Reuters: US tobacco companies drop lawsuit vs FDA over labeling

The three largest U.S. tobacco companies on Tuesday dropped their lawsuit accusing the U.S. Food and Drug Administration of exceeding its authority by closely monitoring the content of their product labels after the agency said it would reconsider its rules.

Altria Group Inc, Reynolds American Inc and Lorillard Inc dismissed their case after the FDA on May 29 said it would review whether to mandate advance approval for label alterations such as changes to logos and background colors, or the use of descriptors such as “premium tobacco.”

In their April lawsuit filed in federal court in Washington, D.C., the companies said the 2009 Tobacco Control Act limited FDA authority to pre-approve label changes to two “narrow” circumstances: products claiming to lower tobacco-related risks, or when prior approval is required by regulation.

By expanding its oversight to cover how labels look, the FDA violated the tobacco companies’ commercial speech rights under the First Amendment, the complaint said.

The plaintiffs included Altria’s Philip Morris USA, Reynolds American’s RJ Reynolds and Lorillard Tobacco, whose respective cigarette brands include Marlboro, Camel and Newport, and some of their smokeless tobacco units.

In its May 29 statement, the FDA said it would not act against tobacco companies that do not seek pre-approval for label changes that create “distinct” products otherwise identical to those being sold, or where the only change is the quantity in each package.

The FDA said the interim policy would remain in place while the agency decides whether to adopt new label approval procedures.

Altria spokesman Brian May said there was no need to pursue the lawsuit in light of the FDA’s announcement. Reynolds American spokesman David Howard declined to comment. Lorillard did not respond to a request for comment.

FDA spokesman Michael Felberbaum declined to comment.

On May 26, Reynolds American won U.S. antitrust approval to buy Lorillard, combining the second- and third-largest U.S. cigarette companies.

The case is Philip Morris USA Inc et al v. FDA et al, U.S. District Court, District of Columbia, No. 15-00544.

http://www.foxnews.com/health/2015/06/03/us-tobacco-companies-drop-lawsuit-vs-fda-over-labeling/

U.S. News: Nevada Republican Gov. Brian Sandoval secures unlikely win with approval of big tax increase

By MICHELLE RINDELS, Associated Press

CARSON CITY, Nev. (AP) — Nevada’s Republican governor, Brian Sandoval, secured an unlikely victory Monday when the conservative state Legislature approved a huge tax increase at his urging as part of a plan to boost education spending.

The $1.1 billion package raises taxes on businesses and cigarettes, and it makes permanent a $500 million bundle of temporary payroll and sales taxes.

Sandoval’s win comes on the last day of the legislative session, and the proposal’s fate had been in doubt until late Sunday when several skeptical Republicans in the state Assembly pledged support.

The plan had faced vocal resistance for months, led by anti-tax conservatives emboldened by election victories in November that increased their majorities in both chambers.

Many critics noted that Nevada voters had overwhelmingly rejected a similar business tax plan and said the lawmakers shouldn’t go against their wishes.

Sen. Don Gustavson said legislators “should be ashamed of themselves to force through the largest tax increase in Nevada’s history that includes the type of tax that voters did not support.”

“And you wonder why our constituents distrust politicians?” he added.

Gustavson and Sens. Pete Goicoechea and James Settelmeyer, all rural Republicans, were the only opposition in the Senate, which passed the tax plan 18-3 Monday.

That vote came after the Assembly passed the plan 30-10 Sunday night after heavy-hitting business groups lined up behind it.

The tax increase will allow Sandoval to pump millions of dollars into programs for poor students and children learning English. The state has lagged behind others for years in education rankings and on school funding, but it has consistently rejected efforts to raise revenue.

Republican Sen. Scott Hammond had been among the skeptics, but he said his concerns about accountability had been eased, in part by the passage of his bill allowing students to use public funds at private schools.

“I can assure you that there have been significant reforms. We have one of the best, if not the best, school choice reform programs now in the nation,” Hammond said. “For that reason, I can support this.”

Elements of the plan include:

— A hike in the business license fee. The fee for corporations would rise from the existing $200 a year to $500, while the fee for the rest of the business entities would remain at $200.

