USA Today Editorial Board: Raise cigarette sales age and see: Our view

The Editorial Board

When California lawmakers voted this month to raise the legal age to buy cigarettes from 18 to 21, they joined Hawaii and more than 100 localities in seeking a new way to prevent vulnerable teenagers from getting hooked.

Almost everyone who smokes started by age 18, research shows. The tobacco industry, among the world’s slickest marketers, has known and used that fact to its benefit for decades. “Raising the legal minimum age for cigarette purchaser to 21 could gut our key young adult market (17-20) where we sell about 25 billion cigarettes,” a Phillip Morris report noted in 1986.

This suggests that raising the age is worth a try. Gov. Jerry Brown, D-Calif., ought to sign the measure, and careful study is warranted to find out to what degree the change  affects teen smoking.

Parents and public health advocates shouldn’t get their hopes too high. Teenage behavior is unpredictable and resourceful; many teens use fake IDs to buy alcohol and no doubt would do the same for tobacco. But unless a few states make the change, the value can’t be calculated. Right now, all but five states set the legal purchase age at 18. In Alabama, Alaska, New Jersey and Utah, it is 19. Hawaii went to 21 on Jan. 1.

Although smoking rates among high school seniors have fallen drastically, from 33.5% in 1995 to 11.4% last year, that still leaves millions of adolescents addicted and vulnerable in later years to cancer, heart disease and premature death. Raising taxes, running anti-smoking ad campaigns, and making smoking less cool  have worked, but more is needed.

Last year, the respected Institute of Medicine projected that if the legal age were raised to 21, by the time today’s teenagers became adults smoking prevalence would be cut by 12%. The greatest impact, the IOM found, would likely be among teens 15 to 17. Meanwhile, other avenues of getting cigarettes are drying up: Vending machines have all but vanished, and less than 10% of stores sell illegally to minors.

Plenty of reasons exist to try to cut further into youth smoking. Nicotine exposure during adolescence is likely to adversely affect cognitive function and development. Adolescents are more prone to addiction than adults because parts of the brain most responsible for decision-making, impulse control and susceptibility to peer pressure are still developing. As for the health effects, the risks for smoking-related illness rise not only with the number of cigarettes smoked per day but also with the number of years a person smokes.

The most persistent argument against raising the age is that at 18, people have the right to marry, to vote and to serve in the military, so they should be able to choose to smoke. But society does set 21 as the age for another dangerous activity, drinking alcohol — a change that has prevented about 900 drunken driving deaths per year. Smoking is the public’s business, too: Everyone helps pick up the tab for the enormous health care costs of tobacco-related illnesses.

In Finland, daily smoking dropped significantly among 14- to 16-year-olds after the legal age was raised from 16 to 18 and enforcement was bolstered. There’s no comparable research in the United States, which is precisely the point. Given the tobacco industry’s success in getting young people hooked, teenagers deserve to find out whether the U.S. has been missing a powerful tool to save their lives.

USA TODAY’s editorial opinions are decided by its Editorial Board, separate from the news staff. Most editorials are coupled with an opposing view — a unique USA TODAY feature.

http://www.usatoday.com/story/opinion/2016/03/21/cigarettes-21-sales-age-california-hawaii-editorials-debates/81730332/

Dr. Eric Johnson: Tobacco tax will deter young people from using products

By Dr. Eric Johnson, Grand Forks – Jamestown Sun

As a Grand Forks physician and chairman of the recently announced efforts to initiate a ballot measure to increase North Dakota’s tobacco taxes, it’s important the public be given the facts right off the bat.

First, North Dakota’s tobacco taxes have not been increased since 1993, ranking us 47th in the nation for cigarette tax rates. If passed, this measure would bring North Dakota’s cigarette tax from 44 cents per pack to $2.20 per pack, just slightly above the average of $2.08 per pack of our neighboring states.

Second, it will treat the liquid nicotine drug (smoked via electronic cigarettes) and those who sell it exactly the same as all other tobacco products.

Third, it will dedicate current revenues exactly where they currently are: to the state’s general fund and back to North Dakota’s cities. New revenues generated from the increase will be split evening between a fund created to support the unmet needs of North Dakota’s veterans and a fund to support health programs associated with chronic disease treatment, county health programs and the mental health and addiction crisis facing our state.

