LA Times: First-time tobacco users lured by flavorings, report says

Melissa HealyContact Reporter
A majority of adolescents who are puffing, vaping or chewing a tobacco product for the first time prefer one with flavor, suggesting that fruity, tangy, spicy or minty flavorings add a powerful allure to the uninitiated.
In a nationwide survey of U.S. children ages 12 to 17, the Food and Drug Administration’s Center for Tobacco Products has found that among those trying a hookah, electronic cigarette, cigar or regular cigarette for the first time, 89%, 81%, 65% and 50%, respectively, chose to try their tobacco product with an added flavoring.
In the United States, the marketing of flavored cigarettes — with the exception of menthol — is prohibited. But a wide range of flavorings is used in tobacco that is vaped, smoked in hookahs, chewed or dissolved in the mouth.
When adolescents were asked about their use of a tobacco product over the last 30 days, large majorities underscored that flavorings continued to play a role in their enjoyment of tobacco products. Asked about their tobacco use in the preceding month, 89% among hookah users said they had used flavored tobacco, compared with 85% of e-cigarette users, 72% of  users of any cigar type, and 60% of cigarette smokers.
The results were published Monday in the Journal of the American Medical Assn.
The study offers new insights into what factors pave the way for an estimated 3,200 American kids each day to try tobacco for the first time. A lifetime tobacco habit is overwhelmingly started in the teen and young adult years, and federal regulators have been keen to blunt smoking’s appeal to first-time users.
Since 2009, the FDA has had sweeping powers to regulate tobacco products in the interest of the public’s health. New evidence that flavorings play a key role in easing a would-be tobacco user’s introduction to the product is sure to spark renewed debate over outlawing flavorings.
“Consistent with national school-based estimates, this study confirms widespread appeal of flavored products among youth tobacco users,” the authors write. “In addition to continued proven tobacco control and prevention strategies, efforts to decrease use of flavored tobacco products among youth should be considered.”
http://www.latimes.com/science/sciencenow/la-sci-sn-first-time-tobacco-flavorings-20151026-story.html

CNN: Raise smoking age to 21 and regulate e-cigs, pediatricians urge

(CNN) Most people who smoke started in their teens. While the number of kids trying tobacco for the first time has declined since the 1970s, there are still new smokers every year and kids’ doctors want to do something about it.

The American Academy of Pediatrics (AAP) came out with a strong new policy statement that urges policymakers to raise the minimum age people could buy nicotine products, be they cigarettes or e-cigarettes, to 21.

The public health benefits of barring people under age 21 from buying these products could be tremendous, including “4.2 million fewer years of life lost” among the next generation of American adults, according to a report released in March by the Institute of Medicine.

Setting a new minimum age nationwide, that study estimated, would result in nearly a quarter-million fewer premature deaths and 50,000 fewer deaths from lung cancer among people born between 2000 and 2019. Teenagers, especially those between ages 15 and 17, are most vulnerable to becoming addicted at a time when their brains are still developing.

The study, conducted at the request of the U.S. Food and Drug Administration, studied the predicted benefits of raising the minimum legal age for buying tobacco products — currently 18 in most states — to 19, 21, and 25 years. The greatest health benefits would actually come from raising the legal age even higher to 25, at which point the report estimates the prevalence of smokers among today’s teens, when they become adults, would decline by 16%.

The number of people who would not smoke if the age limit was raised to 21 is still significant. It’s estimated smoking rates would fall to 12%.

Even though fewer teenagers are using tobacco than ever before, more than half of current smokers say they started smoking before they were 18, studies show. And the number of teens who tried e-cigarettes and hookahs tripled in one year. The AAP policy statement urges the U.S. Federal Food and Drug Administration to regulate e-cigarettes and other electronic nicotine delivery systems the same as other tobacco products.

Chris Hansen of the American Cancer Society’s Cancer Action Network praised the study when it came out in March, saying “powerful interventions are needed to keep youth from lifelong addictions to these deadly products.”

