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North Dakota ranks poorly in smokeless tobacco use

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

Cigarette tax and e cigarettes debated in ND legislature

By KX News

Bismarck, ND -A bill that would have substantially raised taxes on cigarettes in North Dakota failed Friday afternoon.
But two others limiting access to electronic cigarettes passed.
The proposed cigarette tax would have raised taxes more than 200 percent on a package of cigarettes.
Currently the cigarette tax in North Dakota is 44 cents.
By contrast, the tax in Minnesota is 2.90 and in South Dakota it’s a 1.53.
Supporters of the bill say the increase would reduce the number of smokers and lower health care costs.
“Whenever a tobacco tax is increased, smoking, especially youth smoking goes down and it goes down dramatically. That I believe is undeniable,” says Rep. Jon Nelson, R – Rugby.
Bill opponents argued that a tax won’t stop smoking, and burdens business.
“If it truly is our duty to coerce people into a healthy lifestyle through taxation, why don’t we tax fast food with high fat content and high cholesterol, all things supersized and salt,” says Rep. Rick Becker, R – Bismarck.
The cigarette tax bill failed by a 56-34 vote.
The house passed two bills designed to keep e-cigarettes away from kids.
The two bills differ in these ways —
One labels e-cigarettes as tobacco products, tying them to the laws and enforcement already in place for cigarettes.
Those laws include things like compliance checks from local police and how cigarettes are displayed in stores.
The other bill separates e-cigarettes into their own category with their own set of enforcement laws.
“I don’t know how we can separate the idea of discussing e-cigarettes and then we’re going to talk about the taxing of tobacco when it’s clearly a tobacco product,” says Rep. Kenton Onstad, D – Parshall.
“We do not want kids under the age of 18 to buy cigarettes, whether it be on the internet, whether it be in the store. E-cigarettes, anywhere. We don’t want them to by regular cigarettes, we don’t want them to buy e-cigarettes,” says Rep. Al Carlson, R – Fargo.
Both bills now move to the Senate where only one, if any, is likely to pass.
http://www.wdaz.com/news/north-dakota/3679119-cigarette-tax-and-e-cigarettes-debated-nd-legislature

Senators Hear Tobacco Tax Bill

By Steph Scheurer, Reporter, KX News
State senators hear a bill to increase the tax on tobacco.
If passed, the tax on a pack of cigarettes would increase to two dollars.
“I support this bill whole-heartedly,” says Valerie Schoepf, Vice President, Tobacco Free Coalition.
Valerie Schoepf is Vice President of the Tobacco Free Coalition.
Today she shares her personal story in favor of a tobacco tax incentive bill.
“I was 14 years old and a freshman in high school when my dad passed away from lung and brain cancer. He got hooked as a smoker growing up in Parshall North Dakota and he was a lifelong smoker,” says Schoepf.
Senate Bill 2322 would increase taxes on tobacco products from 28 percent to 50 percent.
For cigarettes, the tax would go from 44 cents to two dollars a pack.
“The research without question says it is the cost of tobacco that drives its use,” says Tim Mathern, District 11 Senator.
The bill also adjusts the definition of other tobacco products to include new tobacco and tobacco driven products, like e-cigarettes.
Schoepf says three components are needed to prevent people from taking up smoking.
“Price, tobacco free environments, and education. North Dakota’s doing great on two of those but we’re missing that third leg and that’s diluting those other A plus efforts,” says Schoepf.
“Having one of the lowest tobacco taxes in the nation is not something that we should be proud of. It’s time to raise the tobacco tax for the health of our state and to help protect our youth from a lifelong addiction to nicotine and the deadly consequences of tobacco,” Kristie Wolff, Program Manager, American Lung Assoc. ND.
Not everyone agrees with raising the tobacco tax however.
Mike Rud, President of the North Dakota Retailers Association says North Dakota’s economy is strong and is the last state that needs a business tax increase of any kind.
“Increasing the excise tax could hurt legitimate retailers when adult smokers shift purchases across state lines or to other outlets and as you heard today, at two dollars a pack, we would now be higher than South Dakota and Montana,” says Mike Rud, President, ND Retailers Assoc.
For Carol Two Eagle, tobacco is a part of her daily spiritual life.
“When you tax tobacco, you’re taxing something that’s essential for our religious practice and that’s unconstitutional. I am not sure how you’re going to get around this. but it needs to be addressed because we are the only group in North America, traditional indians, who require this material. Tobacco in our way is holy,” Carol Two Eagle.
Over a dozen people shared their viewpoint with legislators – some for the bill, and some against…
Sponsoring senators say the bill would save an estimated one billion dollars in healthcare costs over the next 10 years.
If passed, the new tobacco tax revenue would be deposited in a state general fund and legislators would decide how the revenue is to be spent.
The bill would exclude FDA approved cessation products like patches and lozenges.
To read more or watch video: http://www.kxnet.com/story/28027041/senators-hear-tobacco-tax-bill

