FDA Struggles To Regulate The Thriving Flavored Cigar Market

By 
Cigarette smoking has been on the decline for years now, but as some people turn to e-cigarettes, others turn to cigars. For a long time, regulators didn’t focus on cigars. This has allowed the market to thrive over the past few years by appealing to smokers in ways cigarettes did not — many cigars are cheap and they come in a variety of flavors.
The 2009 Family Prevention and Tobacco Control Act banned virtually every flavor of cigarettes except menthol. Its purpose was to discourage youth under 18 years old from buying cigarettes. The law also called for cigarette companies to limit the color and design of packaging, and also to display larger health warnings.
Read More: Teens Ditching Cigarettes but Tobacco Consumption Problem Remains
Although teenage smoking declined 33 percent last year, the Centers for Disease Control and Prevention (CDC) found that tobacco use in other forms grew by 123 percent, which could mean that cigarettes are just being switched for other, cheaper forms, especially since cigar and loose tobacco sales increased to 10 percent of all tobacco sold in 2011, from only three percent in 2000.

Flavored Cigars Growing Popularity

But the tobacco companies may have found a loophole when dealing with these new regulations. Although they applied to cigarettes, the regulations made no mention of cigars, and left it up to the Food and Drug Administration (FDA) to use its judgment on whether or not to regulate them.
Since then, convenience stores’ inventories have become loaded with a slew of colorful wrappers adorning various flavors of both small and large cigars, including grape, strawberry, pineapple, chocolate, and many more, according to The New York Times. On top of this, many of them are cheap — three for 99 cents in some places — appealing to many smokers who can’t always afford cigarettes.
“The 20th century was the cigarette century, and we worked very hard to address that,” Gregory N. Connolly, director of the Center for Global Tobacco Control at Harvard School of Public Health, told the Times. “Now the 21st century is about multiple tobacco products. They’re cheap. They’re flavored. And some of them you can use anywhere.”
Flavored cigars account for more than half of all convenience store and gas station cigar sales, Christine Delnevo, a tobacco researcher at Rutgers University, told theTimes, adding that their sales increased almost 40 percent since 2008.
But some people believe the increased sales could be attributed to marijuana use. Some people use the cigar wrapper, which is a tobacco leaf, to roll the marijuana into what’s called a blunt — named after the cigar brand Phillies Blunt. One study found that about a fifth of 5,000 middle and high school students were using cigar wrappers to roll blunts.

How The FDA Is Discouraging Cigars

The FDA has begun sending out notices to tobacco companies, warning them about passing off roll-your-own tobacco as pipe tobacco, which is a way of avoiding taxes and FDA regulation since the two types have two different tax codes.
“The giant has finally awoken and hopefully will do its job,” Ron Bernstein, chief executive of cigarette producer Liggett Vector Brands, told the Times. He’s worried his company is being subjected to unfair competition from cigar makers.
If the FDA does succeed in regulating the largely unregulated cigar market, many people might be turned off of cigars, which are often harsher to smoke unflavored.
“If they take away the flavor, it would be a problem,” Trayvon Henderson, 19, told theTimes. “I’d probably stop smoking them. Or maybe I’d go back to cigarettes.”
http://www.medicaldaily.com/fda-struggles-regulate-thriving-flavored-cigar-market-252279