The American Academy of Pediatrics issued a statement calling the report “a crucial contribution to the debate on tobacco access for young people.”

“There is no safe way to use tobacco,” said Dr. Sandra G. Hassink, the academy’s president.

The FDA cannot raise the age limit nationwide. The minimum age in four states is 19, and in several local jurisdictions including New York City have raised the legal age to 21.

Historically, the tobacco industry has called for “responsible” consumption of tobacco products.

Companies should create more child-resistant packaging to keep curious kids from drinking the liquid nicotine used in e-cigarettes, the AAP policy statement also said. In 2014, there were more than 3,000 e-cigarette calls to U.S. poison centers. As little as half a teaspoon can kill an average-size toddler, according to the AAP. Liquid nicotine is extremely toxic when ingested on its own.

“Tobacco is unique among consumer products in that it severely injures and kills when used exactly as intended,” states the AAP policy statement. “Protecting children from tobacco products is one of the most important things that a society can do to protect children’s health.”

http://www.cnn.com/2015/10/26/health/raise-minimum-smoking-age/

Patient-centered care helps patients overcome mental illness and tobacco use

People diagnosed with chronic mental illness will die an average of 10 years earlier than those without mental illness.
A number of social and biological factors contribute to early mortality, but 40 percent of people with a mental health condition also practice one of the most preventable health risk behaviors — smoking.
A study from the National Institutes of Mental Health found that people with a mental illness smoke nearly half of all cigarettes in America. The Journal of the American Medical Association provided evidence that people with severe mental illness are at a higher risk of cardiovascular death. Depression is three times higher in smokers than in non-smokers, and an estimated 70 to 85 percent of people with schizophrenia are tobacco users.
Evidence supports a bi-directional relationship between tobacco use and depression. For some patients, smoking can alleviate pre-existing symptoms of depression and anxiety by releasing dopamine, a source of pleasure, in the brain. But evidence also suggests that smoking causes depression and other forms of psychosis, and some people with decreased dopamine levels are genetically predisposed to tobacco use and dependence.
Health care providers must address the patient’s tobacco use, a chronic addictive condition, in conjunction with the mental illness to preserve health. To accomplish this, we must:
Treat both conditions at once
Some evidence-based pharmacological methods are dually effective in treating tobacco use and mental illness. For one, bupropion hydrochloride has proven successful in reducing depression and serving as a smoking cessation aid.
Acknowledge the mental health effects of quitting
The decision to quit smoking benefits the patient in the long term, but nicotine withdrawal might exacerbate or lead to depressive symptoms. Patients must communicate with a health care provider about any side effects associated with quitting, such as depression. Patients can also participate in group therapies or meet with a counselor to mitigate the negative effects of quitting smoking.
Ensure that intervention is patient-centered
When patients give up smoking, they’re letting go of a coping mechanism or a companion. The patient should remain the central focus in any intervention, and providers should act with empathy and understanding, because quitting is a process requiring perseverance. A patient-centered plan should incorporate aids to quit smoking as well as mental health support and accessible resources.

Dr. Chizimuzo Okoli is an assistant professor in the UK College of Nursing.

http://www.kentucky.com/2015/10/24/4103534/patient-centered-care-helps-patients.html

