Major cancer groups call for e-cigarette research, regulation

By John Nielsen, ScienceInsider

One telling sign of the popularity of electronic cigarettes, or e-cigarettes, which allow users to inhale nicotine vapors without other harmful chemicals, arrived late last year: The editors of the Oxford Dictionaries declared “vape” their Word of the Year for 2014.

Today, e-cigarettes earned another kind of notice: Two of the largest cancer science and treatment groups in the United States called on the government to start regulating “electronic nicotine delivery systems” and step up research on the health effects of vaping.

“While e-cigarettes may reduce smoking rates and attendant adverse health risks, we will not know for sure until these products are researched and regulated,” said Peter Paul Yu, president of the 35,000-member American Society of Clinical Oncology, in a statement. “We are concerned that e-cigarettes may encourage nonsmokers, particularly children, to start smoking and develop nicotine addiction.” His group was joined by the American Association for Cancer Research, which has more than 33,000 members.

The joint statement endorsed the urgent need for new research into the health effects of e-cigarettes and using tobacco tax revenues to help fund studies. It also included a long list of recommended actions by state and federal government agencies. They include requiring makers of e-cigarettes to register their products with the Food and Drug Administration (FDA), to identify the chemicals and levels of nicotine in various brands, and to agree to help stop teenagers from vaping.

In April 2014, FDA issued a proposal to start regulating e-cigarettes. The proposal would require FDA reviews of e-cigarette products and force makers to stop claiming health benefits until the science is in. The rule would also ban the distribution of free samples of e-cigarettes and vending machine sales. Health warnings would be mandatory. FDA has not finalized the rules, however, and researchers and health professionals say they hope today’s statement will highlight the need to move quickly.

“As someone who runs a treatment program for tobacco addicts, I would love to be able to endorse the use of e-cigarettes as an alternative,” says Michael Steinberg of the Robert Wood Johnson Medical School at Rutgers University, New Brunswick, in New Jersey. “But I cannot do that because we don’t know the risks involved, nor can we be sure that moving to e-cigarettes really helps people stop smoking.” Steinberg says it could turn out that smokers who start vaping tend to end up using both e-cigarettes and flammable ones or that the nicotine produced by e-cigarettes is unexpectedly toxic.

Some researchers worry that any new rules won’t go far enough, soon enough. Neither the FDA proposal nor today’s joint statement calls for a ban on television advertising by e-cigarette makers, for example, notes Stanton Glantz, director of the Center for Tobacco Control Research and Education at the University of California, San Francisco. (Glantz, a frequent critic of the health claims made by makers of e-cigarettes, says he supports such a ban.) There’s also no mention of regulating e-cigarette “flavorings,” such as minty or fruity flavors, which were banned from cigarettes after they were linked to elevated smoking rates among teenagers.

Glantz also worries that it could be years before FDA fully regulates the devices. “It’s an especially torturous political and legal process at the federal level,” he says. Regulations may be easier to finalize on the state and local level, he adds, noting that several states and cities have already imposed restrictions. “I would look for progress at the local level,” Glantz says. “I expect that in this case the most important changes will start at the bottom, not the top.”

In the meantime, e-cigarettes are becoming increasingly mainstream. The small, battery-powered devices first became readily available in the United States in 2006, and sales rose to about $2 billion in 2014 alone. “Vaping” bars where people speak of “vapers’ rights” are popping up in towns and cities. Movie stars have advertised their vaping skills on late-night television talk shows.

This past December, a survey released by the National Institute on Drug Abuse reported that 17% of high school seniors said they’d vaped at least once a month, compared with 14% percent who admitted to smoking. Vaping among 10 graders, at 16%, was more than twice the rate of smoking. Antismoking activists found these reports alarming, arguing that vaping could become a “gateway habit” that could draw nonsmokers toward cigarette use.

http://news.sciencemag.org/health/2015/01/major-cancer-groups-call-e-cigarette-research-regulation

Salt Lake County health study reveals big problem with inaccurate e-liquid labeling