Luckily, North Dakota already fully funds a tobacco prevention program utilizing a small portion of the money won by the state of North Dakota when it sued tobacco companies in 1998 for lying to the public and to Congress about the deadly impacts of tobacco. No moneys from this measure will go toward these efforts.

These are the facts. Seventy-five percent of adult tobacco users started before the age of 18. Significant tobacco tax increases are proven as the most effective way to keep young people from ever starting tobacco. That’s an effort we can all support.

http://www.jamestownsun.com/letters/3990656-tobacco-tax-will-deter-young-people-using-products

Bismarck Tribune: Coalition pushes tobacco tax measure

By NICK SMITH, Bismarck Tribune

Photo by Tom Stromme, Bismarck Tribune

Photo by Tom Stromme, Bismarck Tribune


Members of a coalition seeking an increase in the state’s tobacco tax say their proposed increase would reduce smoking rates as well as state health care costs among other benefits.
“That’s the missing leg of the three-legged stool,” Eric Johnson, a Grand Forks physician and head of the measure’s sponsoring committee, Raise It for Health North Dakota.
Two-thirds of North Dakota voters in 2012 approved a ballot measure making public places smoke-free. In 2008, nearly 54 percent of voters approved the creation of a state tobacco prevention and control program.
Other states that have raised the tax have seen decreases in smoking, according to Johnson, adding that the measure will help beef up the state’s tobacco prevention efforts.
“This is a tax nobody has to pay. It’s a product that creates death,” Johnson said.
Kristie Wolff, with the American Lung Association in North Dakota, said the measure would increase the tobacco tax for cigarettes in North Dakota from 44 cents per pack to $2.20. Taxes on liquid nicotine products would be increased from 28 percent of the wholesale purchase price to 56 percent.
The national average tax on a pack of cigarettes is $1.61.
New tax revenues created through the measure, estimated at about $100 million per biennium, would be split between health-related programs in the state’s Community Health Trust Fund as well as a newly created Veterans Tobacco Tax Trust Fund.
“We’re confident that North Dakota voters will respond positively yet again,” Wolff said.
Only Georgia, Missouri and Virginia have lower tobacco taxes than North Dakota. The tobacco tax in North Dakota hasn’t been raised since 1993.
Being a statutory initiative, 13,452 legitimate signatures will be required at least 120 days before the election. The deadline for turning in signatures for the Nov. 8 election is July 11.
Several unsuccessful attempts have been legislatively in the year since the last tax increase.
Wolff said the increase would bring North Dakota in line with the surrounding states in the tax per pack of cigarettes. The tax in Minnesota is $3 per pack, in Montana it’s $1.70 and in South Dakota it’s $1.53.
“We based it on polling we’ve done,” Wolff told reporters when asked how the group came to the $1.76 per pack increase being proposed.
According to the Campaign for Tobacco-Free Kids, the tax increase could result in a 20 percent drop in youth smoking, preventing about 5,800 youths from becoming adult smokers, Johnson said.
North Dakota Retail Association president Mike Rud said the group he leads will need to review the measure language and watch to see if it gets the necessary signatures for a vote. The group opposed both 2015 bills.
Rud said on first glance the proposed increase is substantial, adding that taxing cigarettes would negatively impact lower-income smokers.
“Taxing a group that can least afford it? It’s a bit troublesome to us,” said Rud, clarifying that tobacco products aren’t illegal and retailers sell them to meet demand among legal buyers.
“There’s got to be a limit to how involved we get with these things,” Rud said.
For more information on ballot petitions being circulated, visit sos.nd.gov.
http://bismarcktribune.com/news/local/govt-and-politics/coalition-pushes-tobacco-tax-measure/article_ecf65fc0-d7ee-5458-9407-3088d50a3aed.html