The Hill: FDA sends e-cigarette regs to White House for review

By Lydia Wheeler
The Food and Drug Administration (FDA) has sent its final rule to regulate additional tobacco products, including electronic cigarettes and cigars, for White House review.
The rule, which was first proposed more than a year ago, was sent to the White House Office of Management and Budget’s Office of Information and Regulatory Affairs on Monday, but it could be weeks before the rule is actually released.
FDA spokesman Michael Felberbaum said the Office of Management and Budget is required to review all significant regulatory actions and has 90 calendar days to do so.
“However, this timeframe can be extended to allow for additional interagency discussion,” he said. “At this time, the FDA cannot provide any further comment until the final rule is published.”
The American Lung Association is hoping for an expedited review.
“We remain deeply troubled that it’s taken 18 months from the time the proposal was released to now,” said Erika Sward, the group’s assistant vice president of national advocacy. “We need to move forward in protecting kids and public heath.”
Sward said the lung association is hoping the final rule will give FDA the authority to truly regulate all tobacco products. Under the proposed rule, she said, there was a loophole for certain “premium” cigars.
“There’s no such thing as a safe tobacco product and certainly not a safe cigar,” she said. “FDA needs to have the basic authority over all tobacco products to make sure kids aren’t buying them and warning labels are required.”
http://thehill.com/regulation/pending-regs/257920-fdas-tobacco-deeming-rule-under-final-review

Stateline: Should the Smoking Age Be 21? Some Legislators Say Yes

By Jenni Bergal, Stateline | Pew Charitable Trust
While a growing number of states have turned their attention to marijuana legalization, another proposal has been quietly catching fire among some legislators—raising the legal age to buy cigarettes.
This summer, Hawaii became the first state to approve increasing the smoking age from 18 to 21 starting Jan 1. A similar measure passed the California Senate, but stalled in the Assembly. And nearly a dozen other states have considered bills this year to boost the legal age for buying tobacco products.
“It really is about good public health,” said Democratic Hawaii state Sen. Rosalyn Baker, who sponsored the legislation. “If you can keep individuals from beginning to smoke until they’re at least 21, then you have a much greater chance of them never becoming lifelong smokers.”
Supporters say hiking the legal age to 21 not only will save lives but will cut medical costs for states. But opponents say it would hurt small businesses, reduce tax revenue and violate the personal freedom of young adults who are legally able to vote and join the military.
Measures to raise the smoking age to 21 also were introduced this year in Massachusetts, New York, Oregon, Rhode Island, Utah, Vermont, Washington and the District of Columbia, according to the Preventing Tobacco Addiction Foundation, an advocacy group aimed at keeping young people from starting to smoke. Iowa and Texas considered measures to increase the legal age to 19. None of those bills passed. And just last week, a Pennsylvania legislator introduced a bill to up the minimum age there to 21.

Cities Act First

In almost every state, the legal age to buy tobacco products is 18. Four states—Alabama, Alaska, New Jersey and Utah—have set the minimum at 19.
Anti-tobacco and health care advocates say that hiking the smoking age to 21 is a fairly new approach in their effort to reduce young people’s tobacco use. Until recently, research on the topic has been somewhat limited, they say.
That hasn’t stopped a growing number of local governments from taking action on their own in the last few years. As of late September, at least 94 cities and counties, including New York City, Evanston, Illinois, and Columbia, Missouri, had passed measures raising the smoking age to 21, according to the Campaign for Tobacco-Free Kids, an advocacy group that promotes reducing tobacco use.
One of those communities is Hawaii County, the so-called “Big Island” of Hawaii, where the law changed last year after a grassroots effort by health care advocates, anti-smoking groups and local high school students. That coalition, joined by teens from across Hawaii, continued its fight at the state level, and legislators heard the message, said Sen. Baker, whose bill also included e-cigarettes, battery-powered devices that deliver vaporized nicotine, which have become popular among young people.
Supporters of raising the smoking age to 21 say that a turning point was a March report by the Institute of Medicine, the health arm of the National Academies of Sciences, Engineering and Medicine, which predicted that raising the age to 21 would cut smoking by 12 percent by the time today’s teenagers are adults. It also would result in about 223,000 fewer premature deaths.
The institute’s report also supported health care advocates’ argument that preventing or delaying teens and young adults from experimenting with smoking would stop many of them from ever taking up the habit. About 90 percent of adults who become daily smokers say they started before they were 19, according to the report.
“Raising the age to 21 will keep tobacco out of high schools, where younger kids often get it from older students,” said John Schachter, state communications director for the Campaign for Tobacco-Free Kids. “If you can cut that pipeline off, you’re making great strides.”
California state Sen. Ed Hernandez, a Democrat who sponsored a measure to raise the smoking age, said it’s good public policy.
“If we make it a law to drive with your seatbelt on to protect the consumer, or to require helmets for people on motorcycles, why can’t we raise the smoking age to protect young adults from becoming addicted to tobacco?” he said.
Supporters also point out that 21 became the national legal drinking age after President Ronald Reagan signed legislation in 1984 that forced states to comply or risk losing millions of dollars in federal highway funds. That has resulted in reduced alcohol consumption among young people and fewer alcohol-related crashes, national studies have found.
“President Reagan thought young people were not ready to make this decision to drink or to drink and drive before they turned 21,” said Rob Crane, president of the Preventing Tobacco Addiction Foundation. “Smoking kills more than six times as many people as drinking.”

