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ERIC JOHNSON: E-cigs’ risks are real while benefits are scant

By Eric Johnson, Op-Ed, Grand Forks Herald
GRAND FORKS — According to the Centers for Disease Control and the U.S. Surgeon General, tobacco kills about 480,000 persons every year in the United States.
In 1964, about 41 percent of adults were cigarette smokers. Today, that rate is down to a little more than 18 percent. Significant strides have been made over the past five decades to reduce smoking and the tremendous health and financial burden it puts on our society.
In North Dakota alone, tobacco use still contributes to about $250 million in health care expenditures.
Encouraging people to quit tobacco remains a high priority with regard to the health of Americans, yet only two states in the nation — Alaska and North Dakota — fund anti-tobacco programs at levels recommended by the CDC.
In North Dakota, our efforts continue to be supported by the public. Public sentiment, expressed at the ballot box and in polling, shows that reducing tobacco use remains a high priority for North Dakotans. In 2008, voters approved Measure 3 to support funding of anti-tobacco programs; and in 2012, the statewide smoke-free law — passed as a ballot measure — got 67 percent of the vote, winning support from a majority of voters in every legislative district.
Some 89 percent of North Dakotans polled in 2013 think the funds designated for tobacco control should stay there.
What works to help people quit tobacco? The U.S. Preventive Task Force and the Surgeon General endorse medications that have proven effectiveness with a known, Food and Drug Administration-approved, safety and side-effect profile.
These include nicotine replacement products such as gum, patches or lozenges, as well as prescription medications such as Chantix (Varenicline) or Wellbutrin (Buproprion).
Proven counseling programs, such as NDQuits (available free to all North Dakotans who use tobacco), also are very effective, particularly when combined with an FDA-approved medication.
Electronic cigarettes (e-cigs) are increasingly popular products that fall into the unproven category. First invented in the 1960s, their popularity has continued to increase as large tobacco companies buy small “mom-and-pop” manufacturers. With more than 250 brands on the market, (“Blu,” “NJOY” and “Vuse” popular in America), e-cigs are battery-powered (some disposable, some rechargeable) with a vaporizer and mouthpiece attached.
When used, commonly referred to as “vaping,” the vaporizer boils the liquid inside, which most frequently contains three major ingredients — humectants (propylene glycol/glycerin, used in fog and smoke machines and antifreeze), nicotine (at varying levels) and flavoring (fruit flavors, bubble gum, cotton candy, bacon and coffee, to name a few).
Unlike other medications that are used to promote quitting tobacco, e-cigs are largely unregulated by the Food and Drug Administration; and to date, we have no real data to show that they are effective as a cessation product nor any data to show that they are safe.
Furthermore, some of these manufacturers have been cited for contaminants in their products, including nickel, arsenic and chromium.
Without FDA oversight, these products aren’t taxed, they can be sold to anyone of any age, and there are no restrictions on advertising, which is why we see and hear ads on TV, in magazines and on the radio.
Though the industry denies it, it’s apparent that these products are being marketed to children (unless we’re supposed to believe that “Hello Kitty” e-cigs are popular among adult users).
E-cig manufacturers, rather than relying on science, really are trying to “normalize” smoking again for the next generation. The recent national Youth Tobacco Survey showed a spike in use of e-cigs by youth, doubling to more than 10 percent in just one year.
In addition, many who use e-cigs become dual users, continuing to use other tobacco products at the same time.
Last but not least, the industry is playing on the desperate idea that anything else would be better than smoking traditional cigarettes. If that’s true, ask yourself why these same companies are so resistant to producing the data to back up their claims.
It’s disappointing that e-cigs have been marketed for more than 35 years and have yet to collect or publish any significant data to show they are safe for users or that they actually help people quit.
Considering these products increasingly are manufactured and marketed by Big Tobacco, I’m not anticipating we’ll see such data any time soon.
The FDA has made it very clear that e-cigs cannot be marketed as smoking cessation products as a result.
As a health care provider, I would love a good, new and novel option to help people quit smoking. Like other conditions I treat as a physician, I want to provide the best possible treatment for my patients, and that means practicing strategies and using medications that have scientific proof that they work and have an established safety profile.
To date, when it comes to quitting tobacco, that answer is not found in electronic cigarettes.
Dr. Johnson is a family physician at Altru Health System in Grand Forks.
http://www.grandforksherald.com/content/eric-johnson-e-cigs-risks-are-real-while-benefits-are-scant

Letter: Big tobacco goes after ‘replacement smokers’

