Working against tobacco

By Nick Smith, Bismarck Tribune
Members of an interim legislative committee heard testimony about tobacco prevention efforts on reservations throughout the state Wednesday.
The interim Health Services Committee heard from health department officials as well as tribal leaders and tobacco prevention coordinators from on and off the state’s reservations.
Krista Fremming, Tobacco Prevention and Control Program director for the state Health Department, said the department collaborates with tribal tobacco program officials and in some cases shares facilities.
“On Dec. 13, 2013, the North Dakota Department of Health coordinated a tribal tobacco strategic session to discuss effective processes to reduce tribal tobacco use,” Fremming said. “Attendees agreed formal tribal tobacco strategic planning is needed to identify the best strategy to address tobacco use on the reservations.”
She said the North Dakota Indian Affairs Commission will be taking the lead on the strategic planning process.
Fremming said due to cessation and prevention programs nearly all schools and colleges on reservations now have tobacco-free and smoke-free policies in place.
Smoke-free tribal buildings are now a staple on reservations, she said, but housing and casinos are another matter.
“The North Dakota Department of Health is partnering with the Intertribal Tobacco Abuse Coalition to address the issue of smoke-free casinos on a statewide level,” Fremming said.
The Sky Dancer Casino in Belcourt has a no-smoking policy and the Four Bears Casino in New Town has a designated room for smoking.
Fremming said the idea is in the planning stages and it would likely take a year or two for any implementation to take place.
Another area of note, Fremming said, is enrollment in the NDQuits program. The NDQuits program pushes to keep people from starting to smoke and help people quit, using online sources, counselors andother services.
“In fiscal year 2013, a total of 152 enrollees were American Indian. In fiscal year 2014 there have already been 125 enrollees who were American Indian during the months of July through November,” Fremming said.
Also testifying Wednesday was Beth Hughes. She serves as executive committee chairman for the North Dakota Center for Tobacco Prevention and Control Policy.
Hughes said two-thirds of its $15.8 million budget is spent on a trio of statewide and community grant programs.
“The policies are to serve all residents both on and off American Indian reservations,” Hughes said. “The Center requires that funded programs show policy and health outcomes that can be documented by adoption of model comprehensive policies and, over time, show reduction in tobacco use.”
Hughes said among the center’s recommendations are continued funding of programs using the federal Centers for Disease Control and Prevention’s recommended best practices.
Chairman Sen. Judy Lee, R-West Fargo, questioned the recommendation. Lee said she believes the center comes off at times as being focusing too explicitly on CDC recommendations and not working as collaboratively as it could with other departments.
“The center is viewed as being a bit heavy-handed,” Lee said.
Lee said the reservations are sovereign nations and cultural sensitivity also needs to be kept in mind.
Hughes said she understood the criticism and it was something she would relay to center staff. She added that there is already a level of collaboration with other departments.
“There is no way that the center could do the work that it does without the other entities in the state,” Hughes said.
http://bismarcktribune.com/news/state-and-regional/working-against-tobacco/article_6ba98b3e-78e6-11e3-a21c-001a4bcf887a.html

War on smoking, at 50, turns to teens: Our view

The Editorial Board, USATODAY

Want kids to quit? Raise cigarette taxes. It works.