Personal Choice

Opponents say that raising the smoking age to 21 would have negative consequences for businesses, taxpayers, and 18-year-olds who should be free to make a personal choice about whether they want to smoke.
Smokers’ rights groups, retailers and veterans’ organizations are among those who’ve opposed such legislation.
“If you’re old enough to fight and die for your country at age 18, you ought to be able to make the choice of whether you want to purchase a legal product or not,” said Pete Conaty, a lobbyist for numerous veterans groups who testified against the California bill. “You could enlist in the military, go to six months of training, be sent over to Iraq or Afghanistan and come back at age 19½ to California and not be able to buy a cigarette. It just doesn’t seem fair.”
Opponents say it’s wrong to compare cigarettes with alcohol. “If you smoke one or two cigarettes and get behind the wheel of a car, you’re not driving impaired,” Conaty said.
Opponents also say taxpayers would take a financial hit if the smoking age is raised because it would mean less revenue from cigarette taxes.
In New Jersey, where a bill to hike the smoking age to 21 passed the Senate last year and remains in an Assembly committee, a legislative agency estimated that tax revenue would be reduced by about $19 million a year.
In California, a fiscal analysis by the Senate appropriations committee estimated that raising the age to 21 would cut tobacco and sales tax revenue by $68 million a year. That would be offset by what the analysis said could be “significant” health care cost savings to taxpayers—reaching as much as $2 billion a year.
Stores that sell tobacco products and e-cigarettes also fear the effect. The Hawaii Chamber of Commerce opposed the measure there.  And Bill Dombrowski, president of the California Retailers Association, suggested that raising the smoking age would simply drive young people to the black market.
“If you raise the age, people under 21 will find the cigarettes somewhere else,” he said.

Health Care Savings

Cigarette smoking is the leading cause of preventable death in the U.S. and is responsible for more than 480,000 deaths a year, according to a 2014 U.S. Surgeon General report, which said the direct medical costs of smoking are at least $130 billion a year.
Supporters of the 21 smoking age say that the savings in health care costs, especially through Medicaid, the federal-state health insurance program for the poor and disabled, will far outweigh any loss in tax revenue for states.
Schachter and other advocates say Hawaii’s action, along with that of dozens of cities, will help spark legislation in other states and create a new standard for when young people take their first puff.
“There is momentum on this issue, and I think you’re going to see more and more states and cities moving in that direction,” Schachter said.
http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2015/10/14/should-the-smoking-age-be-21-some-legislators-say-yes

