Governor Herbert wants to tax e-cigarette sales in Utah, bring in $10M

By ROBERT GEHRKE | The Salt Lake Tribune

Buried in Gov. Gary Herbert’s budget blueprint is a proposal that is sure to have the users of e-cigarettes fuming.

In a footnote on page 22 of his outline, Herbert is proposing a new tax on e-cigarettes that his office predicts will raise $10 million next year.

Herbert, who boasted his budget is free of tax increases, says he doesn’t consider the new e-cigarette tax to be a tax hike, but rather a change in the way the state treats the products.

“It’s just saying, ‘Here’s a product that should fit under the umbrella of tobacco,’ ” Herbert said in an interview with The Tribune. “It’s a health issue and there are some that think this new e-cigarette that young people are getting hooked on, that’s straight nicotine with good flavors and all that stuff that makes it attractive, should be taxed just like we tax tobacco.”

The governor’s office could not provide specific details of how the new e-cigarette tax would work. There are several options, said Herbert’s spokesman Marty Carpenter, and the governor is willing to work with legislators to find the best one.

Rep. Paul Ray, R-Clearfield, an anti-tobacco crusader in the Legislature, said he has met with the governor and representatives from the “vaping” industry and believes the best option would be to tax the e-cigarette liquid, or e-juice, at a lower rate than regular tobacco products, but that it should still be taxed.

Typically, tobacco products other than cigarettes are taxed at 87.5 percent of the wholesale price in Utah. Ray is proposing a rate of about half that for the e-juice. That would add several dollars to the cost of the average bottle of e-juice he said.

“What we have to look at is a fair tax, because tobacco is being taxed and this is a tobacco derivative,” Ray said. “I’ve approached the industry and said, ‘OK, you’re claiming this is less harmful, so let’s go somewhere in the middle, somewhere around 40 percent.’ “

The e-cigarette vaporizers, that turn the juice into steam to be inhaled, would not be taxed. Ray said he hopes the increase in price would be enough to discourage young people from picking up vaping in the first place.

But Aaron Frazier, executive director of the Utah Smoke-free Association, said that upping the price of e-cigarette liquid will mean people will just keep smoking more harmful cigarettes.

“What that’s going to do is protect the tobacco market and drive the price of the e-liquid above and beyond what the price of tobacco cigarettes are,” Frazier said. “Basically, what they’re doing is removing any benefit for a smoker to move over to a scientifically documented less-harmful product and drive them back to smoking tobacco cigarettes.”

Ray said he believes that, within a few years, science will show the health benefits that supporters of e-cigarettes boast about are fiction.

“I think it’s going to be as bad as tobacco down the road,” he said. “People will realize this stuff is not as good as we were told and we’re going to have health problems down the road.”

Frazier said several states have looked at imposing e-cigarette taxes as a cash cow to make up for the tobacco-tax revenue they’re losing because people are using e-cigarettes to quit smoking.

According to the group Americans for Tax Reform, which opposes e-cigarette taxes, Washington, Oregon, Hawaii, Oklahoma, Wisconsin, Indiana, Kentucky, South Carolina, New York, Delaware, Vermont, Massachusetts and Maine have all considered legislation looking to tax e-cigarettes, but it has been defeated. In Arizona, an e-cigarette tax is still pending.

Only two states — Minnesota and North Carolina — have an e-cigarette tax in place, according to the National Conference of State Legislatures. Minnesota taxes the liquids at 95 percent of the wholesale price of the liquids. North Carolina imposes a tax of a nickel per milliliter.

Ray also is planning to once again sponsor legislation to regulate the sales of e-cigarettes. Last session, he ran a bill that got worked over with multiple amendments and was up for passage on the final night when the Legislature adjourned without voting on it.

The bill would require businesses that sell e-cigarettes to be licensed by the state and the retailer could lose its license if it sold e-cigarettes to anyone under the age of 19.

http://www.sltrib.com/news/1941695-155/governor-wants-to-tax-e-cigarette-sales

First Child's Death From Liquid Nicotine Reported as 'Vaping' Gains Popularity

By GILLIAN MOHNEY, ABC News

A toddler from upstate New York could be the first child to die from liquid nicotine, the substance used in e-cigarettes, poisoning in the U.S., concerning health officials as e-cigarettes continue to rise in popularity.

