Bismarck Tribune Editorial: N.D. becomes leader in tobacco fight

North Dakota has garnered praise for its spending efforts to reduce tobacco use. There’s a little irony in this since the Legislature in the past has questioned the amount of spending.
The Campaign for Tobacco-Free Kids looked at how states used the billions of dollars received from lawsuits settled with major tobacco companies in 1998.
According to the Centers for Disease Control and Prevention, North Dakota is the only state to spend at levels it recommended. The state also was one of five states to spend at least 50 percent of what the CDC recommends.
Spending by states on tobacco prevention programs bottomed out at $459.5 million in 2013, according to the campaign’s report, and is expected to reach $468 million in 2016. At the same time, an estimated $25.8 billion will be collected in settlement funds and tobacco taxes. Tobacco companies reportedly spend about $9.6 billion a year on marketing. North Dakota has $10 million planned for fiscal year 2016.
The anti-tobacco campaign appears to be working.
A survey conducted by the state Department of Public Instruction and the Department of Health shows 80 percent of the students responding said they did not use cigarettes, cigars or smokeless tobacco, an increase from 74 percent two years ago. The percentage of high school students who said they had smoked a cigarette at least once in the month dropped from 19 percent to 12 percent. The percentage of high school students who said they had ever tried to smoke a cigarette was 35 percent, down from 41 percent in 2013. Smokeless tobacco use declined from 14 percent to 11 percent this year.

The anti-tobacco effort emphasizes keeping kids from using tobacco and if they do, getting them to quit. The numbers indicate they are being successful. Some have questioned the amount of money being spent and how it’s being used. While the campaign may appear heavy-handed at times, it’s getting the point across. In the past some legislators wanted to spend less on anti-tobacco efforts and divert the tobacco settlement money to other programs. In 2008 North Dakotans passed a measure requiring a portion of the settlement funds be used for tobacco prevention.
Even a tobacco company favors the spending. “We believe states should use (settlement) payments to fund tobacco cessation and underage tobacco prevention programs at levels recommended by the Centers for Disease Control,” Brian May, a spokesman for Philip Morris, told the Forum News Service.
The anti-tobacco effort has been successful in other areas with smoking banned in public areas. And now the efforts go beyond traditional forms of tobacco to vaporing products. The dangers of second-hand smoke is another focus, with apartment residents being urged to demand a smoke-free environment. Some may think this is going too far, but anti-tobacco campaign is on a roll and has the money to keep going.
Society is getting closer to being smoke-free, too fast for some and too slowly for others.
http://bismarcktribune.com/news/opinion/editorial/n-d-becomes-leader-in-tobacco-fight/article_ed7dc472-6eb0-5e6d-b63b-51c4cd23e599.html

WebMD News from HealthDay: Tobacco Exposure and Infertility, Early Menopause

By Kathleen Doheny, HealthDay Reporter

Smoking and being exposed to secondhand smoke may trigger early menopause and infertility in women, a new study suggests.
Other research has linked smoking with higher rates of infertility and perhaps earlier menopause. However, “secondhand smoke is less researched,” especially among never-smoking women, said study author Andrew Hyland, chair of health behavior at Roswell Park Cancer Institute, in Buffalo, N.Y.
In the study, Hyland and his colleagues evaluated women enrolled in the Women’s Health Initiative, a large study launched in 1991 to look at a variety of health issues in more than 160,000 generally healthy, postmenopausal women.
Hyland’s team looked at information about age of menopause and fertility, along with tobacco exposure, among some of the women enrolled in the study. The investigators evaluated information available on about 88,000 women to look at the fertility effects. They also looked at information on about 80,000 to examine onset of natural, or nonsurgical, menopause.
Both smoking and exposure to secondhand smoke were linked to fertility issues and early menopause (before the typical age of 50), the researchers found.
Compared with never smokers, current or former smokers were 14 percent more likely to be infertile and 26 percent more likely to have early menopause. Early menopause has been linked with a higher risk of death from all causes, Hyland pointed out.
Among never smokers, those exposed to the highest level of secondhand smoke (such as living with a smoker for 10 years or more) were 18 percent more likely to have fertility problems and early menopause, the study found.
Women who had ever smoked reached menopause about 22 months before those who never smoked or never were exposed to smoke. Those exposed to the highest level of passive smoke reached menopause 13 months earlier than those not exposed, the findings showed.
But the study cannot prove cause and effect, Hyland added. “This is an observational study looking at data already collected,” he said. “It [the link] could be something associated with early development and exposure as a young child.”

