CBS MoneyWatch: As e-cigarette sales soar, critics eye regulations

By JONATHAN BERR | MONEYWATCH
The Food and Drug Administration expects to publish its much-anticipated regulations for e-cigarettes in June, as the products are surging in popularity. In fact, sales are expanding so rapidly that some experts predict e-cigs will overtake sales of conventional smokes within the next decade.
“From our perspective, the rules are long overdue,” said Erika Sward, assistant vice president of national advocacy at the American Lung Association, who noted the regulations have been in the works for about a year.
The FDA already regulates cigarettes, cigarette tobacco, roll-your-own tobacco and smokeless tobacco. Under the 2009 Family Smoking and Tobacco Control Act, the FDA can “deem” additional tobacco products to be subject to the Federal Food, Drug, and Cosmetic Act. Among other things, firms would be required to register with the FDA and submit product and ingredient listings, and include health warnings and take steps to prevent sales to underage consumers.
“To date, FDA has not been able to fully assess the public health impacts of unregulated tobacco products,” the FDA said in a statement sent to CBS MoneyWatch. “For example, some testing of e-cigarette cartridges has revealed significant variability in nicotine content and the presence of chemical constituents that raise concerns of toxicity.”
Altria Group (MO) and Reynolds American (RAI), two of the biggest tobacco companies, are welcoming the FDA’s efforts, arguing that the patchwork of existing state regulations fails to protect consumers against defective products, some of which have even exploded. The companies are lobbying the FDA to treat e-cigarettes differently than conventional smokes.
Some proponents of e-cigaretttes have claimed that they can be an effective smoking cessation tool. A study published last year found that people who wanted to quit smoking were about 60 percent more likely to be successful if they used e-cigarettes as opposed to other products such as nicotine patches or gum.
Industry critics, including the American Lung Association, counter that the evidence to back up these claims is inconclusive. A study released last month by the Johns Hopkins Bloomberg School of Public Health found that e-cigarettes generate some of the same dangerous chemicals found in traditional smokes.
“There is absolutely no federal oversight of e-cigarettes in terms of what is in them, how they are being marketed,” said Sward of the American Lung Association, adding that e-cigarette makers are “following the Big Tobacco playbook” by offering flavored e-cigarettes that would appeal to underage smokers. “Really, what we are seeing are the same tactics that we saw 30, 40 years ago.”
Altria, which is based in Richmond, Virginia, has put a 116-word warning on packs of its MarkTen e-cigarettes even though it wasn’t legally obligated to do so. AsReuters noted, it said nicotine is “addictive and habit-forming” and that MarkTen isn’t intended for women who are pregnant or breast-feeding or people being treated for depression or asthma. Spokesman Steve Callahan said the wording on the company’s label was based the “available science.”
In a statement to CBS MoneyWatch, Reynolds argued that the FDA needed to regulate e-cigarettes fairly.
“We believe if (the) FDA is going to regulate vapor products, then it should regulate all vapor products — including open systems and the vape shops in which the liquid nicotine used in open systems is mixed or compounded — to create a level playing field where all manufacturers are subject to equal treatment, including FDA inspection/registration/regulation, manufacturing standards and product clearance requirements,” writes Richard J. Smith, a spokesman, in an email.
Whenever the regulations are issued, it will open another front in the decades-long battle that pits people trying to protect the public health against the rights of an industry selling an otherwise lawful product.