The war on smoking, now five decades old and counting, is one of the nation’s greatest public health success stories — but not for everyone.
As a whole, the country has made amazing progress. In 1964, four in ten adults in the U.S. smoked; today fewer than two in ten do. But some states — Kentucky, South Dakota and Alabama, to name just a few — seem to have missed the message that smoking is deadly.
Their failure is the greatest disappointment in an effort to save lives that was kick-started on Jan. 11, 1964, by the first Surgeon General’s Report on Smoking and Health. Its finding that smoking is a cause of lung cancer and other diseases was major news then. The hazards of smoking, long hidden by a duplicitous industry, were just starting to emerge.
The report led to cigarette warning labels, a ban on TV ads and eventually an anti-smoking movement that shifted the nation’s attitude on smoking. Then, smokers were cool. Today, many are outcasts, banished from restaurants, bars, public buildings and even their own workplaces. Millions of lives have been saved.
The formula for success is no longer guesswork: Adopt tough warning labels, air public service ads, fund smoking cessation programs and impose smoke-free laws. But the surest way to prevent smoking, particularly among price-sensitive teens, is to raise taxes. If you can stop them from smoking, you’ve won the war. Few people start smoking after turning 19.
Long before health advocates discovered this, the tobacco industry knew that high taxes kill smoking as surely as cigarettes kill smokers. “Of all the concerns … taxation … alarms us the most,” says an internal Philip Morris document, turned over in a gaggle of anti-smoking lawsuits in the 1990s.
The real-life evidence of taxing power is overwhelming, too. The 10 states with the lowest adult smoking rates slap an average tax of $2.42 on every pack — three times the average tax in the states with the highest smoking rates.
New York has the highest cigarette tax in the country, at $4.35 per pack, and just 12% of teens smoke — far below the national average of 18%. Compare that with Kentucky, where taxes are low (60 cents), smoking restrictions are weak and the teen smoking rate is double New York’s. Other low-tax states have similarly dismal records.
Foes of high tobacco taxes cling to the tired argument that they fall disproportionately on the poor. True, but so do the deadly effects of smoking — far worse than a tax. The effect of the taxes is amplified further when the revenue is used to fund initiatives that help smokers quit or persuade teens not to start.
Anti-smoking forces have plenty to celebrate this week, having helped avert 8 million premature deaths in the past 50 years. But as long as 3,000 adolescents and teens take their first puff each day, the war is not won.
USA TODAY’s editorial opinions are decided by its Editorial Board, separate from the news staff. Most editorials are coupled with an opposing view — a unique USA TODAY feature.
http://www.usatoday.com/story/opinion/2014/01/08/war-on-smoking-50th-anniversary-cigarette-tax-editorials-debates/4381299/

Drugs to Stop Smoking Better Given Together?

By Crystal Phend, Senior Staff Writer, MedPage Today
Reviewed by F. Perry Wilson, MD, MSCE; Instructor of Medicine, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner
Doubling up on tobacco cessation drugs helped smokers quit at first, but didn’t significantly improve longer-term abstinence, a trial showed.
Quit rates at 12 weeks were a relative 36% to 49% better with the addition of sustained-release bupropion (Zyban) to varenicline (Chantix), Jon O. Ebbert, MD, MSc, of the Mayo Clinic in Rochester, Minn., and colleagues found.
One year after the 12-week treatment course, though, abstinence had fallen to where the relative 39% to 40% advantage of combination treatment lost significance, the researchers reported in the Jan. 8 issue of the Journal of the American Medical Association.
“Further research is required to determine the role of combination therapy in smoking cessation,” they concluded.
Bupropion and varenicline both tackle cravings and “rewards” from smoking but through somewhat different routes to nicotinic acetylcholine receptors, leading to hopes for additive or synergistic effects, such as with the combination of bupropion and the nicotine patch, the group noted.
Their study randomized 500 adult smokers desiring to quit to take open-label varenicline along with blinded placebo or sustained-release bupropion for 12 weeks.
For the primary outcome, abstinence rates at week 12 were significantly better with the combination in terms of prolonged cessation with no smoking from 2 weeks after the target quit date (53% versus 43.2%, odds ratio 1.49, P=0.03), although not by point-prevalence of no smoking in the prior 7 days (56.2% versus 48.6%, OR 1.36, P=0.09).
By 26 weeks, prolonged abstinence rates had fallen to 36.6% and 27.6% in the two groups, respectively (OR 1.52, P=0.03), and 7-day point-prevalence abstinence to 38.2% and 31.9% (OR 1.32, P=0.14).
At 52 weeks, neither measure showed a significant difference between groups, although the odds ratios remained roughly the same as before (OR 1.39 and 1.40).
Prolonged abstinence rates at that point were 30.9% with combination therapy and 24.5% with varenicline alone (P=0.11); 7-day point-prevalence abstinence rates were 36.6% and 29.2%, respectively (P=0.08).
However, individuals with high levels of baseline nicotine dependence did achieve a significant impact on both measures of abstinence at 52 weeks with the combination versus monotherapy in a sensitivity analysis.
Combination therapy was associated with more adverse events in terms of both anxiety (7.2% versus 3.1%, P=0.04) and depressive symptoms (3.6% versus 0.8%, P=0.03). No serious adverse events in either group were judged treatment related.
Weight gain was similar between groups through the end of follow-up (4.9 kg [11 lbs], and 6.1 kg [13 lbs], P=0.23).
The researchers cautioned that the study was limited by the 38% rate of dropout and limited generalizability “because patients with serious medical and psychiatric illnesses including those with active substance abuse were excluded.”
http://www.medpagetoday.com/PrimaryCare/Smoking/43680?xid=nl_mpt_DHE_2014-01-08&utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&eun=g436493d0r&userid=436493&email=megan.houn@tfnd.org&mu_id=5533639