By: Beth Hughes, Bismarck, INFORUM
Even though the risks of using tobacco are well documented, it remains the No. 1 cause of preventable death and disease in the country. This year alone, nearly 500,000 Americans will die prematurely because of smoking. Unfortunately, tobacco marketing efforts recruit two new young smokers to replace each tobacco user who dies.
It’s well documented that tobacco companies market to youth in an effort to recruit “replacement smokers.” Research from the Centers for Disease Control and Prevention tells us that smoking and smokeless tobacco use are initiated and established primarily during adolescence. In fact, nearly 9 out of 10 smokers start smoking by the age of 18. Tobacco companies know this and continually look for new ways to hook our youth.
Tobacco companies pay convenience stores – many located near schools – and other tobacco retailers to prominently display advertisements for their products near the entrances, exits and checkouts. Tobacco companies also target a new generation of potential tobacco users by designing items to appeal to youth, such as fruit-flavored products in colorful packaging that make tobacco look and smell like candy.
In addition to new flavors and packaging, price is another factor that affects tobacco use. In states with low tobacco taxes, like North Dakota, it’s easier to make tobacco products affordable, and that makes it easier for youth to obtain tobacco. Research supported by the CDC and the American Lung Association shows that increasing a tobacco tax is one of the most effective ways to reduce youth tobacco use; by making tobacco less affordable, kids are less likely to buy it.
The Center for Tobacco Prevention and Control Policy uses media campaigns to educate the public about the dangers of tobacco use. The Center also works with local public health units across the state to educate our communities on tobacco prevention so our children live healthier lives as fewer of them become addicted to nicotine.
We are committed to preventing tobacco use among our youth and adult populations. We’ve made great progress, but there is more work to be done. Showing support for tobacco prevention efforts in your community is a great start to help reduce youth tobacco use rates. Here is what you can do:
• Support tobacco-free and smoke-free policies within your community. When youth are not exposed to tobacco, it increases their chance to remain tobacco free.
• Support policies that restrict how tobacco is marketed. Tobacco companies are aggressive marketers that target youth through retail displays, internet marketing and magazines that are popular with teens.
• Support tobacco tax increases. Our youth are less likely to use tobacco if it is less affordable.
These strategies are CDC Best Practice strategies – strategies that are proven to reduce youth tobacco use rates. We ask the community to join us in this fight by showing your support for tobacco prevention.

Hughes, Ph.D., is a registered respiratory therapist, and chairwomen, North Dakota Tobacco Prevention and Control Committee.
http://www.inforum.com/event/article/id/428702/group/Opinion/

U.S. Senators call for e-cigarettes advertising ban

​WASHINGTON – Last week U.S. Senator Tom Harkin (D-IA), chairman of the Senate Health, Education, Labor, and Pensions (HELP) Committee, joined Senators Barbara Boxer (D-CA), Dick Durbin (D-IL), Richard Blumenthal (D-CT) and Edward J. Markey (D-MA) in introducing the Protecting Children from Electronic Cigarette Advertising Act, a bill that seeks to prohibit the marketing of e-cigarettes to children and teens.
“When it comes to the marketing of e-cigarettes to children and teens, it’s ‘Joe Camel’ all over again,” said Harkin in a press release. “It is troubling that manufacturers of e-cigarettes — some of whom also make traditional cigarettes — are attempting to establish a new generation of nicotine addicts through aggressive marketing that often uses cartoons and sponsorship of music festivals and sporting events. This bill will take strong action to prohibit the advertising of e-cigarettes directed at young people and ensure that the FTC can take action against those who violate the law. While FDA regulation of these products remains critical, this legislation would complement oversight and regulation by the FDA, and ultimately help prevent e-cigarette manufacturers from targeting our children.”
“Tobacco companies advertising e-cigarettes — with flavors like bubblegum and strawberry — are clearly targeting young people with the intent of creating a new generation of smokers, and those that argue otherwise are being callously disingenuous,” Blumenthal said.
“We’ve made great strides educating young people about the dangers of smoking, and we cannot allow e-cigarettes to snuff out the progress we’ve made preventing nicotine addiction and its deadly consequences,” said Markey.
The senators noted in a press release that e-cigarettes are not subject to federal laws and regulations that apply to traditional cigarettes, including a ban on marketing to youth. The Protecting Children from Electronic Cigarette Advertising Act would permit the Federal Trade Commission (FTC) to determine what constitutes marketing e-cigarettes to children, and would allow the FTC to work with states attorneys general to enforce the ban.
In December, Senators Harkin, Durbin, Boxer, Blumenthal, Markey and Sherrod Brown (D-OH) sent a letter urging the FTC to investigate the marketing practices of e-cigarette manufacturers.
http://www.nacsonline.com/News/Daily/Pages/ND0303141.aspx#.UxSdH0JdXuc