Vaping May Be Hazardous to Your Health

By the Editors
“Mind if I vape?”
The question may become more common as electronic cigarettes become more popular. The answer, however, remains elusive. Etiquette aside, the health effects of inhaling nicotine vapor (hence the term) are largely unknown. More research is clearly needed, but in the meantime, the U.S. Food and Drug Administration has to start regulating e-cigarettes.
U.S. consumers will spend $1 billion on battery-powered smokes this year, 10 times more than they did four years ago. Are e-cigarettes, which come in such flavors as chocolate and butter rum, a benign device to help people stop smoking? Or are they just a new way to feed an old addiction? How safe, compared with tobacco smoke, is the vapor they create?
No one knows. The small studies that have been done so far hint at both pros and cons; one found that smokers cut back on real cigarettes after trying the electronic kind, while anotherfound particles of metal and silicates in e-cigarette vapor that could cause breathing problems. That there are more than 200 brands containing varying levels of nicotine and other substances only makes it harder to assess their safety.
The FDA has indicated it will begin to regulate e-cigarettes this fall. After a federal judge ruled that it couldn’t classify them as medical devices (because they deliver a drug, nicotine), the FDA will regulate them as tobacco products (because nicotine is derived from tobacco). Unlike regular cigarettes, however, e-cigarettes are not known to be lethal. Wariness is warranted, but it’s safe to assume that their vapors are not nearly as dangerous as tobacco smoke.
The FDA’s approach, therefore — and that of states and cities that regulate tobacco use — should be two-pronged: It should find out whether e-cigarettes are indeed safe. And while it does, it should ensure that “vaping” remains restricted to adults who are fully informed of the potential risks.
To begin, e-cigarette makers should be required to report and label all ingredients in the nicotine solutions they use. Even though these deliver fewer poisons than are found in traditional cigarettes, they nevertheless have been found to contain carcinogenic nitrosamines and other harmful impurities derived from the tobacco, as well as the additive diethylene glycol, an ingredient in antifreeze.
Manufacturers should also disclose the amount of nicotine that can be inhaled from their e-cigarettes. Today’s models haven’t been found to give users as large a hit of nicotine as regular cigarettes do, but that may not always be the case. (Some bottles of solution meant to refill e-cigarette cartridges have been found to contain enough nicotine to kill an adult if ingested.) Once more is known about the potential hazards of e-cigarette vapors, the FDA may need to restrict certain substances or place limits on nicotine levels.
Then there is the issue of flavoring — something the FDA forbids in standard cigarettes. All electronic cigarettes are flavored, so to ban flavoring would be to ban the product entirely. But it’s possible to allow tobacco- or even mint-flavored e-cigarettes and still ban or restrict flavors designed to appeal to children, hard as they may be to define.
While they’re at it, the FDA should also ban sales to those younger than 18 and restrict e-cigarette marketing and advertisements in much the same way it limits them for cigarettes. As for health warnings, the agency will need to wait for more data before deciding what exactly they should say.
States and cities, meanwhile, should include e-cigarettes in their restrictions on smoking in public places and office buildings, and apply the same rules on the retail sale of e-cigarettes as they do to tobacco products. Even in towns where there are few restrictions, bars and restaurants would be wise to prohibit “vaping” until they know whether it pollutes the air.
On the question of taxes, states and cities may want to act gradually. If e-cigarettes are found to be valuable smoking-cessation tools, then they may warrant a tax rate that’s lower than what’s imposed on real cigarettes.
It would be great if e-cigarettes turned out to be the breakthrough that gets people to give up smoking tobacco. In the meantime, we should all be careful that e-cigarettes not perpetuate a habit that society has come a long way toward snuffing out. Sensible regulation can help protect that progress.
To contact the Bloomberg View editorial board: view@bloomberg.net.
http://www.bloomberg.com/news/2013-08-18/vaping-may-be-hazardous-to-your-health.html

