike in e-cigarette advertising but claiming the marketing efforts are aimed at young people.

“For years, federal regulations prohibiting tobacco companies from targeting young people have helped to protect a new generation of smokers from getting hooked on nicotine,” said Sen. Richard Durbin (D-IL). “Now, we must close this new gateway to addiction to protect our children.”

Rep. Henry Waxman (D-CA), said he sees parallels between past cigarette marketing and e-cigarette marketing.

“E-cigarette makers are starting to prey on kids, just like the big tobacco companies,” Waxman said. “With over a million youth now using e-cigarettes, FDA needs to act without further delay to stop the companies from marketing their addictive products to children.”

States taking action

Some states have not waited for the federal government to draft rules governing e-cigarettes. Kentucky Gov. Steve Beshear this week signed legislation that outlaws the sale of e-cigarettes to minors.

The law addresses concerns that young people will be lured into using e-cigarettes and, as a result, will become addicted to nicotine. E-cigarette makers, meanwhile, are trying not to be seen as promoting use by young consumers.

One of the main cheerleaders for the new Kentucky law was Lorrilard, a major tobacco firm and parent company of the Blu e-cigarette brand.

"Legislation that prevents the sale or distribution of electronic cigarettes to minors is the right thing to do," said Murray Kessler, Lorillard's chairman and CEO, who attended the bill signing.

Kessler said Lorillard has actively supported age of purchase legislation in other states and encourages states that have not passed similar legislation to do so.

Concerns about cigarette marketing

A new study by Dartmouth researchers, meanwhile, raises new concerns about young people's exposure to advertising for traditional cigarettes. This exposure, the study argues, leads to increased use of tobacco.

“For several years, the emphasis in the tobacco industry has been on direct marketing, especially to young people who are highly price sensitive and who may find coupons, samples, and promotions appealing,” said Samir Soneji, a Dartmouth professor and lead author of the study.

The research team said it found exposure to tobacco coupons and websites increased the chances that a young person would start to smoke. Direct marketing includes coupons and ads sent through the mail or posted on the web, as well as in-store displays and signs.

In 2010, the tobacco industry spent $236 million in cigarette coupons and $22 million in Internet marketing, the study found.

Internet marketing proved particularly effective as some of it made its way to social media, widely used by teens and young adults.

The Food and Drug Administration (FDA) served notice some time ago that it will probably regulate electronic cigarettes but has yet to take the first step.

The FDA said it was preparing proposed regulations in 2011 but none appeared. It said the same thing the following year with the same results. Earlier this year it suggested a proposal would be offered in April.

Now the agency is coming under pressure from some lawmakers to get the process rolling. Five U.S. Senators have written to FDA Commissioner Margaret Hamburg, urging her agency to issue "deeming regulations" for the increasingly popular devices that some smokers have adopted in place of cigarettes.

The letter was signed by Sens. Dick Durbin (D-Il.), Frank Lautenberg (D-N.J.), Richard Blumenthal (D-Conn.), Sherrod Brown (D-Oh.) and Jack Reed (D-R.I.). They note that the number of people who have used e-cigarettes has doubled since 2010 but, to date, the nicotine delivery devices are currently not required to be evaluated or approved by the FDA.

Can currently be marketed to children

“Unlike traditional tobacco products, e-cigarettes can be legally sold to children and are not subject to age verification laws,” the Senators wrote. “E-cigarettes marketed to appeal to kids in candy and fruit flavors, like bubblegum and strawberry, are readily available to youth in shopping malls and online. These products risk addicting children to nicotine, which could be a pathway to cigarettes and other tobacco products.”

Earlier this month the CEO of an e-cigarette company also endorsed some regulation of his industry by the FDA. Eli Alelov, CEO of LOGIC Technology, told ConsumerAffairs that he wants to see manufacturing standards and age restrictions.

“I support raising the bar for the industry,” Alelov said. “Right now my biggest enemy is not the FDA, it's these 'me too' brands that come into the market with cheap electronic cigarettes, trying to make a buck, and they're putting lousy products on the market. That's hurting the entire industry.”

Alelov's company makes e-cigarettes in only two flavors – tobacco and menthol. He says the wide variety of fruit flavored e-cigarettes offered by other companies don't appeal to people who smoke cigarettes, but instead appeal to young people who don't smoke.

'Reasonable regulation'

The general counsel of FIN Branding Group LLC, another e-cigarette company, is also calling for "reasonable regulation."