Smoke interacts with hormones and can have adverse effects as well, he added.

The study was published online Dec. 15 in the journal Tobacco Control.

The findings are a valuable reminder to avoid all smoke, said Patricia Folan, director of the Center for Tobacco Control at North Shore-LIJ Health System in Great Neck, N.Y.

“This study provides additional motivation and incentive for women of all ages to avoid smoking and exposure to secondhand smoke, as well as to quit smoking,” she said. Both are associated with premature birth, low birth weight, infant death and certain birth defects, she added.

“This evidence, in addition to the data from the current study, offers health care providers, particularly ob-gyn practitioners, the information needed to counsel women about the hazards of smoking and secondhand smoke, and to encourage cessation,” Folan said.

http://www.webmd.com/smoking-cessation/news/20151215/active-passive-smoking-tied-to-infertility-early-menopause-study

NBC News: Cigarette Smoke Might Cause Infertility, Early Menopause, Study Shows

by Maggie Fox

Tobacco smoke might do more than cause cancer, heart disease and lung damage. It might also injure fertility in women, researchers reported Tuesday.
Women who smoked the most, and who started at the youngest ages, went through menopause almost two years earlier than women who never smoked, Danielle Smith of the Roswell Park Cancer Institute in Buffalo and colleagues reported.
Women who remembered breathing in the most secondhand smoke went through menopause an average of 13 months earlier than women who didn’t think they’d ever breathed any in, the team reported in the journal Tobacco Control.
The team studied more than 93,000 women taking part in the Women’s Health Initiative Observational Study between 1993 and 1998. They filled out very detailed questionnaires on lifestyle habits, health problems and medical diagnoses.
They found that women who smoked 100 cigarettes or more in their lives had a 14 percent greater risk of infertility and a 26 percent greater risk of going through menopause before they turned 50.
The study helps confirm other studies that have linked smoking with early menopause.
Women who grew up with a smoker in the house for 10 years or more, those who lived with a spouse who smoked for 20 years or more, and those who worked with smokers for 10 years or more were 18 percent more likely to have had infertility problems than women who had never been passive smokers.
Overall, about 15 percent of the women said they had struggled to conceive for a year at a stretch or more, and 45 percent said they went through menopause before they turned 50.
There’s a debate over whether fertility rates have fallen, and many people have blamed chemicals known as endocrine disruptors in cans, bottles and in water supplies. But tobacco also contains these.
The toxins in tobacco smoke can interfere with the production of hormones related to fertility cycles, they can damage the production of egg cells, they can hurt the embryo before it gets implanted in the wall of the uterus, and they can restrict the processes that prepare a womb for pregnancy, the researchers said.
“Tobacco toxins also seem to lower the age of natural menopause by reducing circulating estrogen,” they wrote.
Smoking can also affect men in specific ways. For instance, it seems to damage the male Y chromosome especially badly.
Smoking is on the wane in the U.S. Last month, the Centers for Disease Control and Prevention reported the percentage of U.S. adults who smoke cigarettes declined from 20.9 percent in 2005 to 16.8 percent in 2014.
And smoking bans have made secondhand smoke in the workplace and public areas a thing of the past in most states.
http://www.nbcnews.com/health/womens-health/cigarette-smoke-might-cause-infertility-early-menopause-study-shows-n480661

Fargo Forum editorial: Tobacco cessation succeeds

There is good news in the war against tobacco use: North Dakota is winning.
The Campaign for Tobacco-Free Kids said last week that North Dakota is the only state spending at levels recommended by the U.S. Centers for Disease Control and Prevention on tobacco cessation programs. That level is 50 percent of funds designated from the 1998 tobacco settlement lawsuits.

