Reuters: No change in tobacco use among U.S. youth; e-cigarettes preferred

CHICAGO (Reuters) – Overall tobacco use among U.S. middle and high school students has not changed since 2011, a period in which use of electronic cigarettes increased dramatically, U.S. health officials said on Thursday.

Given that most adult smokers begin using tobacco before age 20, health officials are concerned over the lack of progress in reducing tobacco use among U.S. youth.

According to the latest data from the U.S. Centers for Disease Control and Prevention and the U.S. Food and Drug Administration’s Center for Tobacco Products, 3 million middle and high school students reported using e-cigarettes in 2015, compared with 2.46 million in 2014.

“E-cigarettes are now the most commonly used tobacco product among youth, and use continues to climb,” CDC Director Dr. Tom Frieden said in a statement.

“No form of youth tobacco use is safe. Nicotine is an addictive drug and use during adolescence may cause lasting harm to brain development.”

The FDA, which currently regulates most conventional tobacco products, is finalizing regulations that would bring e-cigarettes under its authority.

Mitch Zeller, of the FDA’s Center for Tobacco Products, said the agency “remains deeply concerned” about the overall high rate at tobacco use among youth and said finalizing those regulations “is one of FDA’s highest priorities.”

Increases in e-cigarette use in 2015 were largely driven by higher use among middle school students, a group in which use of the devices climbed to 5.3 percent in 2015 from 3.9 percent in 2014. There was no change in e-cigarette use among high school students between 2014 and 2015, following a dramatic 13.4 percent increase in 2014.

Overall, data from the 2015 survey show that 4.7 million middle and high school students used at least one tobacco product in the past 30 days, and more than 2.3 million of those students used two or more tobacco products.

There was no significant change in cigarette smoking habits among middle and high school students between 2014 and 2015, with 9.3 percent of high school students and 2.3 percent of middle school students saying they smoked cigarettes.

“Given that the use of e-cigarettes is on the rise among middle and high school students and nicotine exposure from any source is dangerous for youths, it is critical that comprehensive tobacco control and prevention strategies for youths address all tobacco products and not just cigarettes,” study authors wrote in the CDC’s weekly Morbidity and Mortality report.

(Reporting by Julie Steenhuysen; Editing by Dan Grebler)

CDC: No decline in overall youth tobacco use since 2011

Overall tobacco use by middle and high school students has not changed since 2011, according to new data published by the Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration’s (FDA) Center for Tobacco Products in today’s Morbidity and Mortality Weekly Report (MMWR).

Data from the 2015 National Youth Tobacco Survey show that 4.7 million middle and high school students were current users (at least once in the past 30 days) of a tobacco product in 2015, and more than 2.3 million of those students were current users of two or more tobacco products. Three million middle and high school students were current users of e-cigarettes in 2015, up from 2.46 million in 2014.

Sixteen percent of high school and 5.3 percent of middle school students were current users of e-cigarettes in 2015, making e-cigarettes the most commonly used tobacco product among youth for the second consecutive year. During 2011 through 2015, e-cigarette use rose from 1.5 percent to 16.0 percent among high school students and from 0.6 percent to 5.3 percent among middle school students.

From 2011 through 2015, significant decreases in current cigarette smoking occurred among youth, but there was no significant change in the prevalence of current cigarette smoking among this group during 2014 – 2015. In 2015, 9.3 percent of high school students and 2.3 percent of middle school students reported current cigarette use, making cigarettes the second-most-used tobacco product among both middle and high school students.

“E-cigarettes are now the most commonly used tobacco product among youth, and use continues to climb,” said CDC Director Tom Frieden, M.D., M.P.H. “No form of youth tobacco use is safe. Nicotine is an addictive drug and use during adolescence may cause lasting harm to brain development.”

Students use many forms of tobacco

In addition to e-cigarettes and cigarettes, high school students used other tobacco products:

  • 8.6 percent smoked cigars,
  • 7.2 percent used hookahs,
  • 6.0 percent used smokeless tobacco,
  • percent smoked pipe tobacco, and
  • 0.6 percent smoked bidis.