"As the electronic cigarette industry continues to grow, it is important to work with stakeholders, including the FDA, to better understand how new regulations might alter our industry," said FIN Branding Vice President and General Counsel Rebecca Maisel. "We believe that some reasonable regulation that addresses quality control, product consistency, and a ban on selling products to minors is important."

State action

While the FDA ponders regulations, some states are considering action of their own. California is considering a measure that would ban the use of e-cigarettes in locations where smoking is banned. Currently e-cigarettes can be used in public spaces since they do not emit smoke, only water vapor.

The measure, SB 648, would ban e-cigarette use inside or within 20 feet of any public building or in a vehicle owned by the state. It would also allow landlords to ban e-cigarette use in private homes.

The Rhode Island legislature is currently debating a measure to ban e-cigarette sales to minors, but would also greatly restrict online sales of nicotine-containing products by treating e-cigarettes the same as traditional tobacco products.

E-cigarettes contain no tobacco but simulate the act of smoking by using heat to create water vapor that is inhaled. The flavored vapor contains nicotine and many smokers have said they find e-cigarettes an acceptable alternative to tobacco.

Anti-smoking groups, however, don't consider them acceptable. They have called for regulating e-cigarettes as tobacco products.

The Transportation Department has issued a final rule banning battery-powered electronic smoking devices – primarily e-cigarettes – from checked bags aboard commercial aircraft.

The government said it is taking the action as a safety precaution.

“Fire hazards in flight are particularly dangerous, and a number of recent incidents have shown that e-cigarettes in checked bags can catch fire during transport,” said U.S. Transportation Secretary Anthony Foxx, who called the ban a “prudent and important safety measure.”

The move was not unexpected. Back in October the agency issued an interim rule to the same effect, opening it to an extended comment period.

The final rule does allow passengers to carry e-cigarettes in the cabin of the aircraft, but it does not allow them to charge the devices during a flight.

Lithium ion batteries

Batteries, as a rule, make aviation officials nervous. There have been instances of lithium ion batteries in laptop computers and smartphones overheating, with some catching fire. Officials have long worried what would happen if a computer, packed in a suitcase and stowed in the body of a jetliner, caught fire.

In 2014 a plane in Tel Aviv had to be evacuated after the lithium-ion battery powering a passenger's iPhone 5 caught on fire, filling the cabin with smoke. A decade earlier a California teenager suffered second-degree burns when her cell phone caught fire without warning, with investigators pinning the blame on the lithium ion battery.

Granted, the batteries powering e-cigarettes are much smaller, but officials say it only takes a tiny spark to create a catastrophe.

“This final rule is the next step in hazardous materials safety standards following our interim final rule issued last October,” Marie Therese Dominguez, a Transportation Department officials, said. “The rule addresses the risk of fire brought about by carrying these electronic devices in checked baggage or charging them on board aircraft.”

The rule, however, does not stop people from carrying other devices powered by lithium ion batteries -- like computers, phones, and cameras -- in checked bags. It also does not stop a passenger from carrying battery-powered devices in carry-on luggage.

While the Food and Drug Administration (FDA) mulls new regulations of electronic cigarettes, the attorneys general of 29 states are urging the agency to adopt even tougher rules than it has already proposed.

“E-cigarettes have all the addictive qualities of regular, combustible cigarettes, yet they are completely unregulated by the FDA,” said New York Attorney General Eric T. Schneiderman, one of the author of a letter to the FDA signed by the 29 AGs. “While we applaud the FDA’s proposal to start regulating these tobacco products, it falls far short of what is needed to protect our youth.

Among other recommendations, the attorneys general pressed the FDA to prohibit flavors in e-cigarettes, and to restrict advertising and marketing for e-cigarettes in the same manner as for cigarettes.

"Each year, electronic cigarette companies spend millions of dollars advertising their product – often on prime-time television -- glamorizing smoking in the same way combustible cigarettes did before those commercials were banned. And each year, more and more youth try electronic cigarettes, exposing themselves to the proven dangers of nicotine,” the AGs argue.

While some claim that e-cigarettes may have the potential to help smokers quit using combustible cigarettes, the FDA has not approved them as smoking cessation devices, the AGs note, and they say they're concerned that e-cigs will cause teens to become addicted to nicotine and ultimately to start using cancer-causing combustible products that do contain tobacco.

In 2013, e-cigarette advertisements on television reached over 14 million teens, and magazine advertisements reached 9.5 million teens. In just one year, the five largest e-cigarette companies increased their marketing expenditures by 164%.

Over 35 years ago, tobacco companies recognized that flavored cigarettes were attractive to younger smokers, leading the FDA to ban flavored cigarettes.

