Bismarck Tribune: Study links chemical in e-cigs to lung cancer

BLAIR EMERSON Bismarck Tribune
A new study found e-cigarettes may not be a safer alternative to smoking tobacco.
Harvard T.H. Chan School of Public Health recently published the results of a study that found popular e-cigarette flavors contain diacetyl, a chemical linked to a severe lung disease.
“This latest study … is yet another reminder that e-cigarettes are not a safe alternative to tobacco use,” said Jeanne Prom, executive director of the North Dakota Center for Tobacco Prevention and Control Policy.
Researchers studied 51 types of flavored e-cigarettes that appeal to youths. Many E-cigarette brands offer fruit and candy flavors, which Prom said are unique and target kids.
The North Dakota 2015 Youth Risk Behavior Survey reports that 22 percent of high school students report using e-cigarettes at least once in the month prior to taking the survey.
“Our own North Dakota high school students have tried these products,” Prom said. “It’s not a safe alternative. … You’re really just swapping out one poison for another.”

Diacetyl is a flavoring chemical linked to a type of lung disease called bronchiolitis obliterans, or “popcorn lung,” which got its name after workers contracted the lung disease while working in microwave popcorn factories.
Currently, e-cigarettes are unregulated, but the U.S. Food and Drug Administration has proposed a rule to regulate e-cigarettes just as the agency regulates cigarettes and other tobacco products.
“It is our hope that the FDA’s final rules are released very soon and can provide some regulatory framework that can lead to these products being more properly regulated and less available to kids,” she said.
http://bismarcktribune.com/news/study-links-chemical-in-e-cigs-to-lung-cancer/article_ff4f45b4-8374-5ae0-9588-32491eb790ad.html

Medical News Today: Graphic warnings on cigarette packets 'help smokers consider health risks'

Written by
With 2016 just around the corner, many individuals will be gearing up to take on one of the most challenging New Year’s resolutions: to quit smoking. But a new study suggests this challenge could be made easier if graphic warning labels were put on cigarette packets, after finding such warnings trigger more negative feelings toward smoking than text warnings alone.
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Lead study author Abigail Evans, a postdoctoral researcher at Ohio State University, and colleagues publish their findings in the journal PLOS One.
In 2011, the Food and Drug Administration (FDA) published a final rule that required tobacco companies to include color graphics on cigarette packets that depict the negative health implications of smoking.
In 2012, however, a US federal appeals court overturned the ruling, claiming the images put forward by the FDA were “unconstitutional” and were “unabashed attempts to evoke emotion […] and browbeat consumers into quitting.”
According to Evans and colleagues, their findings suggest the decision to overturn the FDA’s rule based on these grounds was wrong; the team says the graphic images do not “browbeat” consumers, and though they do evoke emotion in smokers, the researchers say these emotions make people think more carefully about the health risks of smoking.
“What the court is missing is that without emotions, we can’t make decisions,” says study coauthor Ellen Peters, professor of psychology at Ohio State. “We require having feelings about information we collect in order to feel motivated to act. These graphic warnings helped people to think more carefully about the risks and to consider them more.”

Feelings produced by graphic images ‘acted as a spotlight’