After e-cigarettes and cigarettes, middle school students reported using these products:

  • 2.0 percent used hookahs,
  • 1.8 percent used smokeless tobacco,
  • 1.6 percent smoked cigars,
  • 0.4 percent smoked pipe tobacco, and
  • 0.2 percent smoked bidis.

Among non-Hispanic white and Hispanic high school students, e-cigarettes were the most commonly used tobacco product. Among non-Hispanic black high school students, cigars were the most commonly used tobacco product. Cigarette use was higher among non-Hispanic whites than among non-Hispanic blacks. Smokeless tobacco use was higher among non-Hispanic whites than students of other races.

“We’re very concerned that one in four high school students use tobacco, and that almost half of those use more than one product,” said Corinne Graffunder, Dr.P.H., M.P.H., director of CDC’s Office on Smoking and Health. “We know about 90 percent of all adult smokers first try cigarettes as teens. Fully implementing proven tobacco control strategies could prevent another generation of Americans from suffering from tobacco-related diseases and premature deaths.”

FDA has regulatory authority over cigarettes, cigarette tobacco, roll-your-own tobacco, and smokeless tobacco. The agency is finalizing the rule to bring additional tobacco products such as e-cigarettes, hookahs, and some or all cigars under that same authority.

“The FDA remains deeply concerned about the overall high rate at which children and adolescents use tobacco products, including novel products such as e-cigarettes and hookah,” said Mitch Zeller, J.D., director of the FDA’s Center for Tobacco Products. “Finalizing the rule to bring additional products under the agency’s tobacco authority is one of our highest priorities, and we look forward to a day in the near future when such products are properly regulated and responsibly marketed.”

Regulating the manufacturing, distribution, and marketing of tobacco products – coupled with proven population-based strategies – can reduce youth tobacco use and initiation. These strategies include funding tobacco control programs at CDC-recommended levels, increasing prices of tobacco products, implementing and enforcing comprehensive smoke-free laws, and sustaining hard-hitting media campaigns.

To learn more about quitting and preventing children from using tobacco, visit

Dr. Eric Johnson: Tobacco tax will deter young people from using products

By Dr. Eric Johnson, Grand Forks – Jamestown Sun

As a Grand Forks physician and chairman of the recently announced efforts to initiate a ballot measure to increase North Dakota’s tobacco taxes, it’s important the public be given the facts right off the bat.

First, North Dakota’s tobacco taxes have not been increased since 1993, ranking us 47th in the nation for cigarette tax rates. If passed, this measure would bring North Dakota’s cigarette tax from 44 cents per pack to $2.20 per pack, just slightly above the average of $2.08 per pack of our neighboring states.

Second, it will treat the liquid nicotine drug (smoked via electronic cigarettes) and those who sell it exactly the same as all other tobacco products.

Third, it will dedicate current revenues exactly where they currently are: to the state’s general fund and back to North Dakota’s cities. New revenues generated from the increase will be split evening between a fund created to support the unmet needs of North Dakota’s veterans and a fund to support health programs associated with chronic disease treatment, county health programs and the mental health and addiction crisis facing our state.

Luckily, North Dakota already fully funds a tobacco prevention program utilizing a small portion of the money won by the state of North Dakota when it sued tobacco companies in 1998 for lying to the public and to Congress about the deadly impacts of tobacco. No moneys from this measure will go toward these efforts.

These are the facts. Seventy-five percent of adult tobacco users started before the age of 18. Significant tobacco tax increases are proven as the most effective way to keep young people from ever starting tobacco. That’s an effort we can all support.