Slick ways tobacco companies are targeting youth

By Carrie McDermott • Wahpeton Daily News

Although the tobacco industry states its marketing only promotes brand choices among adult smokers, they appear to be targeting youth with candy and fruit flavored tobacco products. Tobacco companies spend more than $1 million per hour in the United States alone to market their product, according to the U.S. Surgeon General’s Office.
Tobacco companies spend nearly $10 billion annually to advertise and promote their products in convenience stores, gas stations and other retail outlets. The marketing is very effective because two-thirds of teenagers visit a convenience store at least once a week, according to Tobacco Free Kids.
The Wilkin County Youth and Community Prevention Coalition recently shared examples of tobacco products packaged to mimic gum, candy and mints during its board meeting this month. Part of the group’s mission is to prevent and reduce tobacco usage by youth.
Naomi Miranowski, co-coordinator with YCPC, presented trays of candy, gum, breath mints and tobacco products, showing how closely the colors and packaging match.
“Tobacco companies are studying candy marketing to make their products appear safer,” she said. “One of my favorites is the new Camel Snus Frost. It looks like Ice Breakers Frost gum. Young people may think the Snus is okay as it resembles the gum in mom’s purse.”
Snus is a smokeless, moist powder tobacco product, similar to chew, consumed by placing it under the upper lip. The user gets a nicotine buzz on par with that of a cigarette. Unlike chew or dip, the user swallows the by-product rather than spitting it out. Snus is often produced in teen-friendly flavors such as cherry, apple and citrus.
Miranowski held up a recently redesigned box of Marlboro Black menthol cigarettes that uses the same mint green color packaging as Wrigley’s gum.
“They’re doing this purposely,” she said. “The general coloring is the same, bright green like the Mike and Ike’s candy. There are pinks, oranges and yellows that match candy colors.”
Skoal named one of their chews X-tra Mint, similar to Wrigley’s Extra gum. Other new smokeless tobacco products, which are dissolvable and easily concealed, include sticks, strips and orbs, that look like mints, breath strips and toothpicks.
She held up a three-pack of cigarillos that come in a bright pink package and are strawberry flavored. Another pack, grape flavored cigarillos, is bright purple and white. Even a cigar brand, Santa Fe, has a bright purple box.
Cigarillos are small cigars with sweet flavors, colorful packaging and cheap pricing. Brands include Swisher Sweets and Sugarillos, and come in flavors including peach, apple, grape and cherry.
Miranowski said she purchased the tobacco, candy and gum from the local Walmart and explained what she was doing to the clerk, who told her that young tobacco users, those who have recently turned 18 — the legal age to purchase tobacco – usually buy the fruit-flavored tobacco products.
“‘That’s what they go for,’ she told me,” Miranowski said. “They sell out of these things. Kids buy these because they’re cool.”
The YCPC board also examined an e-cigarette in black packaging.
“Stop ‘n’ Go sells a candy that matched the refills almost exactly,” she said. “It’s been eye-opening.”
She said she will use the examples to share during the Hidden in Plain Sight event that’s held at local high schools during their parent-teacher conference nights.
“I want these to be set out so parents can see what these are and how these tobacco products are not safe,” she said.
http://www.wahpetondailynews.com/news/article_92ec8fe0-a094-11e3-9da1-0019bb2963f4.html

A Hot Debate Over E-Cigarettes as a Path to Tobacco, or From It

By , The New York Times

Dr. Michael Siegel, a hard-charging public health researcher at Boston University, argues that e-cigarettes could be the beginning of the end of smoking in America. He sees them as a disruptive innovation that could make cigarettes obsolete, like the computer did to the typewriter.

But his former teacher and mentor, Stanton A. Glantz, a professor of medicine at the University of California, San Francisco, is convinced that e-cigarettes may erase the hard-won progress achieved over the last half-century in reducing smoking. He predicts that the modern gadgetry will be a glittering gateway to the deadly, old-fashioned habit for children, and that adult smokers will stay hooked longer now that they can get a nicotine fix at their desks.

These experts represent the two camps now at war over the public health implications of e-cigarettes. The devices, intended to feed nicotine addiction without the toxic tar of conventional cigarettes, have divided a normally sedate public health community that had long been united in the fight against smoking and Big Tobacco.

The essence of their disagreement comes down to a simple question: Will e-cigarettes cause more or fewer people to smoke? The answer matters. Cigarette smoking is still the single largest cause of preventable death in the United States, killing about 480,000 people a year.

Dr. Siegel, whose graduate school manuscripts Dr. Glantz used to read, says e-cigarette pessimists are stuck on the idea that anything that looks like smoking is bad. “They are so blinded by this ideology that they are not able to see e-cigarettes objectively,” he said. Dr. Glantz disagrees. “E-cigarettes seem like a good idea,” he said, “but they aren’t.”