Men's Journal: E-Cigarettes May Be Just as Bad as The Real Thing

Two new studies have turned out some scary findings about e-cigarettes. The first one, published in the New England Journal of Medicine, revealed that e-cigarette vapor can harbor hidden formaldehyde — a known carcinogen — at levels up to 15 times greater than regular cigarettes. “We discovered this form of formaldehyde hidden in the tiny liquid droplets of the vapor, where it hadn’t been detected before,” says lead researcher David Peyton, a chemistry professor at Portland State University in Oregon. “It has the potential to distribute deeply into the lungs and collect there.”
The second study showed that e-cigarette vapors directly harm human lung tissue. Researchers from the University of Rochester Medical Center in New York found that when the aerosol produced by heated liquid nicotine hits lung cells, it churns up disease-causing free radicals and triggers marked inflammation; they also found the presence of up to six times the level of heavy metals, like copper. What’s more, they discovered that various flavor additives, which are often added to e-cigs, cause additional oxidative damage to lung tissue. This isn’t after years of e-cig use, either. The negative effects “occurred after a few days of vaping,” he says. “Chronic exposure may lead to even more damage.”
These findings add to the fast-amassing stack of research revealing the many potential hazards of e-cigarettes. Since these smokeless devices are not regulated by the Food and Drug Administration, they can contain any number of toxins, carcinogens, or other mystery chemicals. And because e-cigarettes are so new, the long-term health consequences of using them are unknown.
Even so, many people assume that, compared to regular tobacco cigarettes, e-cigs are the lesser of two evils. But that’s not necessarily the case, says Dr. Roy Herbst, chief of medical oncology at Yale Cancer Center and a spokesman for the American Association for Cancer Research. “In the oncology community, we feel they are both evil,” he says. “The big concern with e-cigarettes is lung tissue damage. Regular cigarette smoke contains 60 to 80 known carcinogens, which makes it very bad for the lungs too. However, hot e-cigarette vapor going straight to the lungs can cause actual burning and injury. It’s a different type of damage — but it’s still significant.”
And that’s just their immediate impact. “We still don’t know the long-term effects that e-cigarettes can have on the body,” Herbst says. “There is still so much to learn about them.”
Herbst also thinks e-cigs are an unproven and even detrimental smoking cessation tool — which is, of course, a huge reason why people puff on them. “I treat people with lung cancer, so certainly my goal is to stop people from smoking,” he says. “But these devices deliver such high concentrations of nicotine that they get people very addicted to the drug. If you need help with smoking cessation, there are other, FDA-approved forms of nicotine, such patches or lozenges, that would much better than e-cigarettes.”
And because e-cigs crank out so much nicotine, Herbst also fears that they can be a gateway to tobacco cigarettes. “E-cigarettes are very expensive, so we worry that people will start on them, get addicted to nicotine, and then move on to regular cigarettes, which are generally less expensive and easier to get,” he adds.

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Read more: http://www.mensjournal.com/health-fitness/nutrition/e-cigarettes-may-be-just-as-bad-as-the-real-thing-20150324#ixzz3Vo1Fhu6J

CNN: E-cigarettes: Helping smokers quit, or fueling a new addiction?

By Meera Senthilingam, for CNN

(CNN) It’s a portable piece of technology providing seemingly bottomless access to a drug craved by more than 1 billion people worldwide — nicotine. That craving is caused by smoking tobacco but is now being increasingly satisfied by e-cigarettes and the trend to “vape” instead of smoke.

The selling point is the clean image e-cigarettes purvey by removing the simultaneous exposure to the tar and thousands of chemicals found in the tobacco smoke of regular cigarettes — removing the cause of lung diseases as well as other tobacco-related conditions.

Tobacco kills almost 6 million people each year, according to the World Health Organization (WHO), and a growing number of people are now “vaping” instead of smoking, resulting in industry worth $2.7 billion worldwide.

Since their introduction in 2006, e-cigarettes have become commonplace among smokers trying to kick their habit, with a third of smokers trying to quit in the United Kingdom turning to e-cigarettes to aid them, according to one study. But some critics argue these electronic nicotine delivery systems (ENDS) are fueling a new addiction to nicotine — particularly among young people experimenting with them.

Allure for adolescents

“While ENDS may have the potential to benefit established adult smokers … [they] should not be used by youth and adult non-tobacco users because of the harmful effects of nicotine and other risk exposures,” says Tim McAfee, director the Office on Smoking and Health at the U.S. Centers for Disease Control and Prevention. “Exposure to nicotine can harm adolescent brain development.”

Studies conducted by the CDC through its Adult and Youth National Tobacco Surveys found increased experimentation by youth trying out e-cigarettes but not conventional cigarettes. The gadgetry and flavors associated with the devices is suggested as a reason behind this, with fears of them acting as a gateway into real tobacco smoking.

Screen Shot 2015-03-29 at 2.49.51 PM

But others in the field of tobacco control disagree, stating that whilst people — including youth — may have tried e-cigarettes, the evidence is lacking for their regular use. “Kids like new technology and just experiment or use it once or twice,” says Jean-Francois Etter, professor of Public Health at the University of Geneva.

Etter has been researching the use of e-cigarettes since 2009 and believes they are much safer than conventional cigarettes. “The most dangerous way of consuming nicotine is to smoke it,” he says. Etter argued this point last week at the World Conference of Tobacco or Health in Abu Dhabi.

Whilst Etter says that use among young people should be monitored, he believes the role of e-cigarettes in reducing global tobacco consumption is more important. “They are a gateway out of smoking,” says Etter. The number of people using a combination of tobacco and e-cigarettes is on the rise, according to Etter, resulting in smokers switching and consuming less tobacco each day. “[They have] the same level of nicotine but people are less exposed to toxins … nicotine is not a health problem,” he says. However, further evidence on the long-term health effects of e-cigarettes or nicotine is needed.