Smoking Rates Still High Among the Mentally Ill

By John Gever, Deputy Managing Editor, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner
Smoking rates among Americans with mental illnesses didn’t budge from 2004 to 2011, a period during which rates in the rest of the population fell 14%, researchers said.
Data from the federal Medical Expenditure Panel Survey (MEPS) found that, among respondents with mental illnesses, 25.3% reported current smoking in 2004-2005 (95% CI 24.2%-26.3%), versus 24.9% in 2010-2011 (95% CI 23.8%-26.0%, P=0.50) after adjustments for other predictors of smoking such as income and education, according to Benjamin Le Cook, PhD, MPH, of Harvard Medical School in Cambridge, Mass., and colleagues.
Over the same interval, adjusted smoking rates in other MEPS respondents declined from 19.2% (95% CI 18.7%-19.7%) to 16.5% (95% CI 16.0%-17.0%, P<0.001), the researchers reported in the Jan. 8 issue of the Journal of the American Medical Association.
On the other hand, individuals with mental illnesses who were undergoing treatment showed somewhat greater quit rates than those who were untreated (37.2% versus 33.1%, P=0.005), Cook and colleagues found from a different data set, the 2009-2011 National Survey of Drug Use and Health (NSDUH).
“The mechanisms that support persistently higher rates of smoking among individuals with mental illness are complex and remain understudied,” they wrote. “Patients with mental illness may attribute greater benefits and reward value to smoking compared with patients without psychiatric disorders or may experience more difficult life circumstances, higher negative affect, or a relative lack of alternative rewards.”
Other experts contacted by MedPage Today offered differing views on the high smoking rates among the mentally ill.
John Spangler, MD, MPH, of Wake Forest Baptist Medical Center in Winston-Salem, N.C., said in an email that the nicotine in cigarettes “is very effective at relieving stress and improving mood. You can ask any smoker about that. It also can increase concentration in those with ADHD, and it improves memory as well.”
But Joseph McClernon, PhD, of Duke University, told MedPage Today that smoking as self-medication is not very effective. “Among dependent smokers, much of the relief or improvement in cognitive performance they experience from smoking likely has as much to do with reversing the effects of withdrawal,” he said in an email, which appears to be more severe in patients with some mental illnesses.
A similar viewpoint was expressed by Glen Getz, PhD, of Allegheny Health Network in Pittsburgh. The positive subjective effect of smoking “is only briefly effective and ultimately has counterproductive effects on mood, anxiety, and other emotional problems,” he said.
There was general agreement, however, that it may be more difficult for the mentally ill to quit smoking.
Among the factors cited by Cook and colleagues is a “smoking culture” that has long pervaded the mental health community, including clinicians as well as patients.
They noted that psychiatric inpatients historically were allowed and even encouraged to smoke “to decrease agitation and encourage patient adherence.” Even today, they suggested, many mental health professionals shy away from encouraging their patients to quit smoking for a variety of reasons, ranging from concern that it may distract from other therapeutic efforts to “lack of confidence” that patients can succeed in quitting.
But although such a culture did exist in the past, that’s changing, Douglas Ziedonis, MD, MPH, of the University of Massachusetts Medical School in Worcester, told MedPage Today.
“Nowadays we’re much more focused on wellness in recovery and also looking at the physical health of individuals who have mental illnesses,” he said in an email. “Mental health treatment providers are now realizing that they need to better address tobacco and wellness issues in mental health treatment.”
Said Martin Mahoney, MD, of Roswell Park Cancer Institute in Buffalo, N.Y., and director of New York state’s smoking quitline, “I don’t think there’s anything more important than helping a patients who is addicted to nicotine to get off of that addiction.”
For the current study, Cook and colleagues analyzed data on more than 32,000 MEPS respondents with mental illnesses and some 133,000 without. Participants were considered to have mental illness if they met any of several criteria: having a healthcare visit linked to a psychiatric ICD-9 code, receiving psychotherapy or mental health counseling, filling a prescription for a behavioral health disorder, or having scores on neuropsychiatric tests indicating severe psychological distress or at least moderate depression.
The data on quit rates associated with mental health treatments covered some 14,000 participants in the NSDUH from 2009 to 2011 whose responses indicated at least mild mental illness according to criteria established by the Substance Use and Mental Health Administration.
Differences in smoking prevalence in the MEPS data between those with and without mental illnesses were most pronounced among respondents with apparent depression or distress, for whom the gap was consistently around 15 percentage points through the 8-year study period.
Cook and colleagues acknowledged that the ascertainment of mental illness in both surveys could be faulty because they didn’t use structured diagnostic interviews. Also, as in most federal surveys, persons in institutional settings (including psychiatric inpatients) were excluded.
Another limitation was that the NSDUH did not include data on the timing of smoking cessation versus provision of mental health treatment, leaving open the possibility that some respondents may have quit smoking before receiving treatment. The researchers cautioned that “reverse causality” could therefore have occurred: patients may be more likely to seek mental health treatment after they quit smoking.
Primary source: Journal of the American Medical Association
Source reference: Cook B, et al “Trends in smoking among adults with mental illness and association between mental health treatment and smoking cessation” JAMA 2014; 311: 172-182.
http://www.medpagetoday.com/PrimaryCare/Smoking/43690?xid=nl_mpt_DHE_2014-01-08&utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&eun=g436493d0r&userid=436493&email=megan.houn@tfnd.org&mu_id=5533639

