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

FDA issues warning letters to 3 tobacco companies over "additive-free" claims

Associated Press
NEW YORK (AP) — The Food and Drug Administration issued warning letters to the makers of Winston, Natural Spirit and Nat Sherman cigarettes over their “additive-free” and “natural” label claims.
The agency issued the warnings to ITG Brands LLC, Santa Fe Natural Tobacco Company Inc. and Sherman’s 1400 Broadway N.Y.C. Ltd. The issue over the claims is that they may lead consumers to believe the products pose a lower risk. That claim has to be scientifically proven.
In a statement, the FDA said it has determined that the products under the warning letter need what is called a “modified risk tobacco product order” before they can be marketed in that way. It has not issued any orders for modified-risk products to the market and this is the first time it is using its authority to take action against “natural” or “additive-free” claims.
The companies have 15 days to respond with a plan or dispute the warnings.
There was no immediate response from the companies.
Imperial Tobacco Group Plc. owns ITG Brands, which also makes Kool cigarettes and USA Gold. Reynolds American Inc. owns Santa Fe Natural Tobacco.
The warning comes several days after a large group of anti-tobacco organizations sent the FDA a letter urging the agency to enforce regulations against Santa Fe Natural Tobacco over marketing claims. That letter, sent on Monday, was signed by 29 groups including the American Heart Association, American Legacy Foundation and Campaign for Tobacco-Free Kids.
The anti-tobacco group’s letter alleged that Natural American Spirit’s advertising in magazines such as Sports Illustrated and Vanity Fair violated the Smoking Prevention and Tobacco Control Act.
“The potential for irreparable damage to public health from the marketing of tobacco products with modified risk claims is well illustrated by the industry’s years of deceptive advertising of ‘light’ and ‘low-tar’ cigarettes,” the letter stated.
http://www.usnews.com/news/business/articles/2015/08/27/fda-issues-warning-letters-to-natural-tobacco-makers

LA Times: $2 more for cigarettes? California tobacco tax proposal revived in special session

A proposal to raise the tobacco tax by $2 per pack of cigarettes in California was given new life Wednesday when legislation was announced as part of a special session on healthcare.
Supporters say the new bill has a better chance of passing than one that stalled in the regular session because the $1.5 billion raised by such a tax could help the state pay for healthcare costs for low-income residents, a key goal of the special session.
Sen. Richard Pan (D-Sacramento) said he will introduce the tobacco tax, noting that California’s current 87-cent-per-pack tobacco tax makes the state 33rd in the nation, far below New York, which charges a tax of $4.35 a pack. There is also a $1.01 federal tax on cigarettes.
A rally for the proposal was held Wednesday next to the Capitol by the Save Lives California coalition, made up of groups including the California Medical Assn., the American Cancer Society, the American Lung Assn. and the Service Employees International Union.
The coalition said that if the Legislature fails to muster the two-thirds vote to pass the tax, it will put the tax proposal on the 2016 ballot.
“We know raising the tobacco tax has been proven to prevent and reduce smoking, especially among young people,” Pan told the nearly 100 people at the rally. He said 40,000 people die each year in California from tobacco-related diseases, and treating such illnesses costs taxpayers $18.1 billion annually.
A Field Poll released Wednesday indicates a $2 tobacco tax to pay for healthcare costs is supported by 67% of Californians.
The tax is one of several anti-tobacco bills being considered during the special session, including one raising the smoking age to 21 and another restricting the use of electronic cigarettes in public.
“The special session is an opportunity for lawmakers to take long-overdue action to prevent young people from falling prey to the No. 1 cause of preventable death in California: tobacco addiction,” said Claudia Alvarez, an SEIU delegate and family medicine resident at Harbor-UCLA Medical Center.
Those in the audience at the rally included Jennifer Kent, the governor’s appointee as director of the California Department of Health Care Services.
“To the extent we have an ongoing need for revenues we’re obviously willing to consider both this tax and any other revenue sources,” Kent said in an interview afterward. “We’re here and interested and willing and able to partner” with the coalition.
She said there is a strong link between tobacco use and illnesses covered by Medi-Cal.
The regular-session tobacco tax bill was opposed by groups including the Cigar Assn. of America and the Howard Jarvis Taxpayers Assn., which argued it creates a regressive tax on a declining revenue source.
“At a time when state revenue has recovered and the governor says there is even a surplus, there is no reason for a tax increase,” said Jon Coupal, president of the taxpayers group.
Proponents of the bill estimate 295,000 smokers will kick the habit the first year if the tax goes up $2 per pack, and many others will not start smoking to begin with.
http://www.latimes.com/local/political/la-me-pc-california-tobacco-tax-proposal-revived-for-special-session-20150826-story.html