Valley News Live: Coalition wants to raise North Dakota tobacco tax

By: Natalie Parsons
FARGO, N.D. (Valley News Live) It has been proposed in the state of North Dakota to raise the tax on tobacco products.
If it passes, you will see it on your ballot this November.
Supporters already started collecting some of the required 13,000 plus signatures.
North Dakota has not increased its tobacco tax since 1993 and now the Raise It For Health North Dakota coalition thinks it’s time.
The proposed tobacco tax will increase the tax on cigarettes from $0.44 per pack up to $2.20 per pack.
Scott Platfers says, “Going to have to pay more if I want to continue but I’m hoping that it might deter me too because it’s something I’ve been wanting to quit for a long time.”
The ultimate goal for this tobacco tax increase is to hopefully decrease youth smoking by 20 percent and prevent 5800 youth from ever starting.
The Fargo smoker says, “It’s not going to prevent all of them but I think it’s going to get some of them and every little bit helps.”
The coalition has already started getting signatures on this initiated measure.
The petition needs exactly 13,452 signatures in order appear on the November 8th ballot.
Platfers says, “It’s a double edged sword. It’ll effect me but as long as it would help somebody? Yeah, I would sign it.”
The proposed tobacco tax is estimated to bring in over $100-million new revenue to North Dakota with plans to go towards many health care services.
http://www.valleynewslive.com/home/headlines/Coalition-to-raise-North-Dakota-tobacco-tax-372303722.html

KX News: Raise It For Health North Dakota Coalition Seeks Tobacco Tax Change

By Kaitlyn Wurnig
It will require 13,452 signatures and a yes vote, but the Raise it for Health North Dakota coalition is seeking a change. A change North Dakota has not had in 23 years.
“Increasing the price of tobacco is one of the most effective ways to reduce smoking and other tobacco use, especially among youth,” says Kristie Wolff, American Lung Association.
The coalition submitted a petition to the North Dakota Secretary of State’s office Wednesday to initiate a ballot measure. The ballot measure calls for a tax increase on cigarettes and tobacco products in North Dakota.
“In other states including our neighboring state of Minnesota, we have seen increasing the price of tobacco has reduced smoking across all populations,” says Dr. Eric Johnson, Ballot Chairman.
The proposed measure would increase the tax on cigarettes from 44 cents per pack to $2.20 per pack. Other tobacco products would increase from 28 percent of the wholesale purchase price to 56 percent. Ballot Chairman, Dr. Eric Johnson says the $1.76 increase is estimated to decrease youth smoking and save millions in health care costs.
“With the strong medical evidence to support this initiative, we need to pay attention to the facts,” says Dr. Johnson.
Some people would agree.
“I think it’s a good idea because maybe it’ll give more people an idea of how much money they’re wasting on such a stupid product,” says Gage McMahen.
“In a way it could be good because now they have to spend more for tobacco and it could cut down on younger kids quitting,” says Atlantis Belgarde.
Others don’t support the idea.
“Absolutely not because well for one I’m a smoker. Not that I say smoking is good for ya, but they’re constantly raising taxes on things regardless of who they think it affects and I just don’t feel that raising taxes is a good thing,” says Keith Eiss.
If the measure does pass, 50 percent of the new revenues would go to a veterans tobacco trust fund.  The other 50 percent would benefit a community health trust fund.
North Dakota currently ranks 47th in the nation for tobacco tax rates.
The national average per pack is $1.61.
Read more or watch video: http://www.kxnet.com/story/31488549/raise-it-for-health-north-dakota-coalition-seeks-tobacco-tax-change

Forum News Service: Proposed ND ballot measure would boost tax on cigarettes by $1.76 a pack

By Mike Nowatzki / Forum News Service
A group frustrated with the North Dakota Legislature’s repeated refusal to raise tobacco taxes will attempt to put the issue to voters in November, announcing a ballot initiative Wednesday that would hike the tax on a pack of cigarettes by $1.76.
Backers will need to gather 13,452 signatures by July 11 to place the initiated measure on the Nov. 8 ballot.
Dr. Eric Johnson, a Grand Forks physician and chairman of the measure’s 30-member sponsoring committee, estimated the higher tax would reduce youth smoking by 20 percent, preventing 5,800 youths from ever starting smoking.
He noted North Dakota voters approved a tobacco use prevention and control program in 2008 and passed a smoke-free workplace law in 2012, calling the higher tax “kind of the missing leg of the three-legged stool.”
“We do know that it reduces usage, and that saves money for everybody,” he said.
Supporters estimate the tax increase would generate more than $100 million every two years. Half of the money would be dedicated to a new trust fund to support services and programs for military veterans, while the rest would go into a community health trust fund.