But it’s about more than spending dollars where they were meant to be spent. It’s about results, and on that score North Dakota is a leader. For example, a portion of the money was spent to fund a study of secondhand smoke’s effects in Grand Forks, the results of which were pivotal in that city passing a 2010 law that outlawed smoking in bars, casinos and truck stops. Several North Dakota cities, using information compiled locally and by the North Dakota Center for Tobacco Prevention and Control Policy, easily approved ordinances directed at ending secondhand smoke in public places and businesses. Most of the cities were ahead of a Legislature that remained in the thrall of the state’s tobacco lobby, and it took a 2012 ballot measure to impose statewide restrictions on smoking and secondhand smoke.
There has been some grousing and whining about how tobacco settlement money is being spent in North Dakota. It’s come mostly from special interests that lost the tobacco cessation battle years ago. They were wrong then and are wrong now about the effects of the expenditures. For example, during the time that education and public service efforts were ratcheted up, smoking among youths plunged to 11.7 percent this year after hovering at about 20 percent the eight previous years.
Anti-tobacco programs work. The statistics are unambiguous. Tobacco settlement money has been well-spent in North Dakota, and the CDC and others recognize the state’s success. That’s good news.
Forum editorials represent the opinion of Forum management and the newspaper’s Editorial Board
http://www.inforum.com/opinion/editorials/3903588-forum-editorial-tobacco-cessation-succeeds

WDAY: Sheyenne students write letters to lawmakers asking them to raise tobacco tax

By Jordee Kalk

West Fargo (WDAY TV) – A creative collaboration for students at Sheyenne High School happened Friday.
Senior government students teamed up with a freshman health class to write letters to local legislators on the tobacco tax rate in North Dakota. Students thanked legislators who voted to increase the tobacco tax throughout the state in the last legislative session and encouraged ones who didn’t to think about doing so in the future.

Currently, North Dakota’s tax is 44 cents per carton [sic] of cigarettes.
“For our state we have very strict laws as far as tobacco in public buildings, nut as far as tobacco tax, we are one of the lowest in the nation and that’s what we are trying to deter,” Sheyenne High School Teacher Tom Kirchoffner said.
According to the Campaign For Tobacco Free Kids, the average tobacco tax in the U.S. is $1.60 per pack. The campaign claims North Dakota has the third lowest tax rate.
Read more or watch the video: http://www.wday.com/news/3902095-sheyenne-students-write-letters-lawmakers-asking-them-raise-tobacco-tax

Grand Forks Herald: Report: North Dakota only state spending enough on tobacco prevention

By John Hageman, Grand Forks Herald
A report released this week argues almost every state in the country is not spending enough money on tobacco prevention and cessation programs—every state, that is, except for North Dakota.
The report, released by the Campaign for Tobacco-Free Kids, focuses in part on the billions of dollars states have received since they settled lawsuits against major tobacco companies in 1998. With $10 million set aside for fiscal year 2016, North Dakota is the only state to spend at levels recommended by the Centers for Disease Control and Prevention and was one of five states to spend at least 50 percent of what the CDC recommends.
 
“It’s so frustrating because it’s such a critical investment, and we’re talking about such a small amount of money,” said John Schachter, director of state communications for the Campaign for Tobacco-Free Kids. “When there’s a pot from which to draw from logically—tobacco taxes and the settlement—as we say, it’s a no-brainer.”
States spent as much as $717.2 million on tobacco prevention programs in fiscal year 2008, but that dropped during the recession and bottomed out at $459.5 million in 2013, according to the campaign’s report. Spending will reach $468 million in fiscal year 2016, a fraction of the estimated $25.8 billion they will collect in settlement funds and tobacco taxes, though the budgets for two states were not yet available.
Tobacco companies spend about $9.6 billion a year on marketing, according to the campaign’s report.
“We believe states should use (settlement) payments to fund tobacco cessation and underage tobacco prevention programs at levels recommended by the Centers for Disease Control,” Brian May, a spokesman for tobacco giant Philip Morris, wrote in an email to the Herald.
While tobacco companies cannot advertise on television or the radio, Schacter said “it’s pretty clear the industry is out there in force.” He said the industry spends most of its marketing dollars at “point of sale,” such as displays at convenience stores and gas stations.
“The states still know it’s an issue, but for whatever reason, they’re deciding to spend the money elsewhere,” Schachter said.