Satisfying the craving

Nicotine is the main substance keeping people addicted to smoking tobacco and consequently exposing them to the tar and toxins found in cigarettes. Whilst many people try to kick the habit cold turkey, nicotine replacement through gums and patches has long been advocated as a helping hand. “Nicotine withdrawal is a very unpleasant process,” says Linda Bauld, professor of Health Policy at the University of Stirling, whose recent report for Public Health England identified an extensive and growing market for e-cigarettes worldwide.

“The vast number of people using e-cigarettes are using them to stop smoking; [they’re] about 60% more effective than going cold turkey or buying nicotine replacement therapy over the counter.”

Bauld’s research hasn’t identified a dependence on nicotine with e-cigarettes in the same way as the addiction resulting from regular cigarettes. “E-cigarettes are not the best nicotine delivery devices,” she says referring to the fact nicotine is not seen to enter the bloodstream as readily when using e-cigarettes. That’s backed up by Etter’s research as well as a recent study by researchers at Penn State College of Medicine, in which e-cigarettes were found to be less addictive than tobacco cigarettes.

Screen Shot 2015-03-29 at 2.50.46 PM

They do, however, provide nicotine more effectively than aids such as patches or gums, according to Bauld.

“Patches and gums are a very small market,” says Etter about the quitting devices which first came onto the market 40 years ago. He fears too much restriction on e-cigarettes will limit their impact in achieving a world free of tobacco.

Both Bauld and Etter recognize the need to monitor the consumption of nicotine among teenagers but feel the value of e-cigarettes among adult smokers and their potential to save lives by reducing tobacco consumption should not be underestimated — a sentiment recognized by the World Health Organization.

“[E-cigarettes] could be a way to help people quit but we need more evidence and regulation,” says Armand Peruga, program manager for the WHO’s Tobacco Free Initiative, which has celebrated 10 years of its Framework for Tobacco Control whilst at the conference in Abu Dhabi.

Legislate and regulate

The greatest impact to date in reducing the number of smokers worldwide has been the taxation and legislation restricting tobacco advertising and increasing prices. “For every 10% increase in tax you have 4% reduction in tobacco consumption,” says Peruga.

The growing fear is the increasing domination of big tobacco in the e-cigarette market, which was once seen as a competitor. Their ownerships of popular e-cigarette brands could push out smaller companies in the field, reminiscent of the original tobacco epidemic.

“The intent of big tobacco is to sell their product,” concludes Peruga. “[They may] expand their market to other customers who didn’t use cigarettes but might consider nicotine use.”

But as it seems e-cigarettes are here to stay, most calls are for informed regulation rather than prohibition. “The majority of e-cigarettes — especially when they are well regulated — are likely to be less toxic than cigarettes — and that for smokers is an advantage,” says Peruga.

http://www.cnn.com/2015/03/23/health/e-cigarettes-smoking-addiction-nicotine/

Fargo Forum: Trygve Olson Cartoon

0322-1
 
http://www.inforum.com/opinion/cartoons/3704759-trygve-olson-cartoon-032215

Dickinson Press: Debate over on e-cigs as tobacco products overshadows bills restricting sales to minors

By Mike Nowatzki, Forum News Service

BISMARCK – Two bills being heard at the Legislature this week aim to keep e-cigarettes out of the hands of minors, but the burning issue is whether the nicotine-delivery devices should be classified as tobacco products, which would make them subject to additional taxes.

The North Dakota Department of Health believes e-cigarettes should be considered tobacco products because the nicotine contained in the liquid that’s vaporized by the battery-powered devices is derived from tobacco plants, said Krista Fremming, director of the department’s chronic disease division.

“Defining nicotine devices as tobacco products would allow the state to treat and regulate the sale of these products to minors in the same way the state treats and regulates the sale to minors of other tobacco products, such as conventional cigarettes,” she testified to the Senate Judiciary Committee on Tuesday.

Rep. Diane Johnson, R-Bismarck, prefers not to bring the tobacco-product issue into the debate. Her House Bill 1078 – one of two bills the House passed last month to ban the use of e-cigarettes by minors – refers simply to “nicotine devices,” defining them as “any noncombustible product that can be used by an individual to simulate smoking through inhalation of a substance that contains or delivers nicotine or any other ingredient.”

The bill had its first hearing before the Senate Judiciary Committee on Tuesday.