Police reported that the 1-year-old child died after ingesting liquid nicotine at a home in Fort Plain, New York, on Tuesday. The child was found unresponsive and rushed to a hospital where he was later pronounced dead.

Fort Plain police released a statement saying the death is believed to be a “tragic accident.” They declined to say whether the liquid nicotine was associated with an e-cigarette.

But health officials are concerned if steps aren’t taken to protect children, they could see more fatal accidents similar to this one.

The rise of e-cigarettes and “vaping” in recent years has also meant a rise in the purchase of liquid nicotine. Coming in flavors like cotton candy or gummy bear, health officials say that the brightly colored liquid could appeal to young children.

“One teaspoon of liquid nicotine could be lethal to a child, and smaller amounts can cause severe illness, often requiring trips to the emergency department,” the American Association of Poison Control centers in a statement today. “Despite the dangers these products pose to children, there are currently no standards set in place that require child-proof packaging.”

In November the American Association of Poison Control Centers announced that the number of dangerous “exposures” to liquid nicotine has skyrocketed in recent years with 3,638 exposures as of Nov. 30. An exposure means coming into contact with liquid nicotine through ingestion, inhalation or by absorbing the substance through the skin.

The number is more than double the 1,543 exposures reported in 2013 and exponentially higher than in 2011 when 271 exposures were reported.

Before this week, the only confirmed death related to liquid nicotine happened in 2012 when a man injected himself with the substance, according to the American Association of Poison Control Centers.

Dr. Donna Seger, director of the poison control center at Vanderbilt University Medical Center, said her center has started to get more calls about exposure to e-cigarettes or liquid nicotine.

“They’re not that difficult to get into,” Seger said of the vials that contain the nicotine. “The issue is once the exposure occurs, it could be bad.”

Seger said just a small amount of nicotine can cause dangerous symptoms in children, including seizures.

Phil Daman, president of the Smoke-Free Alternatives Trade Association, said he was “saddened to hear the terrible news.”

“[We] want to always be mindful to put safe products on the market,” said Daman, who said the trade association recommends childproofing products to “err on the side of caution.”

Daman questioned if the child could have gotten a hold of a high-grade liquid nicotine that could be a much higher concentration than what is in many common e-cigarette products. Because e-cigarettes are not federally regulated there is a wide-range of liquid that could be purchased to use in e-cigarette products, ranging from potent high grade liquid nicotine to material that has an extremely small amount of nicotine.

In April the U.S. Centers of Disease Control and Prevention warned they were seeing an increase of calls to poison control centers for liquid nicotine exposure and children were becoming sick after ingesting, inhaling or absorbing the chemical through their skin. The most common symptoms were vomiting, nausea or eye irritation.

“Use of these products is skyrocketing and these poisonings will continue,” U.S. Centers for Disease Control and Prevention Director Dr. Tom Frieden said in April. “E-cigarette liquids as currently sold are a threat to small children because they are not required to be childproof, and they come in candy and fruit flavors that are appealing to children.”

To combat these cases of increased exposure some state lawmakers have introduced bills that would require e-cigarette companies to put child-resistant caps on bottles of liquid nicotine.

In New York State, a bill passed earlier in the year that would require child resistant containers for liquid nicotine. Gov. Andrew Cuomo is set to sign the bill in the next few weeks, according to ABC News affiliate WABC-TV.

At least one e-cigarette, Vapor World, changed their packaging this year so that bottles of liquid nicotine are more child resistant.

http://abcnews.go.com/Health/childs-death-liquid-nicotine-reported-vaping-gains-popularity/story?id=27563788