By , Deseret News
SALT LAKE CITY — An increase in emergency room visits and calls to the local poison control hotline has Salt Lake County Health Department officials concerned about e-liquid used in battery-operated electronic cigarettes.
“You really have to treat it as a drug because it is fatal to a small child,” said Kathy Garrett, tobacco prevention and cessation manager for the Salt Lake County Health Department.
The health department, Garrett said, is encouraging users to put e-cigarettes and the “enticing candy-flavored cartridges” out of the reach of young people.
It is also seeking to pass new regulations to keep manufacturers in check.
“E-liquid is a serious poisoning threat to children,” Garrett said, adding that the United States Food and Drug Administration does not regulate e-liquid manufacturing at all. “If they drink enough of it, it can be fatal to small children.”
The Salt Lake County Health Department recently concluded its own study, where undercover workers visited all 14 vape shops and 16 of the 80 tobacco specialty stores in the county to purchase a variety of e-liquid cartridges for testing at the Center for Human Toxicology at the University of Utah.
Health officials found that 61 percent of the e-liquid cartridges collected strayed at least 10 percent from what was indicated on the labels, with either more or less nicotine content than expected.
Garrett said even the samples that listed no nicotine content had trace amounts, and at least one variety had 7.35 miligrams per milliliter.
1467294“Both specialty stores and vape shops are inconsistent with their labeling,” she said. “These findings support the need for local policy that requires licensing for the manufacturing of e-liquid, and also we’d like to regulate the sale of e-cigarettes to ensure safety standards that include accurate labeling and ingredients with nicotine levels.”
The Utah Legislature has yet to pass legislation that would govern any part of the surging electronic cigarette industry in the state, and the federal government is just beginning to assess the issues surrounding production and sales.
Last year, the number of adults using e-cigarettes topped 40 million nationwide, an increase of more than 620 percent over the previous year. The number of children and teens who use them is on the rise as well, health officials said.
The Utah Department of Health reports that 4.8 percent of adults and 5.8 percent of teens routinely use the nicotine vapor product, according to 2013 data, the latest available. The rate of regular e-cigarette use in Utah more than doubled from 2012 to 2013, and it tripled among Utah students from 2011 to 2013.
Without state or federal laws to govern e-cigarette and e-liquid production and sales, local jurisdictions have taken it upon themselves to protect Utahns, and Garrett said Salt Lake County will be the next to enact a policy.
She expects the board to vote on something as early as next month. If a policy is adopted, the health department would be responsible for enforcing it through random inspections and monitoring of local manufacturing activity.
Garrett said there are several manufacturers in the valley that the health department would love to keep its eye on to make sure they’re following the rules.
“Inaccurate labeling is alarming because consumers don’t know exactly what they’re taking into their bodies or at what level,” she said. “It’s also a real concern for poison control and emergency room staff, who don’t know if the labeled amount of nicotine in a bottle a child has ingested is accurate.”
Nicotine in e-liquids was to blame for 131 calls to theUtah Poison Control Center in 2014, according to the health department.
Health officials also reviewed the availability of child-proof lids for e-liquid cartridges and found that more than a quarter of the samples containing a listed amount of nicotine did not have safety caps.
There are 12 local health departments in the state, and at least Davis, Weber and Utah counties have adopted regulations, while Summit County has an ordinance, but Garrett said most if not all departments would be on board for statewide legislation, which may be presented in the upcoming session of the Utah Legislature.
In the meantime, Garrett said, “if you have e-cigarettes of e-juice lying around, lock it up where a child can’t get into it. Just like any medication, you should lock it up and keep it out of reach.”
http://www.deseretnews.com/article/865619211/Salt-Lake-County-health-study-reveals-big-problem-with-inaccurate-e-liquid-labeling.html?pg=all

Tobacco companies criticize federal judge

WASHINGTON (AP) — Tobacco companies on Wednesday accused a federal judge of forcing them to inaccurately describe themselves as unscrupulous villains who continue to deceive the public.

In an appeals court filing, the industry said statements ordered by the judge in a government lawsuit would only trigger public anger against the companies and should be scrapped.