Science that might resolve questions about e-cigarettes is still developing, and many experts agree that the evidence so far is too skimpy to draw definitive conclusions about the long-term effects of the devices on the broader population.

“The popularity is outpacing the knowledge,” said Dr. Michael B. Steinberg, associate professor of medicine at the Robert Wood Johnson Medical School at Rutgers University. “We’ll have a better idea in another year or two of how safe these products are, but the question is, will the horse be out of the barn by then?”

This high-stakes debate over what e-cigarettes mean for the nation’s 42 million smokers comes at a crucial moment. Soon, the Food and Drug Administration is expected to issue regulations that would give the agency control over the devices, which have had explosive growth virtually free of any federal oversight. (Some cities, like Boston and New York, and states, like New Jersey and Utah, have already weighed in, enacting bans in public places.)

The new federal rules will have broad implications for public health. If they are too tough, experts say, they risk snuffing out small e-cigarette companies in favor of Big Tobacco, which has recently entered the e-cigarette business. If they are too lax, sloppy manufacturing could lead to devices that do not work properly or even harm people.

And many scientists say e-cigarettes will be truly effective in reducing the death toll from smoking only with the right kind of federal regulation — for example, rules that make ordinary cigarettes more expensive than e-cigarettes, or that reduce the amount of nicotine in ordinary cigarettes so smokers turn to e-cigarettes for their nicotine.

“E-cigarettes are not a miracle cure,” said David B. Abrams, executive director of the Schroeder National Institute for Tobacco Research and Policy Studies at the Legacy Foundation, an antismoking research group. “They need a little help to eclipse cigarettes, which are still the most satisfying and deadly product ever made.”

Smoking is already undergoing a rapid evolution. Nicotine, the powerful stimulant that makes traditional cigarettes addictive, is the crucial ingredient in e-cigarettes, whose current incarnation was developed by a Chinese pharmacist whose father died of lung cancer. With e-cigarettes, nicotine is inhaled through a liquid that is heated into vapor. New research suggests that e-cigarettes deliver nicotine faster than gum or lozenges, two therapies that have never quite taken off.

Sales of e-cigarettes more than doubled last year from 2012, to $1.7 billion, according to Bonnie Herzog, an analyst at Wells Fargo Securities. Ms. Herzog said that in the next decade, consumption of e-cigarettes could outstrip that of conventional cigarettes. The number of stores that sell them has quadrupled in just the last year, according to the Smoke Free Alternatives Trade Association, an e-cigarette industry trade group.

“E-cigarette users sure seem to be speaking with their pocketbooks,” said Mitchell Zeller, director of the F.D.A.’s Center for Tobacco Products.

Public health experts like to say that people smoke for the nicotine but die from the tar. And the reason e-cigarettes have caused such a stir is that they take the deadly tar out of the equation while offering the nicotine fix and the sensation of smoking. For all that is unknown about the new devices — they have been on the American market for only seven years — most researchers agree that puffing on one is far less harmful than smoking a traditional cigarette.

But then their views diverge.

Pessimists like Dr. Glantz say that while e-cigarettes might be good in theory, they are bad in practice. The vast majority of people who smoke them now also smoke conventional cigarettes, he said, and there is little evidence that much switching is happening. E-cigarettes may even prolong the habit, he said, by offering a dose of nicotine at times when getting one from a traditional cigarette is inconvenient or illegal.

What is more, critics say, they make smoking look alluring again, with images on billboards and television ads for the first time in decades. Dr. Glantz says that only about half the people alive today have ever seen a broadcast ad for cigarettes. “I feel like I’ve gotten into a time machine and gone back to the 1980s,” he said.

Researchers also worry that e-cigarettes could be a gateway to traditional cigarettes for young people. The devices are sold on the Internet. The liquids that make their vapor come in flavors like mango and watermelon. Celebrities smoke them: Julia Louis-Dreyfus and Leonardo DiCaprio puffed on them at the Golden Globe Awards.

A survey from the Centers for Disease Control and Prevention found that in 2012, about 10 percent of high school students said they had tried an e-cigarette, up from 5 percent in 2011. But 7 percent of those who had tried e-cigarettes said they had never smoked a traditional cigarette, prompting concern that e-cigarettes were, in fact, becoming a gateway.

“I think the precautionary principle — better safe than sorry — rules here,” said Dr. Thomas Frieden, director of the C.D.C.

E-cigarette skeptics have also raised concerns about nicotine addiction. But many researchers say that the nicotine by itself is not a serious health hazard. Nicotine-replacement therapies like lozenges and patches have been used for years. Some even argue that nicotine is a lot like caffeine: an addictive substance that stimulates the mind.