— A hike in the payroll tax. Sandoval’s plan raises the state’s existing modified business tax from 1.17 percent to 1.475 percent of wages beyond the first $200,000 a company pays out each year and sets the rate at 2 percent of those wages for the mining industry and financial institutions. Companies would still get to deduct health care premiums for employees from the calculation.

— A “Commerce Tax” on gross revenue. Industry-specific tax rates will apply to businesses with more than $4 million in Nevada revenue each year. Businesses can count 50 percent of their commerce tax bill as a credit against their modified business tax bill — a provision that’s intended as a perk to those who employ people. The commerce tax aims to capture more money from capital-intensive businesses such as mines and those that do business in Nevada but aren’t based here.

— A flexible payroll tax rate. The plan allows the state to lower the modified business tax rate if revenues from the new commerce tax and MBT rate bring in more revenue than projected.

— An extension of “sunset taxes.” More than $500 million of the plan comes from making a set of expiring payroll and sales taxes permanent.

— Cigarette taxes. The bill raises a tax on cigarette packs by $1, which is expected to generate about $100 million over two years.

http://www.usnews.com/news/politics/articles/2015/06/01/nevada-gop-governor-secures-unlikely-win-with-tax-increase

Reuters: Cigarette warnings work better with pictures, study shows

By Lisa Rapaport, Reuters

Gruesome photographs on cigarette packages may deliver more effective anti-smoking messages than words, a new analysis finds.

Researchers reviewed previous studies comparing images to text warnings on cigarette boxes and found pictures commanded more attention, elicited stronger emotional reactions, summoned more negative attitudes and made it more likely that smokers would vow to quit.

“They say a picture is worth a thousand words — that really seems to be the case here,” said lead study author Seth Noar, co-director of the interdisciplinary health communication program at the University of North Carolina at Chapel Hill.

Globally, tobacco kills about six million people a year, and the annual death tally is expected to reach eight million by 2020, according to the World Health Organization. Smoking can cause heart disease and lung cancer, even when exposure is second-hand, and it can lead to asthma and other breathing difficulties in children who live with smokers.

Just 30 countries, representing about 14 percent of the world’s population, require warning images on at least half of the front and back of cigarette packages with anti-smoking messages in the local language, according to the WHO.

In Australia, for example, cigarette packages have graphic images of sick or dying smokers on the wrappers.

To see how well grotesque images on cigarette packages work as a deterrent, Noar and colleagues analyzed data from 37 experiments involving more than 33,000 people. Every study included in the analysis showed participants both words and pictures to measure which approach was better at discouraging smoking.

The studies reviewed were done in 16 different countries, though most were in the U.S., Canada or Germany, and were published between 2000 and 2013.

Relative to text, images convinced people to think more about the effects of smoking, lowered cravings and increased aversion to cigarettes, the analysis found.

Eight of the studies examined whether participants thought the pictures were effective. This subset of experiments found smokers and nonsmokers thought pictures would encourage them not to start smoking or motivate them to cut back and urge others to quit as well.

When the researchers analyzed data across all of these studies, they found pictures were significantly better than text alone at motivating people to avoid cigarette use.

“Smokers know that cigarettes are bad for them, but they likely tune out vague warnings that they have seen for years, such as ‘smoking causes cancer,’” Noar said by email. “Seeing images of diseased lungs and people suffering from the negative health impacts of smoking appear to affect smokers in ways that simple text-only messages cannot achieve.”

All but one of the studies included in the review lacked data on how the images or texts might impact behavior, the researchers acknowledge in the journal Tobacco Control. The studies also didn’t follow people over long periods of time or measure how repeated exposures to the images might influence behavior, the authors note.

Because smoking is often a social behavior, more research is needed on how social interactions might influence the impact of anti-smoking images on packages, the researchers wrote.

Images may help reach an audience that’s particularly vulnerable — people with lower literacy or education levels, said Jim Thrasher, a researcher in health behavior at the Arnold School of Public Health at the University of South Carolina in Columbia.

“Even among these disadvantaged groups where smoking rates are highest, pictorial warnings are a promising way to stimulate smoking cessation,” Thrasher, who wasn’t involved in the study, said by email.

They may also help young people get the message about smoking, said David Hammond, who researches addiction and cigarette packaging at the University of Waterloo in Ontario, Canada.

