Mayo received approval by the United Network for Organ Sharing (UNOS) to launch a lung transplant program that will treat patients with serious pulmonary disorders, with the goal being to improve their longevity and quality of life. UNOS, the national nonprofit organization that oversees the U.S. organ transplant systems, signifies that a hospital program meets all the institutional and personnel requirements to perform lung transplants.

The lung transplant program is led by Octavio Pajaro, M.D., Ph.D., surgical director, and Ramachandra Sista, M.D., medical director. Together they lead a multidisciplinary team that also includes specialists in nursing, immunology, social work, respiratory therapy, pharmacy, dietary, transplant infectious diseases and other disciplines.

“An integrated, multidisciplinary team is necessary because potential lung transplant recipients can have multiple medical problems and need to undergo a complex operation—most often requiring transplantation of both lungs,” according to Dr. Pajaro.  “The surgery requires two experienced surgical teams working in close communication to prepare, procure and transport the donor lungs safely, while the implanting team removes the diseased lungs and prepares the recipient for the actual transplantation.”

Dr. Sista noted that “A multidisciplinary, advanced lung disease program is pivotal to drive a successful lung transplant program. It is critical that individuals with a variety of lung afflictions be referred to a dedicated lung transplant center, earlier rather than later, so they would not miss a chance for the necessary testing and a timely lung transplantation procedure, if deemed eligible.”

The addition of lung transplants at Mayo Clinic in Arizona supports the long-standing success of transplantation care for patients  across Mayo’s three sites— Arizona, Florida and Minnesota.

Currently, more than 1,500 people in the U.S. are awaiting a lung transplant.

###

About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to medical research and education, and providing expert, whole-person care to everyone who needs healing. For more information, visit http://www.mayoclinic.org/about-mayo-clinic or http://newsnetwork.mayoclinic.org/.

A release from the university explains that the study looked at how often survivors of lung and esophageal cancer went through a kind of imaging called positron emission tomography (PET) scanning as the primary way of monitoring their condition instead of as a backstop to other kinds of scans.

PET scans are expensive but potentially powerful. They let doctors see increased activity by cells inside the body – including fast-growing cancer cells – and can do so early. Many cancer patients receive PET scans as part of diagnosis, to see how advanced their cancer is, and to see how it’s responding to treatment.

But the scans aren’t recommended as the first option for long-term monitoring to watch for recurrence.

In fact, it’s one of the few imaging tools for which the Medicare system imposes limits – currently, three follow-up PET scans per person, even when doctors only order them after spotting something on a CT scan or other medical image.

Too much, too varied?

Despite this, the researchers from the University of Michigan Medical School and Dartmouth-Hitchcock found widespread use when they looked at Medicare data for more than 100,000 lung and esophageal cancer patients who had cancer in the mid-2000s and follow-up care through 2011.

More than 22 percent of the lung cancer patients, and 31 percent of the esophageal cancer patients, had at least one PET scan to look for a cancer recurrence during their follow-up period, without first having a CT scan or other imaging.

Hospitals varied widely in how often they used this approach, from nearly never at some to a majority of the time in others. Some hospitals used it eight times more often than others.

And no matter how often they used it, the result was the same: patients who went to a high PET-use hospital for their lung cancer follow-up were just as likely to survive two years as those who went to a low PET-use hospital.

The release quotes Mark Healy, M.D., a surgical resident and research fellow at the U-M Department of Surgery and member of the Center for Health Outcomes & Policy, as saying, “PET scanning is a great technology and very effective, but using it in this way doesn’t seem to make any difference for these cancers that have a relatively poor prognosis. The appropriate use of PET scanning in follow-up care for lung and esophageal cancer is after findings on lower-cost imaging options.”

National guidelines call for this type of use, but the new findings suggest they are not being followed.

In addition, says Healy, “Our work shows that almost no one is getting to the three-scan limit set by Medicare. But, with many thousands of patients getting one or two scans across the whole country, this is still a very large number, with very high costs. If the intention of the policy is to curb overuse, this doesn’t seem to be a very effective method, and the agency should reevaluate how it structures its limits.”

Better coordination between radiologists and the physicians who care for cancer patients after their treatment might also improve appropriateness, Healy comments.