N.D. in the lead

The campaign’s report highlights North Dakota as an example for the rest of the states to follow, citing a drop in high school student smoking rates in recent years.
But North Dakota hasn’t always been a leader in tobacco prevention spending. In fiscal year 2009, it spent just $3.1 million on those programs, or one-third of CDC-recommended funding. That changed with the passing of a measure in 2008 requiring a portion of the settlement dollars be used to reduce tobacco use.
“The settlement did not dictate how the money from the settlement was spent, but it did point out that the settlement was entered into because of the unacceptable behavior of the tobacco industry,” said Jeanne Prom, executive director of the North Dakota Center for Tobacco Prevention and Control Policy.
North Dakota’s tobacco tax revenue is not used for prevention efforts, she said.
Minnesota will receive $791.7 million in total tobacco revenue in fiscal year 2016 but will spend only $21.5 million on prevention programs, less than half of what the CDC recommends, according to the campaign’s report.
Laura Oliven, the tobacco control manager at the Minnesota Department of Health, called the CDC recommendations “aspirational.” She also pointed out the campaign’s figures don’t capture Blue Cross Blue Shield’s Center for Prevention in Minnesota.
Minnesota’s adult smoking rate has dropped to 14.4 percent, the lowest it has ever recorded, the health department announced in January.
“We do a lot to maximize the funds we have,” Oliven said. “I guess the theme here really is that while we’ve made a lot of great strides, there’s still considerable work to be done.”

Local outcomes

Haley Thorson, a tobacco prevention coordinator at the Grand Forks Public Health Department, said tobacco settlement dollars helped fund a study asking residents about second-hand smoke. She called that a “pivotal piece of information” in Grand Forks passing a law in 2010 that outlawed smoking in bars, casinos and truck stops.
“That policy was passed by the City Council because we really did have the pulse of how the community supported that policy,” she said.
North Dakota passed a similar statewide law in 2012.
The health department receives about $300,000 annually from the Center for Tobacco Prevention and Control Policy, or BreatheND. Thorson said it focuses much of its efforts on tobacco-related policies.
“We used to go into schools and educate kids on the harms of tobacco use, but the better bang for our buck is to establish a comprehensive tobacco-free school policy that allows them to be educated in an environment where they’re not exposed to tobacco use,” she said.
Those efforts appear to be working.
The percentage of North Dakota high school students who smoked at least once in the past month plunged to 11.7 percent this year after hovering around 20 percent for the eight previous years, according to survey results provided by Thorson.
“For the states that aren’t spending anything or next to nothing, they need to see results like these,” Thorson said.
http://www.grandforksherald.com/news/region/3900310-report-north-dakota-only-state-spending-enough-tobacco-prevention

USA Today Network: Study suggests link between flavor in e-cigarettes and lung disease

, USA TODAY Network
Flavored e-cigarettes may seem like an alternative to smoking, but researchers warn that flavored e-cigarettes may not be worth the unknown long-term risks.
Researchers at the Harvard University T.H. Chan School of Public Health tested 51 types of flavored e-cigarettes and flavor canisters for diacetyl, acetoin, and 2,3-pentanedione; three chemicals known to cause respiratory problems in factory workers.
The study tested popular e-cigarette flavors like bubble gum, cotton candy and tutti frutti, and found, at least one of the three chemicals were present in 47 of the 51 products they tested.
With around 7,000 e-cigarette flavors on the market, consumers are essentially at the mercy of the manufacturers, with little hope of knowing what chemicals are used in the products, according to Taylor Hays, director of Mayo Clinic Nicotine Dependence Center.
“There are no FDA regulations on these products. It’s the Wild West of e-cigarettes,” Hays told USA TODAY Network.
He says the popularity of e-cigarettes continues to grow among adults that think the products will wean them off of regular cigarettes and among younger users. The percentage of teens using e-cigarettes tripled from 2013 to 2014, according to an April report from the Centers for Disease Control and Prevention (CDC).
The study was published Wednesday in the journal Environmental Health Prospectives.
Diacetyl has been directly linked to “bronchiolitis obliterans,” which in serious cases can require lung transplants, according to Robert Kotloff, chair of pulmonary medicine at Cleveland Clinic.
The disease, also known as “popcorn lung,” got its name from workers who developed the disease after inhaling diacetyl while working in popcorn factories, according to Kotloff.
While the study doesn’t provide a concrete link between flavored e-cigarette use and lung disease, it does further the debate over the unknown long-term consequences of e-cigarettes use.
“[The study] is an intermediary step showing the presence of a compound which could potentially predispose individuals to develop bronchiolitis obliterans,” Kotloff told USA TODAY Network.
http://www.usatoday.com/story/news/nation-now/2015/12/09/chemical-flavor-e-cigarettes-lung-disease-harvard-study/77043340/