Forbes: Alcohol, Drug Addicts Far More Likely to Smoke Tobacco

Turn on the television at any point of the day to find anti-smoking commercials sprinkled throughout a sports game or nightly sitcom. As many organizations and levels of government focus efforts on eliminating tobacco use from the general population, one sub-population in particular continues to be ignored: individuals addicted to alcohol and drugs in treatment recovery programs.
Published in Addiction – a peer-reviewed journal that covers research related to alcohol, illicit drugs, tobacco and other addictions – a new report concluded that the overall rate of smoking among addicts in treatment for drug and alcohol use was 84%, compared with a rate of 31% for individuals of the general public.
Lead study author Joseph R. Guydish, a professor of Medicine and Health Policy at the University of California, San Francisco (UCSF), said in an interview that tobacco use isn’t just an issue for addiction recovery programs; it’s also a problem for both county and state public health offices supporting rehabilitation facilities.
“At the federal level this means the Substance Abuse and Mental Health Services Administration, the Center for Substance Abuse Treatment, the National Institute on Drug Abuse and the National Cancer Institute,” he said. “Internationally this means the WHO, its Framework Convention on Tobacco Control and its MPOWER principles. These are the agencies that can exert leadership in the area of smoking and addiction treatment, and provide programs with resources needed to better address smoking.”
Researchers reviewed 54 studies, which were published from 1987 to 2013, involving a total of 37,364 participants in 20 countries on six continents. All the reports analyzed were written in English.
“Anyone interested in tobacco control, whether nationally or internationally, should take note,” he said. “We cannot reduce adult smoking much further (at least in the United States) without addressing smoking in sub-populations where smoking rates are high.”
When asked about how often addicts switch over from their drug of choice to nicotine during the recovery process, Guydish admitted that he’s unaware of any relevant data available on the topic. He did note, however, that he believes the “answer would be not very often.”
“Nicotine operates in the same reward pathways of the brain as other addictive drugs, however its effect is relatively weaker than the effect of those other drugs,” he said. “We know that nicotine potentiates the effects of other drugs, but it seems unlikely that a person would stop drug use (for example) and then begin smoking as a replacement. But it is possible.”
He added: “The scenario we hear of more often is one where a person quits smoking, sometimes because they have been in a smoke-free jail or prison, but relapses to smoking in the context of drug treatment where they are surrounded by smokers.”
“Tobacco control researchers have done a great job of implementing tobacco control policies and evaluating their effects in the general population, in healthcare settings and on college campuses,” Guydish said. “Further research should follow this lead and develop, implement, and evaluate a range of policy interventions in addiction treatment programs, such as smoke-free grounds, no evidence of smoking among staff during working hours, and funding to increase availability of smoking cessation interventions.”
http://www.forbes.com/sites/cjarlotta/2015/09/22/alcohol-drug-addicts-far-more-likely-to-smoke-tobacco/