Anti-smoking efforts have saved 8 million American lives

Liz Szabo, USA TODAY

A new analysis says smoking rates have dropped from 42% in 1964 to 18% in 2012.

Anti-tobacco efforts have saved 8 million lives in the 50 years since the publication of a landmark Surgeon General report, “Smoking and Health,” a new analysis shows.
The 1964 report, which concluded that tobacco causes lung cancer, led to a sea change in American attitudes toward smoking. Smoking rates have plunged 59% since then, falling from 42% of adults in 1964 to 18% in 2012, according to the Centers for Disease Control and Prevention.
By avoiding tobacco or quitting the habit, people have gained nearly two decades of life, according to the analysis, published Tuesday in the Journal of the American Medical Association.
An American man’s life expectancy at age 40 has increased by an average of nearly eight years, and a woman’s by nearly 5½ years, since 1964. About one-third of those gains come from decreased tobacco use, the analysis says.
“Tobacco control has been described, accurately, as one of the great public health successes of the 20th century,” CDC director Thomas Frieden writes in an accompanying editorial.
Twenty-six states and Washington, D.C., now ban smoking in indoor public places. As smoking rates have declined, so have the incidence rates of many cancers. About 40% of the decline in men’s overall cancer death rates, in fact, is due to the drop in tobacco use, according to the American Cancer Society.
Tobacco damages virtually every part of the body, Frieden says, causing one-third of heart attacks. Smoking increases the risk of 14 kinds of cancer, including acute myeloid leukemia and tumors of the mouth, esophagus, stomach and pancreas, according to the American Cancer Society. About 443,000 Americans die from smoking-related illnesses every year.
Nearly 18 million Americans have died from tobacco just since the Surgeon General report was published, according to the new analysis, led by Theodore Holford of the Yale University School of Public Health.
Tobacco killed 100 million people worldwide in the 20th century, according to the Campaign for Tobacco-Free Kids. If current trends continue, tobacco will kill an additional 1 billion in the 21st century, the group estimates.
Frieden notes that smoking remains a major health challenge. Nearly one-third of non-smokers are still exposed to secondhand smoke, either at home or at work. Images of smoking are still common on TV and in movies. Tobacco taxes are too low in many parts of the country, making cigarettes affordable for both adults and kids. And although most smokers say they want to quit, few of them receive proven treatment, such as counseling and medication, which together can double their odds of kicking the habit, he writes.
A spokesman for R.J. Reynolds Tobacco Company declined to comment.
David Sylvia, a spokesman for Altria, the parent company of tobacco giant Philip Morris USA, says his company’s goal today is simply to make current smokers aware of its brands, and it has no interest in attracting new smokers.
“Adults should have the ability to choose to purchase a legal product,” Sylvia says. “We want to make sure that when adult, current smokers are choosing their brand, they think about our brand.”
http://www.usatoday.com/story/news/nation/2014/01/07/anti-smoking-efforts-saved-lives/4355227/

Are e-cigarettes dangerous?

By Harold P. Wimmer
Editor’s note: Harold P. Wimmer is the president and CEO of the American Lung Association.
(CNN) — For the makers of electronic cigarettes, today we are living in the Wild West — a lawless frontier where they can say or do whatever they want, no matter what the consequences. They are free to make unsubstantiated therapeutic claims and include myriad chemicals and additives in e-cigarettes.
Big Tobacco desperately needs new nicotine addicts and is up to its old tricks to make sure it gets them. E-cigarettes are being aggressively marketed to children with flavors like Bazooka Bubble Gum, Cap’n Crunch and Cotton Candy. Joe Camel was killed in the 1990s, but cartoon characters are back promoting e-cigarettes.
Many e-cigarettes look like Marlboro or Camel cigarettes. Like their old-Hollywood counterparts, glamorous and attractive celebrities are appearing on TV promoting specific e-cigarette brands. Free samples are even being handed out on street corners.