Wahpeton Daily News: Study: More nicotine found in smokeless tobacco

By Carrie McDermott • Daily News

Users of smokeless tobacco are exposed to equal or higher levels of nicotine and NNK, a cancer-causing chemical in tobacco products, than cigarette smokers, according to a study from the federal government.
Researchers from the Food and Drug Administration and the Centers for Disease Control and Prevention say more data is needed on the toxic components of smokeless tobacco products and the health of those who use them.
In the study, researchers analyzed information from more than 23,000 participants in national health surveys between 1999 and 2012. They looked for markers used to measure the addictive stimulant nicotine and cancer-causing NNK from blood and urine samples. They found the level of cotinine, the marker for nicotine exposure, to be .043 nanograms/milliliter in nonsmokers compared to 180 ng/ml among smokeless tobacco users, about 131 ng/ml in cigarette users and 184 ng/ml among people who used both smokeless tobacco and cigarettes.

Jason McCoy, tobacco prevention coordinator at PartnerSHIP 4 Health in Moorhead, Minnesota, said he’s eager to get this surprising information out to the public.
“We know that in rural parts of the state, one in 10 young white men, basically high school boys, are using Snus and chewing tobacco, thinking it’s less dangerous than smoking,” he said.
He said the only difference is when they use chewing tobacco, they aren’t affecting others with secondhand smoke.
“The individual is potentially damaging themselves more,” he said. “It’s surprising.”
And many young smokeless tobacco users are choosing flavored products, which make it more attractive.
“This ties into other research we have that shows flavored tobacco is viewed, in self reports by teens, as less addictive than regular tobacco,” McCoy said. “On the other end, we know the flavoring makes it more addictive. The part of the brain that ties into the flavor of the product, similar to why you may like Coke over Pepsi, it’s the same triggering mechanism that happens. The flavor gets assigned in your brain along with the nicotine.”
McCoy works with four counties — Becker, Clay, Otter Tail and Wilkin — and gets reports showing that often high school athletes know they don’t want to smoke because of the smell, so they choose smokeless tobacco, also thinking it won’t affect their athletic performance.
“We know that short term, it’s going to cause gum disease and tooth decay, long term, possible mouth, throat and stomach cancers,” he said. “It’s every bit as dangerous as cigarettes.”
He said he’s been told by teachers that students are taking the Ice Breakers mints and filling those containers with Snus, so they can surreptitiously carry the smokeless tobacco around with them.
“When they open it up, it just looks like they’re getting a mint,” he said.
About 3.6 percent of Minnesotans regularly use smokeless tobacco, according to the latest Minnesota Adult Tobacco survey.
For those wanting to quit their nicotine use, the state of Minnesota offers QUITPLAN which provides proven methods of quitting successfully. The program offers phone counseling and nicotine replacement tools at no cost. To find out more, visit www.quitplan.com or call 1-888-354-7526.
http://www.wahpetondailynews.com/news/study-more-nicotine-found-in-smokeless-tobacco/article_a81d5b36-9a9f-11e5-9849-3facbacf33f9.html

Penn State News: Potentially dangerous molecules detected in e-cigarette aerosols