“Nicotine may have some adverse health effects, but they are relatively minor,” said Dr. Neal L. Benowitz, a professor of medicine at the University of California, San Francisco, who has spent his career studying the pharmacology of nicotine.

Another ingredient, propylene glycol, the vapor that e-cigarettes emit — whose main alternative use is as fake smoke on concert and theater stages — is a lung irritant, and the effects of inhaling it over time are a concern, Dr. Benowitz said.

But Dr. Siegel and others contend that some public health experts, after a single-minded battle against smoking that has run for decades, are too inflexible about e-cigarettes. The strategy should be to reduce harm from conventional cigarettes, and e-cigarettes offer a way to do that, he said, much in the way that giving clean needles to intravenous drug users reduces their odds of getting infected with the virus that causes AIDS.

Solid evidence about e-cigarettes is limited. A clinical trial in New Zealand, which many researchers regard as the most reliable study to date, found that after six months about 7 percent of people given e-cigarettes had quit smoking, a slightly better rate than those with patches.

“The findings were intriguing but nothing to write home about yet,” said Thomas J. Glynn, a researcher at the American Cancer Society.

In Britain, where the regulatory process is more developed than in the United States, researchers say that smoking trends are heading in the right direction.

“Motivation to quit is up, success of quit attempts are up, and prevalence is coming down faster than it has for the last six or seven years,” said Robert West, director of tobacco studies at University College London. It is impossible to know whether e-cigarettes drove the changes, he said, but “we can certainly say they are not undermining quitting.”

The scientific uncertainties have intensified the public health fight, with each side seizing on scraps of new data to bolster its position. One recent study in Germany on secondhand vapor from e-cigarettes prompted Dr. Glantz to write on his blog, “More evidence that e-cigs cause substantial air pollution.” Dr. Siegel highlighted the same study, concluding that it showed “no evidence of a significant public health hazard.”

That Big Tobacco is now selling e-cigarettes has contributed to skepticism among experts and advocates.

Cigarettes went into broad use in the 1920s — and by the 1940s, lung cancer rates had exploded. More Americans have died from smoking than in all the wars the United States has fought. Smoking rates have declined sharply since the 1960s, when about half of all men and a third of women smoked. But progress has slowed, with a smoking rate now of around 18 percent.

“Part of the furniture for us is that the tobacco industry is evil and everything they do has to be opposed,” said John Britton, a professor of epidemiology at the University of Nottingham in England, and the director for the U.K. Center for Tobacco and Alcohol Studies. “But one doesn’t want that to get in the way of public health.”

Carefully devised federal regulations might channel the marketing might of major tobacco companies into e-cigarettes, cannibalizing sales of traditional cigarettes, Dr. Abrams of the Schroeder Institute said. “We need a jujitsu move to take their own weight and use it against them,” he said.

Dr. Benowitz said he could see a situation under which the F.D.A. would gradually reduce the nicotine levels allowable in traditional cigarettes, pushing smokers to e-cigarettes.

“If we make it too hard for this experiment to continue, we’ve wasted an opportunity that could eventually save millions of lives,” Dr. Siegel said.

Dr. Glantz disagreed.

“I frankly think the fault line will be gone in another year,” he said. “The evidence will show their true colors.”

http://www.nytimes.com/2014/02/23/health/a-hot-debate-over-e-cigarettes-as-a-path-to-tobacco-or-from-it.html?_r=0

Altria pushes forward on electronic cigarette sales

BY JOHN REID BLACKWELL
Richmond Times-Dispatch
U.S. tobacco giant Altria Group Inc. is pushing more aggressively into the electronic cigarette market, with plans to expand sales of its first e-cigarette brand nationally in the next few months.
Henrico County-based Altria, the parent company of cigarette maker Philip Morris USA, said Wednesday that it plans to start a national rollout of its MarkTen e-cigarette in the second quarter.

