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

U.S. News/HealthDay: Graphic Cigarette Warnings May Target Brain's 'Quit Centers'

By Robert Preidt, HealthDay Reporter

FRIDAY, Feb. 26, 2016 (HealthDay News) — Disturbing images on cigarette pack warning labels activate brain regions crucial in quitting smoking, a new study suggests.

“Regulators can and should use this research to craft more effective warning labels and messages to smokers that both deliver facts about the negative effects of smoking and trigger thoughts and actions that move smokers toward quitting,” said study senior author Raymond Niaura. He is director of science at the Schroeder Institute for Tobacco Research and Policy Studies at the Truth Initiative in Washington, D.C.

“Tobacco is still the leading preventable cause of death in the U.S., and the growing body of research showing the effectiveness of warning labels should energize policymaking,” Niaura said in a news release from Georgetown University Medical Center, in Washington, D.C.

For the study, the researchers conducted brain scans on 19 young adult smokers. During the scans, the smokers were shown non-graphic and graphic pictures used on cigarette pack warning labels. For example, one image included an open mouth with rotten teeth and a tumor on the lower lip. The images were accompanied by the text: “WARNING: Cigarettes cause cancer.”

Seeing the graphic pictures triggered activity in areas of the brain called the amygdala and medial prefrontal region, the study showed. These areas are involved in emotion, decision-making and memory, the researchers said.

“The amygdala responds to emotionally powerful stimuli, especially fear and disgust. And experiences that have a strong emotional impact tend to impact our decision-making,” said study co-lead author Adama Green, a cognitive neuroscientist at the Georgetown University Medical Center and the Truth Initiative.

The study was published online recently in the journal Addictive Behaviors Reports.

“What we found in this study reinforces findings from previous research where scientists have asked participants to report how they think and feel in response to graphic warnings on cigarettes,” said co-lead author Darren Mays, an assistant professor of oncology at Georgetown’s Lombardi Comprehensive Cancer Center.

This study should help researchers understand the biological factors underlying responses to such warnings. And it may help them learn how these warnings can work to motivate a change in behavior, Mays said.

http://health.usnews.com/health-news/articles/2016-02-26/graphic-cigarette-warnings-may-target-brains-quit-centers

Duluth News Tribune: Training targets high tobacco use among addicts, mentally ill

By John Lundy

If someone is dealing with other addictions or mental health issues, it’s not the time to ask them to stop smoking.

Right?

Wrong, says an addictions psychiatrist from New Jersey who’s in Duluth to help lead a two-day training seminar on helping individuals with special challenges overcome tobacco use.

“The newer research suggests that when people address their smoking they actually have better long-term outcomes,” said Jill Williams, who specializes at Rutgers University’s Robert Wood Johnson Medical School in treatment of tobacco and other addictions in mentally ill populations. “When you cue the brain with nicotine, it’s really not different than other drugs.”

Williams is making her third visit to Duluth at the behest of the American Lung Association in Minnesota. After conducting a one-day session in the Twin Cities, she came to the Public Safety Building in Duluth on Thursday to work with about 60 behavioral health professionals from throughout Northeastern Minnesota; the training continues today.

The target is a topic that has “been shuffled to the side,” in the words of Pat McKone, regional senior director for the American Lung Association.

Even as tobacco use overall in the United States continues to decline to unprecedented lows, use by vulnerable groups such as addicts and the mentally ill remains stubbornly high, McKone and Williams said.

For instance, according to Williams:

  • Although the rate of smoking in Minnesota is down to 14 percent, the rate for Minnesotans with addictions or mental illness is between 40 and 60 percent.
  • The No. 1 cause of death in alcoholics is health problems related to tobacco use.
  • Fifty percent of people with mental illness die of tobacco-related causes.

“We always remark to the audience: Imagine if 50 percent of our patients died of suicide, how that would be front page news,” Williams said. “Fifty percent die from tobacco and we don’t do anything about it.”

People with serious mental illnesses die, on average, 25 years earlier than the rest of the population, McKone said. “And it’s not from suicide; it’s not from drug overdose. It’s from heart disease, COPD and cancer.”

Over a couple of years, Williams has offered the training to about a thousand specialists in Minnesota, she said. But they still represent a minority.

“What we hear them say … is that they’re the lone voice at their agency and everyone else is sort of opposed or still believes the myths or the idea that we should let people smoke and not pay attention to it,” Williams said. “So we still have a lot more people to get to.”

One sign of that is that only one in four mental health treatment centers has a smoking-cessation program, she said.

Families of individuals being treated for addiction or mental illness should advocate for treating their loved one’s tobacco addiction along with the other problems, McKone said. She called the reduced life expectancy for people with addictions and mental illness a social injustice.

Williams added: “Everyone has someone in their family with mental illness or addiction, and we can’t just look the other way.”

http://www.duluthnewstribune.com/news/3956324-training-targets-high-tobacco-use-among-addicts-mentally-ill

Today Show: Video: E-cigarette explodes in pocket, man left with second-degree burns

A frightening explosion of an e-cigarette in a Kentucky man’s pocket was caught on camera in a convenience store. The man was hospitalized Tuesday with second-degree burns after the battery in his electronic cigarette exploded in his pants pocket.