Teen tobacco users likely to use it in multiple forms

By Reuters Media

A national survey of U.S. middle and high school students finds that those who use tobacco or nicotine products are likely to also use more than one type of product.

About 15 percent of the adolescents reported smoking cigarettes, cigars, pipes, bidis, hookahs or water pipes, using dissolvable forms of tobacco or “vaping” e-cigarettes. And twice as many in that group used two or more of these product types compared to those who said they used only one.

“Our study really shows that kids are using more than one of these products at the same time,” said Youn Ok Lee of RTI International in Research Triangle Park, North Carolina, the report’s lead author.

Lee said there are many varieties of tobacco products available. And each type of product also has a diverse range of options, such as flavors.

“So we don’t really know a lot about how this range of products might affect kids’ use of tobacco,” she told Reuters Health.

Using data from a 2012 national survey of nearly 25,000 U.S. students, researchers found that about 7 percent reported using one tobacco product in the past 30 days. About 4 percent said they used two tobacco products in that time. Another 4 percent said they used three or more products.

“I was a little bit surprised by just how many kids were using more than one product,” Lee said. “Even more surprising was that using three or more products is more popular than using cigarettes alone.”

Overall, about 3 percent of kids exclusively used cigarettes and about 2 percent exclusively used cigars. Those products were the most popular and their use increased with age.

The study team also found that almost 1 percent of students reported exclusively using e-cigarettes, which contain no tobacco but deliver a vapor laced with nicotine, the addictive substance in tobacco.

That’s more than the 0.4 percent who reported using e-cigarettes in combination with traditional cigarettes.

The increasing popularity of e-cigarettes is a concern for U.S. health officials as use has tripled between 2013 and 2014.

Lee noted that the results don’t tell why young people are using more than one form of tobacco, or how often the survey participants had used the products.

The researchers did find that being a boy, using flavored products, being dependent on nicotine, being receptive to advertising and having friends who used any tobacco products were all factors linked to an increased risk of using more than one product.

Policymakers and researchers should look at how these products affect tobacco use among middle and high school students, said Lee, because little is known about the influence of non-cigarette products.

Moreover, these products may create a public health issue by introducing people who would never have smoked cigarettes to nicotine, she said.

Lee emphasized that it’s important to look at all tobacco products together – not individually.

SOURCE: http://bit.ly/1za0ykL Pediatrics, online February 2, 2015.

http://www.inforum.com/news/3671610-teen-tobacco-users-likely-use-it-multiple-forms

Opinion: Raise tobacco tax

By: REBEKAH HARTMAN, Mandan
It is time for North Dakota to raise the tobacco tax. I know firsthand that raising the price is an effective way to help people quit smoking.
I am personally affected by our state’s low rate of tobacco taxes as my husband is in a constant struggle to battle his addiction to tobacco. When we lived in Minnesota, the price of cigarettes was high enough that buying a pack forced him to stop and think about what — exactly — the money was going for and if there was a better way to spend the dollars. Now that we’re in North Dakota, where the cigarette prices are shockingly low, there is little pause when deciding to buy a pack.
I’m urging our state legislators to support the proposals before them to increase the state tobacco taxes. Our elected officials should seize the opportunity to increase taxes on all tobacco products as it would reduce smoking rates, support countless people who are desperately trying to break their addiction, and ultimately lower health care costs for all North Dakotans.
http://bismarcktribune.com/news/opinion/mailbag/raise-tobacco-tax/article_7d15ce12-df00-50f2-a0e2-47a0658cfa34.html

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

By Samantha Olson, Medical Daily

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

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

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

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

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

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

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

Source: Cosgrove K. Journal of Neuroscience. 2014.