Smoking not 'lesser evil' in mental health treatment settings

By: Maiken Scott, Newsworks
Picture an AA meeting, and a gigantic coffee urn and a cloud of smoke come to mind.
In fact, the two men who started AA, Dr. Bob and Bill W. both died from tobacco-related illnesses.
Public health experts say smoking is still pervasive among people living with addiction and mental illness, and it’s often not seen as a priority in treatment settings.
For example, smoking rates in Philadelphia have dropped significantly over 10 years, but haven’t budged among people with mental illnesses and substance-abuse issues.
Smoking is often seen as a “lesser evil” in mental health and addiction treatment settings, explained Ryan Coffman, tobacco policy manager for Philadelphia’s Department of Public Health. It’s not a priority, and some providers assume it helps their clients cope.
Research shows the opposite to be true, says Coffman. “Individuals living with mental illness and substance-abuse disorders who smoke have more severe symptoms, poorer well-being and functioning, they have more hospitalizations, and are at a greater risk for suicide,” he said.
Research also shows that people who quit smoking along with quitting other drugs have better recovery outcomes.
Philadelphia is increasing efforts to train mental health providers on tobacco-cessation programs, and to provide them with the most up-to-date resources available to their clients, Coffman said.
But for these efforts to really take root, a major cultural shift will have to occur, said University of Pennsylvania psychiatrist Robert Schnoll, who studies tobacco cessation.
“Research indicates that upwards of 25 percent of mental health care facilities still permit smoking on the grounds and on the premises,” he explained. “There’s pervasive use of cigarettes, or cigarette breaks, as a reward for pro-social behavior, so that’s certainly one of the issues we need to address going forward.”
Some providers think their clients don’t care about tobacco cessation, he said, or don’t understand the benefits. Some also simply don’t see it as their responsibility.
Research also indicates that smoking rates are high among people who work in mental health treatment settings, Schnoll said.
http://www.newsworks.org/index.php/homepage-feature/item/75483-smoking-not-lesser-evil-in-mental-health-treatment-settings?linktype=hp_impact

Don't fall for tobacco industry e-cigarette smokescreen

By Michaeline Fedder, Deborah P. Brown and Bonita Pennino
No one should have to choose between their health and a paycheck. Which is why, with all that is still unknown about the dangers of e-cigarette use, we must put public health first and prohibit the use of these unregulated products in all workplaces, including restaurants, bars and casinos. Unfortunately a bill recently passed by the Baltimore City Council purporting to ban e-cigarette use in the city allows restaurants, taverns and casinos to opt out, which not only weakens Baltimore and Maryland’s longstanding and popular smoke-free laws, it threatens the health of many city workers. We urge Mayor Rawlings-Blake to see through the tobacco industry smokescreen and use her power to veto this ordinance.
Turning the clock back by allowing the use of e-cigarettes in public places could create a host of new problems — encouraging new tobacco users, reversing efforts that have made smoking socially unacceptable, creating enforcement confusion for business owners and the public, and potentially putting the health of Baltimore’s restaurant, bar and casino workers and patrons at risk.
While e-cigarette manufacturers may make unverified claims that the ingredients are just “water vapor” or “safe,” without further research and federal regulation there is no sure way for e-cigarette users to know what they are consuming. Nor is there any way of knowing what nonusers are exposed to and the extent of the risk to their health. There are hundreds of types of e-cigarettes on the market today, and the products vary considerably by ingredients and quality control and assurance. Prohibiting the use of e-cigarettes in workplaces, restaurants and bars can protect the public health by preventing nonusers from being exposed to the potentially harmful chemicals in these products.
An increasing number of studies have examined the contents of e-cigarette aerosol. Unlike a vapor, an aerosol contains fine particles of liquid, solid or both. Propylene glycol, nicotine and flavorings were most commonly found in e-cigarette aerosol. Other studies have found the aerosol to contain heavy metals, volatile organic compounds and tobacco-specific nitrosamines, among other potentially harmful chemicals. A 2009 study done by the U.S. Food and Drug Administration (FDA) found cancer-causing substances in several of the e-cigarette samples tested. FDA tests also found nicotine in some e-cigarettes that claimed to contain no nicotine.
The public should know more about e-cigarettes before allowing users to expose others to potential dangers. Studies have already shown that the use of e-cigarettes can cause short-term lung changes and irritations, while the long-term health effects are unknown.Both exposure to and health effects of secondhand aerosol from e-cigarettes require further research, but preliminary studies indicate nonusers can be exposed to the same potentially harmful chemicals as users, including nicotine, ultrafine particles and volatile organic compounds. This exposure could be especially problematic for vulnerable populations such as children, pregnant women and people with heart disease. No worker or patron should be subject to inhaling the unknown aerosol emitted from electronic smoking devices.
By passing this reckless measure allowing the use of e-cigarettes in workplaces, Baltimore City Council members have fallen for the tobacco industry’s tricks. We are all too familiar with the age-old tactics of the tobacco industry such as designating smoking areas and notifying the public when smoking is allowed. We learned the hard way that these strategies do nothing to protect the health of workers and patrons from the dangers of secondhand smoke. These tactics are nothing but a ruse to promote smoking in public places, thus continuing addiction to a deadly product and guaranteeing sales of cigarettes well into the future. We should not repeat the same mistake now in Baltimore with e-cigarettes. No one, regardless in which section of a restaurant, tavern or casino they are working, dining or gaming, should have to choose between their health and a good job or a good time.
It is well understood that smoke-free laws are popular in Maryland and should not be weakened. And laws prohibiting the use of e-cigarettes in public places are steadily on the rise — with 156 municipalities and counting already prohibiting the use of e-cigarettes in all workplaces, including restaurants, bars and gaming facilities. Everyone has the right to breathe safe smoke-free and aerosol-free air in their place of work or leisure, and Mayor Rawlings-Blake should protect that right by vetoing this ordinance.
Michaeline Fedder is director of government relations in Maryland for the American Heart Association; Deborah P. Brown is president and CEO of the American Lung Association of the Mid-Atlantic; Bonita Pennino is the Maryland government relations director for the American Cancer Society Cancer Action Network.