NY Times Opinion: Clashing Views on E-Cigarettes

A British government agency has issued a bullish assessment of the value of electronic cigarettes in helping people to quit smoking. It found that e-cigarettes can reduce the health risks of smoking by 95 percent because they deliver nicotine to satisfy an addiction, but far fewer harmful chemicals than regular cigarettes. It also found little evidence that large numbers of consumers who had never smoked were taking up e-cigarettes. That seemed to challenge the notion that e-cigarettes would be a gateway to more dangerous products.

But the study is hardly definitive; experts in America have drawn different conclusions on usage and on the gateway issue.

The British assessment, commissioned by Public Health England and conducted by academic experts, was cautious in its claims. It noted that the best results are obtained when e-cigarettes are used in combination with professional counseling and smoking-cessation medication.

In the United States, according to the Campaign for Tobacco-Free Kids, e-cigarette use by young people has grown more rapidly than in Britain. The user population includes many children who have never smoked and thus may be vulnerable to being hooked by nicotine and later moving to traditional cigarettes.

By coincidence, a day before the British study was issued, a study tracking more than 2,500 students at 10 Los Angeles schools who had never smoked tobacco, published in the Journal of the American Medical Association, came to the opposite conclusion. It said ninth graders who had tried e-cigarettes were far more likely than other students to start smoking “combustible tobacco” (cigarettes, cigars, hookahs) within a year.

Strong regulation is needed in Europe and the United States to protect young people from advertising and promotions designed to lure them into trying e-cigarettes and perhaps getting hooked on them. America’s Food and Drug Administration needs to issue rules it proposed last year and make them even stronger by banning flavors that appeal to youngsters.

http://www.nytimes.com/2015/08/24/opinion/clashing-views-on-e-cigarettes.html?_r=0

AP: Teens' E-Cigarette Use Linked With Later Smoking

By LINDSEY TANNER AP Medical Writer
Teens who use e-cigarettes are more likely than others to later smoke conventional cigarettes and other tobacco products, a study at 10 Los Angeles high schools suggests.
The study doesn’t prove that electronic cigarettes are a “gateway drug” but some doctors say it bolsters arguments that the devices should be strictly regulated as proposed by the Food and Drug Administration.
Whether teens had tried just one e-cigarette or were habitual users isn’t known, nor is whether they became heavy smokers or just had a few puffs. That information would be needed to help determine whether nicotine from e-cigarettes predisposed users to seek out other sources.
Despite those limitations, the study “is the strongest evidence to date that e-cigarettes might pose a health hazard by encouraging adolescents to start smoking conventional tobacco products,” said Dr. Nancy Rigotti, director of a tobacco research and treatment center at Massachusetts General Hospital. Her commentary and the study were both published in Tuesday’s Journal of the American Medical Association.
E-cigarettes haven’t been extensively studied and there’s no scientific consensus on any potential benefits or harms, including whether they lead kids to become regular smokers.
The new, government-funded study involved about 2,500 14-year-olds who had never used conventional tobacco products including cigarettes. Students were first surveyed in fall 2013. The Los Angeles study population was diverse but whether the same results would be found nationwide is uncertain.
At the start, about 9 percent — 222 kids — said they had used e-cigarettes at least once, similar to rates seen in a recent national survey. Almost one-third of them tried cigarettes, cigars or water pipes within the following six months, versus just 8 percent of the kids who’d never tried e-cigarettes. The gap persisted when students were surveyed again, a year after the study began.
Hookahs and cigars were more popular than regular cigarettes in both groups.
The researchers considered traits that might make teens more likely to use tobacco, including impulsiveness, delinquent behavior and parents’ smoking habits. Their analysis showed those traits played a role but didn’t fully explain the link between e-cigarettes and later tobacco use.
University of Southern California researcher Adam Leventhal, the study’s lead author, noted that e-cigarettes were initially introduced as a potentially safer alternative to tobacco for smokers who were trying to cut down, but they have evolved into a recreational product for some users.
Available for nearly a decade, e-cigarettes are battery-powered devices that turn nicotine-containing liquid into vapor that is inhaled. Though nicotine can be addictive, e-cigarettes lack the chemicals and tars of burning tobacco.
National data show e-cigarettes have become more popular among teens than regular cigarettes.
Leventhal said his study “does little to dispel concerns that recreational e-cigarette use might be associated with moving on to these very harmful tobacco products.” But he said more research is needed to determine if e-cigarettes are really the culprit.
University of Rochester tobacco researcher Deborah Ossip said because teens’ brains are still developing, they’re more sensitive to the effects of nicotine, and that using just a few e-cigarettes could make them vulnerable to using nicotine in other forms. She had no role in the research.
The FDA in 2014 proposed rules that would ban the sale of electronic cigarettes to minors and would add the devices to the list of tobacco products it regulates. Laws banning the sale of e-cigarettes to minors have been enacted or proposed in several states.
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Online:
JAMA: http://jama.ama-assn.org
FDA: http://tinyurl.com/pe7nqtl
http://abcnews.go.com/Health/wireStory/teens-cigarette-linked-smoking-33155901