In All Flavors, Cigars Draw In Young Smokers

By SABRINA TAVERNISE
BALTIMORE — At Everest Greenish Grocery, a brightly lit store on a faded corner of this city, nothing is more popular than a chocolate-flavored little cigar. They are displayed just above the Hershey bars along with their colorful cigarillo cousins — white grape, strawberry, pineapple and Da Bomb Blueberry. And they were completely sold out by 9 one recent evening, snapped up by young people dropping by for a snack or stopping in during a night of bar hopping.
“Sorry, no more chocolate,” the night clerk, Qudrad Bari, apologetically told a young woman holding a fruit drink.
In 2009, Congress passed a landmark law intended to eliminate an important gateway to smoking for young people by banning virtually all the flavors in cigarettes that advocates said tempted them. Health experts predicted that the change would lead to deep reductions in youth smoking. But the law was silent on flavors in cigars and a number of other tobacco products, instead giving the Food and Drug Administration broad discretion to decide whether to regulate them.
Four years later, the agency has yet to assert that authority. And a rainbow of cheap flavored cigars and cigarillos, including some that look like cigarettes, line the shelves of convenience stores and gas stations, often right next to the candy. F.D.A. officials say they intend to regulate cigars and other tobacco products, but they do not say how or when. Smoking opponents contend that the agency’s delay is threatening recent progress in reducing smoking among young people.
Cigarette sales are down by a third over the past decade, according to federal data, but critics of the agency say the gains are being offset by the rise of cheaper alternatives like cigars, whose sales have doubled over the same period and whose flavored varieties are smoked overwhelmingly by young people. Loose tobacco and cigars expanded to 10 percent of all tobacco sold in the United States in 2011, up from just 3 percent in 2000, federal data show.
“The 20th century was the cigarette century, and we worked very hard to address that,” said Gregory N. Connolly, the director of the Center for Global Tobacco Control at the Harvard School of Public Health. “Now the 21st century is about multiple tobacco products. They’re cheap. They’re flavored. And some of them you can use anywhere.”
The F.D.A. is now wrestling with how to exercise its authority over an array of other tobacco products. In recent weeks, for example, it sent warning letters to several companies that it says are disguising roll-your-own tobacco as pipe tobacco, a practice that industry analysts say has become a common way to avoid federal taxes and F.D.A. regulation.
“The giant has finally awoken and hopefully will do its job,” said Ron Bernstein, the chief executive of Liggett Vector Brands, a cigarette producer that is worried about unfair competition from cigar makers and others.
Mitchell Zeller, 55, a public interest lawyer who became the director of the F.D.A.’s Center for Tobacco Products this spring, acknowledged in an interview that the emergence of new tobacco products meant a new look was needed.
“What we’ve seen in the past 10 years is this remarkable transformation of the marketplace,” Mr. Zeller said. “There are products being sold today — unregulated products — that literally did not exist 10 years ago.”
But new rules have to be grounded in scientific evidence, he said, and written to withstand legal challenges. The tobacco industry won a recent court fight against graphic images on cigarette labels.
As for the criticism that the agency has been slow to act, Mr. Zeller said, “Message received.”
But the F.D.A.’s careful approach exasperates smoking opponents.
“We shouldn’t need 40 years of study to figure out that chocolate- and grape-flavored cigars are being smoked by young people,” said Matthew L. Myers, the president of the Campaign for Tobacco-Free Kids. Traditional handmade cigars were seen as a luxury for older men, but much of the recent growth has been in products sold in convenience stores to low-income customers. Flavored cigars now represent more than half of all convenience store and gas station cigar sales, up nearly 40 percent since 2008, according to Nielsen market data analyzed by Cristine Delnevo, a tobacco researcher at Rutgers University.
A three-pack of Good Times flavored cigarillos at Everest costs 99 cents, an alluring price for the store’s clientele: young, poor African-Americans.