More about the study and next steps

Healy and senior author Sandra L. Wong, M.D., M.S., chair of surgery at Dartmouth and a former U-M researcher, used Surveillance, Epidemiology, and End Results (SEER) and Medicare-linked data to perform the study.

The data come from hundreds of hospitals nationwide, but the individual hospitals can’t be identified under the terms of the data use.

Healy and his colleagues have found the same effect in pancreatic cancer; they’ve shared those results at national conferences.

They hope their findings will help providers of all kinds understand the best use of PET scanning in cancer care, and patients as well.

“Following evidence-based guidelines for clinical follow-up is the way to go. Don’t order PET in asymptomatic patients,” says Healy. “And for patients, if you are not having symptoms and you’re doing well, there’s no reason to seek out this scan.”

###

In addition to Healy and Wong, the study’s authors are Huiying Yin of CHOP, and Rishindra Reddy of the U-M Department of Surgery. The study was funded by the National Institutes of Health (CA009672), the Agency for Healthcare Research and Quality (HS20937) and the American Cancer Society.

This according to a study by Mayo Clinic researchers published in the Journal of Thoracic Oncology. “A decline in smoking rates has been, and continues to be, a critical step to reduce lung cancer risk and deaths,” says the study’s lead author Ping Yang, M.D., Ph.D., an epidemiologist at Mayo Clinic Cancer Center. “But, it also means that fewer people have benefited from early detection of lung cancer, because more patients don’t qualify for low-dose CT scans.” The current lung cancer screening criteria set by the U.S. Preventive Services Task Force (USPSTF) recommends CT screening for adults between the ages of 55 and 80 who have smoked at least one pack a day for 30 years and are still smoking, or have quit within 15 years.

In a study published in JAMA in 2015, Dr. Yang and her colleagues found that two-thirds of patients in the U.S. with newly diagnosed lung cancer would not meet the current USPSTF screening criteria, suggesting a need to adjust the definition of patients at high risk.

In the current study, Dr. Yang and her colleagues set out to identify which specific populations of individuals are at risk, but are being missed by the current lung cancer screening criteria. Researchers retrospectively tracked two groups of people with lung cancer: a hospital cohort made up of 5,988 individuals referred to Mayo Clinic and a community cohort consisting of 850 residents of Olmsted County, Minnesota.

They found that, compared to other risk categories, patients who quit smoking for 15 to 30 years accounted for the greatest percentage of patients with lung cancer who didn’t qualify for screening.

The newly defined high-risk group constituted 12 percent of the hospital cohort and 17 percent of the community cohort.

“We were surprised to find that the incidence of lung cancer was proportionally higher in this subgroup, compared to other subgroups of former cigarette smokers,” says Dr. Yang. “The common assumption is that after a person has quit for so many years, the lung cancer rate would be so low that it wouldn’t be noticeable. We found that assumption to be wrong. This suggests we need to pay attention to people who quit smoking more than 15 years ago, because they are still at high risk for developing lung cancer.”

Equally important, the current study found that expanding the criteria for CT screening would not significantly add to the number of false-positive cases and would save more lives with an acceptable amount of radiation exposure and cost. Dr. Yang and her colleagues showed that expanding the criteria to include this risk category could add 19 percent more CT examinations for detecting 16 percent more cases. They calculated the expansion would result in minimal increases in false-positive results (0.6 percent), over diagnosis (0.1 percent), and radiation-related lung cancer deaths (4 percent).

“Lung cancer rates are dropping, because smoking is decreasing, but that doesn’t mean that our current screening parameters are good enough,”

Dr. Yang says. “It is understandable, because the relative importance of risk factors changes over time. We need to adjust screening criteria periodically, so we can catch more lung cancers in a timely fashion. Based on our data, which are more recent and come from a well-defined population, I think that we should take action to screen this group, which is at high risk of developing the disease.”

She recommends additional research to confirm if similar trends are being seen in populations beyond Olmsted County Minnesota.  If confirmed, she recommends that policymakers consider changing the lung cancer screening guidelines to include people who quit smoking more than 15 years ago. She also recommends that policymakers continue to re-examine lung cancer screening criteria to account for changes in groups that are most at risk.