“Today, we urge the FDA to do the right thing and protect our youth from yet another tobacco epidemic,” the letter continues. “We don’t need these e-cigarettes aimed at our youth. What we need are strong FDA regulations that protect the public health and protect our youth from a lifetime of nicotine addiction. The FDA should ban all flavored electronic cigarettes and should prohibit e-cigarette advertising on television, radio and youth-oriented magazines.”

E-cigarettes have taken something of a beating recently, as numerous studies have identified negative health consequences from using the nicotine burners while others have challenged the claim that e-cigs can help people stop smoking.

But now a large survey of smokers in England finds that people who use e-cigs to help them stop smoking are 60% more likely to succeed than those who use other over-the-counter therapies such as nicotine patches or gum.

The study, conducted by University College London and published in Addiction, surveyed 5,863 smokers between 2009 and 2014 who had attempted to quit smoking without the aid of prescription medication or professional support; 20% of people trying to quit with the aid of e-cigarettes reported having stopped smoking conventional cigarettes at the time of the survey.

The research, chiefly funded by Cancer Research UK, suggests that e-cigarettes could play a positive role in reducing smoking rates.

"E-cigarettes could substantially improve public health because of their widespread appeal and the huge health gains associated with stopping smoking," says Prof. Robert West of UCL's Department of Epidemiology & Public Health, senior author of the study.

Even better with professional help

West said, however, that the success rate for those using Britain's National Health Service stop-smoking program was even better -- nearly three times better than do-it-yourself smoking cessation programs.

The researchers noted that, while some use e-cigs to stop smoking, others may want to continue using them indefinitely.

"It is not clear whether long-term use of e-cigarettes carries health risks but from what is known about the contents of the vapour these will be much less than from smoking," West said. 

West also said he sees no sign that e-cigarettes are leading to a resurgence of smoking in the UK.

"Some public health experts have expressed concern that widespread use of e-cigarettes could "re-normalise" smoking. However, we are tracking this very closely and see no evidence of it. Smoking rates in England are declining, quitting rates are increasing and regular e-cigarette use among never smokers is negligible." 

It's easy to purchase e-cigarettes on the Internet, researchers say. Too easy.

A study by the University of California, San Diego School of Medicine says e-cigarette markets who sell their products online are aggressive in their marketing and make purchasing e-cigarettes easy for all ages.

E-cigarettes are a relatively recent invention. Only around since 2007, they have sold millions because users inhale nicotine vapor, not tobacco smoke.

“We found e-cigarette vendors were highly engaged in promoting the culture of ‘vaping’ online, including posting images to Instagram, a social media site used by 52% of teens,” said Tim K. Mackey, first author of the study. “Despite the fact that 47 states prohibit the sale of e-cigarettes to minors, the results highlight the potential of the Internet to encourage e-cigarette initiation and underage purchasing. This is particularly concerning given that the FDA does not have specific proposed regulations for online e-cigarette sales."

E-cigarettes contain no tobacco but the courts have ruled that they are tobacco products. As such, they come under the regulatory control of the FDA, which has yet to enact regulations. Proposed regulations were issued last year and are currently being reviewed.

Increasing use by young people

While most states have moved into the vacuum to impose some regulations, such as setting age limits on who can purchase the products, e-cigarettes are finding their way to plenty of underage consumers.

The researchers point to data from the 2014 National Youth Tobacco Survey showing e-cigarette use tripled among middle and high school students from 2013 to 2014.

While the jury is still out on potential harm, e-cigarettes are growing in popularity, in part because these battery-operated devices that look and feel like a tobacco cigarette come in all sorts of flavors, like bubble gum and peach fuzz.

The researchers say people who use these devices exhale a mixture of volatile organic compounds, heavy metals, and ultrafine particles that usually contain aerosolized nicotine in a cloud of vapor.

The study looked at 57 online vendors and found that 68% of them displayed one or more health warnings about the devices on their website. But the authors said the notices were usually written in smaller fonts or placed discretely in the terms and conditions section of a website.

Hard to prove age

More disturbing, one-third of the vendors had no detectable way to determine the age of who was buying the e-cigarettes. Most required only a simple click to say the buyer was within the legal age limit.

“The study found that online e-cigarette vendors use a variety of sophisticated and aggressive marketing practices, including promotional offers and high social media engagement to promote the sale of their products,” said Mackey.

As a result, sales are booming. Industry analysts estimate that online sales make up 25% to 30% of the $2 billion annual e-cigarette market, which may account for a high presence of vendors on social media.