On a recent evening, Mr. Bari, a native of Pakistan, was in a generous mood. He had just broken his Ramadan fast with sweet tea and was helping a customer with the last 30 cents needed for a pack of Newports. But he said flavored cigars were actually more popular in his store than cigarettes. Sometimes people pay for them with spare change.
Jay Jackson, a 19-year-old nursing assistant in hospital scrubs, rarely has the $6.50 for a pack of cigarettes, which she also smokes, but can usually come up with a dollar for the kind of cigar she likes. Flavors improve the taste of cigars that are otherwise so harsh they make her light headed, she said, paying Mr. Bari for two — chocolate and cherry.
Mr. Bari said he remembered only strawberry, vanilla and chocolate when he first arrived 10 years ago. “Now look at this,” he said, motioning toward the cigar shelf disapprovingly. Some companies are producing small filtered cigars that look like cigarettes in brown wrappers, avoiding the federal taxes and F.D.A. regulation required for cigarettes. Mr. Bernstein, the cigarette producer, contended that such cigars made up much of the recent increase in cigar sales. A typical pack of 20 costs about $2, compared with about $6 for a pack of cigarettes.
Tobacco in cigars is cured by a different method than tobacco in cigarettes. And cigars come in a wrapper made of tobacco, while cigarettes are wrapped in paper. Smaller cigars popular among young people tend to be inhaled more, making the health risks similar to cigarettes.
Nationally, about one in six 18- to 24-year-olds smoke cigars, federal research shows, compared with only 2 percent of people over 65. More than half of the younger users smoke flavored cigars, with the highest rates among the poorest and least educated.
Those are familiar circumstances in certain parts of Baltimore, where life expectancy for men can be as low as 63 years, a level last seen for all American men in the 1940s. The smoking rate here is double the national one — a pattern that Devin Miles, a high school junior who started smoking cigarettes when he was 10, said was obvious at his school.
“Everybody smokes, even the teachers,” he said.
Cigar producers say they are bracing for F.D.A. action, even as sales have flattened in the last few years, dampened by new taxes. But they question a flavor ban, pointing out that the F.D.A. has yet to prohibit the most common flavor, menthol, in cigarettes and that chewing tobacco still comes in flavors.
“We continue to ask the question, ‘What’s the rationale?’ ” said Joe Augustus, a spokesman for Swisher International, a cigar producer. Flavors have existed “since the beginning of time,” he said, and are popular with “the guys who are cutting your lawn and fixing your car.”
There is also evidence that cigar purchases are related to marijuana use. In a survey of 5,000 middle and high school students in Massachusetts in 2003, researchers found that about a fifth were using cigar wrappers to smoke marijuana.
Mr. Bari, the night clerk, said many of his customers used the wrappers for marijuana. “It’s the younger generation,” he said. “Your sister’s crying, your daughter’s crying, you don’t care.”
One customer, Torri Stevens, a 19-year-old who said she worked at a strip club in Washington, said she sometimes smoked as many as 12 blunts a day, a name for marijuana in a cigar wrapper that is associated with Phillies Blunt, a cigar brand.
Black youths were the one group that registered a rise in cigar smoking nationally. Twelve percent of black high school students smoked cigars in 2011, compared with 7 percent in 2009, the C.D.C. said.
Maryland, where the legal age to buy cigarettes is 18, did its own survey and found that cigar smoking had increased across the entire high school population. It is now one of at least six states where cigar smoking among youths now equals or surpasses cigarette smoking, according to the C.D.C.
Alarmed officials started a public education campaign. A Web site, TheCigarTrap.com, shows an ice cream truck adorned with a giant lit cigar and children running after it.
On a recent night at Everest Greenish Grocery, Mr. Bari sold cigars to patrons of a nearby transvestite bar and people who were just leaving work.
Trayvon Henderson, 19, was still wearing his McDonald’s uniform when he stopped in for a chocolate cigarillo. Cigars are stylish, he said, and some of his favorite rappers smoke them.
“If they take away the flavor, it would be a problem,” he said, cigarillo in hand. “I’d probably stop smoking them. Or maybe I’d go back to cigarettes.”
http://www.nytimes.com/2013/08/18/health/in-all-flavors-cigars-draw-in-young-smokers.html?pagewanted=1&_r=0