Study: Teens using e-cigs much more likely to start smoking cigarettes


More bad news for young people who smoke e-cigarettes.
Doing so makes them much more likely to start smoking traditional cigarettes within a year than peers who don’t smoke e-cigarettes, according to a new analysis published online Tuesday and scheduled for the November issue of JAMA Pediatrics.
The latest news about e-cigarettes comes at a time when their use is soaring among youngsters. The number of middle school and high school students using electronic cigarettes tripled from 2013 to 2014, according to government figures released this spring, a startling increase that public health officials fear could reverse decades of efforts combating the scourge of smoking.
The popularity of e-cigarettes among teenagers now eclipses that of traditional cigarettes, the use of which has fallen to the lowest level in years.
In the latest study, researchers analyzed data from a national sample of nearly 700 nonsmokers who were between ages 16 and 26 in 2012, and again in 2013. All of them said “definitely no” when they were asked if they would try a cigarette offered by a friend or believed they would smoke a cigarette within the next year.
Only 16 of the participants used e-cigarettes when they were initially surveyed, but six of them had progressed to cigarette smoking by the next year, or about 38 percent. By contrast, only 10 percent of the youths who were not e-cigarette users  started smoking traditional cigarettes.
The study was conducted by the University of Pittsburgh Center for Research on Media, Technology and Health and the Dartmouth-Hitchcock Norris Cotton Cancer Center.
In the past, few studies looked at whether e-cigarette users who initially did not smoke were at risk for taking up both the use of e-cigarettes and traditional cigarettes, or the exclusive use of cigarettes. Previous studies could not determine whether e-cigarette use preceded cigarette use, researchers said. Those studies also looked at different youngsters over different time periods.
The latest study analyzed the same individuals over time.
“This is the first longitudinal, national study to show that e-cigarette use among youth directly leads to regular cigarette use, even among people who insist at baseline that they never will smoke regular cigarettes,” said lead author Brian Primack, who is assistant vice chancellor for health and society at Pittsburgh’s Schools of the Health Sciences. “It is also the first to include young adults, as opposed to strictly teenagers.”
Researchers said one limitation was the relatively small number in the sample size. The findings need to be replicated with larger samples. Even so, after controlling for well-known risk factors, such as age, sex, socioeconomic status and risk-taking, “we think the effect is real,” said Samir Soneji, an assistant professor at the Dartmouth Institute for Health Policy and Clinical Practice and one of the authors.
E-cigarettes accelerate the progression to traditional cigarette smoking, he said.
The quandary for public health officials is this, he said. “Are they more dangerous for kids than they are helpful for adults who are trying to quit smoking?”
http://www.washingtonpost.com/news/to-your-health/wp/2015/09/08/study-teens-using-e-cigs-much-more-likely-to-start-smoking-cigarettes/

USA Today: Teens find a new use for e-cigarettes: Vaping marijuana

, USA TODAY
Teenagers have discovered a new way to inhale marijuana — e-cigarette vaporizers, according to a study released Monday.
About 27% of high school students who have used both marijuana and e-cigarettes reported using the devices to vaporize cannabis. Those most likely to vaporize pot with e-cigarettes included males and younger students.
E-cigarettes are designed to vaporize solutions containing nicotine, said co-author Meghan Rabbitt Morean. But, she noted, “teenagers are resourceful, and it was only a matter of time.”
Vaporizers give kids a better way to hide what they’re inhaling.
“It’s so much easier to conceal e-cigarette pot use,” said Morean, an assistant professor at Oberlin College. “Everybody knows that characteristic smell of marijuana, but this vapor is different. It’s possible that teenagers are using pot in a much less detectable way.”
Researchers at Yale University based their findings on answers from a survey sent to nearly 4,000 Connecticut students. The study was published Monday in Pediatrics.
About 28% of students in the study had tried e-cigarettes.
Morean said people should remember to be cautious when interpreting her findings. There haven’t been any other studies showing teens are using e-cigs to vaporize marijuana. She noted that scientists don’t fully understand the health effects of e-cig-vaporized cannabis.
Marijuana use in other forms can cause several health problems such as short-term memory loss, slow learning, decreased sperm count and lung damage, according to the Centers for Disease Control and Prevention.
“We now know it’s happening, but there are more questions about who is using and how damaging it is,” Morean said.
E-cigarette use among youth increased more than 200% from 2011 to 2013, according to a report in the journal Nicotine and Tobacco Research. Those surveyed had not tried regular cigarettes.
“Unfortunately, there is really no end for what can be vaporized in these devices,” said Erika Sward, a spokeswoman for the American Lung Association.
Supporters of e-cigarettes, who describe them as a healthier alternative to regular cigarettes, found fault with the new survey. The study may not accurately reflect what teens across the country are doing because it surveyed students in only one state, said Phil Daman, president of the Smoke-Free Alternatives Trade Association and attorney for Daman & Associates.
His group strongly discourages underage use of vapor products.
“While some teens experiment, it’s vital that parents and guardians talk to their children about not using any age-restricted products including vapor products,” Daman said.
Morean said she and her colleagues plan to conduct additional studies.
She hopes researchers in other states will provide additional data, to provide a clearer picture of national trends.
“This research is so new,” Morean said.
http://www.usatoday.com/story/news/2015/09/04/e-cigarettes-vape-marijuana-students-connecticut/71703472/

