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/

Healthline News: Teen E-Cigarette Use Linked to Breathing Problems

A study of adolescents in Hong Kong found respiratory issues were 30 percent more likely in vapers than non-vapers.
Written by Roberta Alexander

E-cigarettes and vaporizers, widely touted as a way to quit smoking, remain controversial. For every supporter who sees them as useful, there is a health expert suggesting that these products are dangerous in their own way.
A new study out of Hong Kong is not likely to settle the issue any time soon.
Researchers looked at the respiratory health of Chinese adolescents, both those who use e-cigarettes and those who do not. The results, published in JAMA Pediatrics, have raised concerns about the impact of e-cigarettes on the health of minors.

Ecig Teen
Indeed, one of the authors of the study, Daniel Ho, Ph.D., of the University of Hong Kong, said in a press release, “E-cigarettes are certainly not harmless and serious health problems of long-term use will probably emerge with time.”
Ho is an associate professor in the School of Public Health whose main research interests are in adolescent health in relation to tobacco, alcohol, and obesity.
He and fellow researchers found that adolescents who use e-cigarettes were approximately 30 percent more likely to report respiratory symptoms than adolescents who do not use them.

Thousands of Students Studied

More than 45,000 students in Hong Kong participated in the study. Data was collected between 2012 and 2013.
Of the sample population, 1.1 percent of students reported e-cigarette use within the past 30 days. Those students were 30 percent more likely than their peers to report respiratory problems.
The results are suggestive but not definitive. Dr. Norman H. Edelman, senior consultant for scientific affairs for the American Lung Association, found the study intriguing.
“It’s important [but] we need to know if the lungs are injured. It’s not clear if this really affects the lungs. We’re not sure what the symptoms are,” Edelman told Healthline.
He wondered if the young subjects were reporting soreness in their throats, excessive coughing, or difficulty breathing. He would like to see a follow-up study, perhaps in the United States.
“We need to do lung function tests,” he said.
“Whenever you breathe in something, you don’t know what’s in it. Some of the data suggest irritation,” Edelman said. “We don’t know what the negative effects are. This is just a beginning.”
E-cigarettes and vaporizers use liquids that have varying amounts of nicotine or none at all. These liquids are not regulated by the U.S. Food and Drug Administration (FDA), but generally also contain propylene glycol, a suspected lung irritant, and vegetable glycerin.
“While supporters [of e-cigarette use] are optimistic about the potential for harm reduction in the minority of established cigarette smokers, [for] which convincing evidence is lacking, this does not seem to justify the potential harm of renormalizing cigarette smoking, delaying smoking cessation, and escalating to real cigarette smoking, especially among the majority of non-smoking young people,” Edelman said.

E-Cigarettes Gaining in Popularity

The use of e-cigarettes have surpassed the use of conventional cigarettes among young people in the United States.

Mitch Zeller, director of the Center for Tobacco Products at the FDA, called those numbers “astounding and concerning” in an interview earlier this year.
“Nicotine is very harmful to the developing child and adolescent brain,” Zeller said. “Parents should take no comfort in the fact that their kids are using an e-cigarette rather than a burning cigarette because of the presence of nicotine.”
http://www.healthline.com/health-news/teen-e-cigarrette-use-linked-to-breathing-problems-111715#1

New York Times: U.S. Smoking Rate Declines, but Poor Remain at Higher Risk

By SABRINA TAVERNISE

WASHINGTON — Smoking, the leading cause of preventable death in the United States, continued to decline last year, federal health authorities reported Thursday, with the share of American adults who smoke dropping to 16.8 percent, down from 17.8 percent in 2013.

Smoking has been one of the brightest public health successes of recent history. Nearly half of all Americans smoked in the 1960s, but a broad push against the habit, starting with the surgeon general’s warning in 1964, helped bring rates down. The rate has dropped by about a fifth since 2005, when it was 21 percent.