Significant increase in fires due to improper disposal of smoking materials

By: Michael Yoshida, WDAZ
Officials with the Grand Forks Fire Department say they’ve seen a significant increase in fires caused by careless use of smoking materials. A deck fire on Monday was the latest, and in the last year there have been about ten accidental fires, one resulting in death. These fires can cause damages ranging in cost from $1,000 to excess of $100,000. Often times, fire marshals find that the cause of fires is careless and improper disposal of smoking materials. Officials say that if you choose to smoke, be responsible and aware.
Fire Marshal Brandon Boespflug said, “Every one of these fires are preventable. The deaths caused by these fires are preventable, and the key is if you’re going to smoke, smoke smart.”
Some tips for fire safety while smoking include using proper ashtrays, and not using your foot to put out smoking materials. For more safety information click here.
http://www.wdaz.com/event/article/id/19010/#sthash.c6JZoybR.dpuf

Letter: Tobacco tax is working

By:  Gina Johnson, Red Wing
In July 2013, a new law went into effect raising our state tobacco tax by $1.60, causing the average price of cigarettes to raise to $7.50 a pack.
Many people were concerned about how tobacco users who have limited income would manage. As a public health professional, I am pleased to see many tobacco users are now getting professional help to quit tobacco.
A recent study done by QUITPLAN Services, a free tobacco cessation program available to any Minnesotan, shows that this tax hike is reducing the smoking rates. The increased price of cigarettes has caused an increase in many smokers to seek out professional cessation support to help them quit.
QUITPLAN Services saw an increase of 256 percent in the first two weeks of July 2013 compared to the same time period in July 2012.
This data proves that price increases work, and that our communities are one gigantic step closer to becoming tobacco free.
Thank you to everyone who supported the $1.60 increase!
Gina Johnson is the Clearway Minnesota tobacco grant coordinator with Goodhue County Human and Health Services.
http://www.republican-eagle.com/content/letter-tobacco-tax-working#sthash.xxzIkHT6.dpuf
 

Letter of the Day (Aug. 13): Electronic cigarettes

An article last month (“Up in vapor,” July 13) described research related to electronic cigarettes and smoking cessation. As one who conducts research related to electronic cigarettes, I feel compelled to provide additional findings.
First, the Italian researchers cited in the article also conducted an experiment with smokers by randomly assigning them into using electronic cigarettes with or without nicotine (published in PLOS ONE). They found that smokers who used electronic cigarettes with nicotine reduced and quit smoking at the same rate as those who used electronic cigarettes without nicotine. This suggests the limited ability of nicotine-delivering electronic cigarettes to aid smoking cessation.
Second, researchers have studied the effect of secondhand electronic cigarette smoking. This work, published in Inhalation Toxicology, found that nonsmokers who stayed in the same room with electronic cigarette users showed elevated nicotine concentration in the blood, comparable to that of secondhand cigarette smoke.
The Freedom to Breathe Act of 2007 protects nonsmokers, particularly those who work at bars and restaurants, from the harmful effect of secondhand smoking. Given the known effects of secondhand electronic cigarette smoking, the Legislature should consider expanding the act.
KELVIN CHOI, Minneapolis
http://www.startribune.com/opinion/letters/219329381.html