Bismarck Tribune: Coalition pushes tobacco tax measure

Photo by Tom Stromme, Bismarck Tribune

Photo by Tom Stromme, Bismarck Tribune

Members of a coalition seeking an increase in the state’s tobacco tax say their proposed increase would reduce smoking rates as well as state health care costs among other benefits.
“That’s the missing leg of the three-legged stool,” Eric Johnson, a Grand Forks physician and head of the measure’s sponsoring committee, Raise It for Health North Dakota.
Two-thirds of North Dakota voters in 2012 approved a ballot measure making public places smoke-free. In 2008, nearly 54 percent of voters approved the creation of a state tobacco prevention and control program.
Other states that have raised the tax have seen decreases in smoking, according to Johnson, adding that the measure will help beef up the state’s tobacco prevention efforts.
“This is a tax nobody has to pay. It’s a product that creates death,” Johnson said.
Kristie Wolff, with the American Lung Association in North Dakota, said the measure would increase the tobacco tax for cigarettes in North Dakota from 44 cents per pack to $2.20. Taxes on liquid nicotine products would be increased from 28 percent of the wholesale purchase price to 56 percent.
The national average tax on a pack of cigarettes is $1.61.
New tax revenues created through the measure, estimated at about $100 million per biennium, would be split between health-related programs in the state’s Community Health Trust Fund as well as a newly created Veterans Tobacco Tax Trust Fund.
“We’re confident that North Dakota voters will respond positively yet again,” Wolff said.
Only Georgia, Missouri and Virginia have lower tobacco taxes than North Dakota. The tobacco tax in North Dakota hasn’t been raised since 1993.
Being a statutory initiative, 13,452 legitimate signatures will be required at least 120 days before the election. The deadline for turning in signatures for the Nov. 8 election is July 11.
Several unsuccessful attempts have been legislatively in the year since the last tax increase.
Wolff said the increase would bring North Dakota in line with the surrounding states in the tax per pack of cigarettes. The tax in Minnesota is $3 per pack, in Montana it’s $1.70 and in South Dakota it’s $1.53.
“We based it on polling we’ve done,” Wolff told reporters when asked how the group came to the $1.76 per pack increase being proposed.
According to the Campaign for Tobacco-Free Kids, the tax increase could result in a 20 percent drop in youth smoking, preventing about 5,800 youths from becoming adult smokers, Johnson said.
North Dakota Retail Association president Mike Rud said the group he leads will need to review the measure language and watch to see if it gets the necessary signatures for a vote. The group opposed both 2015 bills.
Rud said on first glance the proposed increase is substantial, adding that taxing cigarettes would negatively impact lower-income smokers.
“Taxing a group that can least afford it? It’s a bit troublesome to us,” said Rud, clarifying that tobacco products aren’t illegal and retailers sell them to meet demand among legal buyers.
“There’s got to be a limit to how involved we get with these things,” Rud said.

Valley News Live: Coalition wants to raise North Dakota tobacco tax

By: Natalie Parsons
FARGO, N.D. (Valley News Live) It has been proposed in the state of North Dakota to raise the tax on tobacco products.
If it passes, you will see it on your ballot this November.
Supporters already started collecting some of the required 13,000 plus signatures.
North Dakota has not increased its tobacco tax since 1993 and now the Raise It For Health North Dakota coalition thinks it’s time.
The proposed tobacco tax will increase the tax on cigarettes from $0.44 per pack up to $2.20 per pack.
Scott Platfers says, “Going to have to pay more if I want to continue but I’m hoping that it might deter me too because it’s something I’ve been wanting to quit for a long time.”
The ultimate goal for this tobacco tax increase is to hopefully decrease youth smoking by 20 percent and prevent 5800 youth from ever starting.
The Fargo smoker says, “It’s not going to prevent all of them but I think it’s going to get some of them and every little bit helps.”
The coalition has already started getting signatures on this initiated measure.
The petition needs exactly 13,452 signatures in order appear on the November 8th ballot.
Platfers says, “It’s a double edged sword. It’ll effect me but as long as it would help somebody? Yeah, I would sign it.”
The proposed tobacco tax is estimated to bring in over $100-million new revenue to North Dakota with plans to go towards many health care services.