Poll results as of 9:30 am on March 17, 2016

Poll results as of 9:30 am on March 17, 2016


North Dakota’s current tax of 44 cents on a pack of cigarettes ranks 47th lowest among states and hasn’t been increased since 1993, despite several attempts in the Legislature, including two bills defeated last year after strong pushback from retailers and distributors.
If approved by voters, the proposed new tax of $2.20 per pack would be lower than Minnesota’s $3-per-pack tax but higher than Montana’s $1.70 and South Dakota’s $1.53. The national average is $1.61 per pack.
The measure is being pushed by the Raise it for Health Coalition, which consists of 10 groups: the North Dakota Medical Association, American Lung Association in North Dakota, North Dakota Veterans Coordinating Council, Tobacco Free North Dakota, Campaign for Tobacco-Free Kids, North Dakota Nurses Association, North Dakota Chapter of the American Academy of Pediatrics, March of Dimes, North Dakota Association of Counties and the Dakota Boys and Girls Ranch.
 
 

Bismarck Tribune: Group proposes to raise tax on tobacco

NICK SMITH, Bismarck Tribune

A coalition seeking to reduce tobacco use in North Dakota will unveil a proposed ballot measure Wednesday, which would raise the state’s tobacco tax — one of the lowest in the nation.
The group, Raise it for Health North Dakota, will make its announcement in Memorial Hall inside the state Capitol on Wednesday.
A spokeswoman for the group said details of the proposed measure wouldn’t be disclosed until the announcement.
As of January, data from the tobacco prevention group Campaign for Tobacco-Free Kids showed that North Dakota’s tobacco taxes are at 44 cents per pack. Only Georgia, Missouri and Virginia are lower. The tobacco tax in North Dakota hasn’t been raised since 1993.
Two bills proposing tobacco tax increases in the 2015 session failed.
House Bill 1421 would have raised the state’s cigarette tax to $1.54 per pack. It would also have raised the excise tax on other tobacco products from 28 percent of the wholesale purchase price to 43.5 percent. House lawmakers killed it by a 34-56 vote.
Senate Bill 2322 would have raised the cigarette tax in the state to $2 per pack; it failed in the Senate by a 17-30 vote.
Last session, health care officials supported the bills while retail groups opposed it. Several legislative attempts to raise the tax have failed since 1993.
Opponents of the 2015 bills used 2012 data from the Centers for Disease Control and Prevention to argue tobacco use isn’t a major problem in North Dakota. The data showed that North Dakota in 2012 ranked 37th in adult smoking and 49th in smokeless tobacco use. Among youth smokers, North Dakota ranked 34th among 44 states reporting data.
North Dakota voters in November 2012 approved a ballot measure making public places smoke-free. Two-thirds of voters supported the measure.
http://bismarcktribune.com/news/local/govt-and-politics/group-proposes-to-raise-tax-on-tobacco/article_4bd0f2cc-48bf-5e23-9008-be55a0db7268.html