Secondhand Smoke, Asthma Link Remains

By Cole Petrochko, Staff Writer, MedPage Today
Children with asthma were more likely to be exposed to secondhand smoke than those without the disease, researchers found.
From 1999 to 2010, the overall rate of exposure to secondhand smoke among children without asthma declined from 57.3% to 44.2%, but the exposure rate remained nearly constant over the same time period for children with asthma, only declining from 57.9% to 54%, according to Kenneth Quinto, MD, of the National Center for Health Statistics in Hyattsville, Md, and colleagues.
And the latest statistics, from 2007 to 2010, show that children with asthma who were female, Mexican-American, from families with income below 350% of the federal poverty line, and ages 6 to 11 had greater exposure to environmental tobacco smoke than those without asthma, they wrote in a National Center for Health Statistics data brief.
Past research has tied secondhand smoke exposure to exacerbated asthma symptoms in children and increased risk of mental illness in healthy adults. Other research has also tied neonatal smoke exposure from smoking mothers to hearing loss and behavior problems in the child.
Quinto and co-authors also cautioned that secondhand smoke exposure in all children was associated with risks of middle ear infection, bronchitis, pneumonia, coughing and wheezing, worse lung function, and the development of asthma. They added that in 2007 to 2010, one in 10 children had asthma.
The authors gathered data from the NHANES (National Health and Nutrition Examination Survey) from 1999 to 2010 to measure trends in environmental tobacco smoke exposure in children with and without asthma, and to stratify rates of exposure by sex, race, income, and age group. Income was broken down by earnings 350% or greater than the poverty line, 185% to less than 350% of the poverty line, and less than 185% of the poverty line.
Exposure to secondhand smoke was classified as serum cotinine levels between 0.05 ng/mL and 10 ng/mL in children who didn’t smoke themselves. Children were considered smokers if they were 12 to 19 years old and answered “yes” when asked if they had used tobacco in the 5 days prior to the survey or if their serum cotinine levels were greater than 10 ng/mL. “Serum cotinine is a breakdown product of nicotine,” the authors noted.
Children were considered to have asthma if a parent affirmed on the survey that a healthcare professional had diagnosed them with asthma and if they still had asthma.
By age group, there was no significant difference in secondhand smoke exposure for children with and without asthma ages 3 to 5 and 12 to 19 in the 2007 to 2010 data. However, children ages 6 to 11 with asthma were exposed to secondhand smoke significantly more often than those without asthma in that time (58.8% versus 44.7%, P<0.05).
In families with household incomes lower than 350% of the poverty line, children with asthma were significantly more likely to be exposed to environmental tobacco smoke than those without asthma (P<0.05 for both groups). There was no significant difference in smoke exposure in families earning 350% or more above the poverty line.
Mexican-American children with asthma were significantly more likely than those without asthma to have been exposed to secondhand smoke (38.2% versus 27.4%, P<0.05). White, black, and other race children had no significant differences in exposure between those with and without asthma.
Additionally, girls with asthma were more likely than girls without asthma to have been exposed to secondhand smoke (57.6% versus 43.6%, P<0.05), while there was no significant difference seen in boys.
The authors cautioned that future research should look to explain the reasons for group differences.

Study Says Smoking Bans Don't Hurt Bars, Restaurants

A new study suggests a statewide law banning smoking in public places would not harm the restaurant and bar industry and the people who work in it.
The study has been done in North Carolina, the nation’s leading state for tobacco production. It is the home of major tobacco companies including the nation’s largest one, Phillip Morris. It’s also the home of RTI International, a think tank that has explored various health issues including those that are smoking-related.
Missouri is one of eight states without anti-smoking laws that has been studied by RTI. The lead author of the study, Brett Loomis, says the findings are straightforward.
He says local smoking ban ordinances in Missouri “were unrelated to any changes in restaurant and bar employment in those communities and revenues in eating and drinking places also were unaffected by the law.”
RTI looked at eleven years of employment and revenue records for Missouri bars and restaurants, the businesses most often targeted by local ordinances approved in almost cities-and the businesses most likely to oppose local ordinances.
The study has been indirectly underwritten by Pfizer, which makes an anti-smoking drug. Loomis says the company attended no meetings, had nothing to do with gathering and analyzing information. He says it had no influence on the findings.
Read the Summary
Read the Full Report
http://www.ozarksfirst.com/story/study-says-smoking-bans-dont-hurt-bars-restaurants/d/story/wZ7rRs6YMUGa5lsirLp2Jw