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

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

By Editorial Board, The Washington Post

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

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

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

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

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

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

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

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

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

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

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

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

Forum editorial: Close off e-cig sales to minors

Fargo Forum Editorial

The Legislature should follow the lead of several North Dakota cities and ban the sale of e-cigarettes to minors. As it stands now, even with sales bans in Fargo, Bismarck, Casselton, Mapleton and other cities, e-cigs can be (and likely are being) sold to minors all over the state. It’s a gaping loophole in a state law that in every other way treats e-cigs like tobacco products.

E-cigs are touted as an effective option for tobacco users to get off cigarettes, although the research is inconclusive. But they also appeal to kids because they are used by some minors for “vaping,” which kids think is “cool,” according to public health experts. E-cigs don’t contain tobacco, but they can be nicotine delivery devices. Often the substances in e-cigs include candy flavors. There is little doubt the products are aimed at adolescents, according to new research. And kids are taking them up at alarming rates.

That being said, e-cig sellers in Fargo insist it is against company policy to sell to anyone under age 18, no matter what a state’s law or city’s ordinances allow or prohibit. In fact, e-cig retailers say they want a state law that bans sales to minors, and will work with legislators in the upcoming session.

While the retailers’ public attitude is good news, questions remain. Where are kids getting e-cigs? Why is use up among minors? Who is policing what?

Most troubling: There is no question e-cigs are a gateway to smoking among teens. New studies indicate that as more minors try e-cigs (up in several states), chances increase that they will try tobacco and get hooked. Nicotine, whether in an e-cig or a cigarette, is addictive. It should come as no surprise that big tobacco companies are in the e-cig business.

The state of North Dakota, with what appears to be support from e-cig sellers, should close the sales-to-minors loophole. Without informed and firm action, e-cigs could erode the progress that’s been made to reduce tobacco use in the 50 years since the first surgeon general’s report revealed the health risks of smoking.

Forum editorials represent the opinion of Forum management and the newspaper’s Editorial Board.

http://www.inforum.com/opinion/3637026-forum-editorial-close-e-cig-sales-minors

E-Cigarette Use on Rise for Teenagers, Study Finds

The New York Times, By SABRINA TAVERNISE

WASHINGTON — A new federal survey has found that e-cigarette use among teenagers has surpassed the use of traditional cigarettes, even as smoking of traditional cigarettes has continued to decline. Health advocates say the upward trend for e-cigarette use is dangerous because it is making smoking seem normal again. They also worry it could lead to an increase in smoking of traditional cigarettes, though the new data do not show that.

The survey, released Tuesday by the National Institute on Drug Abuse, measured drug and alcohol use this year among middle and high school students across the country. More than 41,000 students from 377 public and private schools participated. It is one of several such national surveys, and the most up-to-date.

It was the first time this survey measured e-cigarette use, so there were no comparative data on the change over time. Other surveys have shown e-cigarette use among middle and high school students to be much lower, but increasing fast.

“The numbers are stunning,” said Matthew L. Myers, president of the Campaign for Tobacco Free Kids, an advocacy group.

The survey found that 17 percent of 12th graders reported using an e-cigarette in the last month, compared with 13.6 percent who reported having an traditional cigarette. Among 10th graders, the reported use of e-cigarettes was 16 percent, compared with 7 percent for cigarettes. And among 8th graders, reported e-cigarette use was 8.7 percent, compared with just 4 percent who said they had smoked a cigarette in the last month.

A 2013 youth tobacco survey by the federal Centers for Disease Control and Prevention released in November found that the share of American high school students who use e-cigarettes rose to 4.5 percent in 2013 from 2.8 percent in 2012. The share of middle school students who use e-cigarettes remained flat at 1.1 percent over the same period.

The gap between the two sets of findings was substantial, and researchers struggled to explain it. Both are broad, reliable federal surveys that go back years, and their methodologies do not differ greatly. The drug abuse institute uses individual school grades, while the disease centers combine grades, which may account for some of the difference.

Some experts said that the new data suggested the rate may have increased substantially since 2013, though it will be impossible to know for sure until the C.D.C. releases its 2014 data sometime next year.