InForum: Mentally ill more likely to smoke, die from tobacco-related illness

The mentally ill and those battling substance abuse are much more likely than others to smoke, and suffer higher illness and death rates as a result.
The American Lung Association in North Dakota is launching an effort to target smoking cessation programs at those who are mentally ill or dealing with addictions.
Tobacco control advocates also are working with mental health professionals to take a more aggressive approach to help those with behavioral health problems quit smoking.
“We have seen a decline in all populations except those with mental illness or substance abuse,” said Reba Mathern-Jacobson, director of tobacco control for the American Lung Association in North Dakota, referring to the drop in smoking among most groups.
As a result, those with mental illnesses and addictions can die decades earlier than the general population, and smoking is a major contributor to sickness and early death, according to statistics cited by the federal Substance Abuse and Mental Health Services Administration:
• About half of people with behavioral health disorders smoke, compared to 23 percent of the general population.
• People with mental illnesses and addictions smoke half of all cigarettes made, and are only half as likely as other smokers to quit.
• Smoking-related illnesses cause half of all deaths among people with behavioral health disorders.
“Folks are dying a lot sooner than they need to,” said Carlotta McCleary, executive director of Mental Health America in North Dakota, an advocacy group. The issue is starting to draw more attention, she said, and collaborations are forming to address the problem.
“People who are alcoholic die from tobacco-related diseases more than they do from alcohol-related diseases,” Mathern-Jacobson said.
Those with mental illness or substance abuse problems find it more difficult to quit smoking for a variety of reasons.
Nicotine’s mood-altering effects put people with mental illness at greater risk for cigarette use and nicotine addiction. Also, people with mental illness are more likely to face stressful lives, have lower incomes and lack access to health care, making quitting more difficult.
“People might be self-medicating, that kind of thing,” by using nicotine, McCleary said.
Another problem is what tobacco control advocates view as a lackadaisical attitude among some mental health professionals.
“It’s been seen as a lesser of evils,” Mathern-Jacobson said. “Now that population is bearing the brunt of it.”
Mental health professionals are significantly more likely to smoke than other health professionals, surveys show, which might suggest a culture that is more tolerant of tobacco, she said.
It’s worth noting that nicotine dependence is listed as a behavioral disorder in the diagnostic manual used by mental health clinicians, Mathern-Jacobson said. “Nicotine is a drug, let’s treat it like one.”
Melissa Markegard, a tobacco control coordinator with Fargo Cass Public Health, said she believes mental health clinicians are increasingly more likely to take nicotine addiction seriously.
“A lot of times, smoking is a trigger for other substances, especially alcohol,” she said. “It’s kind of like you can’t do one without the other.”
More integration of behavioral health and general health care would help to combat smoking among the mentally ill and those battling addictions, McCleary said.
“It’s not just OK to focus on behavioral health alone,” or on physical health in isolation, she said. There is a growing movement in health care to do more to combine the two, McCleary added, but said much more integration is needed.
The American Lung Association in North Dakota is bringing in an expert to help train behavioral health professionals including psychiatrists, counselors, nurses, social workers and other treatment providers who serve people with mental illness or substance abuse disorders.
The training sessions will be June 21-22 in Fargo and will feature Dr. Jill Williams, an addiction psychiatrist from Rutgers Robert Wood Johnson Medical School. Details still are pending. Anyone interested can contact Mathern-Jacobson atreba.mathern-jacobson@lung.org or by calling 701-354-9719.
http://www.inforum.com/news/3986011-mentally-ill-more-likely-smoke-die-tobacco-related-illness

LA Times – Capitol Times: Lawmakers show surprising courage against Big Tobacco

The Legislature showed some guts last week in standing up to the tobacco lobby and its political money.

It could have shown more, however, by mustering the courage to raise taxes on cigarettes, cigars and chewing crud.

California’s tobacco tax is among the lowest in the nation and hasn’t been hiked since 1998 — and then only by the voters, not the weak-kneed legislators.

The national average state cigarette tax is $1.61 per pack. California’s is about half that, 87 cents. We rank 35th. New York is first at $4.35.

But give our lawmakers credit: They did the next best thing, even if it was a punt to local government. They passed a bill allowing counties to seek voter approval of a local tobacco tax.

The tax revenue could be used to help smokers kick the habit and treat their tobacco-related ailments.

The main purpose, however, is to discourage people from buying smokes, a strategy that works — and worries cigarette makers. Researchers have found that for every 10% increase in the cigarette price, there’s a 4% reduction in use.

Let’s put the rap on legislative fortitude in perspective: To pass any tax increase, a two-thirds vote is needed. Passing a bill that allows someone else to raise a tax requires only a simple majority, which Democrats can handle without buying off Republicans.

The local tax bill, by Assemblyman Richard Bloom (D-Santa Monica), passed the Assembly on a 46-27 vote, far short of the 54 needed for two-thirds.

“Tobacco is a poison,” Bloom told me. “We shouldn’t even be debating this anymore. We should be doing everything to keep it out of the hands of young people.”

It was a bad day for tobacco interests. The Assembly passed two other bills that could have even greater immediate impact.

One, by Sen. Ed Hernandez (D-West Covina), would raise the smoking age from 18 to 21.

Opponents argued it wouldn’t be fair that someone under 21 could die for their country but couldn’t smoke. So active military personnel were exempted.

The bill passed 49 to 25.

Hernandez says research shows that 90% of smokers begin puffing before age 21, and 80% before 18.

San Francisco last week raised its smoking age to 21. So have Hawaii and New York City.

But I’m skeptical. Come on! We can’t even enforce the age 18 limit. Kids get smokes at 14 or whenever they want.

Yes, argue the proposal’s advocates, but the 14-year-olds get their cigarettes from 18-year-olds. They wouldn’t be close enough to the 21-year-olds.

Perhaps. But what’s to stop the 18-year-olds from being supplied by those who are 21, and then passing them down to little sister?

The second big bill that passed makes total sense and is overdue. The measure, by Sen. Mark Leno (D-San Francisco), would regulate electronic cigarettes like tobacco. Their use would be prohibited everywhere cigarettes are banned: in restaurants, theaters and other public places.