“One of the challenges for cigarette warnings is that many of the most severe health consequences don’t appear for a number of years,” Hammond, who wasn’t involved in the study, said by email. “Images help to make these health consequences more salient and real for youth and young adults.”

http://www.duluthnewstribune.com/features/3756926-cigarette-warnings-work-better-pictures-study-shows

LA Times: California Senate votes to restrict e-cigarettes as tobacco products

By PATRICK MCGREEVY

The state Senate on Tuesday approved a bill that would ban electronic cigarettes from restaurants, theaters and other public places in California where smoking is prohibited to address health concerns.

Sen. Mark Leno (D-San Francisco) said his bill would treat e-cigarettes, also known as “vaping” devices, as tobacco products because they often use nicotine and are popular with teenagers.

Youth e-cigarette use rising; heart group calls for regulation

“Of great concern is that the fastest growth segment of new users is among middle and high school students who are now smoking electronic cigarettes,” Leno told his colleagues. “They are advertised on television. They are advertised on billboards.”

The measure, which would also subject e-cigarettes to the same licensing requirements as tobacco, was approved by a 24-12 vote, with Sen. Jeff Stone of Murrietta the only Republican to vote for the bill.

Senate Republican leader Bob Huff of Diamond Bar said e-cigarettes work on vapor that does not spread as much as tobacco smoke, so they should be treated differently in public.

“E-cigs are used by people trying to kick the tobacco habit,” Huff said. He voted against the bill, saying the state should wait until the federal government takes action.

Stone noted that his mother was a former smoker who died of cancer. He said the tobacco and vaping industries are marketing e-cigarettes to young people with flavors including watermelon, tutti frutti and cotton candy while the vapor has nicotine derived from tobacco. He said “vaping” is a gateway to cigarette smoking.

“Now we are exposing a whole new generation of millenials to this fashionable way of smoking tobacco in a way that is going to jeopardize their lives,” Stone said. The measure next goes to the Assembly for consideration.

http://www.latimes.com/local/political/la-me-pc-california-senate-votes-to-restrict-ecigarettes-like-tobacco-products-20150602-story.html

Reuters: California Senate votes to raise smoking age to 21 from 18

LOS ANGELES | BY ALEX DOBUZINSKIS
The California Senate voted on Tuesday to raise the legal smoking age in the most populous U.S. state to 21 from 18, in a move that could make California one of the states with the highest smoking age.
The measure was approved by the Senate 26-8 and must now be approved by the state Assembly.
“We will not sit on the sidelines while big tobacco markets to our kids and gets another generation of young people hooked on a product that will ultimately kill them,” Senator Ed Hernandez, a Democrat and the bill’s author, said.
“Tobacco companies know that people are more likely to become addicted to smoking if they start at a young age,” Hernandez added in a statement.
The Institute of Medicine, the health arm of the National Academy of Sciences, has said that increasing the smoking age to 21 would result in more than 200,000 fewer premature deaths nationally for those born between 2000 and 2019.
The Cigar Association of America opposed the bill, contending that 18-year-olds can serve in the military, vote and sign contracts and should thus enjoy the right to smoke, according to the Los Angeles Times.
David Sutton, a spokesman for Altria Group Inc, the parent of Philip Morris USA, said in an emailed statement that Altria believed states should defer to the federal government and “allow FDA and Congress the opportunity to think through this issue further before enacting different minimum age laws.”
Representatives for R.J. Reynolds Tobacco Company, a unit of Reynolds American Inc, did not return calls seeking comment.
Hawaii lawmakers approved a measure in April to raise the smoking age to 21, and that is awaiting the state governor’s signature. Democratic Governor David Ige has not indicated whether he will sign the measure, and has until June 29 to decide whether to veto it, a spokeswoman for his office said.
Since 2013, New York City has required tobacco purchasers to be 21 or older, according to the National Conference of State Legislatures. No state has a smoking age that high, but Alabama, Alaska, Utah and New Jersey set it at 19.
(Reporting by Alex Dobuzinskis and Cynthia Johnston; Editing by Sandra Maler)
http://www.reuters.com/article/2015/06/02/us-usa-smoking-california-idUSKBN0OI2EI20150602

Opinion: Cigarette smoking’s growing income gap

By: Peter Orszag

The income gap between smokers and nonsmokers has grown. And it’s something companies may need to address directly in their efforts to help employees kick the habit.