E-cigarettes have split the public health world, with some experts arguing that they are the best hope in generations for the 18 percent of Americans who still smoke to quit. Others say that people are using them not to quit but to keep smoking, and that they could become a gateway for young people to take up real cigarettes.

But that does not seem to be happening, at least so far. Daily cigarette use among teenagers continued to decline in 2014, the survey found, dropping across all grades by nearly half over the past five years. Among high school seniors, for example, 6.7 percent reported smoking cigarettes daily in 2014, compared with 11 percent five years ago.

Most experts agree that e-cigarettes are far less harmful than traditional cigarettes. But they contain nicotine, an addictive substance that some experts contend is potentially harmful for brain development. Some experts also warn that nicotine use could establish patterns that leave young people more vulnerable to addiction to other substances.

The survey found significant declines in the use of other drugs. Among high school seniors, about 6 percent reported having taken a prescription drug, substantially down from the peak of 9.5 percent in 2004. Abuse of Vicodin, the opioid pain reliever, declined by nearly half among 12th graders over five years.

In states with medical marijuana laws, 40 percent of high school seniors who reported using marijuana in the past year said they had consumed it in food, compared with 26 percent in states without such laws.

http://www.nytimes.com/2014/12/17/science/national-institute-on-drug-abuse-e-cigarette-study.html?_r=0

USA Today – Our View: E-cigarettes cloud progress on teen smoking

USA Today Editorial Board

E-cigarettes, once seen as a harmless alternative to tobacco smoking, are beginning to look more like a new gateway to addiction.

This year, for the first time, more teens used electronic cigarettes than traditional ones: 17% of high school seniors used the devices, vs. 14% who smoked cigarettes. Kids in eighth and 10th grades favored them 2-to-1 over traditional smokes, according to an eye-opening University of Michigan survey released Tuesday.

In one sense, there is good news. Teen smoking hit a record low last year after a steady decline since the late 1990s, leaving fewer teens vulnerable to the risk of cancer, heart disease and emphysema that comes with tobacco use. But e-cigarettes are a troubling alternative.

Just as scientists didn’t grasp the danger of tobacco when the nation was becoming addicted, they don’t fully understand the risks posed by e-cigarettes now.

One is obvious: addiction.

E-cigs, battery-powered nicotine inhalers that produce a vapor cloud, could be every bit as addictive as tobacco. With sales skyrocketing to $754 million, 30 times five-year-ago levels, and tobacco giants Altria and Reynolds entering the business, millions of people are getting hooked.

This is particularly a problem during the teen years because that is when nearly all smokers pick up their habit.

For manufacturers, the logic is inescapable: Addict a teenager and you could have a customer for life; miss the moment and you have no customer at all. So in ways subtle and not so subtle, e-cigarette makers have applied Big Tobacco’s advertising and marketing practices.

One prominent tactic is their use of celebrities — including former Playboy centerfold Jenny McCarthy, singer Courtney Love, actor Stephen Dorff and teen heartthrob Robert Pattinson of Twilight fame — to make “vaping” look sexy and rebellious.

No one knows how dangerous this is because with federal oversight missing, no one knows exactly what’s in the devices, some made in China. A Japanese study found hazardous substances in the vapor at higher levels than in cigarette smoke.

There are obvious ways to address the problem, starting with attention from the newly confirmed surgeon general, Vivek Murthy, and analysis by the Food and Drug Administration of e-cigarette content. Both worked with tobacco but could be thwarted by a Congress rigidly opposed to regulation.

Alternatively, states could fill the breach. Nearly a dozen still allow e-cigarette sales to minors when they plainly should not. They could also use the 1998 tobacco settlement negotiated with the industry long before e-cigarettes existed. The accord defines covered products in a way that includes e-cigarettes, because nicotine is derived from tobacco.

By invoking the settlement, state attorneys general would be able to clamp down on marketing that’s targeted at youth, including certain celebrity promotions, concert sponsorships and access to free samples.

After a decades-long battle against youth smoking, it would be tragic to see a new generation of teens hooked on a different but potentially dangerous substitute.

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/2014/12/16/e-cigarettes-teen-smoking-university-of-michigan-editorials-debates/20485297/