On Wednesday – the annual nationwide “Kick Butts Day” – committee members will take up the other House bill, HB 1186, which would make it an infraction to sell or give anyone under 18 an electronic smoking device or alternative nicotine product, or for minors to buy, possess or use them.

Fremming said the health department supports that bill’s requirements for child-resistant packaging and salesperson-assisted sales to limit e-cigarettes from being marketing to youths. But it’s still concerned that the bill defines e-cigarettes as non-tobacco products.

The bill’s prime sponsor, Rep. Kim Koppelman, R-West Fargo, has argued that while e-cigarettes use nicotine extracted from tobacco, they’re not tobacco products.

Koppelman was among the House lawmakers who voted to defeat a House bill that would have increased the excise tax on a pack of cigarettes from 44 cents to $1.54 while also defining e-cigarettes as tobacco products. He called it a back-door way to taxing e-cigarettes.

Mike Rud, president of the North Dakota Petroleum Marketers Association, said Tuesday the group supports Koppelman’s bill because it’s more comprehensive and opposes classifying e-cigarettes as tobacco products because the U.S. Food and Drug Administration is developing regulations for e-cigarettes.

“I think we’re going to see a lot of changes when those come out. There’s no sense in muddying the waters right now,” he said.

As of December, Minnesota and Vermont were the only states that taxed e-cigarettes and e-vapor products. Twelve state legislatures considered bills last year taxing e-cigarettes but didn’t pass them, according to Tobacco E-News, an industry publication.

In North Dakota, 23 cities have updated their ordinances to prohibit e-cigarette sales to minors, according to the North Dakota Center for Tobacco Prevention and Control Policy.

Three of those cities – Wahpeton, West Fargo and Grand Forks – require those who sell e-cigarettes to obtain a tobacco retailer license. That could become a state requirement if lawmakers classify e-cigarettes as tobacco products, which supporters say would reduce e-cigarette sales to minors.

Rud said most retailers have made a conscious decision not to sell e-cigarettes to minors, already treating them as tobacco products.

E-cigarette users argue the devices are safer than traditional cigarettes, are a useful tool for those trying to quit smoking and shouldn’t be subject to tobacco excise taxes. Fremming said the health department feels nicotine products approved by the FDA for tobacco cessation – which currently doesn’t include e-cigarettes – should be excluded from the definition of nicotine devices because their safety and efficacy is proven.

While the tobacco products definition will continue to be a source of debate, no opposition has surfaced so far to the idea of restricting e-cigarette sales to minors.

Fremming said the rate of North Dakota high school students who reported trying e-cigarettes nearly tripled from 2011 to 2013, from 4.5 percent to 13.4 percent, and high school students who have tried e-cigarettes are almost twice as likely to try conventional cigarettes.

At least 41 states currently prohibit sales of electronic cigarettes or vaping/alternative tobacco products to minors, including Minnesota and South Dakota, according to the National Conference of State Legislatures.

Whitney Klym, a senior at St. Mary’s Central High School in Bismarck and a member of its SADD group, told the committee Tuesday she has seen e-cigarettes used at school, parties and other events by students as young as 14.

“It is becoming a dangerous social norm among youth,” she said.

http://www.thedickinsonpress.com/news/legislature/3702058-debate-over-e-cigs-tobacco-products-overshadows-bills-restricting-sales