​Hookahs deliver toxic benzene in every puff

Many young people consider hookahs a hip and safer way to smoke, but a new study finds fumes from the water pipes contain the toxin benzene.
Benzene has been linked to an increased risk for leukemia in prior research, according to a scientific team reporting Nov. 21 in the journal Cancer Epidemiology, Biomarkers & Prevention.
“In contrast to what is believed, hookah tobacco smoking is not a safe alternative to smoking other forms of tobacco,” study author Nada Kassem, associate director of the Center for Behavioral Epidemiology and Community Health at San Diego State University, said in a journal news release.
Researchers analyzed levels of S-phenylmercapturic acid (SPMA) — a metabolite (byproduct) of benzene — in the urine of 105 hookah smokers and 103 nonsmokers exposed to smoke from the water pipes.
After an event in a hookah lounge, SPMA levels were four times higher than normal in hookah smokers and 2.6 times higher than normal among people who had attended but hadn’t puffed on a hookah. After a hookah-smoking event in a private home, SPMA levels were two times higher among hookah smokers, but normal among nonsmokers.
“Hookah tobacco smoking involves the use of burning charcoal that is needed to heat the hookah tobacco to generate the smoke that the smoker inhales,” Kassem explained.
“In addition to inhaling toxicants and carcinogens found in the hookah tobacco smoke, hookah smokers and nonsmokers who socialize with hookah smokers also inhale large quantities of charcoal combustion-generated toxic and carcinogenic emissions,” she said.
Kassem believes that “because there is no safe level of exposure to benzene, our results call for interventions to reduce or prevent hookah tobacco use, regulatory actions to limit hookah-related exposure to toxicants including benzene, and include hookah smoking in clean indoor air legislation.”
http://www.nlm.nih.gov/medlineplus/news/fullstory_149609.html
Copyright © 2014 HealthDay. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
HealthDay

Smoking while using oxygen blamed for fire at Fargo's Sanford Medical Center

FARGO (KFGO-AM) — Investigators say a patient who was smoking while using oxygen caused a fire that injured both the patient and a staff member at Sanford Medical Center in downtown Fargo last week.
Fire chief Steve Dirksen says the combination of pure oxygen and open flame is extremely volatile.  He says it was quick response by hospital employees that prevented a much more serious situation.
The exact nature of the injuries has not been disclosed because of the patient confidentiality law.
Hospital employees who responded to a smoke alarm early Thursday in the room rescued the patient, had the fire out when firefighters arrived and evacuated patients in nearby rooms.
Damage to the room was minor.
http://kfgo.com/news/articles/2014/nov/17/smoking-while-using-oxygen-blamed-for-fire-at-fargos-sanford-medical-center/

Sanford fire caused by smoking around oxygen

By Forum staff reports
FARGO – Fargo fire investigators say the fire that injured two people and caused the evacuation of several patients at Fargo’s downtown Sanford Medical Center on Thursday was caused by someone smoking while using oxygen.

Sanford officials said the fire originated in a patient room early Thursday morning and was extinguished by staff members before it spread.

The patient in that room and one staff member were hurt in the fire.

Ten patients had to be evacuated to other parts of the hospital.

Fargo Fire Marshal Ryan Erickson said he was not sure whether officials would recommend criminal charges against the person who was smoking around the oxygen.

