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.

If you are a cigarette smoker, would you give up the real thing for one of those electronic jobs? A lot of people have tried them.

A study released the Centers for Disease Control and Prevention (CDC) found that about 21% of adults who smoke traditional cigarettes had used e-cigarettes in 2011, compared with about 10 percent in 2010.

Overall, about six percent of all adults have tried e-cigarettes, with estimates nearly doubling from 2010. The study is the first to report changes in awareness and use of e-cigarettes between 2010 and 2011.

Moving to e-smokes

During 2010–2011, adults who have used e-cigarettes increased among both sexes, non-Hispanic whites, those aged 45–54 years, those living in the South, and current and former smokers and current and former smokers.

In both 2010 and 2011, e-cigarette use was significantly higher among current smokers compared to both former and never smokers. Awareness of e-cigarettes rose from about four in 10 adults in 2010 to six in 10 adults in 2011.

“E-cigarette use is growing rapidly,” said CDC Director Tom Frieden, MD, MPH. “There is still a lot we don’t know about these products, including whether they will decrease or increase use of traditional cigarettes.”

Is it safer?

Although e-cigarettes appear to have far fewer of the toxins found in smoke compared with traditional cigarettes, the impact of e-cigarettes on long-term health must be studied. Research is needed to assess how e-cigarette marketing could impact initiation and use of traditional cigarettes, particularly among young people.

“If large numbers of adult smokers become users of both traditional cigarettes and e-cigarettes -- rather than using e-cigarettes to quit cigarettes completely -- the net public health effect could be quite negative,” said Tim McAfee, MD MPH, director of the Office on Smoking and Health at CDC.

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." 

There's been a huge increase in the last few years in the number of calls to poison centers involving e-cigarette liquids containing nicotine.

A CDC study published in the agency's Morbidity and Mortality Weekly Report says calls shot up from 1 per month in September 2010 to 215 per month this past February. And, the report says, the number of calls per month involving conventional cigarettes did not show a similar increase during the same time period.

Sen. Barbara Boxer (D-Calif.) called the increase in poisoning cases "alarming" and said the report "should serve as a wake-up call to the American people that it is time for the FTC and the FDA to regulate these products to help prevent more tragedies."

"I am particularly concerned that many e-cigarettes are packaged in bright colors and flavored to smell like candy or fruit, which puts children at higher risk of poisoning," Boxer said.

In February, Boxer introduced the Protecting Children from Electronic Cigarette Advertising Act to prohibit the marketing of e-cigarettes to children and teens. 

The trade group for e-cigarette manufacturers, the Smoke Free Alternatives Trade Association (SFATA), said it supports stronger safety measures. In a statement, executive director Cynthia Cabrera said the manufacturers "support federal age restrictions on the purchase of vapor products, childproof caps and proper labeling to safeguard against accidental ingestion of e-liquid by minors or adults."

Kids at risk

More than half (51.1%) of the calls to poison centers due to e-cigarettes involved young children 5 years and under, and about 42% of the poison calls involved people age 20 and older.

The analysis, which compared total monthly poison center calls involving e-cigarettes and conventional cigarettes, found the proportion of e-cigarette calls jumped from 0.3% in September 2010 to 41.7% in February 2014.

Poisoning from conventional cigarettes is generally due to young children eating them. Poisoning related to e-cigarettes involves the liquid containing nicotine used in the devices and can occur in three ways: by ingestion, inhalation or absorption through the skin or eyes.

“This report raises another red flag about e-cigarettes -- the liquid nicotine used in e-cigarettes can be hazardous,” said CDC Director Tom Frieden, M.D., M.P.H. “Use of these products is skyrocketing and these poisonings will continue. E-cigarette liquids as currently sold are a threat to small children because they are not required to be childproof, and they come in candy and fruit flavors that are appealing to children.”

A sweeping study

Data for this study came from the poison centers that serve the 50 states, the District of Columbia, and U.S. Territories. The study examined all calls reporting exposure to conventional cigarettes, e-cigarettes, or nicotine liquid used in e-cigarettes.

Poison centers reported 2,405 e-cigarette and 16,248 cigarette exposure calls from September 2010 to February 2014. The total number of poisoning cases is likely higher than reflected in this study, CDC says, because not all exposures might have been reported to poison centers.

“The most recent National Youth Tobacco Survey showed e-cigarette use is growing fast, and now this report shows e-cigarette related poisonings are also increasing rapidly,” said Tim McAfee, M.D., M.P.H., Director of CDC’s Office on Smoking and Health. “Health care providers, e-cigarette companies and distributors, and the general public need to be aware of this potential health risk from e-cigarettes.”