U.S. District Judge Gladys Kessler ordered the largest cigarette makers to admit they had lied for decades about the dangers of smoking, and to publicize a federal court’s conclusion that Altria, R.J. Reynolds Tobacco, Lorillard, and Philip Morris USA deliberately deceived the public.

The companies said the statement was misleading and too broad.

In 2009, the U.S. Court of Appeals for the District of Columbia Circuit directed Kessler to craft corrective statements confined to purely factual and uncontroversial information that would reveal previously hidden truths about the tobacco industry’s products.

But the companies said in the new filing that Kessler went beyond those instructions and ordered a series of inflammatory statements that require the defendants to denigrate themselves.

The companies said that in accordance with the appeals court’s ruling, they stand ready to disseminate statements that provide public health information about cigarettes.

Arguments in the case will be heard on Feb. 23.

http://news.yahoo.com/tobacco-companies-criticize-federal-judge-192705159–finance.html

Opinion: A tobacco tax increase would make Maryland healthier

Matthew L. Myers, Washington – The Washington Post

The Dec. 28 editorial “A tax that saves lives” pointed out that Maryland’s push to reduce smoking is not only good public health policy but also good fiscal policy. It helps reduce tobacco-related health-care costs, which total $2.7 billion a year in Maryland, including $476 million paid by the state’s Medicaid program.

That should spur Gov.-elect Larry Hogan (R) and legislators to step up efforts to prevent kids from using tobacco and to help users quit.

Ideally, Maryland would increase its tobacco tax. The last tobacco tax increase, in 2008, helped reduce smoking among youth and adults.

Maryland must also increase funding for its tobacco prevention and cessation programs, which have been cut by more than half in recent years. Maryland will receive $543 million from the 1998 tobacco settlement and tobacco taxes this year, but it will spend just $8.5 million on tobacco prevention. This paltry sum is less than 18 percent of what the Centers for Disease Control and Prevention recommends. These programs save lives and money. Washington state saves more than $5 in health-care costs for every $1 spent on its program.

Maryland can’t let up; the tobacco industry isn’t letting up in promoting its products. Nationwide, Big Tobacco spends $8.8 billion a year on marketing, including more than $120 million in Maryland. The result: Tobacco remains the No. 1 cause of preventable death. Unless Maryland’s leaders continue to fight this scourge, the state will pay a high price in lives and dollars.

Matthew L. Myers, Washington

The writer is president of the Campaign for Tobacco-Free Kids.

http://www.washingtonpost.com/opinions/a-tobacco-tax-increase-would-make-maryland-healthier/2014/12/31/0cbfb454-905a-11e4-a66f-0ca5037a597d_story.html

Cigarette Addiction Affects Men, Women's Brains Differently; Brain Scans Reveal Need For Tailored Treatment

By Samantha Olson, Medical Daily

Smoking is addictive and bad for the body in a laundry list of ways, but it hooks men and women differently. Researchers at Yale University studied the brains of men and women using positron emission tomography (PET) scans. Their intention was to measure the changing levels of dopamine, which control the brain’s pleasure and reward pathways, in men and women’s brains, and published their findings in the Journal of Neuroscience earlier this month.

Dopamine levels increase when addictive substances, such as the nicotine found in cigarettes, enter the body and flood the brain. For the first time, researchers have developed a way to watch the dopamine levels change while a person smokes. Researchers observed the dopamine levels of 16 addicted cigarettes smokers — eight men and eight women — with at least 17 years of smoking behind them.

Each participant was told to smoke one or two cigarettes whenever they wanted while under observation, and they weren’t allowed to use any nicotine patches or medications during the study. The study’s lead researcher Kelly Cosgrove, a radiology professor from Yale University, scanned each of their brains, and pieced each of the images together in order to create a sequence of brain movements.

Dopamine struck women harder and faster in one section of the brain called the dorsal putamen, while men had moderate to low activation in the same area. Men, on the other hand, had much faster and consistent activity in the ventral striatum, while women were only mildly affected. But what did all this mean?

“I think it confirms that strategies that focus on drug reward are likely to work better for men –- these would include the nicotine replacement strategies [like the patch],” Cosgrove, told the Huffington Post. “And for women it highlights that we need different and new medications — ones that target the reasons why women smoke, such as to relieve stress and manage mood.”