Teens can easily buy e-cigarettes online, study says

Liz Szabo, USA TODAY
Teens can easily buy e-cigarettes online even though sales to minors are banned in 41 states, a new study shows.
Teens in the study were able to buy e-cigarettes online in 94% of attempts, according to a report published today in JAMA Pediatrics.
Internet retailers rejected only five out of 98 attempted purchases because of age, according to the study, in which researchers closely supervised 11 teen participants. Five attempts were blocked by parental control settings on the computers.
None of the teens were asked to show proof of age when the packages were delivered. In fact, 95% of orders were left at the doorstep, the study says.
Researchers, whose previous studies have shown that young people can easily order alcohol online, say they were careful to make sure that the study didn’t encourage kids to break the law.
Parents of the teens, ages 14 to 17, gave consent for kids to join the study and use their credit cards for the e-cigarette purchases. Researchers also cleared the study with local law enforcement.
Kids today have greater access to credit cards than many people realize, says the American Lung Association’s Erika Sward. Many teens routinely use family credit cards to buy online music, games and apps.
Previous studies have found that teens can easily buy conventional cigarettes online, Williams says. About 1 million young people reported buying tobacco online in 2012.
Although the Food and Drug Administration has proposed regulations for e-cigarettes, including a ban on selling them to minors, it has has not finalized these rules. The proposed rule does not ban Internet sales.
E-cigarettes use a battery to heat liquid nicotine into a vapor that can be inhaled. They don’t produce smoke.
E-cigarettes are increasingly popular with young people. A 2014 study found that 17% of high school seniors used e-cigarettes, more than twice as many as used conventional cigarettes.
States have been racing to regulate e-cigarettes out of concern that they will addict young people to nicotine.
North Carolina requires online retailers to verify e-cigarette customers’ ages with a government records database, says Rebecca Williams, the study’s lead author and a research associate at the University of North Carolina-Chapel Hill.
Harold Farber, a pediatric pulmonologist at Texas Children’s Hospital in Houston, says he’s not surprised by the study’s findings. He notes that e-cigarettes are marketed in ways that appeal to teens, with flavors such as grape, cotton candy and bubble gum. He’s concerned that e-cigarettes will addict young people to nicotine, which could lead them to regular tobacco.
“Ninety percent of adult smokers start before age 18,” says Farber, who was not involved in the new study. “The industry knows very well that in order to get their next generation of customers, they need to get them before they become adults. We’re seeing the e-cig industry follow the tobacco industry’s playbook.”
Without regulation by the FDA, the market for e-cigarettes is akin to the “wild West,” says Sward. She calls the study’s findings “extraordinarily troubling.”
“The status quo is benefitting the e-cigarette industry and the tobacco industry,” which has become a powerful force in the e-cigarette market, says Sward, who was not involved in the new study. “We need the Obama administration to act now to protect kids.”
A spokesman for the Smoke-Free Alternatives Trade Association, an e-cigarette industry group, says its members take the responsibility to protect kids very seriously.
“We certainly don’t want teenagers to have access to them,” says Phil Daman, president of the e-cigarette association.
R.J. Reynolds Vapor Co. does not sell e-cigarettes online, spokesman Richard Smith says. “Face-to-face sales allow for greater security against youth access to tobacco products, as clerks can check IDs,” Smith says.
Daman says his organization encourages members to use age verification software when selling e-cigarettes online.
“Implementing the use of age verification software is a reasonable, highly effective and cost-efficient way for the vapor products industry to prevent minors from making unauthorized purchases online,” Daman says.
In the new study, conducted from February 2014 to June 2014, seven of 98 online e-cigarette vendors claimed to use age verification techniques capable of complying with North Carolina law. Yet teens were able to place orders at six of those seven websites, showing that the retailer’s age verification systems didn’t work, Williams says.
“If people aren’t using age verification software, if they’re not doing what they’re supposed to be doing, there’s no excuse for it,” Daman says. “Responsible corporate citizens should be ensuring that they use this age verification software.”
http://www.usatoday.com/story/news/2015/03/02/teens-buy-e-cigarettes-online/24118331/