But the secondhand-smoke problem persists in private homes where each family sets its own rules. While the family smoker sometimes is banished to the patio, that’s not always the case.

And if the smoker is filling the house with fumes, the health of everyone who lives there could suffer, according to the federal Centers for Disease Control (CDC). That’s why getting the smoker in your life to quit could be the best New Year’s resolution you come up with for 2016, says Dr. Gregory L. Jantz, a mental health expert and certified addiction specialist who is the founder of A Place of Hope, a counseling center near Seattle.

“There are many reasons why smokers should make an effort to quit,” Jantz says. “But certainly near the top of the list is the health of the people around them.”

Since 1964, about 2.5 million nonsmokers have died from health problems caused by exposure to secondhand smoke, according to the CDC.

In children, secondhand smoke can cause ear infections; more frequent and severe asthma attacks; respiratory symptoms, such as coughing, sneezing, and shortness of breath; respiratory infections, such as bronchitis and pneumonia; and a greater risk for sudden infant death syndrome, the CDC reports.

Adults who never smoked also aren’t immune to the effects of secondhand smoke, the CDC reports. They can suffer from heart disease, lung cancer and stroke.

The good news is that secondhand-smoke exposure has decreased over the years.

From 1988 to 1991, about 88 percent of nonsmokers who were tested showed evidence of being exposed to secondhand smoke. That had dropped to 25 percent by 2011-12, the CDC reported.

“That’s a move in the right direction, and it would be great to see that percentage continue to drop,” Jantz says.

Here are a few steps anyone can take toward making their homes smoke free in the coming year:

• The organization Americans for Nonsmokers Rights recommends posting a sign on your front door to notify visitors that your home is smoke free. The group also suggests you let all caregivers and babysitters know that they are not to smoke in or around your home, and that you request any smokers who live in the house to smoke outdoors, away from entrances and windows.
• Recognize that the smokers in your life face a difficult task if they try to quit, Jantz says. Encourage them to gradually wean themselves off the cigarette habit. Various products on the market can help, such as nicotine patches, though the success rate isn’t high. Smokers can also try a product that has a higher success rate and doesn’t require nicotine replacement, such as NicoBloc (www.nicoblocusa.com), a solution that is placed on the cigarette filter and blocks most of the tar and nicotine intake, allowing the smoker to quit over time. NicoBloc also reduces the amount of secondhand smoke from the cigarette.
• Don’t stop with just the house. You also can make any family vehicles smoke free, further reducing the time family members might be exposed to secondhand smoke.

“Nicotine addiction can be stubborn,” Jantz says. “When people have multiple addictions, it’s often the last one they are able to kick. But don’t be discouraged. People do quit, and if there are smokers in your life and in your home, they can quit, too.”

A release from the publisher explains that scientists are looking to the brain to understand why setting a “quit day” isn’t a surefire way to rid oneself of a cigarette habit. Recent neuroimaging studies have shown that smokers have less activity in the brain regions associated with self-control, raising questions around whether targeting these neurobiological circuits could be a way to treat addiction.

The release quotes senior study author Nora Volkow, Director of the U.S. National Institute on Drug Abuse, as saying, “We are interested in trying to probe how repeated use of drugs ultimately influences our ability to control our desires. We are starting to work through how drugs affect areas of the brain that normally enable us to self-regulate, to create goals and to be able to achieve them, and how those changes influence the behavior of the person addicted.”

One study highlighted in the review explored how improving self-control can help smokers with their cravings. Texas Tech University and University of Oregon researchers recruited 60 undergraduate students (27 cigarette smokers and 33 nonsmokers) to participate in an integrative body-mind training program that included relaxation training techniques. Each of the students came into the program expecting to learn meditation and relaxation techniques for stress reduction and cognitive improvement. The students were split into two groups so that half received mindfulness meditation training (e.g., becoming self-aware of one’s experience) and half received relaxation technique (e.g., relaxing muscle group).