The report shows that e-cigarette liquids containing nicotine have the potential to cause immediate adverse health effects and represent an emerging public health concern. That, according to CDC, makes developing strategies to monitor and prevent future poisonings critical.

Here's the latest chapter in the continuing debate over whether e-cigarettes are a cure or an affliction: a study from the University of California San Francisco that finds e-cigs may in fact be a new route to conventional smoking and nicotine addiction.

In what is said to be the first analysis of the relationship between e-cigarette use and smoking among adolescents in the United States, UCSF researchers found that adolescents who used the devices were more likely to smoke cigarettes and less likely to quit smoking. The study of nearly 40,000 youth around the country also found that e-cigarette use among middle and high school students doubled between 2011 and 2012, from 3.1 percent to 6.5 percent.

“Despite claims that e-cigarettes are helping people quit smoking, we found that e-cigarettes were associated with more, not less, cigarette smoking among adolescents,” said lead author Lauren Dutra, a postdoctoral fellow at the UCSF Center for Tobacco Control Research and Education.

“E-cigarettes are likely to be gateway devices for nicotine addiction among youth, opening up a whole new market for tobacco,” she said. The study was published online on March 6 in JAMA Pediatrics.

A trade group took issue with the study, saying it "is implying conclusions that simply aren't borne out by the data."

In a prepared statement, Cynthia Cabrera, Executive Director, Smoke Free Alternatives Trade Association (SFATA), said: "As the survey summary itself states, it wasn't designed to derive any insight about motivation or a possible causal relationship between use of e-cigarettes and combustible cigarettes. What the survey data does show is that cigarette smoking among teens has decreased." 

FDA action expected

The U.S. Food and Drug Administration (FDA) has been considering regulations that could restrict advertising and sales of the popular battery-powered devices, which look like cigarettes and deliver an aerosol of nicotine and other chemicals.

Several states and cities, including New York and Los Angeles, have banned the use of e-cigs, generally treating them as though they were tobacco products. 

In Congress, five U.S. Senators introduced the "Protecting Children from Electronic Cigarette Advertising Act" last month. It would  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,” Sen. Barbara Boxer (D-Calif.) said. “This bill will help protect our children from an industry that profits from addiction.”

Manufacturers promote the devices as safer alternatives to cigarettes and as smoking cessation aids. They are sold in flavors such as chocolate and strawberry that are banned in conventional cigarettes because of their appeal to youth.

Cabrera denied that the e-cig industry is targeting children.

"Our industry does not sell or market to minors, and it is our view that no one under 18 should use electronic cigarettes. Electronic cigarettes and vaping products are intended strictly for adults who smoke cigarettes. We fully support limitations on the sale of these products to youth at retail to further reduce access to anyone under 18," she said.

Students studied

In the new UCSF study, the researchers examined survey data from middle and high school students who completed the National Youth Tobacco Survey in 2011 and 2012.

The authors found that the devices were associated with higher odds of progression from experimenting with cigarettes to becoming established cigarette smokers. Additionally, adolescents who smoked both conventional cigarettes and e-cigarettes smoked more cigarettes per day than non-e-cigarette users.

“It looks to me like the wild west marketing of e-cigarettes is not only encouraging youth to smoke them, but also it is promoting regular cigarette smoking among youth,” said senior author Stanton A. Glantz, PhD, UCSF professor of medicine and director of the Center for Tobacco Control Research and Education.

Contrary to advertiser claims that e-cigarettes can help consumers stop smoking conventional cigarettes, teenagers who used e-cigarettes and conventional cigarettes were much less likely to have abstained from cigarettes in the past 30 days, 6 months, or year. At the same time, they were more likely to be planning to quit smoking in the next year than smokers who did not use e-cigarettes.

The new results are consistent with a similar study of 75,000 Korean adolescents published last year by UCSF researchers, which also found that adolescents who used e-cigarettes were less likely to have stopped smoking conventional cigarettes.

In combination, the two studies suggest that “e-cigarettes may contribute to nicotine addiction and are unlikely to discourage conventional cigarette smoking among youths,” said the scientists.

The federal Centers for Disease Control and Prevention reported last year that the majority of adolescents who have ever smoked e-cigarettes also have smoked regular cigarettes. An estimated 1.78 million U.S. students have used the devices as of 2012, the CDC reported.

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.