Opinion: Chamber's tobacco tax stance flawed

I used to believe smoking was just a part of life. My parents, grandparents, uncles, aunts, cousins, neighbors, doctors, nurses, teachers, etc. all smoked around me as I was growing up.
For years, I worked in bars and restaurants where people smoked. The more they smoked, the more they drank. The more they drank, the more they spent. The more they spent, the more I made. Simple.
I even participated in a public service announcement urging people to vote against banning smoking in bars in restaurants many years ago. I would be a hypocrite if I did not disclose that information.
I was dead wrong.
State Chamber executive Andy Peterson’s opinion piece in The Forum (Sunday, July 12) offering a rationale that it’s “free enterprise” for the Greater ND Chamber of Commerce’s stance on lobbying against a cigarette tax increase prompted me to research what this stance may be costing his members.
North Dakota has the sixth-lowest cigarette tax per pack in the United States, $0.44 per pack. Montana, $1.70 per pack. South Dakota, $1.53 per pack. Minnesota, $2.90 per pack. Canada, $2.80 per pack.
Statistically, there are more than 440,000 workers in North Dakota (Bureau of Labor Statistics, U.S. Department of Labor).
I couldn’t find exact numbers but let’s say, conservatively, half of those workers, 220,000, work for the 1,037 member businesses listed on the Chamber’s website. Four of the top five largest employers in the state are also members of the Greater ND Chamber of Commerce. The fifth employer was not disclosed.
The average cost to a business per employee who smokes is $5,816 a year, per a 2013 Ohio State University study. A Gallup poll from 2013, “estimates that 19 percent of workers still smoke and that workers who smoke cost the U.S. economy $278 billion annually in lost productivity due to absenteeism and extra health care costs. This figure is based on an analysis of the cost of extra missed workdays due to poor health, partial absenteeism due to smoke breaks, and additional health care costs compared with workers who do not smoke.”
So let’s say, conservatively, 41,800 workers (220,000 x 19 percent) employed by the Greater ND Chamber businesses still smoke. That is potentially costing these member businesses $243,108,800 ($5,816 x 41,800).
The most recent revenue numbers I could find from cigarette sales in North Dakota was $68,951,521 for 2009.
Hmm?
Now I’m just beginning my graduate studies in business, but it appears it would be in the Greater ND Chamber’s best interest to encourage a cigarette tax increase.
Not only would an increase in the cigarette tax raise revenue for some of Peterson’s members, it would decrease the amount of money most if not all of his member businesses are losing out on paying for smoking- related costs.
Simple.
http://www.inforum.com/letters/3799718-letter-chambers-tobacco-tax-stance-flawed