Before and at the end of 2 weeks, after 5 hours of 30 minute sessions, the students received brain scans, filled out self-report questionnaires, and received objective measure of carbon monoxide on their smoking amounts and habits. Even though many of the students said they smoked the same number of cigarettes before and after the training, for those who received mindfulness meditation, an objective measure of carbon dioxide percentage in their lungs showed a 60 percent reduction in smoking over 2 weeks after the study.

“The students changed their smoking behavior but were not aware of it,” says lead study author Yi-Yuan Tang, a Professor of Psychological Sciences at Texas Tech. “When we showed the data to a participant who said they had smoked 20 cigarettes, this person checked their pocket immediately and was shocked to find 10 left.”

“We then measured intention to see if it correlated with smoking changes and found there was no correlation,” he says. “But if you improve the self-control network in the brain and moderate stress-reactivity, then it’s possible to reduce smoking.”

Other studies showed how integrative body-mind training could decreases participant’s levels of the stress hormone cortisol, as well as increase immune reactivity. Specific changes in the brain have also been identified, showing stronger connectivity between regions linked to self-control.

Mindfulness meditation is of course one strategy to strengthen self-control. While this is early evidence that such programs can change the brain so people are less motivated to smoke, there are still unanswered questions about how often this therapy would need to be conducted, how long the benefits last, and whether some individuals benefit more than others. We also need to learn whether such treatments can be applied to other forms of addiction, such as over-eating or drinking.

“Even though one therapy works on something, you cannot say this therapy is better than others,” Tang says. “We can only get a full picture through systematic research and practice but I think this is a field with a lot of promise and that we should be open minded.”

“Mindfulness meditation, as well as other strategies that are aimed at strengthening self-control, are likely to be useful for the management of addiction, but not necessarily for everybody,” Volkow adds. “However, understanding how our brain works when we do interventions that strengthen self-control can also have multiple implications that relate to behaviors that are necessary for health and well-being.”

COPD, the third most common cause of death in the United States, describes a group of lung conditions that severely impact the breathing of nearly 15 million people in the U.S. (or six percent of the population) and more than 65 million worldwide.

According to a study conducted by the organization Health Union, only 38% of respondents were aware of COPD or its risk factors prior to their diagnosis. Almost one-third did not know their initial or current diagnosis stage. And at diagnosis about two-thirds wished they knew more about the potential impact of COPD and how to stop or slow down its progression. “I think if asked, most people actually realize that smoking causes disease. However, the survey reveals that important information about the variety and severity of these types of disease is not reaching those at risk for COPD,” says Leon C. Lebowitz, respiratory therapist and COPD.net moderator. “When armed with information, patients do take steps to change their lives. The survey shows that post diagnosis 68% of those that were current smokers quit and an additional 15% were trying to quit smoking. That’s huge.”

COPD clearly affects all aspects of life. Eighty-seven percent of respondents with COPD say they were unable to do as much as they could prior to acquiring the disease, with 32% needing some form of help from a caregiver. In addition, respiratory infections, high blood pressure, and depression were frequently experienced among respondents.

COPD and the accompanying breathing difficulties can make everyday physical activities like walking and even talking extremely difficult. There is currently no known way to undo the damage to the lungs.

“This survey illustrates the need for more COPD awareness and education amongst the general public and patients as well,” said Tim Armand, president and co-founder of Health Union. “As the incidence of COPD continues to grow, hopefully educational efforts like COPD in America and the new COPD.net website can bridge the information gap and ultimately improve care.”

The COPD In America survey was conducted online in April of 2015 with 1,009 respondents who were diagnosed with chronic obstructive pulmonary disease and were U.S. citizens either living in the U.S. or abroad.

Avoid Bars and Alcohol

This might seem hard to do during the New Year’s festivities, but it’s better to skip a few social engagements than engage in a dangerous and possibly fatal habit! Alcohol and tobacco are often linked in people’s minds, and even one or two drinks could tempt you to go back. The SeniorHealth experts recommend finding other activities that make you feel good – and don’t tempt you to smoke. Spending time with family and friends at a non-alcoholic gathering is a great way to kick off 2015

Keep Moving

Find a way to stay physical even in cold weather – join a gym, go mall walking. According to the SeniorHealth experts, people who are more active look younger and stay fitter than those who aren’t exercising. Activity can also help you stay away from cigarettes by keeping you occupied, and by helping to reduce stress. Ask your doctor what kind of exercise is best for you.