A report from the Centers for Disease Control and Prevention shows the promotion of e-cigarettes is reaching our children with alarming success. In just one year, e-cigarette use doubled among high school and middle school students, and 1 in 10 high school students have used an e-cigarette. Altogether, 1.78 million middle and high school students nationwide use e-cigarettes.

The three largest cigarette companies are all selling e-cigarettes. Because tobacco use kills more than 400,000 people each year and thousands more successfully quit, the industry needs to attract and addict thousands of children each day, as well as keep adults dependent to maintain its huge profits.
Nicotine is a highly addictive substance, whether delivered in a conventional cigarette or their electronic counterparts. The potential harm from exposure to secondhand emissions from e-cigarettes is unknown. Two initial studies have found formaldehyde, benzene and tobacco-specific nitrosamines (a well-known carcinogen) coming from those secondhand emissions. We commend New York City recently for banning the use of e-cigarettes indoors.
No e-cigarette has been approved by the FDA as a safe and effective product to help people quit smoking. Yet many companies are making claims that e-cigarettes help smokers quit. When smokers are ready to quit, they should call 1-800-QUIT NOW or talk with their doctors about using one of the seven FDA-approved medications proven to be safe and effective in helping smokers quit.
According to one study, there are 250 different e-cigarette brands for sale in the U.S. today. With so many brands, there is likely to be wide variation in the chemicals — intended and unintended — that each contain.
In 2009, lab tests conducted by the FDA found detectable levels of toxic cancer-causing chemicals — including an ingredient used in anti-freeze — in two leading brands of e-cigarettes and 18 various e-cigarette cartridges.
There is no safe form of tobacco. Right now, the public health and medical community or consumers have no way of knowing what chemicals are contained in an e-cigarette or what the short and long term health implications might be.
Commonsense regulation of e-cigarettes by the U.S. Food and Drug Administration is urgently needed. In the absence of meaningful oversight, the tobacco industry has free rein to promote their products as “safe” without any proof.
A proposal to regulate e-cigarettes and other tobacco products has been under review at the White House Office of Management and Budget since October 1, 2013. The Obama administration must move forward with these rules to protect the health of everyone, especially our children.
The opinions expressed in this commentary are solely those of Harold P. Wimmer.
http://www.cnn.com/2014/01/06/opinion/wimmer-ecigarette-danger/

Fargo City Commissioners look to update tobacco ordinances

Fargo, ND (WDAY TV) – Fargo city commissioners are taking a step to stop the increase of e-cigarette use among minors.
Right now, electronic cigarettes are not regulated by the FDA, meaning there are no laws about their use.
In the last year, the percentage of US middle and high school students who reported using them has doubled.
Even though most Fargo businesses have their own rules prohibiting minors, legally anyone can buy them.
Monday night the city council plans to update its tobacco ordinances to include e-cigarettes and all its parts; so that no one can sell to anyone under 18, and minors cannot purchase them.
Holly Scott/Tobacco Prevention Coordinator: “I would venture a guess that most places would not sell to a minor, but by having it written in city ordinance, that way we just ensure that all businesses are following the same set of rules, in that, kinds can’t have access to these products.”
http://www.wday.com/event/article/id/92153/

US is marking 50th anniversary of surgeon general report that turned the tide against smoking