The researchers said the findings could impact the U.S. Food and Drug Administration’s 2014 proposed regulations of e-cigarette use, sale, marketing, and manufacturing to include online monitoring of the laws.

Companies that make and sell e-cigarettes are quick to point out how they are different from tobacco cigarettes.

For starters, they contain no tobacco. They deliver flavored nicotine in vapor form.

But the Centers for Disease Control and Prevention (CDC) says these nicotine delivery devices have one big thing in common with cigarettes – the way in which they are marketed.

In its most recent Vital Signs report, the CDC notes e-cigarette ads use many of the same themes – independence, rebellion, and sex – used to sell cigarettes and other conventional tobacco products.

That's of concern, the CDC says, because it has found that about seven out of 10 middle and high school students – more than 18 million young people – see e-cigarette advertising in stores, online, in newspapers and magazines, or on television and in movies.

No marketing restrictions

Currently e-cigarette marketing faces none of the restrictions imposed on tobacco. Health officials are worried that will translate into a surge of young people being hooked on nicotine.

“The same advertising tactics the tobacco industry used years ago to get kids addicted to nicotine are now being used to entice a new generation of young people to use e-cigarettes,” said CDC Director Tom Frieden. “I hope all can agree that kids should not use e-cigarettes.”

The CDC is concerned about the health effects of nicotine on young, developing bodies. In 2014, e-cigarettes became the most commonly used tobacco product among youths, surpassing conventional cigarettes.

From 2011 to 2014, the CDC said e-cigarette use among high school students soared from 1.5% to 13.4%, and among middle school students from 0.6% to 3.9%.

Spending on e-cigarette advertising rose from $6.4 million in 2011 to an estimated $115 million in 2014, the CDC said.

Regulations still in the works

The Food and Drug Administration (FDA) has the authority to regulate e-cigarettes, but is still in the final stages of that process. The FDA's official position is that many of the potential risks are unknown. It also says it is unknown whether the products have any potential benefit.

However, the BBC reported Monday that health authorities in the UK have approved a brand of e-cigarette as an aid to help people stop smoking. That means Britons could get a prescription for e-cigarettes through the government-run National Health Service.

Public Health England says e-cigarettes are far less harmful than tobacco and help smokers quit.

The Food and Drug Administration (FDA) is in the process of finalizing rules to regulate e-cigarettes, and just about everyone who has been following the process assumes the rules will ban sales to people under 18.

When that happens, the focus will next shift to whether e-cigarette marketing is targeting young people who aren't allowed to buy the product. In fact, it already has.

You may recall that tobacco companies were accused of using youth-oriented marketing gimmicks during the 1980s and 90s. A new report suggests e-cigarette marketers are turning to social media to reach their most lucrative market.

Unfortunately for health officials, researchers at Drexel University and the University of Southern California suggest it is next to impossible to contain social media marketing.

Influential tweets

"As public health researchers our job is to figure out whether people are seeing messages that might lead them to make unhealthy decisions," Kar-Hai Chu, the study's author, said in a release. "If an e-cigarette tweet reaches underage users and makes them curious about trying e-cigarettes, that is something we would want to know. The results of the study could help provide guidelines and advice for many potential regulations."

Social media has changed the game for all marketers, not just those selling e-cigarettes. Companies can easily used social media platforms to extend the reach of their advertising. Not only that, they can more narrowly target their message to a specific audience and track its reception.

The problem the study authors see is that once an ad message goes beyond its primary target and is picked up by social media, anyone can see it, regardless off their age. It doesn't have to “go viral” to have major impact. Policymakers, the study says, need to understand that before finalizing regulations governing advertising.

Internet a major advertising medium

The Centers for Disease Control and Prevention (CDC) has noted that 39.8 percent of teens who are exposed to e-cigarette advertising see it on the internet, especially on social media sites like Twitter.

"We chose Twitter because hundreds of millions of people all over the world use it to express their opinions about important topics, so it's a huge source of information and a quick and efficient way for researchers to learn about those opinions," Chu said. "A fascinating thing about Twitter is that users choose which messages they think are important to pass on to their friends. From a marketing perspective, companies and brands are very active on Twitter, including Blu, the brand we chose for this study."

The study followed three months of Twitter traffic, originating with tweets from the Blu e-cigarette company's official handle "@blucigs." As researchers expected, followers of @bluecigs spread the messages to others within their networks through retweets.

"The retweet network in our data demonstrated how rapidly and widely messages diffused--reaching an exponential number of users," said Christopher Yang, a professor in Drexel's College of Computing & Informatics, who was a co-author of the paper.