Strategize for Traveling

Whether you’re traveling to see family or for business, you should plan ahead to avoid temptations to smoke during your trip. Ask for a nonsmoking room, the SeniorHealth experts say. If you’ve

Traveling for pleasure can be an enjoyable way to spend time. Traveling for work may be mixed with stress and rewards. Whether you travel for business or pleasure, prepare yourself for unexpected smoking temptations. Learn stress-reduction techniques – deep breathing, meditation – so you can cope with the frustrations and delays of travel. The SeniorHealth experts also suggest carrying an index card that lists your reasons for quitting, so you can read it in moments of temptation.

Remember, the SeniorHealth experts say, you should take it one day at a time and remember that it will get easier to be smoke free. They suggest the following affirmations to get you through the rough periods:

All I have to do is just not smoke today.

I can do anything for this one day.

Nothing will be too much for me.

I can even break the day down into each of its 24 hours if the struggle demands it.

I can survive 60 minutes at a time without a cigarette.

I will do whatever I need to, to live without a cigarette today.

They also suggest a technique called “the one-minute vacation”:

1. Take a deep, slow breath through your nose.

2. Picture yourself in your favorite restful spot.

3. Exhale slowly, holding that scene in your mind.

4. As you continue to think of that scene, focusing on feeling your neck and shoulder muscles relax.

5. Open your eyes, feel refreshed, and repeat as often as you like.

For more information, visit http://nihseniorhealth.gov/.

Breast Cancer

BRCA 1 and 2 Genes

The agency experts recommend that you consider a genetic test for these breast-cancer genes if you have a family member with breast, ovarian, or peritoneal cancer. You might benefit from genetic counseling and taking the test. Go here for more information: http://www.cancer.gov/cancertopics/factsheet/Risk/BRCA.

Mammogram

Talk with your health care team about how often you need a mammogram. The answer may depend on your age, family health history or personal health history. To learn more about what a mammogram involves, visit http://womenshealth.gov/publications/our-publications/fact-sheet/mammograms.html

Cervical Cancer

Get a Pap smear every 3 years or get a combination Pap smear and human papilloma virus (HPV) test every 5 years until age 65, the SeniorHealth experts say.  Guidelines on this test have been changing, so be sure to ask your health care provider for the latest information.

Colon Cancer

You should have a screening test for colon cancer between the ages of 50 and 75. The SeniorHealth experts emphasize that there are several different kinds of screenings, including blood tests and colonoscopies. Your doctor can help you choose one.  If you are over 75, talk with your doctor about whether you should continue the screenings. Visit here to learn more: http://www.nlm.nih.gov/medlineplus/ency/article/002071.htm

Depression

It’s as important to monitor your emotional health as it is your physical health. You should talk to your health care providers, the SeniorHealth experts say, if you have experienced, over the last two weeks, feelings of sadness or hopelessness and felt no pleasure or interest in activities. Go to this link to learn more about depression and older adults:  http://nihseniorhealth.gov/depression/aboutdepression/01.html

Diabetes

Ask your doctor if you should be screened for this autoimmune disease, which can affect vital organs including the heart, brain and kidneys. Visit here to learn more: http://diabetes.niddk.nih.gov/dm/pubs/diagnosis/index.aspx.

Hepatitis C Virus (HCV)

The SeniorHealth experts recommend that you get screened once for HCV infection if

you were born between 1945 and 1965

you have ever injected drugs

you received a blood transfusion before 1992.

If you currently are an injection drug user, get regular screenings. To learn more about hepatitis C screening, go here: http://www.cdc.gov/hepatitis/hcv/pdfs/hepctesting-diagnosis.pdf.

High Blood Cholesterol

Expserts advise a regular blood-cholesterol check if you smoke; are overweight or obese; have a personal history of heart disease or blocked arties; or have a male relative who had a heart attack before age 50 or a female relative before age 60.

For more information about high blood cholesterol, visit http://www.nhlbi.nih.gov/health/health-topics/topics/hbc/diagnosis.