The expansion of MarkTen follows the company’s recent test marketing of the product in Indiana and Arizona.
It also follows Altria’s announcement on Feb. 3 that it would bolster its presence in the e-cigarette market — what some call the “e-vapor” category — by acquiring e-cigarette maker and distributor Green Smoke Inc. for $110 million in a deal expected to close in the second quarter.
MarkTen was Altria’s first venture into the e-cigarette category, which is still small compared with the market for conventional cigarettes.
Yet electronic cigarette sales have been growing quickly and are now estimated at between $1 billion and $2 billion a year. Numerous companies have introduced e-cigarette products.
“It really is early days in e-vapor,” Marty Barrington, Altria’s chairman and CEO, said in a presentation to industry analysts and investors on Wednesday.
“Consumers are still choosing. They are trying to find their product. They are trying to find their brand,” Barrington said, adding that Altria’s goal is to be a leader in the e-cigarette category no matter how much it grows.
MarkTen is made by Altria’s product-development subsidiary, Nu Mark.
That company started test-marketing the e-cigarette in Indiana last August. In December, it expanded the test market to Arizona and made improvements to the product, including a new flavor system and adding a battery charger to the package.
“We are really happy with the performance,” Barrington said, noting that MarkTen has achieved a market share of 48 percent in only seven weeks of sales in Arizona.
Unlike conventional cigarettes, e-cigarettes do not burn tobacco or contain tobacco leaf. The battery-powered devices heat a liquid solution containing nicotine, artificial flavorings, and propylene glycol or vegetable glycerine, which creates a vapor that is inhaled by the smoker, or “vaper.”
Barrington has spoken cautiously to investors and analysts about the potential for e-cigarettes because the category’s growth could be affected by consumer acceptance, taxes and government regulation. The U.S. Food and Drug Administration is considering how it might regulate e-cigarettes.
FDA regulation remains a “wild card” for e-cigarettes because restrictive regulation by the federal agency could slow down marketing efforts in the category, said Steve Marascia, director of research at Capitol Securities Management Inc. in Henrico.
While the extent to which e-cigarette sales will grow remains unclear, “the tobacco companies need to do something, because they are looking at 3 to 4 percent volume declines in (conventional) cigarettes going forward, and they need to offset that,” Marascia said.
Barrington said Altria estimates that about 90 percent of adult cigarette smokers are aware of e-cigarettes and about two-thirds have tried them, but only a small number use them daily.
Yet Altria’s decision to expand its MarkTen sales and acquire Green Smoke may indicate that the company’s leaders have become more optimistic about the category, said industry analyst Bonnie Herzog of Wells Fargo Securities.
“Given early success of MarkTen in Arizona where the brand supposedly grew to 48 percent share, (Altria) seems more emboldened to ‘play to win’ in this new category, and ultimately we believe (the company’s) full participation will catapult growth of the category,” Herzog wrote in a note to investors.
http://www.timesdispatch.com/business/tobacco-industry/altria-pushes-forward-on-electronic-cigarette-sales/article_6f5fe50c-9975-11e3-91f3-001a4bcf6878.html

TobacNo! Surgeons General and Teens Unite for a Tobacco-Free Generation

By: Chelsea-Lyn Rudder , HuffPost IMPACT Blog
Last week, the Food and Drug Administration released its first youth-oriented anti-tobacco campaign. Unlike previous campaigns, “The Real Cost” does not feature images of smoking-related illnesses, such as cancer and emphysema. In an effort to put a new twist on prevention, “The Real Cost” will attempt to appeal to the millennial generation’s sense of vanity and dignity. Forget the old-school ads, which showed ailing elderly adults and morbid images like body bags in a morgue. “The Real Cost” reminds teens that cigarettes and other tobacco products will rob them of their good looks and bully them into becoming addicted to nicotine. One of the ads features a personified cigarette who pesters a teenage boy, who is trying to spend time with friends, until he gives into his addiction to nicotine and goes outside to smoke.
Everyone hates a bully these days, and I applaud the FDA’s attempt at innovation, but young people know that the real life costs of smoking go beyond trivial and cosmetic implications. The question still remains: How can we move beyond gimmicks and get young people to stop using tobacco products once and for all?
Ritney Castine, 27, has firsthand experience with the real costs of tobacco use. And as a result, has spent most of his life trying to answer that question: “My uncle, who I cared about very deeply died of lung cancer. I wanted to know, what it was that took my uncle away from me. Turns out, it was his lifelong addiction, of smoking a pack of Marlboro cigarettes a day.” Ritney’s uncle passed away when he was only 10 years old, but his death inspired Ritney’s palpable spirit of activism. As a student, Ritney campaigned against the tobacco industry throughout his home state of Louisiana. He was instrumental in the lobbying process, which resulted in a statewide ban against smoking in public places with the exception of bars and casinos. Ritney is now the Associate Director of Youth Advocacy for the Campaign for Tobacco-Free Kids, a not-for-profit based in Washington, D.C.
This week, Ritney will head back to Louisiana to participate in a summit on February 11 in New Orleans, which marks the 50th anniversary of the surgeon general’s landmark tobacco report. “TobacNo! Tobacco-Free Generation” will bring together former surgeons general, current Acting Surgeon General Dr. Boris Lushniak and tobacco-free youth advocates to review the legacy of the 1964 report and to develop strategies to end tobacco use amongst future generations. The summit is hosted by Xavier University of Louisiana and the Louisiana Cancer Research Center. The event is open to the public and will be live-streamed at TobaccoSummit.com.
Last week tobacco-free advocates scored a big win with the announcement of CVS’s plan to remove all tobacco products from its stores. Calling the sale of tobacco products “inconsistent with our key purpose — helping people on their path to better health,” CVS says that tobacco products will no longer be available at their pharmacies after October 1 of this year. Former Surgeon General Dr. Regina Benjamin, lead organizer of “TobacNo,” issued a statement commending CVS’s actions and urging other companies to take the same steps. “We in public health hope others will follow the CVS example because it will make a difference and help our next generation become tobacco-free.”
http://www.huffingtonpost.com/chelsealyn-rudder/tobacno-project_b_4757628.html?utm_hp_ref=impact&ir=Impact

E-cigarettes: Are manufacturers using flavors to lure minors to vape?