More important, he said, by the second level of followers, researchers saw a big shift in the types of users who were seeing the messages. After three months, a single tweet that originally went out to just 214 followers ended up through retweets reaching 2,600 unique users.

E-cigarettes have been losing much of their initial luster as a safer alternative to tobacco as one study after another finds some new problem with the electronic nicotine burners. 

The latest is something of a shocker: researchers say e-cigarettes appear to increase the virulence of drug- resistant and potentially life-threatening bacteria, while decreasing the ability of human cells to kill these bacteria.

"As health care professionals, we are always being asked by patients, "Would this be better for me?" lead investigator Laura E. Crotty Alexander, M.D., said. "In the case of smoking e-cigarettes, I hated not having an answer. While the answer isn't black and white, our study suggests a response: even if e-cigarettes may not be as bad as tobacco, they still have measurable detrimental effects on health."

Crotty Alexander and other researchers at the VA San Diego Healthcare System (VASDHS) and the University of California, San Diego (UCSD), tested the effects of e-cigarette vapor on live methicillin-resistant Staphylococcus aureus (MRSA) and human epithelial cells.

MRSA commonly colonizes the region of the nasal passage where the bacteria and the cells that line the passage are exposed constantly to inhaled substances such as e-cigarette vapor and cigarette smoke.

"The virulence of MRSA is increased by e-cigarette vapor," Crotty Alexander said. Exposure to e-cigarette vapor increased the virulence of the bacteria. However, she added, the vapor did not make the bacteria as aggressive as cigarette smoke exposure did in parallel studies her group conducted.

Early warnings, not much action

Scientists have been warning of potential health hazards in e-cigs for years but the popularity of the devices has continued to grow amid light regulation.

In 2010, researchers at UC-Riverside concluded that e-cigarettes are potentially harmful and urged regulators to consider removing e-cigarettes from the market until their safety is adequately evaluated.

Last month, a CDC study reported that calls to poison control centers shot up from 1 per month in September 2010 to 215 per month in February 2014. The number of calls per month involving conventional cigarettes did not show a similar increase during the same time period.

Also in April, a study published in the academic journal Clinical Cancer Research finds that the vapor from e-cigarettes damages human cells in much the same way as the smoke from traditional cigarettes. Scientists at Boston University grew a batch of human bronchial cells in the presence of e-cig vapor and another batch in the presence of tobacco smoke. The result: the two batches of cells showed similar patterns of gene expression, which can cause the mutations that lead to cancer.

In March, a University of California San Francisco study found that e-cigs may be a new route to conventional smoking and nicotine addiction. UCSF researchers found that adolescents who used the devices were more likely to smoke cigarettes and less likely to quit smoking. 

Study details

To conduct the e-cigarette vapor experiment, the researchers grew MRSA in culture with vapor concentrations similar to inhalers on the market. They tested first for biochemical changes in the culture known to promote pathogen virulence and then introduced epithelial cell- and alveolar macrophage-killing assays.

The researchers looked at five factors that contribute to MRSA virulence: growth rate, susceptibility to reactive oxygen species (ROS), surface charge, hydrophobicity and biofilm formation. In particular, e-cigarette vapor led to alterations in surface charge and biofilm formation, which conferred greater resistance to killing by human cells and antibiotics.

Crotty Alexander said that one possible contribution to the increased virulence of MRSA was the rapid change in pH induced by e-cigarette vapor. Exposure changed the pH from 7.4 up to 8.4, making the environment very alkalotic for both bacterial and mammalian cells. This alkalosis stresses the cells, giving them a danger signal, leading to activation of defense mechanisms. The bacteria make their surface more positively charged, to avoid binding by the lethal antimicrobial peptides produced by human innate immune cells. The bacteria also form thicker biofilms, increasing their stickiness and making MRSA less vulnerable to attack.

These changes make MRSA more virulent. However, when MRSA is exposed to regular cigarette smoke, their virulence is even greater.

Cigarette smoke induces surface charge changes 10-fold greater than that of e-cigarette exposure, alters hydrophobicity and decreases sensitivity to reactive oxygen species and antimicrobial peptides.

In a mouse model of pneumonia, cigarette smoke exposed MRSA had four-times greater survival in the lungs, and killed 30% more mice than control MRSA. E-cigarette vapor exposed MRSA were also more virulent in mice, with a three-fold higher survival.

Unfortunately, while e-cigarette vapor is increasing bacterial virulence, Crotty Alexander has found that the vapor is also decreasing the ability of human epithelial cells to kill pathogens.

The study was presented at the 2014 American Thoracic Society International Conference.