But the national numbers mask deep trouble spots within the American population. About 43 percent of less educated Americans smoked in 2014, compared with just 5 percent of those with a graduate degree. About a third of Americans insured by Medicaid, the health insurance program for the poor, smoked, compared with 13 percent of Americans with private insurance.

The figures, reported by the Centers for Disease Control and Prevention, underscored the extent to which smoking in America has become a problem of the poor. Nearly six million Americans covered by Medicaid smoke, as well as almost nine million uninsured Americans, or about a third of the uninsured population.

Smoking-related diseases accounted for more than 15 percent of annual Medicaid spending from 2006 to 2010, or about $39 billion a year, according to the American Lung Association.

“Disparities are the single most important issue in smoking,” said Kenneth E. Warner, a professor of public health at the University of Michigan School of Public Health.

Dr. Warner added: “The people who are politically influential believe the smoking problem has been solved. It’s not in their neighborhoods. Their friends don’t smoke. Those who still smoke are the poor, the disenfranchised, the mentally ill. That’s who we need to focus on.”

On Thursday, the federal government appeared to take aim at that problem by proposing a rule that would prohibit smoking in public housing nationwide.

Nationally, success of the antismoking campaign has been striking. Progress among the poor and less educated, however, has been far slower.

About 43 percent of people with only a high school equivalency diploma smoke, virtually unchanged from 2005. In comparison, smoking declined by about 26 percent among people with college degrees, to 8 percent from 11 percent. For people with a high school diploma only, smoking declined by about 12 percent, to 22 percent.

Smoking among people who live at or above the poverty line declined by about 26 percent, to 15 percent from about 21 percent in 2005. Those below the poverty line declined by about 12 percent, to 26 percent from 30 percent, the report found.

American Indians and Alaskan Natives had the highest smoking rate, about 29 percent, followed by Americans of more than one race, about 28 percent of whom smoked.

Whites and blacks smoked at about the same rate in 2014 — about 18 percent — while Hispanics had a much lower rate, 11 percent.

http://mobile.nytimes.com/2015/11/13/health/us-smoking-rate-cdc-report.html?_r=0

The Washington Post: Who still smokes in the United States — in seven simple charts

By Brady Dennis
Cigarette smoking among U.S. adults has fallen to the lowest rate in generations, according to data released Thursday by the Centers for Disease Control and Prevention. That’s good news, considering that smoking still accounts for about 480,000 deaths annually in the United States, along with an estimated $300 billion in health costs and lost productivity.
But the CDC numbers also offer an interesting glimpse at the 17 percent of adults who continue to light up. People in the Midwest, for instance, smoke more on average than Americans elsewhere in the country. People on Medicaid are more than twice as likely to smoke as those on Medicare. Adults with a GED certificate smoke at eight times the rate of those with graduate degrees. Asians smoke less than other ethnic groups. Men smoke more than women, but not by much.
Here are seven charts, based on CDC data, that detail the current landscape of smoking in the United States:
1) Half a century ago, more than two of every five adults were smokers. But that has fallen steadily over time. From 2005 to 2014, the adult smoking rate declined from 20.9 percent to 16.8 percent. Public health officials are hoping to to drive that rate below 12 percent by 2020.
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2) Cigarette smoking has fallen sharply among 18- to 24-year-olds. In fact, the percentage of smokers in that age group dropped by nearly a third over the past decade, CDC data show,  the sharpest decline of any group. But that striking change might be attributable, at least in part, to the growing popularity of e-cigarettes, hookahs and other “non-cigarette tobacco products,” CDC officials said.
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3) People with lower levels of education tend to smoke at higher rates. The new data also show that smoking among people with graduate and undergraduate degrees has fallen more sharply over the past decade than among most other groups.
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4) Smoking among multiracial people and those classified as American Indian or Alaska Natives (AI/AN) far outpaces that of other ethnic groups. Notably, Asians continue to have the lowest rate of smokers and, along with Hispanics, have cut their smoking rates steeply over the past decade. CDC officials said the disparities across ethnic groups, which are consistent with previous research, might partly be due to cultural differences related to the acceptability of tobacco use.
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5) Midwesterners still smoke at higher rates than anyone else in the country. This was true a decade ago. But Thursday’s data show that while other regions have cut smoking rates by 20 percent or more since 2005, the Midwest’s dropped only 14.4 percent.
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6) U.S. adults who are uninsured or on Medicaid smoke at rates more than double that of people who have Medicare or private insurance. There could be many factors at play here. But health officials said one contributing factor is likely the “variations in tobacco-cessation treatment coverage and access to evidence-based cessation treatments” across different insurance types.
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7) The number of heavy smokers seems to be declining. Between 2005 and 2014, the number of daily smokers dropped from 36.4 million to 30.7 million. Those daily smokers also reported smoking fewer cigarettes over time, from an average of 16.7 a day in 2005 to 13.8 a day in 2014. The number of people smoking more than 30 cigarettes a day fell by almost half.
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https://www.washingtonpost.com/news/to-your-health/wp/2015/11/12/smoking-among-u-s-adults-has-fallen-to-historic-lows-these-7-charts-show-who-still-lights-up-the-most/