By Ivey DeJesus | idejesus@pennlive.com , The Patriot-News, Central PA

To understand the concern that the marketing of electronic cigarettes might lure minors into a life of nicotine addiction, consider some of the flavors: cherry, bubble gum, cola, milk chocolate and sugar cookie.
Since their introduction into the U.S. market in 2009, e-cigarettes have grown exponentially in popularity and sales, to the tune of $1.7 billion. Legions of lifelong users have converted to vaping, trading the tar and carcinogens of cigarettes for the seemingly safer alternative.
But with such an aforementioned variety of flavors in e-cigarettes, health experts, substance abuse prevention officials and lawmakers are increasingly concerned that e-cigarette manufacturers are targeting teens.
“They are adding all these interesting flavors and they are pandering to people who are nonsmokers or more specifically kids,” said Dr. Richard Bell, a Berks County pulmonologist and a member of the Pennsylvania Medical Society. “I’m not sure an adult would be attracted to a bubblegum flavor cigarette.”
Bell echoes widely held concerns in the public health community that Big Tobacco is increasingly marketing the electronic devices to minors — using many of the same promotional techniques it used to hook generations to cigarettes — with television and magazine ads, sports sponsorships and cartoon characters.
“Whether e-cigarettes can safely help people quit smoking is also unknown, but with their fruit and candy flavors, they have a clear potential to entice new smokers,”The American Medical Association recently opined.
E-cigarettes are not subject to the federal ban on television advertising. Those calling for action say that much the same same way Big Tobacco used the Marlboro Man, Joe Camel and attractive celebrities to promote their product, e-cigarette manufacturers are doing with modern-day celebrities. 
The market saturation amazes Linda Doty, prevention specialist with the Cumberland Perry County Drug and Alcohol Commission. Doty recently Googled e-cigarettes near her Carlisle office and learned that between the West Shore and Newville, there are 100 e-cigarette retailers, the majority of them convenience stores, which draw heavy traffic from young people stopping in for sodas and snacks.
Doty said she is concerned that the increase in young e-cigarette users is playing out amid a dearth of medical evidence regarding their safety. She said a recent study by the the Smoking and Health Behavior Research Laboratory at the Pennsylvania State University found that 20 percent of middle school students who had tried e-cigarettes said they had never smoked regular cigarettes.
“Even e-cigarette manufacturers recommend that breast-feeding women and those with health complications not use the products,” Doty said. “To me that’s an acknowledgment that this could have potential for harm.”
Indeed, a study last year by the U.S. Centers for Disease Control and Prevention found that use of e-cigarettes among teens in 2012 had more than doubled from the previous year. However, at the same time, cigarette smoking among teens continued to decline.
Currently, no federal or state law governs the sale of e-cigarettes. A bill in the state Senate would restrict the sale of the devices to people 18 and older.
Harrisburg resident Keith Kepler challenges the notion that e-cigarettes — and their fruity, candy flavored choices — will lure kids into smoking.
“I’m 57 and, doggone it, I still like strawberry and chocolate,” said Kepler, who began to smoke at 14 and recently quit with the help of e-cigarettes. “That’s the most ridiculous thing I’ve heard of. I still chew bubble gum. You’re telling me we can’t have things flavored bubble gum, because it will lure kids? I don’t get that.”
http://www.pennlive.com/midstate/index.ssf/2014/02/post_662.html