He reminded people to never smoke near an oxygen source, even when it’s turned off.

http://www.inforum.com/content/sanford-fire-caused-smoking-around-oxygen

Ready to quit smoking? Here's what works best

Kim Painter, Special for USA TODAY
It’s always a good time to quit smoking. But if smoking cessation has a season, it’s about to begin.
Thursday is the American Cancer Society’s Great American Smokeout, a day on which all smokers will be encouraged to abstain or start making a plan to quit. In coming weeks, even more people will make resolutions to quit as New Year’s Day approaches.
Sadly – with smoking causing 480,000 deaths each year in the United States – most will not succeed, at least this time.
One reason: most people try to do it alone, and just 4% to 7% of those people manage to quit on any given attempt, according to the cancer society. Getting help can raise quitting rates to 25% or more, at least in studies, the society says.
But what kind of help?
“We have a gold standard, and it’s a combination of counseling and medication,” says Yvonne Hunt, a program director at the National Cancer Institute’s tobacco control research branch. But just 4% of potential quitters use such combinations, according to the federal Centers for Disease Control and Prevention.
There are several methods to choose among, Hunt says: “People can mix and match and find a combination that works best for them.”
Among the proven methods:
• Counseling. One way to start planning a quit attempt is to call 1-800-QUIT-NOW (1-800-784-8669) to reach counselors on your state’s quit line. In-person counseling is available through many clinics and hospitals. Increasingly, counseling also is available through text messages (such as the cancer institute’s SmokefreeTXT program). Some websites and apps offer advice too, but quality varies.
• Varenicline (Chantix). This prescription pill is the most effective smoking-cessation drug in studies. It can ease withdrawal symptoms and make smoking less satisfying by blocking the effects of nicotine. The pills carry warning labels – which a Food and Drug Administration panel recently voted to keep – saying they have been linked to mood swings, depression and suicidal thoughts. But those side effects are rare “and generally it’s accepted as a safe medication,” says Lee Westmaas, director of tobacco control research at the cancer society.
• Bupropion SR (Wellbutrin, Zyban). This is another prescription pill. It is best known as an antidepressant but it also can decrease cravings and withdrawal symptoms in those quitting smoking. Common side effects are dry mouth and difficulty sleeping.
• Nicotine-replacement therapies.
Nicotine from a patch, gum, spray, inhaler or lozenge can ease withdrawal symptoms and cravings in the first weeks and months without cigarettes. Some require a prescription and all are considered medications. They can be combined with non-nicotine medications. They have various side effects. For example, patches can cause skin irritation and nicotine gum can cause mouth sores.
Not on the list of proven methods: hypnosis, acupuncture and laser therapy. “You will certainly find people who swear by these methods, but they do not have a solid evidence base behind them,” Hunt says.
Some smokers also may be surprised that electronic cigarettes – e-cigarettes – are not listed as quit-smoking aids by groups such as the cancer society or the National Cancer Institute. The increasingly popular devices contain nicotine, but unlike nicotine-replacement therapies, they are not regulated and have not been thoroughly studied as quitting aids.
“The sale of e-cigarettes is going 100 miles an hour and the science is going five miles an hour,” says Jonathan Bricker, a psychologist specializing in smoking cessation at Fred Hutchinson Cancer Research Center, Seattle.
Bricker’s own research focuses on improving counseling methods. It is clear smokers need more and better help than is available now, he says: “We are not helping 65% to 75% who want to quit.”
But it’s also important for smokers who fail one — or many — quit attempts to keep trying, Westmaas says. “Each attempt gives them more information about what to do differently next time.”
More information on quitting is at the federal government’s smokefree.gov site and the cancer society’s cancer.org site.
Benefits of quitting:
For those who need reminders about why they should quit, here – according to the cancer society – are some benefits after:
20 minutes: heart rate and blood pressure drop
12 hours: carbon monoxide levels in blood drop to normal
2 weeks to 3 months: circulation and lung function improve
1 year: excess coronary heart disease risk cut in half
5 years: risk of mouth, throat and bladder cancer cut in half
10 years: risk of dying of lung cancer cut in half
15 years: risk of coronary heart disease same as non-smokers’
http://www.usatoday.com/story/news/nation/2014/11/16/quit-smoking-what-works/18812269/

Our View: Do more to keep e-cigs, youths apart

The Times Editorial Board, SC Times

Surveys of Minnesota and U.S. youth show alarming increase in e-cigarette use. Lawmakers can slow this increase by immediately acting to limit access.