Clearing the smoke around teen e-cigarette use

Shari Rudavsky, The Indianapolis Star
INDIANAPOLIS — No one says publicly that they want teens to start using e-cigarettes. Nor do most argue about statistics that show that youth have been flocking to this funky alternative to tobacco.
The controversy in many state legislatures centers on what to do about it.
Last year, for the first time, more U.S. teens used e-cigarettes than smoked, 17% vs. 14%, according to a University of Michigan study, making it clear that state-enforced age limits alone don’t work.
Thus far, the Food and Drug Administration has opted not to act. So some states, including Indiana, are trying piecemeal solutions to keep vaping out of young hands, from increasing taxes to closer regulation of the industry.
In Indiana, an effort to tax the products went nowhere. A measure that would increase strictures of so-called vape shops is moving through the Indiana General Assembly. The question is whether it would produce the desired effect.
Vape shop owners argue they are not the problem and that too much regulation would only limit access for former smokers who have replaced their nicotine habit with vaping.
One shop owner told The Star he has no interest in the youth market. At the Indy Vapor Shop on the Westside, the first in Indiana, owner Mike Cline displays a sign announcing no sales to anyone under age 18 and rarely does one cross the threshold. In the five years his shop has been open, he’s denied service to fewer than 10 teens because of age.
“Really I think the idea of minors trying to buy from vape shops is way overblown,” Cline said. “We don’t do sales to minors.”
Someone, however, is selling to minors.
In 2013 more than a quarter-million middle and high school students who had never smoked tried e-cigarettes, according to a Centers for Disease Control and Prevention study that appeared in August. That number had tripled since 2011.
Still, most students don’t head to vape shops, many agree. Instead, they can pick them up at gas station convenience stores, raising health concerns.
Concerned about what we don’t know
E-liquids in sweet flavors, such as candy cane or bubble gum, may draw youth, as will delivery systems that can resemble a variety of other products, such as video game controllers, pens or soda cans, said Earnest Davis, a tobacco health educator for the Marion County Public Health Department.
Some may not realize that when they partake, they’re doing something akin to smoking.
“A lot of youth high schoolers that I talk to, say, ‘I’m not smoking cigarettes; I’m just using a flavored e-juice,'” Davis said. “Right now, they’re just in a wow factor…. It’s one of the scarier things we’re seeing, that everyone thinks it’s cool.”
Health officials say that they are particularly concerned not just with what we know about e-cigarettes but also about what we don’t know.
E-cigarettes do not contain tobacco, but the liquids involved can contain a number of other products, including formaldehyde and metals such as nickel, lead and chromium, whose effect on health is not known, said Dr. Aasha Trowbridge, a family medicine physician with Franciscan St. Francis Health.
“What we do know is that e-cigarettes release chemicals; they’re not harmless,” said Trowbridge, also medical director of the Aspire Tobacco-Free Program. “We know enough to say that the products that are released with burning the liquid are certainly of concern.”
Consuming nicotine in any form, including e-liquids, can be addictive and have detrimental effects on brain development, Trowbridge said.
What concerns Trowbridge most, however, is that many of her young patients tell her they have experimented with e-cigarettes, which suggests they may be more likely to start smoking.
The CDC study published earlier this year found that teens who had never smoked, but had vaped, were twice as willing to try conventional cigarettes.
“That is one of my greatest concerns; are we introducing a product that may not have been something a child would have looked at before and would now say, ‘Hey let me try this,'” Trowbridge said. “It is a perfect gateway drug to conventional cigarettes…. We’re giving our teenagers and youth one more way to be introduced to tobacco.”
For some, a way to quit smoking
Supporters of vaping point to other research that suggests that teens who do experiment with e-cigarettes do not partake regularly. In addition, none of the studies has asked whether teens actually use nicotine products when they vape, said Gregory Conley, president of the American Vaping Association, based in New Jersey.
The fruity flavors may sound designed to appeal to teens, but they also have adult fans, said Conley, who credits a watermelon-flavored vapor product with his own success quitting tobacco. He cites studies that show that 60% to 70% of adult vapers use fruity or sweet flavors.
Cline, who opened his own vape shop six years ago, claims vaping has helped many a smoker kick that bad habit. Cline said he has not smoked conventional cigarettes since he started vaping. Over time, he’s gradually weaned down the nicotine strength of what he vapes.
While Cline said he’s not averse to some tweaks to the law to protect minors and other consumers, he’s wary of going too far.
“We’re trying to reach a level that we as an industry can comply with and support and at the same time protect the consumer,” he said. “We do believe that regulation is both needed and necessary, we just don’t want to be regulated to the point where we can’t do business.”
‘I see it as very similar to cigarettes’
In Indiana, only the bill increasing regulations on the industry progressed. It would give the state the ability to check whether stores sell to minors.
Attorney General Greg Zoeller at the start of this legislative session had proposed a number of measures, including taxing the products and including e-cigarettes in the state’s smoking ban.
Tobacco’s history and the lack of solid data on the health effects of e-cigarettes prompted him to call for the actions on e-cigarettes, Zoeller said.
“Frankly I see it as very similar to cigarettes in the past,” he said. “I do think that these things should not be seen as socially acceptable. There’s unknown risks here.”
Health officials like Davis agree that it would be a shame if e-cigarette use continues to rise among teens at the same time as conventional cigarette use finally falls.
“We worked so hard to eradicate the use of traditional cigarettes among youth, just to have it replaced by something else,” he said.
http://www.usatoday.com/story/news/nation/2015/03/01/clearing-the-smoke-around-teen-e-cigarette-use/24228671/

Op Ed: How to lower Grand Forks’ high tobacco-use rates

By: Theresa Knox

On Feb. 23, the Herald ran a story about the dismal rates among adults of chewing tobacco use (“N.D. ranks highly in smokeless tobacco use,” Page A1).

As the story reported, North Dakota was ranked 49th out of 50 states and District of Columbia, with 7.6 percent of its adults using smokeless tobacco.

The story went on to interview several people with personal stories about the toll of tobacco in their lives. It ended with the quote, “They all know someone who’s died from tobacco-related cancer.”

These statistics are terrible. And they are not just statistics. As the article referenced, each number represents a person. These are people we know and love — people we work with, and people whom we don’t want to see sick and dying from the No. 1 cause of preventable death: tobacco use.