Cigarette Taxation Helps to Reduce Drinking Among Groups Considered Vulnerable

Tobacco use is the leading cause of preventable death and disability in the U.S., while heavy drinking ranks as the third leading cause of preventable death. Cigarette taxation has been recognized as one of the most significant policy instruments to reduce smoking. Given that smoking and drinking often occur together, a first-of-its-kind study has examined cigarette taxation and found that increases are associated with modest to moderate reductions in alcohol consumption among vulnerable groups.
Results will be published in the January 2014 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.
“Smoking and heavy drinking co-occur at alarmingly high rates,” said Sherry McKee, associate professor of psychiatry at Yale University School of Medicine as well as corresponding author for the study. “Tobacco can enhance the subjective effects of alcohol and has been shown to increase the risk for heavy and problematic drinking. Smokers drink more frequently and more heavily than non-smokers, and are substantially more likely than non-smokers to meet criteria for alcohol abuse or dependence. The co-occurrence of smoking and drinking is of particular clinical significance given evidence that health consequences exponentially increase with combined versus singular abuse of alcohol and tobacco.”
“Smoking and drinking are strongly linked for a host of reasons including complementary pharmacologic effects, shared neuronal pathways, shared genetic associations, common environmental factors, and learned associations,” added Christopher W. Kahler, professor and chair of the department of behavioral and social sciences at Brown School of Public Health. “However, it is possible to intervene through behavioral treatments, pharmacotherapy, and policy to affect both behaviors in a positive way.”
“Cigarette taxes have broad population reach and have been recognized as one of the most significant policy instruments to reduce smoking,” said McKee. “Increases in cigarette taxes predict decreases in smoking initiation, increases in quitting, and reductions in cigarette-related morbidity and mortality. By increasing the price of cigarettes, taxes are thought to encourage smokers to reduce their use of cigarettes or quit altogether, and discourage non-smokers from starting to smoke.”
McKee and her colleagues examined data gathered through personal interviews with 21,473 alcohol consumers as part the National Epidemiological Survey on Alcohol and Related Conditions, a survey conducted by the National Institute on Alcohol Abuse and Alcoholism. Analyses evaluated whether increases in cigarette taxes between Waves I (2001-2002) and II (2004-2005) were associated with reductions in quantity and frequency of alcohol consumption. These analyses were conducted by gender, hazardous drinking status, age, and income group, and were further adjusted for demographics, baseline alcohol consumption, and alcohol price.
“We hypothesized that the public health benefits of cigarette taxes would extend beyond smoking to reduce alcohol consumption,” said McKee. “Results suggest that increases in cigarette taxes were associated with reductions in alcohol consumption over time among male smokers. The protective effects were most pronounced among subgroups who are most at risk for adverse alcohol-related consequences, including male heavy drinkers, young adults, and those with the lowest income.”
“These findings suggest that if states increase taxes on cigarettes, they are not only likely to reduce smoking — based on a large body of literature — but they also may have a modest impact on heavy drinking rates among men, those with lower income, and those who drink most heavily,” said Kahler. “In other words, policies that target one specific health behavior may have broader benefits to public health by affecting additional health behaviors that tend to co-occur with the targeted health behavior.”
Kelly Young-Wolff, post-doctoral research fellow at Stanford Prevention Research Center, and one of the study’s co-authors, agreed, adding that these results support research that targets the interactions of tobacco and alcohol. “Results from our study can pave the way for a productive line of future research aimed at reducing secondary public health harms such as alcohol-related violence, drunk driving, and alcohol-related morbidity and mortality.”
“While the study does not show a causal association,” added Kahler, “in the context of laboratory, clinical, and policy studies conducted to date, it suggests that policy makers and clinicians may have significant opportunities to address heavy drinking and smoking together.”
http://www.sciencedaily.com/releases/2013/08/130810063508.htm