Two surveys released the past week — one state and one national — deliver a powerful message about the most pressing issue regarding e-cigarettes:
Government needs to lead a stronger charge to keep them out of the hands — and bodies — of minors.
To this point, most of the e-cigarette debate has been about whether e-cigarettes — which electronically convert liquid nicotine into vapor to be inhaled — are as harmful as traditional tobacco and secondhand smoke.
That debate has raged for years, even decades. A resolution seems months, or more likely, years away.
What’s more pressing to resolve — as evidenced by two surveys of youths’ nicotine use — is slowing the fast-rising number of minors who are trying these devices.
How fast?
The 2014 Minnesota Youth Tobacco Survey released Monday found 28 percent of high school students have tried e-cigarettes. On Thursday, the Centers for Disease Control and Prevention reported 4.5 percent of high school students nationally used e-cigarettes regularly in 2013 — triple the percent from 2011. Equally disturbing: 12 percent of U.S. high school students and 3 percent of middle-schoolers had tried them at least once.
And remember, e-cigarettes have been widely available in America for only about seven years.
Such findings make it clear e-cigarettes hold potential for creating countless new generations with unhealthy and high rates of nicotine addiction.
Hasn’t America learned enough hard lessons from 50 years of tobacco-based nicotine addiction to know it needs to snuff out that potential now instead of waiting for more research?
Ultimately, there is no debate that nicotine is a potent, addictive drug. E-cigarettes are simply a delivery mechanism.
So lawmakers should act now to keep the drug and the delivery system out of the hands of minors.
An easy decision is to enact a federal ban on selling minors e-cigarettes, “e-juice” and related products. Minnesota is one of about 35 states with such bans. However, sales via the Internet still provide youth access.
Another important step is to apply the same rules to the marketing of e-cigarettes that are applied to traditional tobacco.
After all, even a cursory glance at products and advertising makes it clear many producers are targeting youth. Think everything from trendy-looking e-cigarettes (and accessories) to bubble-gum flavored e-juice.
Finally, there is merit in increasing the taxes paid on all e-cigarette products.
Such an approach proved successful in reducing youth use of traditional tobacco. And it might even dissuade adults from nicotine addiction.
Again, too much of the debate about whether and how to regulate e-cigarettes remains focused on comparisons to traditional tobacco.
Seeing how e-cigarettes are gaining traction among youth, the focus needs to shift to keeping these nicotine-delivery devices out of their hands — at least until they are legal adults.
http://www.sctimes.com/story/opinion/2014/11/16/view-keep-e-cigs-youths-apart/19089759/

CDC: E-Cigarette Use Rising in High School Kids

By MIKE STOBBE AP Medical Writer
Use of electronic cigarettes by high school students tripled over three years, according to a new government report released Thursday.
In a large national survey last year, 4.5 percent of high school students said they had used e-cigarettes in the previous month. That’s up from 1.5 percent in 2011 and 2.8 percent in 2012.
It’s not known, though, how many were repeatedly using e-cigarettes and how many only tried it once during that month and didn’t do it again.
E-cigarettes began to appear in the United States in late 2006, but marketing has exploded in recent years. The devices heat liquid nicotine into a vapor. They are often described as a less dangerous alternative to regular cigarettes, but experts say nicotine — including the nicotine in e-cigarettes — is especially harmful to children.
Dozens of states outlaw the sale of e-cigarettes to minors, and federal officials have proposed a nationwide ban on such sales.
The report’s e-cigarette findings are disheartening, said Dr. Patrick T. O’Gara, president of the American College of Cardiology. Smoking rates has slowly been declining over the last several decades, but “we risk going backwards if a new generation of smokers becomes addicted to nicotine,” O’Gara said, in a statement.
The Centers for Disease Control and Prevention report comes from a survey of more than 18,000 high school and middle school students.
The CDC survey also found 13 percent of high school students recently smoked regular cigarettes, and that about 23 percent used some form of tobacco product — be it cigarettes, e-cigarettes, flavored cigars, hookahs or something else.
http://abcnews.go.com/Health/wireStory/cdc-cigarette-rising-high-school-kids-26893757