Over the past several decades, smoking rates have fallen sharply among high-income, highly educated Americans and not as much for less educated, low-income people. The result is that, in 2013, the smoking rate exceeded 20 percent for people with a high school degree or less while among those with a graduate degree it was just 5.6 percent. Among people living in poverty, smoking was almost twice as common (29 percent) as among those at or above the poverty line (16 percent).

The good news is that the financial incentives many companies are considering, and some are now using, to help people quit smoking can work, as a new study in the New England Journal of Medicine shows. The researchers randomly assigned employees of CVS Caremark and their relatives and friends to different groups, which were given various financial incentives to stop smoking. This study did two fabulous things that are unfortunately quite unusual in the corporate wellness field: It used a randomized controlled trial (to boost confidence in the causality of its results), and it paid careful attention to the teachings of behavioral economics – testing, for example, whether carrots or sticks were more effective.

The results were encouraging. People who were told they would receive an individual bonus of $800 for quitting stopped at almost three times the rate of those not offered any direct financial inventive. Behavioral theory generally suggests, though, that loss aversion would work even better. In other words, if subjects made an initial deposit that they would stand to lose if they failed to quit, that would provide an even stronger incentive. And that was indeed the case, the researchers found, but people had to be willing to make the deposit in the first place. And because many were not willing to do that, the bonus approach was more effective overall. So unless a company finds a way to force its employees to follow the stick approach, the bonus works better.

These findings were widely reported in the news, but one thing went largely if not entirely unnoticed: A table in the appendix to the study showed that, for each of the four kinds of interventions studied, the share of high-income smokers who quit – those earning $60,000 or more – was larger than that of lower-income smokers. The reason, according to the study’s lead author, is that lower-income smokers were less willing to participate under any of the incentive programs offered. That was true despite the bonus or deposit being the same dollar amount for everyone, and therefore a higher share of income for lower-paid workers.

Reducing smoking among any group of employees is a good thing, and companies should act on this new research. At the same time, it is reasonable to be concerned about the gap in smoking rates by socioeconomic status, which is one of the forces widening the gaps in life expectancy by education and income. To reverse this trend, disproportionately larger dollar bonuses may be needed to get lower earners to quit.

Contact Peter Orszag at porszag3@bloomberg.net

http://www.delawareonline.com/story/opinion/contributors/2015/05/26/cigarette-smokings-growing-income-gap/27977649/

Forum editorial: Minnesota tobacco use down

The anti-tobacco work of ClearWay Minnesota in conjunction with other tobacco cessation efforts has had remarkable results in reducing smoking rates among all age groups in Minnesota. It’s a record worthy of high praise. It’s unambiguous evidence that focused, science-based anti-tobacco campaigns can work.

Numbers released last week by ClearWay show only 14.4 percent of Minnesotans smoke cigarettes, down from 22.1 percent in 1999. The decline through the time period has been steady, and corresponds to increased education and imposition of legal restrictions on smoking in public places. Add new medical research about second-hand smoke, and graphic anti-smoking television advertising, and it appears the multi-faceted message is getting through.

But not to every age cohort.

In ClearWay statistics from 2010 to 2014, smoking hardly dipped at all (1 percent) in the 25-44 year-old group, from 19.7 percent to 18.7 percent. A similar slight improvement was measured in the 45-64 year-old cohort, compared with a huge drop (from 21.8 percent to 15.3 percent) in Minnesotans age 18-24. Which could lead to the conclusion that some Minnesotans don’t get smarter as they age. But whatever the reason, the overall percentages of all Minnesotans who smoke is down over the longer study period, and that’s good news for smokers who quit, non-smokers and reduced impacts on health costs associated with tobacco use. The trends are good.

ClearWay is not resting on its excellent record. In the eight years it has left in its mandate (funded by the national tobacco settlement of a few years back), the agency’s agenda includes raising cigarette taxes, which all studies show discourage young people from purchasing tobacco, and raising the age for tobacco purchases from 18 to 21. Again, research finds that raising the age to beyond high school age contributes to fewer high school students trying tobacco. New York City and Hawaii have already taken that step.