STAT: E-cigarettes widely seen as harmful in STAT-Harvard poll

By DAVID NATHER And SHEILA KAPLAN
WASHINGTON — Most Americans believe electronic cigarettes are harmful to people’s health, according to a new national poll — even though scientists have not reached a consensus on the risks of the increasingly popular products.
The results of the poll, by STAT and the Harvard T.H. Chan School of Public Health, could bolster the Food and Drug Administration as it moves to regulate e-cigarettes for the first time. There is solid support for a broad range of government restrictions among both Democrats and Republicans, with virtually no partisan differences to be found.
E-cigarettes have been around only since 2004 — too little time for researchers to have completed definitive studies on their health effects — but already they are more popular among teenagers than conventional cigarettes.
Manufacturers market the products as safer than tobacco cigarettes and as an effective way to help people stop smoking. The poll results, however, suggest that the public isn’t buying this pitch.

Read the full poll results here

E-cigarette users don’t inhale cancer-causing tobacco smoke. Instead, the devices produce a vapor from heated liquid nicotine. For many public health experts, though, the concern is that they still contain nicotine — which is addictive — and may expose users to various toxic chemicals.
Americans do think they’re less dangerous than tobacco cigarettes, but that doesn’t mean they think the products are safe. The survey found that 65 percent of adults believe e-cigarettes are harmful to the people who use them. That’s less than the 96 percent who say tobacco cigarettes are harmful, but more than the 58 percent who say the same thing about marijuana.
Those results appear to be the main reason the public is ready to embrace regulations that would treat e-cigarettes largely like tobacco cigarettes, including rules that go beyond what are actively being considered at the federal level.
“They believe it’s less harmful than tobacco, but they do think it is harmful, and that sets off all the other answers,” said Robert Blendon, a professor of health policy and political analysis at Harvard who directed the poll.