Women were more affected by the sensation of smoking, such as its taste and the smell of smoke, while men were more affected by the nicotine itself. Men are much more likely to use chewing tobacco because they don’t care about the cigarette or the activities smoking brings with it; they just want that nicotine. Women, on the other hand, may do better smoking a low-nicotine cigarette, so long as they have a cigarette in hand to take a drag and blow smoke from.

“If [women] are smoking more for the taste and sensory effects, then low-nicotine cigarettes might be an effective way to wean themselves off the regular cigarettes, whereas men might have more nicotine withdrawal and not really get much out of those [low-nicotine] cigarettes,” Kenneth Perkins, a psychiatric professor at the University of Pittsburgh who was not involved in the study, told HuffPost. “The possibility is that they might be a more effective way for women to quit than men, but that’s purely speculative at this point.”

Source: Cosgrove K. Journal of Neuroscience. 2014.

http://www.medicaldaily.com/cigarette-addiction-affects-men-womens-brains-differently-brain-scans-reveal-need-315628

The Post's View: Maryland’s cigarette tax is saving lives

By Editorial Board, The Washington Post

AMID AN electoral backlash against high taxes in Maryland, anti-smoking advocates have abandoned a campaign to raise the state-imposed levy on cigarettes. Politically, that makes perfect sense. As public-health policy, it is foolish.

A new study by Maryland’s Department of Health and Mental Hygiene shows that the state’s drop in teen smoking rates, already steep following three sharp tax increases since 1999 on a pack of cigarettes, has continued in the past few years.

The rate of cigarette smoking among underage youth in the state has fallen from 23 percent in 2000 to just 11 percent last year. Since 2008, when the per-pack levy was doubled, to $2, smoking among high school youth has fallen by about a third; according to the state study, for the first time, slightly more teenagers now smoke cigars than smoke cigarettes.

Adult smoking has also fallen by about a fifth since 2000. Smoking among both youth and adults in Maryland is considerably below the national average, which is about 16 percent for youth and 18 percent for adults.

No doubt, the anti-tax mood in Maryland was central to Republican Larry Hogan’s upset victory in November’s gubernatorial election. That sentiment notwithstanding, the smoking numbers are a strong argument for leaving in place the state’s relatively high levies on tobacco products, which are not just a revenue source but also a means of saving lives.

According to the state study, hospital admissions to treat tobacco-related cancers in Maryland have fallen by 11 percent from 2000 to 2011, saving more than $102 million in hospital charges in 2011 alone.

The state study also showed a strong link between youth smoking and other forms of substance abuse. Minors who smoked were three times more likely than non-smokers to have used alcohol in the past 30 days, five times more likely to have used marijuana, six times more likely to have used other illegal drugs, and nine times more likely to have used — or, more likely, abused — prescription drugs.

It’s no coincidence that states that have been loath to offend the tobacco or anti-tax lobbies by raising the tax on cigarettes have significantly higher smoking rates. As we’ve noted before, a case in point is Virginia, where the per-pack levy is among the lowest in the nation, the price of a pack of cigarettes is $2 lower than in Maryland and the smoking rate is much higher. For continuing to bow before the throne of King Tobacco, the Old Dominion will pay a price in the public health of its citizens.

As smoking rates nationally have fallen, the use of e-cigarettes among high school-age youth appears to be rising. That’s a worrying trend, given that e-cigarettes also contain nicotine, which is highly addictive, and could promote the use of cigarettes and other harmful substances.

You don’t have to be enamored of the nanny state to recognize that tobacco use, especially cigarette smoking, correlates directly with lung cancer and other diseases and is a major threat to public health. Nor is there any serious doubt that tax increases have played a critical role in cutting cigarette use, especially among price-sensitive teens.