Article by: MIKE STOBBE , Associated Press
ATLANTA — Fifty years ago, ashtrays seemed to be on every table and desk. Athletes and even Fred Flintstone endorsed cigarettes in TV commercials. Smoke hung in the air in restaurants, offices and airplane cabins. More than 42 percent of U.S. adults smoked, and there was a good chance your doctor was among them.
The turning point came on Jan. 11, 1964. It was on that Saturday morning that U.S. Surgeon General Luther Terry released an emphatic and authoritative report that said smoking causes illness and death — and the government should do something about it.
In the decades that followed, warning labels were put on cigarette packs, cigarette commercials were banned, taxes were raised and new restrictions were placed on where people could light up.
“It was the beginning,” said Kenneth Warner, a University of Michigan public health professor who is a leading authority on smoking and health.
It was not the end. While the U.S. smoking rate has fallen by more than half to 18 percent, that still translates to more than 43 million smokers. Smoking is still far and away the leading preventable cause of death in the U.S. Some experts predict large numbers of Americans will puff away for decades to come.
Nevertheless, the Terry report has been called one of the most important documents in U.S. public health history, and on its 50th anniversary, officials are not only rolling out new anti-smoking campaigns but reflecting on what the nation did right that day.
The report’s bottom-line message was hardly revolutionary. Since 1950, head-turning studies that found higher rates of lung cancer in heavy smokers had been appearing in medical journals. A widely read article in Reader’s Digest in 1952, “Cancer by the Carton,” contributed to the largest drop in cigarette consumption since the Depression. In 1954, the American Cancer Society announced that smokers had a higher cancer risk.
But the tobacco industry fought back. Manufacturers came out with cigarettes with filters that they claimed would trap toxins before they settled into smokers’ lungs. And in 1954, they placed a full-page ad in hundreds of newspapers in which they argued that research linking their products and cancer was inconclusive.
It was a brilliant counter-offensive that left physicians and the public unsure how dangerous smoking really was. Cigarette sales rebounded.
In 1957 and 1959, Surgeon General Leroy Burney issued statements that heavy smoking causes lung cancer. But they had little impact.
Amid pressure from health advocates, President John F. Kennedy’s surgeon general, Dr. Luther Terry, announced in 1962 that he was convening an expert panel to examine all the evidence and issue a comprehensive, debate-settling report. To ensure the panel was unimpeachable, he let the tobacco industry veto any proposed members it regarded as biased.
Surveys indicated a third to a half of all physicians smoked tobacco products at the time, and the committee reflected the culture: Half its 10 members were smokers, who puffed away during committee meetings. Terry himself was a cigarette smoker.
Dr. Eugene Guthrie, an assistant surgeon general, helped persuade Terry to kick the habit a few months before the press conference releasing the report.
“I told him, ‘You gotta quit that. I think you can get away with a pipe — if you don’t do it openly.’ He said, ‘You gotta be kidding!’ I said, ‘No, I’m not. It just wouldn’t do. If you smoke any cigarettes, you better do it in a closet,'” Guthrie recalled in a recent interview with The Associated Press.
The press conference was held on a Saturday partly out of concern about its effect on the stock market. About 200 reporters attended.
The committee said cigarette smoking clearly did cause lung cancer and was responsible for the nation’s escalating male cancer death rate. It also said there was no valid evidence filters were reducing the danger. The committee also said — more vaguely — that the government should address the problem.
“This was front-page news, and every American knew it,” said Robin Koval, president of Legacy, an anti-smoking organization.
Cigarette consumption dropped a whopping 15 percent over the next three months but then began to rebound. Health officials realized it would take more than one report.
In 1965, Congress required cigarette packs to carry warning labels. Two years later, the Federal Communications Commission ordered TV and radio stations to provide free air time for anti-smoking public service announcements. Cigarette commercials were banned in 1971.
Still, progress was slow. Warner recalled teaching at the University of Michigan in 1972, when nearly half the faculty members at the school of public health were smokers. He was one of them.
“I felt like a hypocrite and an idiot,” he said. But smoking was still the norm, and it was difficult to quit, he said.
The 1970s also saw the birth of a movement to protect nonsmokers from cigarette fumes, with no-smoking sections on airplanes, in restaurants and in other places. Those eventually gave way to complete smoking bans. Cigarette machines disappeared, cigarette taxes rose, and restrictions on the sale of cigarettes to minors got tougher.
Tobacco companies also came under increasing legal attack. In the biggest case of them all, more than 40 states brought lawsuits demanding compensation for the costs of treating smoking-related illnesses. Big Tobacco settled in 1998 by agreeing to pay about $200 billion and curtail marketing of cigarettes to youths.
In 1998, while the settlement was being completed, tobacco executives appeared before Congress and publicly acknowledged for the first time that their products can cause lung cancer and be addictive.
Experts agree the Terry report clearly triggered decades of changes that whittled the smoking rate down. But it was based on data that was already out there. Why, then, did it make such a difference?
For one thing, the drumbeat about the dangers of smoking was getting louder in 1964, experts said. But the way the committee was assembled and the carefully neutral manner in which it reached its conclusion were at least as important, said Dr. Tim McAfee, director of the Office on Smoking and Health at the Centers for Disease Control and Prevention.
At the same time, he and others said any celebration of the anniversary must be tempered by the size of the problem that still exists.
Each year, an estimated 443,000 people die prematurely from smoking or exposure to secondhand smoke, and 8.6 million live with a serious illness caused by smoking, according to the CDC.
Donald Shopland finds that depressing.
Fifty years ago, he was a 19-year-old who smoked two packs a day while working as a clerk for the surgeon general’s committee. He quit cigarettes right after the 1964 report came out, and went on to a long and distinguished public health career in which he wrote or edited scores of books and reports on smoking’s effects.
“We should be much further along than we are,” the Georgia retiree lamented.
http://www.startribune.com/lifestyle/health/238716101.html?page=all&prepage=1&c=y#continue