There is still much to be accomplished to achieve as smoke-free a society as possible. A lot has been done, often led by private sector companies that banned smoking from the workplace before cities and states enacted overall smoking bans in buildings and, in many instances, outdoor public spaces. Decades of research into smoking-related illness and death, and the proven health hazards of secondhand smoke, have been the underpinnings of changing public policy. ClearWay’s work and similar complementary efforts have been pivotal in changing the way enlightened Americans view tobacco use.

Forum editorials represent the opinion of Forum management and the newspaper’s Editorial Board.

http://www.inforum.com/opinion/editorials/3751883-forum-editorial-minnesota-tobacco-use-down

Fargo Forum: Anti-tobacco groups eye raising purchasing age to 21 in Minnesota

By Patrick Springer

MOORHEAD – Minnesota tobacco control advocates may propose raising the legal age for buying cigarettes to 21 years old.
Hawaii, New York City and more than 30 municipalities in Massachusetts have raised the legal age for buying tobacco, and the experiment will be closely watched, said Andrea Mowery, vice president of ClearWay Minnesota, a foundation that promotes prevention and cessation of smoking and tobacco use.
ClearWay Minnesota, funded by the state’s share of the 1998 tobacco settlement, will only move ahead with a proposal if a wide consensus of health groups and public health groups agree the approach has merit, Mowery told The Forum editorial board.
“We’re part of a broad coalition,” she said, and listed the American Cancer Society, American Lung Association and American Heart Association as frequent partners. “There’s a very collegial and collaborative process.”
More than 9 of every 10 smokers start before the age of 19 or 20, a reality that is behind the nascent movement to raise the legal age for buying tobacco, Mowery said.
Earlier efforts, which public health officials credit with reducing smoking rates, have centered on raising tobacco taxes and banning smoking in public places.
Teenagers are especially sensitive to price increases spurred by tax increases, which have been shown to be the most effective means to date of curbing youth smoking, Mowery said.
“Youth and young adults are much more sensitive to price,” she said.
Smoking prevalence continues to decline in Minnesota, where the smoking rate stood at 14.4 percent last year, down 35 percent since 1999 and the lowest rate ever recorded, according to the Minnesota Adult Tobacco Survey in 2014.
“So really significant progress,” Mowery said.
The national adult smoking rate is 19 percent. In North Dakota, the adult smoking rate was 21.9 percent in 2011, according to the Centers for Disease Control.
Persistent gaps remain in smoking rates, with those who have less than a high-school education the most likely to smoke, with a rate of 28.6 percent.
Young adult smoking decreased by 6.4 percentage points over the past four years, dropping to 15.3 percent from 21.8 percent, the only noteworthy decline for any age group.
“That is quite a stark departure,” Mowery said.
But that drop coincided with a sharp spike in the use of e-cigarettes, which jumped from a rate of 0.7 percent to 5.9 percent from 2010 to 2014.
The age group most likely to smoke is the 25- to 44-year-old bracket, with a rate of 19.7 percent for men and 18.7 percent for women.
American Indians smoke at a rate that far surpasses the overall population—a rate of 59 percent, quadruple the 14.4 percent overall rate.
“On the whole we’re making good progress,” Mowery said, adding that challenges remain.
http://www.inforum.com/news/3748538-anti-tobacco-groups-eye-raising-purchasing-age-21-minnesota

"Darth Vapor" Sending Students to the Hospital

Reported by Michigan 9 & 10 News

A new form of synthetic marijuana is sending teenagers to the hospital.

A Mason County student is in critical condition after inhaling something called “Darth Vapor”, a substance smoked with an E-cigarette.

School officials at Journey High School in Scottville called 911 yesterday afternoon after the 19-year-old had a seizure.

And it’s not the first problem with the drug in the area.

The sheriff says this is the fourth time since March that they’ve seen an overdose on the vapor. They had it tested, and confirmed it’s a form of synthetic marijuana.

It’s not regulated by the state, which he says, makes it hard to prevent more trips to the ER.

“Just because it’s not regulated by state law doesn’t stop you from being a parent. Your parental rights trump state law as far as I’m concerned,” says Mason County Sheriff Kim Cole.

The sheriff wants parents to help prevent more overdoses on “Darth Vapor”, which put a 19-year-old in critical condition

“The big thing is the parents need to know what these kids are getting into. If you see your child has a e-cig look into that, question why they have it and what they’re putting into it because you mark my words were going to be doing a story on somebody dying,” says Sheriff Cole.