Roughly 9 out of 10 Americans support banning the sale of e-cigarettes to minors under age 18 — a law already passed in most states. A similar number favor requiring warning labels stating that e-cigarettes contain nicotine.
About 7 out of 10 say people shouldn’t be allowed to use e-cigarettes indoors in public places like restaurants and workplaces, and 6 out of 10 say the government should ban e-cigarette ads on TV, just as it bans ads for tobacco cigarettes.
Even the biggest partisan differences are slight. The warning labels on e-cigarette packages are supported by 98 percent of Democrats and 87 percent of Republicans.
And on taxes — a subject that usually sets off food fights in Washington — there is solid support from both parties: 63 percent of Republicans and 72 percent of Democrats say they support taxing e-cigarettes in the same way that tobacco cigarettes are taxed.
The results suggest that Americans have largely made up their minds on how e-cigarettes should be treated, and that they’re using tobacco cigarettes as their frame of reference — even as scientists are still trying to determine what the health consequences of e-cigarettes are.
“For a new product … you wouldn’t have expected that people would have reached as firm a judgment about this as they have,” said Blendon. On the proposed policies the poll asked about, he added, “their responses are nearly identical to what you find asking about tobacco cigarettes.”
That’s how Anna Glasscock, a Republican retiree who lives near Springfield, Ill., decided her views on e-cigarettes. She’s a former smoker who knows the health risks of tobacco and said e-cigarettes “shouldn’t even exist” because “any addictions are not good.”
Glasscock, one of the people in the poll who agreed to a follow-up interview, said e-cigarettes should be regulated and taxed — she considers it a “sin tax.” Even though e-cigarettes are different from tobacco cigarettes, she said, “I don’t see that replacing one with the other makes any difference.”
Gregory Conley, president of the American Vaping Association, the main advocacy group for e-cigarette makers, blamed the poll results on “unethical propaganda campaigns” against e-cigarettes that have led to “a confused populace.”
“This poll is not measuring public opinion, but the effectiveness of a well-funded corporate strategy to destroy a category that is eroding a cash cow for Big Pharma,” he said.
But Vince Willmore, a spokesman for the Campaign for Tobacco-Free Kids, said it was “not surprising that the public wants to apply common-sense regulations to e-cigarettes” and urged the Obama administration to issue the FDA’s e-cigarette regulations as soon as possible.
The one issue the public is split on is whether to ban the sale of flavored nicotine cartridges — an issue that doesn’t have any parallel with tobacco cigarettes. Fewer than half of Americans think that’s a good idea.
Supporters argue that flavored cartridges attract young people to start using e-cigarettes, and that they will later move on to tobacco cigarettes.
The telephone poll of 1,014 adults was conducted Oct. 7-11 and has a margin of error of 3.7 percentage points.
John Dunn of Garland, Texas, a suburb of Dallas, said he has used e-cigarettes to quit smoking tobacco cigarettes. But a friend who tried the same thing got hooked on e-cigarettes.
“I think they’re pretty different, but also I’ve seen people get on the vapors and not be able to stop,” said Dunn, 33, a Democrat. He’s in favor of some regulation, including warning labels: “They should know they might get addicted.”
E-cigarette makers say that e-cigarettes help smokers quit, and there is some evidence from a small number of studies that they do — although scientists say more research is needed. The survey found that 38 percent of Americans believe e-cigarettes can help people quit smoking, but that 47 percent don’t think they’re effective.
At the same time, public health advocates — and government regulators such as the FDA and the Centers for Disease Control and Prevention — have strong concerns that e-cigarettes serve as a “gateway” for non-smokers to start using tobacco products. More than half of Americans — 56 percent — believe e-cigarettes make teenagers more likely to try tobacco cigarettes, according to the poll.
At a panel discussion on e-cigarettes last month, CDC Director Tom Frieden declared that e-cigarettes are “highly addictive” and that the goal should be to “keep kids away from all forms of nicotine.” The CDC reported earlier this year that e-cigarette use tripled among high-school and middle-school students from 2013 to 2014.
The FDA is preparing to issue a final version of a rule that would extend the agency’s authority to regulate e-cigarettes. The proposal, recently submitted to the White House Office of Management and Budget for final revisions, would likely require pre-market reviews of e-cigarettes — a process that is used to prove whether potentially risky products are safe. The FDA is also expected to ban e-cigarette sales to minors under age 18 and require warning labels stating that the products contain nicotine. The regulation drew 135,000 comments from the public when the original proposal was published.
The agency is also considering a separate proposal that could require broader warnings about the dangers of nicotine — especially accidental exposure to infants and children — and possibly require child-resistant packages for e-liquids, which are liquid nicotine combined with colorings and flavorings.
Some in Congress, however, are trying to prevent the FDA from taking action that might damage the industry. A House spending bill includes a provision by Representative Robert Aderholt (R-Ala.) that would keep the FDA from requiring premarket review for e-cigarettes that are already being sold in stores. Aderholt’s office did not respond to requests for comment.
Even if much of the public is ready to regulate e-cigarettes, Aderholt will find at least some support from those who don’t think they are dangerous enough to need new rules.
“They’re not a cigarette. The only thing you’re inhaling is vapor,” said Chris Grieser, a Republican from Cheyenne, Wyo. who participated in the survey. “That’s no different from standing over a pot of boiling water.”
Researchers aren’t so sure about that, though. One study earlier this year found that e-cigarette vapor can contain cancer-causing formaldehyde at levels far higher than those found in tobacco cigarettes.
The original e-cigarettes were manufactured by small companies, but when it became clear that they were catching on, the more established tobacco companies such as RJ Reynolds and British American Tobacco bought out or partnered with some of these smaller businesses, or launched their own divisions. This has given more clout to industry groups such as the American Vaping Association.
This is the first of a series of monthly polls being conducted by STAT and the Harvard T.H. Chan School of Public Health.
http://www.statnews.com/2015/11/09/e-cigarettes-widely-seen-as-harmful-in-stat-harvard-poll/