E-Cigarettes: Separating Fiction From Fact

By Serena Gordon
HealthDay Reporter
It’s the new year, a time when a smokers’ thoughts often turn to quitting.
Some people may use that promise of a fresh start to trade their tobacco cigarettes for an electronic cigarette, a device that attempts to mimic the look and feel of a cigarette and often contains nicotine.
Here’s what you need to know about e-cigarettes:
What is an e-cigarette?
The U.S. Food and Drug Administration (FDA) describes an e-cigarette as a battery-operated device that turns nicotine, flavorings and other chemicals into a vapor that can be inhaled. The ones that contain nicotine offer varying concentrations of nicotine. Most are designed to look like a tobacco cigarette, but some look like everyday objects, such as pens or USB drives, according to the FDA.
How does an e-cigarette work?
“Nicotine or flavorings are dissolved into propylene glycol usually, though it’s hard to know for sure because they’re not regulated,” explained smoking cessation expert Dr. Gordon Strauss, founder of QuitGroups and a psychiatrist at Lenox Hill Hospital in New York City. “Then, when heated, you can inhale the vapor.”
The process of using an e-cigarette is called “vaping” rather than smoking, according to Hilary Tindle, an assistant professor of medicine and director of the tobacco treatment service at the University of Pittsburgh Medical Center. She said that people who use electronic cigarettes are called “vapers” rather than smokers.
Although many e-cigarettes are designed to look like regular cigarettes, both Tindle and Strauss said they don’t exactly replicate the smoking experience, particularly when it comes to the nicotine delivery. Most of the nicotine in e-cigarettes gets into the bloodstream through the soft tissue of your cheeks (buccal mucosa) instead of through your lungs, like it does with a tobacco cigarette.
“Nicotine from a regular cigarette gets to the brain much quicker, which may make them more addictive and satisfying,” Strauss said.
Where can e-cigarettes be used?
“People want to use e-cigarettes anywhere they can’t smoke,” Strauss said. “I sat next to someone on a plane who was using an e-cigarette. He was using it to get nicotine during the flight.” But he noted that just where it’s OK to use an e-cigarette — indoors, for instance? — remains unclear.
Wherever they’re used, though, he said it’s unlikely that anyone would get more than a miniscule amount of nicotine secondhand from an e-cigarette.
Can an e-cigarette help people quit smoking?
That, too, seems to be an unanswered question. Tindle said that “it’s too early to tell definitively that e-cigarettes can help people quit.”
A study published in The Lancet in September was the first moderately sized, randomized and controlled trial of the use of e-cigarettes to quit smoking, she said. It compared nicotine-containing e-cigarettes to nicotine patches and to e-cigarettes that simply contained flavorings. The researchers found essentially no differences in the quit rates for the products after six months of use.
“E-cigarettes didn’t do worse than the patch, and there were no differences in the adverse events,” she said. “I would be happy if it turned out to be a safe and effective alternative for quitting, but we need a few more large trials for safety and efficacy.”
Strauss noted that “although we can’t say with certainty that e-cigarettes are an effective way to quit, people are using them” for that purpose. “Some people have told me that e-cigarettes are like a godsend,” he said.
Former smoker Elizabeth Phillips would agree. She’s been smoke-free since July 2012 with the help of e-cigarettes, which she used for about eight months after giving up tobacco cigarettes.
“E-cigarettes allowed me to gradually quit smoking without completely removing myself from the physical actions and social experience associated with smoking,” Phillips said. “I consider my e-cigarette experience as a baby step that changed my life.”
Are e-cigarettes approved or regulated by the government?
E-cigarettes are not currently regulated in a specific way by the FDA. The agency would like to change this, however, and last April filed a request for the authority to regulate e-cigarettes as a tobacco product.
The attorneys general of 40 states agree that electronic cigarettes should be regulated and sent a letter to the FDA in September requesting oversight of the products. They contend that e-cigarettes are being marketed to children; some brands have fruit and candy flavors or are advertising with cartoon characters. And, they note that the health effects of e-cigarettes have not been well-studied, especially in children.
Are e-cigarettes dangerous?
“It’s not the nicotine in cigarettes that kills you, and the nicotine in e-cigarettes probably won’t really hurt you either, but again, it hasn’t been studied,” Strauss said. “Is smoking something out of a metal and plastic container safer than a cigarette? Cigarettes are already so bad for you it’s hard to imagine anything worse. But, it’s a risk/benefit analysis. For a parent trying to quit, we know that secondhand smoke is a huge risk to kids, so if an electronic cigarette keeps you from smoking, maybe you’d be helping kids with asthma or saving babies.”
But on the flip side, he said, in former smokers, using an e-cigarette could trigger the urge to smoke again.
The other big concern is children using e-cigarettes.
“More and more middle and high school kids are using e-cigarettes,” Tindle said. “Some are smoking conventional cigarettes, too. The latest data from the CDC found the rate of teens reporting ever having used an e-cigarette doubled in just a year. We could be creating new nicotine addicts. We don’t know what the addictive properties of e-cigarettes are,” she added.
“It’s shocking that they’ve been allowed to sell to minors,” Tindle said.
More information
The U.S. Food and Drug Administration has more about electronic cigarettes.
http://health.usnews.com/health-news/news/articles/2014/01/03/e-cigarettes-separating-fiction-from-fact