If Mr. Hogan intends to cut taxes, as he has promised, the tobacco tax is one he’d be well advised to leave intact.

http://www.washingtonpost.com/opinions/marylands-cigarette-tax-is-saving-lives/2014/12/27/36f2818a-8573-11e4-9534-f79a23c40e6c_story.html

Tobacco tax: Move for $2 per pack gains momentum in CA

By Dr. Nicholas Leeper | Special to the Mercury News

The changing of the New Year brings about a fresh start. If you are one of the estimated 46.6 million Americans who smoke cigarettes, quitting the habit is likely being considered for a New Year’s resolution. Polls have shown that a vast majority of smokers would like to quit, and we at the American Heart Association are dedicated to giving smokers every edge we can to put their habit in the past. One such proven way to encourage quitting is a tobacco tax.

This is why we are joining with doctors, health care workers, taxpayers and other nonprofit health organizations to support a $2-per-package tax on the cost of tobacco.

The benefits to our state would be enormous and would more accurately account for the true cost of tobacco. Currently, California spends about $9 billion a year on tobacco-related medical care, with taxpayers footing about a third of that. In fact, in data compiled from the Centers for Disease Control, the true cost to society in California is $15 for every pack sold. Our current tobacco tax is 87 cents.

A tobacco tax is also a particularly effective way to prevent younger people from ever taking up the habit. A staggering 80 percent of smokers start before they are 18, while only one in 100 begin at age 26 or older. The Congressional Budget Office estimates that, based on previous research, a 10 percent increase in the cost of tobacco will result in a five to 15 percent decrease in youth tobacco usage. This compares to three to seven percent for adults.

Education about the ill effects of tobacco over the past several decades has been instrumental in lowering the rate of smoking in the United States. Toward that end, the tax would bolster proven youth prevention programs to deter smoking. A few years ago, it was estimated that even the $1 added tobacco tax then proposed in California would have prevented 200,000 children in California from becoming adult smokers.

Given that tobacco is a major contributor to coronary disease in our nation, we at the American Heart Association are always looking at effective policies that result in fewer smokers. The Congressional Budget Office estimates that if even a roughly $1 per package tax were to be instituted on cigarettes next year, there would be 2.6 million fewer adult smokers over the age of 18 by 2021. This would certainly be helpful in a nation where 443,000 people die from smoking-related diseases yearly, including 46,000 heart-related deaths attributed to secondhand smoke.

If these statistics just seem like numbers on a page, just think about the intangibles, such as the value added from having more years with a grandparent, or not watching a loved one suffer through the pain of emphysema, heart disease or cancer. These are things on which it’s impossible to place a monetary value, but with an estimated 100,000 California lives that will be saved in future years through a tobacco tax, they are nonetheless primary benefits.

So, in the New Year, if you need help to quit smoking, please visit our website, http://www.heart.org, for more information. And please join with us at http://www.savelivesca.com and support a $2-per-package tobacco tax next year. The life you save may be yours or a loved one’s.

Dr. Nicholas Leeper is Assistant Professor of Cardiovascular Surgery and Medicine at Stanford University Medical Center and president of the American Heart Association, Silicon Valley Division. He wrote this for this newspaper.

http://www.mercurynews.com/opinion/ci_27190645/tobacco-tax-move-2-per-pack-gains-momentum

Higher tobacco taxes save lives

By: Vincent DeMarco, Baltimore

A recent op-ed criticizing Maryland’s tobacco tax increases ignores the most important consequence of these measures: a dramatic decrease in tobacco use by teens that has saved thousands of young people from preventable tobacco-related deaths and serious illnesses (“Md. cigarette taxes have unintended consequences,” Dec. 18).

According to data compiled by the Campaign For Tobacco Free kids, within two years after the 2008 increase in the state cigarette tax, from $1 per pack to $2 per pack, there was a 29 percent drop in teen smoking in Maryland.

That translated into 15,000 fewer high school smokers (some of whom have become non-smoking young adults by now); more than 70,000 kids today who will not become adult smokers; more than 30,000 kids alive today who will avoid future premature smoking-related deaths; and more than $1.5 billion in long-term health care cost savings tp the state.

The Maryland Department of Health and Mental Hygiene recently released a study showing that between 2010 and 2013 there was an 18 percent drop in Maryland teens smoking cigars. This happened at a time when nationally there was no statistically significant change in teen cigar smoking.