Nearly one quarter of high school boys in North Dakota use smokeless tobacco (22 percent). That is higher than the adult use rate and the fifth worst in the country.

We know that most smokers begin their addictive habit before the age of 18, and nearly 4,000 kids try their first cigarette every day. That’s almost 1.5 million young people per year.

The tobacco industry pours billions into advertising to create a perception that tobacco use is fun and glamorous.

But, guess what? We don’t have billions to counteract that type of messaging — and we don’t need it.

There is a solution that is nearly free of charge; and it works. Research bears out this claim.

I will tell you what that solution is, but first, ask yourself this question: Is it easier to quit using tobacco or to avoid ever taking up the habit?

It is easier (and cheaper) to avoid taking up this addictive habit.

Second, I ask you to rethink your attitudes about tobacco use and why it is not acceptable in indoor and outdoor public places. There is no denying that second-hand smoke and toxic litter from cigarette butts and spitting on the ground are bad for people and animals. But there is an even more important reason to prohibit tobacco use in indoor and outdoor public places: Public policy that keeps kids from seeing tobacco use as a normal activity will decrease youth initiation of tobacco use.

Remember, most people don’t chew or smoke tobacco.

An effective way to keep our next generation of North Dakotans from ever taking up using tobacco is to pass laws that keep tobacco use –including e-cigarettes, cigarettes and smokeless tobacco — out of our parks.

We can pass public policy that creates tobacco free environments. These policies don’t tell people they can’t use tobacco, if they choose to use. People are still free to smoke or chew. These policies prevent the use of products in otherwise safe and healthy places.

Grand Forks Park Board commissioners have the chance to take a deliberate and determined step to protect the health and safety of Grand Forks youth by adopting a comprehensive tobacco-free parks policy. They can take the lead to separate the connection between sports and chew, parks and tobacco.

And the result?

We know the result. A comprehensive tobacco-free parks policy, prohibiting use of all tobacco products in all Park District parks, grounds and facilities will result in cleaner parks and less secondhand smoke exposure.

And the most celebrated result?

Fewer Grand Forks youth will start using tobacco, and fewer among the next generation of North Dakotans will struggle with tobacco addiction and the toll of the illness and death that result from tobacco.

That is the solution. And it costs next to nothing.
http://www.grandforksherald.com/opinion/op-ed-columns/3688567-theresa-knox-how-lower-grand-forks-high-tobacco-use-rates