These cute vapor devices are particularly appealing to minors, sold with yummy flavors such as chocolate, cotton candy and cherry — and usually laced with addictive nicotine.

The bill passed 52 to 21.

One Los Angeles study, Leno says, found that 9th-graders who use e-cigarettes are four times as likely to get hooked on tobacco.

“Clearly, Big Tobacco’s next move is to addict a new generation to nicotine,” Leno says.

Three other anti-smoking bills also passed the Assembly the same day. One would close loopholes in the state’s smoke-free workplace laws. Another would require all schools to be tobacco free. The third would impose a state licensing fee on tobacco retailers.

Passage of the six-bill package earned kudos for Speaker Toni Atkins (D-San Diego) on her last day as Assembly leader. Assemblyman Anthony Rendon (D-Paramount) takes over this week.

Last year, the tobacco lobby and its legislative minions stalled the bills in the Assembly after two key measures — raising the smoking age and regulating e-cigarettes — passed the Senate.

One reason is obvious: So far in this election cycle, the major tobacco companies have plied legislators with nearly $364,000 in campaign contributions, according to MapLight, which tracks political money. Of that, 83% has gone to Republicans — who make up only 35% of the Legislature — and 17% to Democrats.

Add the last election cycle to this one, and Big Tobacco has donated $894,000, 71% to Republicans and 29% to Democrats.

Most Democrats voted for the anti-tobacco legislation. Most Republicans voted against.

The Senate intends to approve Assembly amendments and send the entire package to noncommittal Gov. Jerry Brown this week. Unless.

Behind the scenes, Senate leader Kevin de León (D-Los Angeles) quietly is offering to negotiate with tobacco. If the industry were to allow the Legislature to pass a state tobacco tax, perhaps some of the package could be snuffed.

Then sponsors of a November ballot initiative that would raise the state cigarette tax by $2 per pack might be persuaded to withdraw their measure. That would save the tobacco industry upward of $100 million fighting the initiative.

And unions that are pushing it could plow their money into Democratic legislative races instead. Plus, there wouldn’t be a tobacco tax on the ballot to complicate life for a union-sponsored extension of Brown’s soak-the-rich income tax hike.

It’s all very complex. And unlikely. The Legislature has exhibited about all the courage it can against terrifying tobacco.

http://www.latimes.com/politics/la-me-pol-sac-cap-tobacco-20160307-column.html

ADA News: ADA, others "concerned" about tobacco products

By Jennifer Garvin, American Dental Association News

Silver Spring, Md. — The ADA and 35 other health organizations have asked the Food and Drug Administration to be more diligent about requiring tobacco companies to obtain approval before introducing new tobacco products to market.

In a Feb. 26 letter to Mitchell Zeller, director, Center for Tobacco Products, the organizations shared that they are “increasingly concerned” that tobacco companies are introducing new tobacco products into the marketplace without proper regulatory review.

The Family Smoking Prevention and Tobacco Control Act of 2009 gave the FDA unprecedented authority to regulate the manufacturing, distribution and marketing of tobacco products. It also requires tobacco companies to seek FDA approval before introducing new tobacco products to the market.

“The premarket review provisions of the Tobacco Control Act are intended to prevent the tobacco industry from continuing to introduce new tobacco products that are more harmful, more addictive and more appealing, particularly to young people,” stated the letter.

The letter also points out that the Tobacco Control Act prohibits commercial marketing of a new tobacco product unless FDA has issued an order finding the product “appropriate for the protection of the public health.” It singles out several new products it claims are non-compliant with the act. These products include:

  • Marlboro Midnight, a menthol cigarette;
  • Grizzly Wintergreen, a new snuff;
  • Three new brands of snus from Kretek International Inc: Thunder Xtreme, Offroad and Oden’s Extreme;
  • Marlboro Black NXT, a crushable menthol capsule.

“FDA’s failure to take the actions necessary to remove these products from the market represents a serious failure to protect the public health,” the letter stated.

“Given that the avoidance of premarket review seriously undercuts the public health protections of the Tobacco Control Act, please explain why no enforcement actions have been taken by FDA against these products and indicate what the agency plans to do to prevent additional products from entering the market without the required regulatory review.”

Read the entire letter here.

http://www.ada.org/en/publications/ada-news/2016-archive/march/ada-35-health-organizations-concerned?nav=news