This progress, which also resulted in saving thousands of Maryland youth from tobacco addiction and preventable death and illnesses, occurred in part because of the 2012 increase in the state tax on cigars, along with an effective public education campaign by the state health department.

Granted, there will always be some people who will seek to avoid the tobacco tax by going to other states or resorting to smuggling. But very seldom will this involve children, whose lives we are saving in record numbers.

And we know from experience that the drop in cigarette sales in Maryland far outweighed the increase in sales in neighboring states that didn’t increase their tobacco tax. And were are fully confident in Maryland Comptroller Peter Franchot’s ability to prevent and prosecute those who would try to illegally smuggle cigarettes into the state.

In addition to saving lives, tobacco tax increases are good for Maryland taxpayers because they both reduce the health-care cost for tobacco-related illnesses and help fund critical health care programs. The 2008 tobacco tax increase partially funded the expansion of health care to over 100,000 uninsured Marylanders.

Although the Maryland Taxpayers’ Association doesn’t seem to want Marylanders to have these benefits, many independent polls show the vast majority of Marylanders clearly understand these benefits and would strongly support further increases in the tobacco tax to save more lives and money for the state.

-The writer is president of the Maryland Citizens’ Health Initiative.

http://www.baltimoresun.com/news/opinion/bs-ed-tobacco-letter-20141222-story.html

Cigarette smoking costs weigh heavily on the healthcare system

Reuters via Fox News

Of every $10 spent on healthcare in the U.S., almost 90 cents is due to smoking, a new analysis says.

Using recent health and medical spending surveys, researchers calculated that 8.7 percent of all healthcare spending, or $170 billion a year, is for illness caused by tobacco smoke, and public programs like Medicare and Medicaid paid for most of these costs.

“Fifty years after the first Surgeon General’s report, tobacco use remains the nation’s leading preventable cause of death and disease, despite declines in adult cigarette smoking prevalence,” said Xin Xu from the Centers for Disease Control and Prevention (CDC), who led the study.

Over 18 percent of U.S. adults smoke cigarettes and about one in five deaths are caused by smoking, according to the CDC.

Xu and colleagues linked data on healthcare use and costs from the 2006-2010 Medical Expenditure Panel Survey to the 2004-2009 National Health Interview Survey for a nationally-representative picture of smoking behavior and costs.

Out of more than 40,000 adults, 21.5 percent were current smokers, 22.6 percent were former smokers and 56 percent had never smoked. The researchers used prior data on smoking-related disease and deaths to calculate the proportion of healthcare spending by each person that could be attributed to smoking.

They also adjusted their figures for factors like excess drinking, obesity and socioeconomic status, and calculated the proportion of spending by payer.

In that analysis, 9.6 percent of Medicare spending, 15.2 percent of Medicaid spending and 32.8 percent of other government healthcare spending by sources such as the Veterans Affairs department, Tricare and the Indian Health Service, were attributable to smoking.

Of the $170 billion spent on smoking-related healthcare, more than 60 percent was paid by government sources, they wrote in the American Journal of Preventive Medicine.

Smoking-related healthcare costs affect most types of medical care, said Kenneth Warner at the University of Michigan School of Public Health. “Smoking infiltrates the entire body, through the blood stream, and causes disease in many of the body’s organs,” he told Reuters Health in an email.

Along with lung and heart problems, smoking can cause eye disease, skin problems and many cancers including pancreatic and bladder cancer, noted Warner, who was not involved in the new analysis.

“This study shows that, in addition to the human misery it inflicts, (smoking) imposes a substantial burden on the nation’s health care institutions, especially those funded by the public’s tax dollars,” he said.

The true cost of tobacco use may be even higher, Xu said. His study didn’t include medical costs linked to other tobacco products like cigars and chewing tobacco.

In 1964, the Surgeon General gave the first report on smoking and health. Since then, there have been many anti-tobacco efforts, ranging from banning tobacco in workplaces to quit-smoking help lines.

Mass media campaigns can be effective in reducing cigarette use, Xu said. In particular, the CDC’s current “Tips from Former Smokers” campaign is credited with an estimated 100,000 smokers quitting permanently.