High Blood Pressure

Have your blood pressure checked at least every 2 years, the SeniorHealth experts say. High blood pressure (hypertension) can cause strokes, heart attacks, kidney and eye problems, and heart failure. Here are the basics of a blood-pressure test: http://www.nhlbi.nih.gov/health/health-topics/topics/hbp/diagnosis.

HIV

People 65 or under should get an HIV screening. If you are older than that, ask your health care provider if it’s the right thing for you. Here is some information about HIV testing: http://www.aids.gov/hiv-aids-basics/prevention/hiv-testing/hiv-test-types/.

Lung Cancer

A lung-cancer screening could be in order if you’re between the ages of 55 and 80, have a 30 pack-year smoking history, and smoke now Talk to your doctor or nurse about getting screened for lung cancer if you are between the ages of 55 and 80, have a 30 pack-year smoking history, and smoke now or have quit within the past 15 years. (According to the SeniorHealth experts, your pack-year history is the number of packs of cigarettes smoked per day times the number of years you have smoked.) Learn more about lung cancer screening tests: http://nihseniorhealth.gov/lungcancer/faq/faq16.html.

Osteoporosis

The SeniorHealth experts recommend having a screening at age 65 to evaluate the strength of your bones. The most common test is a DEXA scan — a low-dose x-ray of the spine and hip. Women who are younger than 65 and at high risk for bone fractures, you should be screened. Here’s more information about DEXA scans: http://www.nlm.nih.gov/medlineplus/ency/article/007197.htm.

Overweight and Obesity

You can find your body mass index (BMI) by entering your height and weight into a BMI calculator, such as the one available at: http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm. A BMI between 18.5 and 25 indicates a normal weight. People with a BMI of 30 or higher could be obese. Talk to your doctor or nurse about getting changing your behaviors to lose weight, since overweight or obesity can lead to diabetes and heart disease.

Sexually Transmitted Infections

Ask your health care providers if you should have a screening test for infections such as gonorrhea and chlamydia. Learn more: http://womenshealth.gov/publications/our-publications/fact-sheet/gonorrhea.html#e and http://womenshealth.gov/publications/our-publications/fact-sheet/chlamydia.html#d.

Vision Disorders

Have a dilated eye exam at least once a year, the NIH experts say, if you’re 60 or older. You may need more frequent checkups if you’re at risk for an age-related eye disease or if you have one already. Learn what a comprehensive dilated eye exam involves: http://nihseniorhealth.gov/healthyeyes/eyeexam/01.html.

Other Tests

Be sure to alert your doctor or nurse about any change in your health. Ask them if you should be tested to find out the cause of that change.

For more information about other senior-health issues, visit http://nihseniorhealth.gov/.

The findings were published in the journal Libertas Academica.

The treatment the researchers focused on is gefitinib, a drug that’s already used to treat other kinds of cancer. The study looked at the effect of the drug on patients with non-small cell lung cancer, which does not have many treatment options.

Non-small-cell lung cancer is any type of lung cancer other than small-cell lung cancer—the most common type of the illness.

For the study, researchers looked at 12 patients who had advanced non-small cell lung cancer. The patients had a poor prognosis but hadn’t undergone chemotherapy. The investigators evaluated the participants in terms of the response rate to gefitinib as well as progression-free survival, overall survival and quality of life.

The average age of the patients evaluated was 69 years, and the average length of treatment was about 62 days.

The researchers found that the average overall survival for the population evaluated was almost five months. Progression-free survival was about three months, and quality of life scores were higher in African Americans than they were in Caucasians and older patients.

“Gefitnib is an overall active and well-tolerated therapy for this subgroup of patients with a poor prognosis and was found to improve quality of life,” says Nagla Karim, MD, PhD, associate professor in the division of hematology oncology at the UC College of Medicine. “In spite of the small number of patients in the study, our results suggest that older patients and those who were African Americans had higher quality of life scores and felt this treatment improved their outcomes. This study may provide evidence that gefitnib could be an option for therapy in this subgroup of patients for which chemotherapy is not recommended.”

This study is funded in part by AstraZeneca, which markets gefitinib under the trade name Iressa. Karim cited no conflict of interest.