The team reached their conclusion by assessing 244 adults of an average age of 34 who smoked between 5-40 cigarettes a day.
For 4 weeks, smokers were given their preferred brand of cigarettes in packaging that had been modified; some packets contained warning text only – such as “cigarettes cause fatal lung disease” – some contained warning text plus one of nine graphics depicting the dangers of smoking, while others consisted of warning text, graphics plus additional text detailing the risk of every cigarette smoked.
The warning graphics used were developed by the FDA and contained disturbing images, such as a man smoking through a hole in his throat, depicting a surgical procedure known as a tracheostomy that is a result of some smoking-related cancers.
Each week for the 4-week period, smokers collected their cigarettes from the lab and completed surveys detailing how the new packaging made them feel about smoking.
Compared with participants who received text-only packaging, those who received packaging with graphic warnings were more likely to read or look closely at the information, were more likely to remember the information, and were more likely to report that the packaging made them feel worse about smoking.
“The feelings produced by the graphic images acted as a spotlight,” notes Peters. “Smokers looked more carefully at the packages and, as a result, the health risks fell into the spotlight and led to more consideration of those risks.”
In addition, smokers who received packaging with graphic warnings were also more likely to view the information as more “credible” than those who received text-only packaging, and they were also slightly more likely to say they planned to quit smoking.
“For a health issue like smoking, which causes about a half-million deaths a year in the United States, even small effects can have a large impact in the population,” says Peters. “The effect was small, but it was not unimportant.”
Overall, the researchers say their findings show graphic warnings are more effective than text-only warnings for getting consumers to consider the health risks of smoking. They add: “Policies requiring such labels have the potential to reduce the number of Americans who smoke. The effect induced by graphic warning labels appears to have utility in communicating more and more credible information, useful to promoting risk perceptions and quit intentions among smokers in the US and around the world.”
This research supports another study reported by Medical News Today earlier this year, which found a combination of health warning graphics and text on cigarette packets increased knowledge about the dangers of smoking among young adults, compared with text-only warnings.

http://www.medicalnewstoday.com/articles/304495.php

Fargo Forum: WF high school rethinking assignment to urge lawmakers to hike tobacco tax

By Helmut Schmidt

WEST FARGO – Add to North Dakota’s tobacco tax or leave it alone?
That’s a question Sheyenne High School teachers agree would have been better left up to students to decide.

On Friday, senior government class students teamed up with a freshman health class in a collaborative project to write letters to local legislators about the tobacco tax rate in North Dakota. The students thanked lawmakers who voted to increase the tobacco tax in the state during the last session, and encouraged those who didn’t support a higher tax on tobacco to consider doing so in the future.
“For our state, we have very strict laws as far as tobacco in public buildings, but as far as tobacco tax, we are one of the lowest in the nation, and that’s what we are trying to deter,” health teacher Tom Kirchoffner told WDAY-TV.
The original intent was to send the letters to the legislators, but that’s not what happened.
“After this group of teachers did the project, they sat down and they debriefed it. What were the strengths of that project … and what were some of the areas for improvement?,” district spokeswoman Heather Konschak said Tuesday.
That debriefing took place Friday, she said.
“They realized as they chatted about it that one of the areas for improvement would have been that they gave the student group their perspective,” Konschak said. “The students weren’t able to discuss it and come up with their own perspective. And from a government class standpoint, that’s not what you do. You allow kids to discuss and form their own perspective and viewpoint.”
The teachers “decided that because that’s not what happened in the project, that they weren’t going to send the letters,” because it is possible that’s “not an accurate depiction of what the kids would have picked if they had been given the opportunity to do it on their own,” Konschak said.
The decision was “there should have been more open dialogue,” to let the students choose their positions on the issue, Konschak said.
Konschak said one of the teachers got the idea from a conference. The project was in addition to the required curriculum, she said.
Kirchoffner didn’t immediately return a phone message seeking comment Tuesday. He was unavailable because he’s a basketball coach and was traveling to a game, Konschak said.
North Dakota’s tax per pack of cigarettes is 44 cents, which puts it at 48th in the nation. Minnesota’s per pack tax is $2.90, putting it at No. 8 in the U.S., according to the Campaign for Tobacco-Free Kids.
New York has the highest state tax per pack at $4.35, while Missouri has the lowest state tax at 17 cents per pack. The national average is $1.60 per pack, the campaign reports.
Those figures do not include local taxes. The highest state-local tax combination per pack is $6.16 in Chicago, with New York City second at $5.85 per pack, the campaign reports.
http://www.inforum.com/news/3904754-wf-high-school-rethinking-assignment-urge-lawmakers-hike-tobacco-tax

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/