Reuters Health: Adolescent e-cigarette use tied to breathing problems

BY ANDREW M. SEAMAN
Adolescents who reported using e-cigarettes were about 30 percent more likely to report respiratory symptoms than those who never used e-cigarettes, in a study from China.
The increased risk of breathing problems – like a cough or phlegm – varied depending on whether or not the adolescents also smoked traditional cigarettes.
“Among never smoking adolescents, e-cigarette users are twice as likely to report respiratory symptoms than non-users,” study author Dr. Daniel Ho, of the University of Hong Kong School of Public Health.
 
“E-cigarettes are certainly not harmless and serious health problems of long-term use will probably emerge with time,” Ho added in an email to Reuters Health.
E-cigarettes deliver nicotine through a vapor, which contains propylene glycol and flavoring chemicals known to be bothersome to the respiratory system, the researchers write in JAMA Pediatrics.
While past research found some short-term respiratory effects in adults after e-cigarette use, the researchers say no study had looked for these effects in adolescents.
The new findings are drawn from data collected between 2012 and 2013 from over 45,000 schoolchildren in Hong Kong with an average age of about 15.
Overall, 1.1 percent of students reported smoking e-cigarettes within the past 30 days, and about 19 percent of all students reported respiratory symptoms.
Students who smoked e-cigarettes were 30 percent more likely to report breathing problems, compared to those who didn’t use the devices.
The difference in breathing problems was most pronounced among students who said they never smoked traditional cigarettes. These students were over twice as likely to report breathing problems as those who didn’t use e-cigarettes.
Students who reported using e-cigarettes and also smoking traditional cigarettes at some point in their lives were at a 40 percent increased risk of breathing problems, compared to those who didn’t use the devices.
While the study can’t prove the devices caused breathing problems among children, the researchers say the findings support the World Health Organization’s recommendation to regulate e-cigarette use among children.
“Other studies have also shown that adolescent e-cigarette users are more likely to initiate cigarette smoking than non-users,” Ho said. “One in two smokers will be killed by tobacco; two in three if started from a young age.”
Parents, he said, can prevent e-cigarette and traditional cigarette use among their children by not using the devices or tobacco, not exposing their children to secondhand smoke and setting strict smoke-free rules at home.
“E-cigarette use is a controversial topic,” Ho said. “While supporters are optimistic about the potential for harm reduction in the minority of established cigarette smokers, (for) which convincing evidence is lacking, this does not seem to justify the potential harm of re-normalizing cigarette smoking, delaying smoking cessation, and escalating to real cigarette smoking, especially among the majority non-smoking young people.”
http://www.reuters.com/article/2015/11/09/us-health-ecigarettes-adolescents-breath-idUSKCN0SY22Y20151109#UoWlC6rr1iRdS4YY.99