To see the video: http://www.today.com/video/video-e-cigarette-explodes-in-pocket-man-left-with-second-degree-burns-631071811975

Medical News Today: E-cigarettes impair immune responses more than tobacco

Written by Yvette Brazier

As evidence emerges that e-cigarettes are not as safe as advertisers claim, a new study shows that flavorings classed as “Generally Recognized as Safe” by the US Food and Drug Administration are best avoided in smoking. The findings are presented at the American Association for the Advancement of Science annual meeting in Washington, DC.

Cigarettes kill more than 480,000 people annually in the US. Since e-cigarettes appeared on the scene, many assume them to be a safer alternative, because smokers are not inhaling known carcinogens.

But as researchers analyze the contents of e-cigarettes, they are finding that some of them could be as risky as tobacco.

Ilona Jaspers, PhD, professor of pediatrics and director of the curriculum in toxicology at the University of North Carolina (UNC) School of Medicine has been researching new and emerging tobacco products, including e-cigarettes.

Having already found that cigarette smoking significantly impairs the immune responses of mucosal cells in the respiratory system, Jaspers’ lab is now looking at how e-cigarette chemicals affect immune responses in smokers’ airways.

E-cigarette flavorings not ‘recognized as safe’ for inhalation

But people do not consume e-cigarette flavorings orally, they inhale them. And the potential for toxic effects of inhalation have not been assessed, in most cases.While the Food and Drug Administration (FDA) may class e-cigarette flavorings “Generally Recognized as Safe,” Jaspers points out that this classification means they are safe for oral consumption.

Jaspers, who is also deputy director of the UNC Center for Environmental Medicine, Asthma and Lung Biology, explains:

“The digestive systems and respiratory systems are very different. Our stomachs are full of acids and enzymes that break down food and deal with chemicals; this environment is very different than our respiratory systems. We simply don’t know what effects, if any, e-cigarettes have on our lungs.”

Researchers studied the effects on smokers of cinnamon-flavored e-liquids and cinnamaldehyde, the chemical that gives cinnamon flavor to an e-cigarette.

Results showed that the cinnamaldehyde e-liquids had a significant negative impact on epithelial cells that could set off a chain of cellular mechanisms potentially leading to impaired immune responses in the lung.

Jaspers elaborates: “The chemicals compromise the immune function of key respiratory immune cells, such as macrophages, natural killer cells and neutrophils.”

Negative effect of e-cigarettes on respiratory immune system

The team also obtained tissue samples from the epithelial layer inside the nasal cavities of smokers, non-smokers and e-cigarette users, to analyze changes in the expressions of nearly 600 genes involved in immune responses.

They then tested nasal lavage fluid, urine and blood samples obtained from participants to detect changes in genetic and proteomic markers of tobacco and nicotine exposure and other markers of inflammation or immune responses.

In conventional cigarette smokers, they observed signs that a number of key immune genes in the nasal mucosa were suppressed.

In e-cigarette users, they found the same genetic changes, as well as suppression of additional immune genes. The findings imply that e-cigarettes have an even broader effect on the respiratory mucosal immune response system than conventional cigarettes.

The next step will involve in-vitro and in-vivo studies into the effects of chemicals on long-term e-cigarette smokers. Research will focus on immune suppression in the respiratory mucosa, with particular focus on cinnamon-flavored e-liquids.

Further evidence that e-cigarette smoking weakens the immune system was published recently in Medical News Today.

http://www.medicalnewstoday.com/articles/306444.php

WDAZ: Devils Lake landlord honored for going tobacco-free

By Kelsie McMahon

DEVILS LAKE, ND (WDAZ-TV) – The secondhand smoke from even one tenant smoking indoors can cause health problems for people in multiple other units.

In North Dakota it is legal to smoke inside an apartment, but one landlord is making a difference in Devils Lake.

Dan Lagein, Lagein Apartments owner: “Probably over a year ago we went smoke free.”

Dan Lagein was honored today for being the first landlord in Devils Lake to make five of his apartment units tobacco-free.

Lagein: “With Liz’s help here we’ve got all the signage and the verbiage for our contracts, so that started all that probably about six months ago.”

Liz Bonney, Lake Region District Health: “Well right now the law reads you can actually smoke inside your apartment within the confines, but not in any common areas and not within 20 feet of the building. What Dan has done is he has taken the state policy, our motto policy I should say, and kicked it up a notch.”

Signs show smoking is prohibited inside the building and within 20 feet of the entrance.

Lagein says there were several requests from tenants to go smoke free.

Lagein: “The smoke that resonates through the whole building, the tenants were just tired of the smoke smell for the small percentage that do it, it affects everybody involved.”

In North Dakota 18%of people smoke, but secondhand smoke can affect everyone.

Bonney: “The larger population needs to be acknowledged and they need to have a place to go and a place to rent that is, you know, protects them and their kids and is tobacco free.”

The hope now is that it will create a domino effect for other property owners.

Bonney: “Now that other property managers and property owners are going to see that he’s taken the step, it’s kind of like the first domino falling and maybe tenants will start speaking up.”

Lagein says while people may still sneak a smoke, the change has made a difference in the smell of the building.

Lagein: “It’s a great day for all of us and especially for the young ones involved or anybody involved that is sensitive to smoke or doesn’t appreciate it, you know, it just gives them their rights too.”

A move by one landlord that could make a difference for housing in the whole community.

Officials say secondhand smoke can cause cancer, heart attacks, and Sudden Infant Death Syndrome.

To read more or watch the video: http://www.wdaz.com/news/north-dakota/3945265-devils-lake-landlord-honored-going-tobacco-free