Doctors say smoking vapors is the most dangerous way to ingest something, because the toxins have direct access to your blood.

“It’s almost like taking it in an IV. I mean you just absorb it and it doesn’t go through your liver. So you’re getting the drug directly into the vein, into the circulation,” says Dr. Robert Kowalski, and MD at Munson Healthcare Cadillac Hospital.

And because these vapors are so new and unregulated, treatment can be difficult.

“Most of the treatment for these overdoses is symptomatic. In other words we don’t have a specific antidote for these medications or drugs,” says Kowalski

A business in Ludington has agreed to take the vapor off the shelves, but teens can still manage to get their hands on it.

“I would, you know, tell young adults and children that sell it to you. They’re not pharmacists. They’re not physicians they just want to sell you the drug,” says Kowalski.

All of the overdoses involved students in mason county. The Ludington Schools Superintendent says they’re working with staff and students to prevent problems in the future.

————————-

A 19-year-old is in critical condition after inhaling a substance from an e-cigarette.

The call came in Monday afternoon from Journey High School in Scottville.

The man used an e-cigarette to inhale the substance that caused him to overdose.

The Mason County Sheriff says a 16-year-old was taken to juvenile court for giving the vapor to the 19-year-old.

During the investigation, deputies also found an unloaded rifle in the 16-year-old’s car.

The 19-year-old was airlifted to a Grand Rapids hospital for treatment.

Stay with Northern Michigan’s News Leader throughout the day on air and online for more information on this developing story.

http://www.9and10news.com/story/29102864/19-year-old-in-critical-condition-after-inhaling-e-cigarette-substance

MEDPAGE TODAY: E-Cigs Hamper Ability to Cough

Just one exposure significantly diminished cough reflex sensitivity.

by Nancy Walsh, Senior Staff Writer, MedPage Today

DENVER — Exposure to electronic cigarette vapors significantly diminished cough reflex sensitivity in a group of healthy volunteers, a researcher reported here.

Using a capsaicin cough challenge, the time until the concentration of capsaicin that can induce five or more coughs (C5) was significantly longer after an electronic cigarette “vaping” session, rising from a mean log C5 of 0.50 at baseline to 0.79 15 minutes after exposure (P<0.0001), according to Peter V. Dicpinigaitis, MD, of Albert Einstein College of Medicine in New York City.

“We have previously shown that chronic smokers of tobacco cigarettes have reduced cough reflex sensitivity to capsaicin compared with healthy nonsmokers, presumably on the basis of chronic cigarette smoke-induced desensitization of airway cough receptors,” he said.

“What impressed us in this study what that this was just one exposure, and there was a real effect, a significant effect,” he said in a press conference at the annual meeting of the American Thoracic Society.

Electronic cigarettes are increasingly popular devices that are intended to deliver vapor containing nicotine to the lungs without exposing the lung tissue to the damaging products of tobacco combustion. However, little is known about their effects on the respiratory system, and even less is known about their effects on the sensitivity of the cough reflex.

Cough sensitivity is important in that coughing is a very important protective mechanism for eliminating foreign particles, and suppression of this could render someone more susceptible to respiratory tract infection, he explained.

Capsaicin challenge has become a standard research tool for investigating the effects of various exposures on cough reflex sensitivity, in that the challenge is safe, dose-dependent, and reproducible.

To explore these effects, Dicpinigaitis and his colleagues enrolled 30 lifetime nonsmokers who each underwent a single session of vaping, which consisted of 30 puffs on a disposable device at 30-second intervals. This provided an exposure to nicotine of 1.5 to 1.8 mg, which approximates that of a single tobacco cigarette.

The effects on C5 were transient, as was shown by the fact that 24 hours after the exposure, there was a decline in mean log C5 to 0.55 (P=0.0002).

The clinical significance, if any, of this transient, acute effect and the consequences of chronic exposure remain to be elucidated.

But the take-home messages of the study, he said, were that the vapor in e-cigarettes is not simply a benign, inert vapor, and it may have not only this acute, peripheral effect, but it also may have a delayed central brain effect.

Also, the results raise the question of what might happen with prolonged, chronic exposure, given the physiologic effect of just one exposure, Dicpinigaitis added.

http://www.medpagetoday.com/MeetingCoverage/ATS/51600