USA Today: A year later, CVS says stopping tobacco sales made a big difference

Jayne O’Donnell, USA TODAY
The decision to stop tobacco sales at all of its drugstores a year ago caused people to buy 95 million fewer packs of cigarettes in 13 states, CVS Health says in a new study out Thursday.
The new study compared total sales of tobacco products at all types of stores in the 13 states where CVS has more than 15% of market share with sales in states that don’t have any CVS stores.
The study, conducted by CVS’ Health Research Institute, evaluated cigarette pack purchases at drug, food, mass merchandise, dollar, convenience and gas station stores in the eight months after CVS stopped selling tobacco products. Over the same period, the average smoker in these states purchased five fewer cigarette packs. The 95 million fewer packs sold, CVS said, was a 1% decrease in the number of packs sold.
During 2014, nearly 264 billion cigarettes were sold in the United States, a decrease from approximately 273 billion sold in 2013, according to the Centers for Disease Control.
The CVS study also showed a 4% increase in nicotine patch purchases in the 13 states in the period immediately following the end of tobacco sales, which the company says shows there also was “a positive effect on attempts to quit smoking.”
CVS and its foundation also announced Thursday that it is funding a new school-based tobacco-prevention curriculum through the textbook company Scholastic.
The effort might have been able to influence Troyen Brennan, a physician who is CVS Health’s chief medical officer. In an interview, Brennan said he smoked for a few years while in his teens.
Brennan says he expects the study results should address critics who said CVS’ move was “not going to make a difference overall.”
But at least one critic says CVS is making a questionable leap by taking credit.
“CVS only sold a very small percentage of the nation’s cigarettes to start with, and financial analysts have said the impact of CVS’ move wouldn’t have a major impact on smoking rates,” says Jeff Stier, a senior fellow at the free market-oriented National Center for Public Policy Research. “But the bold claim that its decision to stop selling cigarettes actually got a significant number of smokers to just buy the mostly ineffective nicotine patches and quit smoking only illustrates how little the company knows about the difficulty of quitting.”
Stier’s group receives 1.4% of its funding from the tobacco and e-cigarette industry.
“We know that more than two-thirds of smokers want to quit – and that half of smokers try to quit each year,” Brennan says. “We also know that cigarette purchases are often spontaneous. And so we reasoned that removing a convenient location to buy cigarettes could decrease overall tobacco use.”
The new data, Brennan says, show CVS’ decision “did indeed have a real public health impact.”.
Junk food often is an impulse purchase as well. CVS spokeswoman Carolyn Castel says the company also is placing healthier foods —such as yogurt and fresh fruit — in key locations in the front of the store.
http://www.kare11.com/story/news/2015/09/02/cvs-stopping-tobacco-sales/71606590/

Number of cigarette smokers drops to 15%: CDC

The number of cigarette smokers in the United States has dropped to about 15 percent of the population, its lowest point in decades, U.S. health authorities said Tuesday.
“The prevalence of current cigarette smoking among U.S. adults declined from 24.7 percent in 1997 to 15.2 percent in January-March 2015,” said the report by the Centers for Disease Control and Prevention’s National Center for Health Statistics.
The figures will be updated once the entire year’s data is available.
Smoking continues to be more common among men (17.4 percent) than women (13.0 percent), the report found.
Smoking is most common among African Americans (18.1 percent), followed by whites (17.1 percent) and Hispanics (10.4 percent).
According to the U.S. surgeon general, smoking is known to cause “a host of cancers and other illnesses and is still the leading preventable cause of death in the United States, killing 480,000 people each year.”
Smokers made up 42 percent of the U.S. population in 1965, a fraction that has dropped steadily over the years, according to the CDC.
http://www.nydailynews.com/life-style/health/number-cigarette-smokers-drops-15-cdc-article-1.2344374