The combination of research, publicity, policy and treatment has prevented eight million premature deaths in the U.S. since 1964, according to a 2014 Surgeon General’s report. Based on research published this year by Warner and his colleagues, he said, “Almost a third of the increase in adult life expectancy since 1964 is attributable to tobacco control.”

“Smoking kills about 480,000 Americans each year and remains the leading cause of preventable death and disease in the United States. No matter what age, it is never too late to quit,” Xu said.

http://www.foxnews.com/health/2014/12/22/cigarette-smoking-costs-weigh-heavily-on-healthcare-system/

Smoking Rates Continue to Decline

MMWR – MORBIDITY AND MORTALITY WEEKLY REPORT

The CDC recently updated its statistics about current cigarette smoking among adults. In its MMWR article of November 28, 2014, it tracked changes in smoking between 2005 and 2013. In general, the trends of previous years continued. Here are some of the results:

  • The proportion of U.S. adults who smoke declined from 20.9% to 17.8%, a 15% decline during that period. The 17.8% is a modern low in adult smoking prevalence.
  • The proportion of daily smokers declined from 16.9% to 13.7%, a 19% decline and another all time low.
  • Among daily smokers, the proportion who smoked at least one pack per day decreased from 52.1% to 36.4%, a 30% decline. And daily smokers now average 14.2 cigarettes, down from 16.7, a 15% decline.

Thus, there has been a decline in overall smokers, a slightly greater decline in daily smokers and in number of cigarettes smoked by daily smokers, and a major decline in the number of cigarettes consumed by daily smokers.

The profile of smokers is relatively unchanged:

  • Men (20.5%) are more likely to be smokers than women (15.3%)
  • Smoking prevalence is higher among adults aged 25-44 years (20.1%) and lowest among those over age 65 (8.8%)
  • Among ethnic groups, multiple race groups had the highest rates (26.8%), followed by American Indian/Native Alaskan (26.1%), Whites (19.4%), Blacks (18.3%), Hispanics (12.1%), and Asians (9.6%).
  • Smokers continue to be stratified by education level, often used as a marker for social class. Those without a high school diploma had smoking rates of 24.2%, followed by those with high school diplomas (22%), undergraduate college degrees (9.1%), and graduate degrees (5.6%). Those who obtained General Education Development (GED) certificates in lieu of high school graduation had the highest rates (41.4%). It is likely that many of these persons were incarcerated and thus also had medical conditions associated with high smoking rates, such as mental illness and substance use disorders.
  • Persons living below the federal poverty level had higher rates (29.2%) than those above that level (16.2%).
  • LGB adults were more likely to be smokers (26.6%) than straight adults (17.6%).

Thus, the trend of smoking to be concentrated among the less educated, the poor, and the LGB population continued. Not included in this report, but summarized previously by a special MMWR are recent data documenting the much higher rates among persons with behavioral health issues, the groups with the highest smoking rates in the entire population. Notably, those working in the health professions in the United States have some of the lowest smoking rates in the world, with some surveys showing that only 1% of physicians are smokers.

This new report should encourage us that progress, indeed, is happening. But, the slow rate of decline, in the face of all the evidence about the harms of smoking and the accumulating tobacco control policies such as taxes, clean indoor air laws, counter-marketing, and coverage for smoking cessation therapies, is sobering. As smokers increasingly resemble members of marginalized parts of the American community, the risk is that resources for tobacco control will be diverted to other causes. Yet, over 40 million people still smoke, including many of the most vulnerable of us. And close to 500,000 people die each year from smoking-associated illnesses. We need to capture better the sense of urgency buried in those statistics.

Finally, it is important to recognize two new potential threats to the health of the nation—electronic cigarettes and marijuana. Right now the rhetoric about the benefits and harms of these two commodities outstrips the evidence. We do know that the use of the e-cigarette is climbing, and it is highly likely that marijuana use is also increasing in the wake of state legalization efforts. We also know that because these commodities contain immense potential for profit, marketing efforts to promote usage are certain to increase. As we continue our efforts against the harm from using combustible tobacco, we need to track the use of these new potential threats, as well as to assemble evidence about what happens to those who use them.