Officials hope to educate on e-cigarettes

By Matthew Liedke • Daily News
Advocates pushing for tobacco prevention are now having to deal with a new device on the market that isn’t subject to the same regulations as traditional cigarettes.
Jennifer Mauch, Richland County Tobacco Prevention coordinator, said a rising issue is e-cigarettes, and how traditional companies seem to be getting more and more involved.
“Altria, which produces Marlboro products, is among other large tobacco companies that are buying e-cigarette manufacturers,” Mauch said. “I’ve been looking back at the way traditional tobacco products were advertised and the advertising for e-cigarettes seems very much like a repeat.
“I think they are seeing that this is where the market is going, so they are buying it up,” said Mauch, who added that e-cigarettes make up 1 percent of national smoking sales.
The problem with these devices, Mauch explained, is the Food and Drug Administration doesn’t regulate e-cigarette products, as they don’t contain tobacco. This leads to not even knowing what is in the e-cigarette.
“They may be in fact safer than traditional cigarettes, but we just don’t know,” Mauch said. “The issue is that we don’t know how much nicotine is in them, or what else is in them. There are some who say they don’t contain any nicotine, but we don’t know if that’s the case.”
The laws in the different states throughout the country also give challenges to regulating the e-cigarette product. In North Dakota, Mauch explained, there is no age restrictions on the products which she called “a major gateway.”
North Dakota was proactive in another law, though, which bans using e-cigarettes inside all places that traditional tobacco products are not allowed. However, in other states, such as Minnesota, it can still be used inside such places.
“The fear is that it’s becoming a social norm again,” Mauch said. “So it’s like moving backwards.
Currently, Mauch said the best thing she can do is educate the public about e-cigarettes.
“It always starts small,” Mauch said. “At this point we are just trying to educate people and have them realize that we don’t know if this is a safe product yet, so proceed with caution if you plan to use it. Unless they are studied further and regulated, we really want to get people to notice the education that is out there and be careful.”
In terms of her own office dealing with the situation, Mauch said she is currently working with communities and schools to get youth tobacco ordinances in place, which add e-cigarettes to the definitions of tobacco products.
http://www.wahpetondailynews.com/news/article_2055b402-9117-11e3-8f2b-001a4bcf887a.html

FDA launching $115M multimedia education campaign showing at-risk youth 'real cost' of smoking

By MICHAEL FELBERBAUM  AP Tobacco Writer
WASHINGTON — The Food and Drug Administration is using ads depicting wrinkled skin on youthful faces and teenagers paying for cigarettes with their teeth in a campaign to show the nation’s young people the costs associated with smoking.
The federal agency said Tuesday it is launching a $115 million multimedia education campaign called “The Real Cost” that’s aimed at stopping teenagers from smoking and encouraging them to quit.
Advertisements will run in more than 200 markets throughout the U.S. for at least one year beginning Feb. 11. The campaign will include ads on TV stations such as MTV and print spots in magazines like Teen Vogue. It also will use social media.
“Our kids are the replacement customers for the addicted adult smokers who die or quit each day,” said Mitch Zeller, the director of the FDA’s Center for Tobacco Products. “And that’s why we think it’s so important to reach out to them — not to lecture them, not to throw statistics at them — but to reach them in a way that will get them to rethink their relationship with tobacco use.”
Zeller, who oversaw the anti-tobacco “Truth” campaign while working at the nonprofit American Legacy Foundation in the early 2000s, called the new campaign a “compelling, provocative and somewhat graphic way” of grabbing the attention of more than 10 million young people ages 12 to 17 who are open to, or are already experimenting with, cigarettes.
According to the FDA, nearly 90 percent of adult smokers started using cigarettes by age 18 and more than 700 kids under 18 become daily smokers each day. The agency aims to reduce the number of youth cigarette smokers by at least 300,000 within three years.
“While most teens understand the serious health risks associated with tobacco use, they often don’t believe the long-term consequences will ever apply to them,” said FDA Commissioner Margaret Hamburg. “We’ll highlight some of the real costs and health consequences associated with tobacco use by focusing on some of the things that really matter to teens — their outward appearance and having control and independence over their lives.”
Two of the TV ads show teens walking into a corner store to buy cigarettes. When the cashier tells them it’s going to cost them more than they have, the teens proceed to tear off a piece of their skin and use pliers to pull out a tooth in order to pay for their cigarettes. Other ads portray cigarettes as a man dressed in a dirty white shirt and khaki pants bullying teens and another shows teeth being destroyed by a ray gun shooting cigarettes.
The FDA is evaluating the impact of the campaign by following 8,000 people between the ages of 11 and 16 for two years to assess changes in tobacco-related knowledge, attitudes and behaviors.
The campaign announced Tuesday is the first in a series of campaigns to educate the public about the dangers of tobacco use.
In 2011, the FDA said it planned to spend up to $600 million over five years on the campaigns aimed at reducing death and disease caused by tobacco, which is responsible for about 480,000 deaths a year in the U.S. Future campaigns will target minority youth, lesbian, gay, bisexual and transgender youth and youth in rural areas.
Tobacco companies are footing the bill for the campaigns through fees charged by the FDA under a 2009 law that gave the agency authority over the tobacco industry.
 http://www.therepublic.com/view/story/e2170c9ad67b4bc08ab8228b121857ea/US–FDA-Tobacco-Campaign