Based on the current evidence, the association’s position is that e-cigarettes that contain nicotine are tobacco products and should be subject to all laws that apply to these products. The association also calls for strong new regulations to prevent access, sales and marketing of e-cigarettes to youth, and for more research into the product’s health impact.

A release from the association quotes Nancy Brown, CEO, as saying, “Over the last 50 years, 20 million Americans died because of tobacco. We are fiercely committed to preventing the tobacco industry from addicting another generation of smokers,” said Nancy Brown, CEO of the American Heart Association. “Recent studies raise concerns that e-cigarettes may be a gateway to traditional tobacco products for the nation’s youth, and could renormalize smoking in our society. These disturbing developments have helped convince the association that e-cigarettes need to be strongly regulated, thoroughly researched and closely monitored.”

“E-cigarettes have caused a major shift in the tobacco-control landscape,” said Aruni Bhatnagar, Ph.D. FAHA, lead author and chair of cardiovascular medicine at the University of Louisville. “It’s critical that we rigorously examine the long-term impact of this new technology on public health, cardiovascular disease and stroke, and pay careful attention to the effect of e-cigarettes on adolescents.”

The policy statement recommends a federal ban on e-cigarettes for minors and details concerns that these products may be another entry point for nicotine addiction among young people. The authors cite one JAMA Pediatrics study of 40,000 middle and high school students that indicated adolescents consider e-cigarettes as high-tech, accessible and convenient, especially in places where smoking cigarettes is not allowed.

Echoing its recent comment letter on the Food and Drug Administration’s proposed tobacco oversight rule, the association recommends strict laws that curb the intense marketing and advertising of e-cigarettes, and ban flavorings in these products.

Ads using celebrities and alluring flavors make the products more appealing to children and adolescents. A recent Pediatrics study cited youth exposure to e-cigarettes advertising skyrocketed over 250 percent from 2011 to 2013, effectively reaching 24 million young people.

“In the years since the FDA first announced it would assert its authority over e-cigarettes the market for these products has grown dramatically,” Brown said. “We fear that any additional delay of these new regulations will have real, continuing public health consequences. Hence, we urge the agency to release the tobacco deeming rule by the end of this year.”

In addition to federal oversight of e-cigarettes, the association guidance also examines state smoke-free laws in relation to these products. While the toxic substances in e-cigarettes are lower than those in cigarette smoke, non-smokers could be involuntarily exposed to nicotine in any confined space where e-cigarettes are used. Unregulated e-cigarettes could potentially turn back the clock to the days when smoking in public was normal behavior, undoing years of work on smoke-free laws and hampering current enforcement. Given these concerns, the association supports including e-cigarettes in these state laws, if the change can be made without weakening existing laws.

Another key recommendation examines e-cigarettes in tobacco-cessation counseling. The statement points to the lack of evidence establishing e-cigarettes as a primary smoking-cessation aid. Some studies suggest that the use of e-cigarettes to help smokers quit may be equal or be slightly better than nicotine patches. The association will continue to encourage clinicians to use proven smoking-cessation strategies as the first line of treatment for any patient. But it reiterates in the statement that when repeated efforts with conventional treatment fails, is intolerant, or rejected by a patient who wants to utilize e-cigarettes to help them quit, clinicians should not discourage their use by the patient.

However, the statement stresses that clinicians be educated so they can inform patients that e-cigarettes are unregulated, may contain low levels of toxic chemicals, and have not been FDA-approved as cessation devices. The association also proposes that given the lack of long-term research studies on e-cigarette safety that it’s appropriate for a health care professional to suggest that a patient set a quit date for their e-cigarette use.

Finally in the new statement, the association calls for comprehensive and continuous research on e-cigarettes’ use, their characteristics, their marketing, and their long-term health effects on individual users, the environment, and public health.

“Nicotine is a dangerous and highly addictive chemical no matter what form it takes – conventional cigarettes or some other tobacco product,” said association President Elliott Antman, M.D. “Every life that has been lost to tobacco addiction could have been prevented. We must protect future generations from any potential smokescreens in the tobacco product landscape that will cause us to lose precious ground in the fight to make our nation 100 percent tobacco-free.”