North Dakota ranks poorly in smokeless tobacco use

By Robin Huebner Forum News Service
FARGO — Chris Carlson’s nicotine habit started with chewing tobacco and his college fraternity brothers.
He really got hooked in the mid ’80s as an exchange student in Sweden, where he says everyone – including his female classmates – chewed the smokeless tobacco known as “snus.”
“I’ve got warm, sweet memories of the time,” said Carlson, 51, Fargo, who teaches college public speaking courses and is an adjunct instructor of Norwegian and Scandinavian studies at Concordia College.
While Carlson fondly recalls the rituals and relaxed feelings he said went along with using smokeless tobacco, his memory of that 24-year period is selective.
“You don’t remember all the times it made you nauseous,” he said.
Carlson also smoked cigarettes, but at the urging of his children, gave up both vices about eight years ago with the help of nicotine gum.
He fully understands the difficulty in quitting a substance that is highly addicting and deeply rooted in culture.
At a time when anti-smoking laws have carved out a strong foothold in North Dakota, the state is at the other end of the spectrum with smokeless tobacco.
Statistics from the U.S. Centers for Disease Control and Prevention show that North Dakota is in the middle of the pack for cigarette smoking, but is third worst – behind Wyoming and Mississippi – in the percentage of adults who use chewing tobacco or snuff.
The ranking lists all 50 states and the District of Columbia.
North Dakota was ranked 49th with 7.6 percent of its adults using smokeless tobacco in 2011 – the most recent year for which numbers are available.
South Dakota ranked 43rd with 6.8 percent, and Minnesota was 32nd with 4.8 percent of adults using smokeless tobacco.
The highest percentage of smokeless tobacco users in North Dakota by race are American Indians, who double up on the number of Caucasians using it.
A tribal tradition
Neil Charvat is a former smoker and smokeless tobacco user whose career now focuses on preventing people from picking up the habit.
Charvat, 44, works closely with the state’s Indian reservations as director of the tobacco prevention and control program for the North Dakota Department of Health in Bismarck.
While the state’s smoke-free laws don’t apply to reservations because of their sovereign nation status, the state does fund tribal tobacco prevention programs.
Charvat said it can be tricky educating American Indians about tobacco because the traditional form of it is often central to their religious beliefs.
“If we say, ‘Tobacco is bad,’ that’s a direct insult to their religion,” he said.
So when tribal educators go into schools on the reservation, they make an important distinction from the very start.
“We teach from the viewpoint of it being commercial vs. traditional tobacco,” said Jackie Giron, tobacco prevention coordinator for the Turtle Mountain Band of Chippewa.
Charvat said traditional tobacco grown by tribes doesn’t contain the additives and chemicals that commercial tobacco contains.
In addition, it’s meant for ceremonial use only – not recreation.
In some cases, addictions took hold after tribes began using commercial tobacco for those ceremonies when they weren’t able to obtain traditional tobacco, Charvat said.
As years went on, some commercial tobacco companies even sponsored powwows.
“They portrayed it as something sacred and not harmful to you, which it is,” Giron said.
She said she sees both adults and children chewing tobacco at Turtle Mountain. It means the education process needs to start early, in kids as young as 3 and 4 – and continue through high school and college, she said.
“All you can do is take baby steps sometimes,” Giron said.
Just as dangerous
One challenge in keeping people from starting with smokeless tobacco and helping them quit involves a common, but mistaken belief.
“Some of that has to do with the misconception that if you don’t inhale, it might be somewhat safer,” said Holly Scott, a tobacco prevention coordinator at Fargo Cass Public Health.
In fact, it’s equally as risky.
“When chewing, they’re actually getting more nicotine than in cigarettes, increasing their nicotine addiction,” said Melissa Markegard, who is also a tobacco prevention coordinator at Fargo Cass Public Health.
The incidence of many types of cancer and other diseases can be attributed to smoking and/or chewing tobacco, but combining the products makes it even worse.
“It greatly increases (the risk of lung cancer) if they use both together,” Markegard said.
While there are fewer opportunities than ever to smoke in North Dakota, the same restrictions don’t apply to chewing tobacco because it’s easier to hide.
Charvat said as a teen, he used to smoke a cigarette outside of his school, and then tuck a chew into his mouth before going to class.
Youth at risk
A survey of more than 10,500 North Dakota high school students in 2013 found 13.8 percent of them had used chewing tobacco, snuff or dip during the past 30 days.
It also found chewing tobacco is more often used in smaller towns than in urban centers – 15.1 percent to 11.2 percent, respectively.
“In Western and rural cultures, it’s more commonplace and accepted,” Charvat said.
According to the survey, the Williston area had the highest incidence of chewing tobacco use in high school students, while the Grand Forks area had the lowest.
The Youth Risk Behavior Survey, a collaboration of federal, state and local health education agencies, will be conducted again this spring.
Scott said her overall goal is to “de-normalize” all tobacco use because it’s the state’s No. 1 cause of preventable disease and death.
Charvat is optimistic North Dakota will show up better the next time rankings are compiled because the people he’s working with are motivated.
“They all know someone who’s died from tobacco- related cancer,” he said.
http://bismarcktribune.com/news/state-and-regional/north-dakota-ranks-poorly-in-smokeless-tobacco-use/article_86fa27cb-e925-5210-9ee7-2456e943dbde.html

Letter: Support e-cigarette age restrictions

By Tom Woodmansee, Bismarck

House Bill 1265 would require e-vapor products (commonly referred to as e-cigarettes) to be sold only to adults 18 years of age and above, an important goal that we should all agree on. We support enactment of underage access prevention for e-vapors and alternative nicotine products, which is why we support House Bill 1265.
This bill includes broad definitions to ensure that these new product forms are included in North Dakota’s existing underage access prevention laws.
Products that contain nicotine, whether they are traditional tobacco products like cigarettes, cigars or smokeless tobacco or new e-vapor products, are for adults only. We don’t believe people who are under legal age should be purchasing these products. Currently, 41 states prohibit sale of e-vapor products to minors.
The bill would also establish statewide policy regarding sales of these new types of products such as e-vapor. This bill would provide uniform policy for e-vapor and alternative nicotine product sales across North Dakota and avoid a patchwork of differing local restrictions or ordinances that could cause confusion among adult consumers and retailers.
That’s why we support this legislation to help ensure that e-vapor products are only available to adult consumers and to support retailers in having uniform state standards for tobacco and alternative nicotine product sales to continue to help address underage access to all types of products that contain nicotine.
Let’s do the right thing and pass House Bill 1265. It’s the responsible approach that will help make these products only available to adults and out of kids’ hands.
Woodmansee is with the North Dakota Grocers Association.
http://www.inforum.com/letters/3684232-letter-support-e-cigarette-age-restrictions