Cigarette Taxes Linked to Binge Drinking

By Elbert Chu, Associate Producer, MedPage Today
Cigarette tax hikes were associated with a drop in the number of binge drinking bouts among male smokers and the amount of alcohol consumed when they did drink, investigators found.
Compared with male smokers who were not hit with any cigarette tax increases, those who were binged seven fewer times a year — a 22% drop — and drank 11% less — roughly a third of a drink — per “episode,” according to a study published online inAlcoholism: Clinical and Experimental Research.
Excessive drinking costs the U.S. about $234 billion each year, noted Sherry A. McKee, PhD, of Yale University School of Medicine and colleagues.
“We were surprised at the strength of the associations between increases in cigarette taxes and reductions in alcohol consumption,” McKee told MedPage Todayin an interview. She and her co-authors noted that to their knowledge, “no prior study has considered the potential for crossover association of cigarette taxation on drinking outcomes using a longitudinal, epidemiological U.S. sample.”
The researchers dug into prospective surveys of 21,473 U.S. alcohol drinkers from theNational Epidemiological Survey on Alcohol and Related Conditions. Two data sets provided the before-and-after cigarette tax increases. One set from 2001 and 2002, and another from 2004 and 2005.
Among the sample, 51% lived in the 31 states that increased cigarette taxes. Increases ranged from seven cents to $1.60 (mean = 61 cents, SD= 42 cents, median = 40 cents).
The investigators also accounted for alcohol prices, education, marriage status, and ethnicity. They further stratified their sample by age, drinking level, sex, and income.
The survey asked respondents about their drinking habits in the previous 12 months on a scale that ranged from “every day” to “never in the last year,” and how many drinks in consumed in each bout. Drinking was classified as “hazardous” when men reported downing more than 14 drinks per session, or women seven drinks. Also labeled as a “hazardous” drinker was anyone who binged at least once in the year they were surveyed.
Only people who said they smoked daily were included as smokers. Smokers who were also hazardous drinkers were more likely male, younger, and less likely to be married, compared with other drinkers.
Women drinkers showed no associated response to increased cigarette taxes. McKee attributed the difference between the sexes to higher rates of male drinkers in the U.S. population. “Eight percent of the population meets the criteria for alcohol use disorder. Out of that, five percent are men and three percent are women,” she told MedPage Today.
In young adults ages 18 to 29, increased cigarette taxes reduced the frequency of binge drinking (b= -0.19, P= 0.02). A similar effect was seen among smokers 50 and older (b = -0.23,P=0.04). Non-smokers showed no changes in their drinking habits.
“Nicotine acts with specific receptors in the brain unrelated to alcohol but have non-nicotine compounds that induce triggers and cues unrelated to nicotine receptors,” said Gregory N. Connolly, DMD, MPH, faculty director for the Center for Global Tobacco Control at the Harvard School of Public Health. “So the researchers may have found something big.
“We do know the opposite is true. Alcohol and the social acceptance of smoking in the bar induces relapse. The bar or pub has become the nicotine classroom for the young,” Connolly continued.
The primary limitation of the study was the reliance on people to accurately recall and record their drinking habits. In addition, the timing of the tax increases was not consistent across all states, nor does the data account for online or bulk purchases of alcohol that could be exempt from taxes.
“Absolute magnitude of increases in cigarette taxes was in the direction expected (greater increases in tax were associated with less heavy and less frequent drinking); however, the pattern of results was unchanged,” the authors wrote. It is unclear whether there’s any upper limit to the effect of increased taxes and associated drinking reductions, McKee said.
To be sure, there are other avenues for future research on other associated behaviors mentioned in the study like the rates of sex crimes and drunk driving among youth.
Although there are attempts to develop a safer cigarette underway, “smoking is the number one leading cause of morbidity in the U.S., and alcohol is the number three preventable cause of morbidity,” McKee said. “This study suggests that there are positive spillover effects to enacting these tax policies. If you can change one, you’re likely to change the other behaviour.”
Smokers are more likely to drink too much alcohol, particularly more vulnerable young men. With both behaviors so closely linked, what are the most effective strategies you use with your patients to curb binge drinking? Let us know by Adding Your Knowledge below. — Sanjay Gupta, MD
http://www.medpagetoday.com/theguptaguide/publichealth/40918