Nicotine Poisoning Blamed on E-cigs

BY 
Threats of nicotine poisoning are now serving as the catalyst of new protests against electronic cigarettes, prompting some countries to consider regulating or banning the e-cigs.  The European Union is currently considering either bans or regulation, and some places such as Spain have already banned the e-cigs.
Some cities in the US are also considering bans or stronger regulations on the products.   New York, Chicago, and Oklahoma City are also seeking regulation with some cities choosing to treat the e-cigs as tobacco products, even though they do not contain any tobacco.  New York just recently passed a ban on e-cig product usage in public places.
E-cigs are electronic cigarettes that feature a heating element.  They contain propylene glycol which produces a vapor when heated and also have a flavoring liquid.  The liquids come in a variety of flavors and contain different levels of nicotine.
The e-cigs are used by people who are trying to quit smoking tobacco, and many people see them as a safer alternative to regular cigarettes which contain several carcinogenic compounds.
The liquids used for e-cigs contain concentrated amounts of nicotine and are being blamed for poisoning children who accidently drink the fluid.  In May 2013, an Israeli 2 year old reportedly died after drinking the fluid and ingesting a lethal dose of nicotine.
In Sweden, 29 cases of nicotine poisoning were attributed to e-cigs last year.  Due to less strict requirements, e-cig users are able to use in more places, which may be leading to accidental overdoses as users are not required to wait for a smoking break.
Nicotine poisoning can exhibit many side effects such as nausea and vomiting, abdominal cramps, agitation and weakness.  Severe cases can lead to coma and respiratory failure.
Nicotine has an average lethal dosage of 0.5 to 1 milligram per kilogram in body weight for humans.  It is easily absorbed through the skin.  It has a half life of approximately two hours.
Most overdoses happen with simultaneous use of nicotine products, such as smoking and use of a patch at the same time.
Emergency treatment of nicotine poisoning includes administering activated charcoal and gastric lavage.
Nicotine has been used and valued for centuries due to its positive effects.  It can relieve depression, suppress appetites and can help with mental focus.  Nicotine is widely believed to be highly addictive, although some theories suggest that pure nicotine is not addictive, but it is only addictive when used in tobacco form.
No matter what the true reason, tobacco usage is highly addictive and has been attributed to several health problems, such as strokes and lung cancer.  The e-cigs are seen as a safer alternative by many users and some health officials have even come out in favor of e-cigs over regular tobacco.
Other officials claim that e-cigs are unregulated and have not been fully researched for potential side effects.  Authorities claim that the health hazards from inhaling the propylene glycol mist are unknown.
Some cities that are considering bans on e-cigs are concerned that they may be used by teenagers as a gateway into cigarette smoking. According to a youth survey by the US Center for Disease Control, 10 percent of high school students have tried using e-cigs.  CDC official called the results troubling.  Opponents blamed the increase in teenage usage on advertising featuring popular celebrities such as Jenny McCarthy and Courtney Love touting the benefits of the e-cigs.
Proponents of the e-cigs point out that the products are safer than the traditional cigarettes and say that many people have been able to stop using traditional tobacco thanks to the use of e-cigs.  Many satisfied customers point that the e-cigs have been their only alternative as nicotine patches are costly, and smoking cessation pills such as Chantix can have severe side effects such as suicidal thoughts.
http://www.newschanneldaily.com/nicotine-poisoning-blamed-e-cigs/2316/kb-hallmark/