By Scott Gilbert

HERSHEY, Pa. — Electronic cigarettes produce highly-reactive free radicals — molecules associated with cell damage and cancer — and may pose a health risk to users, according to researchers at Penn State College of Medicine.
The use of e-cigarettes is on the rise. According to the Centers for Disease Control and Prevention, more than 20 percent of young adults have tried e-cigarettes, and current smokers and recent former smokers are most likely to have used them.
E-cigarettes deliver nicotine in water vapor instead of by burning tobacco. The battery-operated devices have been marketed as an alternative to traditional cigarettes.
Despite their growing popularity, very little is known about toxic substances produced by e-cigarettes and their health effects.
“There’s a perception that e-cigarettes are healthier than regular cigarettes, or at least not as harmful as regular cigarettes,” said John P. Richie Jr., professor of public health sciences and pharmacology. “While e-cigarette vapor does not contain many of the toxic substances that are known to be present in cigarette smoke,  it’s still important for us to figure out and to minimize the potential dangers that are associated with e-cigarettes.”
Previous studies have found low levels of aldehydes, chemical compounds that can cause oxidative stress and cell damage, in e-cigarette “smoke.” But until now, no one has looked for free radicals, the main source of oxidative stress from cigarette smoke. Highly reactive free radicals are a leading culprit in smoking-related cancer, cardiovascular disease and chronic obstructive pulmonary disease.
Instead of smoke, e-cigarettes produce aerosols, tiny liquid particles suspended in a puff of air. The researchers measured free radicals in e-cigarette aerosols.
They found that e-cigarettes produce high levels of highly reactive free radicals that fall in the range of 1,000- to 100-times less than levels in regular cigarettes.
“This is the first study that demonstrates the fact that we have these highly reactive agents in e-cigarette aerosols,” Richie said. Results were published in the journal Chemical Research in Toxicology.
“The levels of radicals that we’re seeing are more than what you might get from a heavily air-polluted area but less than what you might find in cigarette smoke,” Richie said. The radicals are produced when the device’s heating coil heats the nicotine solution to very high temperatures.
Further research is needed to determine the health effects of highly reactive free radicals from e-cigarettes.
“This is the first step,” Richie said. “The identification of these radicals in the aerosols means that we can’t just say e-cigarettes are safe because they don’t contain tobacco. They are potentially harmful. Now we have to find out what the harmful effects are.”
Richie is currently conducting studies to carefully measure total numbers of free radicals in e-cigarette aerosols and to identify their chemical structures.
“That will help us interpret the data better to know how dangerous they are,” he said.
Other investigators on this project were Reema Goel and Jonathan Foulds, Department of Public Health Sciences, and Neil Trushin and Bogdan Prokopczyk, Department of Pharmacology, all at Penn State; Erwann Durand and Ryan J. Elias, Penn State College of Agricultural Sciences.
National Institute on Drug Abuse of the National Institutes of Health and the Center for Tobacco Products of the U.S. Food and Drug Administration funded this research. (P50-DA-036107)
http://news.psu.edu/story/383055/2015/12/02/research/potentially-dangerous-molecules-detected-e-cigarette-aerosols

AP: Higher cigarette taxes could save babies' lives, study finds

CHICAGO — When it costs more to smoke, fewer babies die, according to a new study that links rising cigarette taxes with declines in infant mortality, especially among blacks.
With nearly 4 million annual births nationwide, the results suggest that a $1 increase in cigarette taxes would be expected to lead to 750 fewer infant deaths each year, the researchers said.
Smoking during pregnancy can lead to complications including sometimes dangerous premature births and sudden infant death syndrome. U.S. smoking rates declined during years examined in the study – 1999 to 2010. The research, paid for by the National Institutes of Health, was published online Tuesday in the journal Pediatrics.
The study
Cigarettes are subject to state and federal excise taxes. Dr. Stephen Patrick of Vanderbilt University and colleagues examined data on changes in those taxes and cigarette prices from every state over 11 years. They also analyzed federal data on infant mortality in each state.
Taxes per cigarette pack increased from 84 cents to $2.37 on average, adjusted for inflation. Infant mortality per 1,000 births decreased from about 7 deaths to 6 deaths on average. Among blacks, deaths declined from about 14 to 11 per 1,000 births.
The researchers considered factors other than smoking that influence infant mortality, including family income and education, but still found a link with rising taxes.
The context
Almost 11 percent of U.S. women smoke during pregnancy, federal data show. Previous studies have linked higher cigarette taxes with declines in smoking during pregnancy and with better newborn health. The researchers say their work is the first examining these taxes and U.S. infant mortality rates.
Raising tobacco taxes is among strategies the Centers for Disease Control and Prevention supports to reduce smoking. A U.S. Surgeon General report last year said reducing smoking among pregnant women and women of reproductive age “remains a critical component of public health efforts to improve maternal and child health.”
The researchers say the taxes could have negative consequences for pregnant smokers who don’t quit and can’t afford to buy necessities because of high cigarette prices – a possibility the study didn’t examine. The study lacked information on all variables that could affect infant mortality. Still, they say their study adds to evidence for policymakers to consider in seeking ways to reduce infant deaths.
http://www.cbsnews.com/news/higher-cigarette-taxes-save-babies-lives-study-finds/