Forum News Service: Proposed ND ballot measure would boost tax on cigarettes by $1.76 a pack

By Mike Nowatzki / Forum News Service
A group frustrated with the North Dakota Legislature’s repeated refusal to raise tobacco taxes will attempt to put the issue to voters in November, announcing a ballot initiative Wednesday that would hike the tax on a pack of cigarettes by $1.76.
Backers will need to gather 13,452 signatures by July 11 to place the initiated measure on the Nov. 8 ballot.
Dr. Eric Johnson, a Grand Forks physician and chairman of the measure’s 30-member sponsoring committee, estimated the higher tax would reduce youth smoking by 20 percent, preventing 5,800 youths from ever starting smoking.
He noted North Dakota voters approved a tobacco use prevention and control program in 2008 and passed a smoke-free workplace law in 2012, calling the higher tax “kind of the missing leg of the three-legged stool.”
“We do know that it reduces usage, and that saves money for everybody,” he said.
Supporters estimate the tax increase would generate more than $100 million every two years. Half of the money would be dedicated to a new trust fund to support services and programs for military veterans, while the rest would go into a community health trust fund.

Poll results as of 9:30 am on March 17, 2016

Poll results as of 9:30 am on March 17, 2016

North Dakota’s current tax of 44 cents on a pack of cigarettes ranks 47th lowest among states and hasn’t been increased since 1993, despite several attempts in the Legislature, including two bills defeated last year after strong pushback from retailers and distributors.
If approved by voters, the proposed new tax of $2.20 per pack would be lower than Minnesota’s $3-per-pack tax but higher than Montana’s $1.70 and South Dakota’s $1.53. The national average is $1.61 per pack.
The measure is being pushed by the Raise it for Health Coalition, which consists of 10 groups: the North Dakota Medical Association, American Lung Association in North Dakota, North Dakota Veterans Coordinating Council, Tobacco Free North Dakota, Campaign for Tobacco-Free Kids, North Dakota Nurses Association, North Dakota Chapter of the American Academy of Pediatrics, March of Dimes, North Dakota Association of Counties and the Dakota Boys and Girls Ranch.

Bismarck Tribune: Group proposes to raise tax on tobacco

NICK SMITH, Bismarck Tribune

A coalition seeking to reduce tobacco use in North Dakota will unveil a proposed ballot measure Wednesday, which would raise the state’s tobacco tax — one of the lowest in the nation.
The group, Raise it for Health North Dakota, will make its announcement in Memorial Hall inside the state Capitol on Wednesday.
A spokeswoman for the group said details of the proposed measure wouldn’t be disclosed until the announcement.
As of January, data from the tobacco prevention group Campaign for Tobacco-Free Kids showed that North Dakota’s tobacco taxes are at 44 cents per pack. Only Georgia, Missouri and Virginia are lower. The tobacco tax in North Dakota hasn’t been raised since 1993.
Two bills proposing tobacco tax increases in the 2015 session failed.
House Bill 1421 would have raised the state’s cigarette tax to $1.54 per pack. It would also have raised the excise tax on other tobacco products from 28 percent of the wholesale purchase price to 43.5 percent. House lawmakers killed it by a 34-56 vote.
Senate Bill 2322 would have raised the cigarette tax in the state to $2 per pack; it failed in the Senate by a 17-30 vote.
Last session, health care officials supported the bills while retail groups opposed it. Several legislative attempts to raise the tax have failed since 1993.
Opponents of the 2015 bills used 2012 data from the Centers for Disease Control and Prevention to argue tobacco use isn’t a major problem in North Dakota. The data showed that North Dakota in 2012 ranked 37th in adult smoking and 49th in smokeless tobacco use. Among youth smokers, North Dakota ranked 34th among 44 states reporting data.
North Dakota voters in November 2012 approved a ballot measure making public places smoke-free. Two-thirds of voters supported the measure.

LA Times – Capitol Times: Lawmakers show surprising courage against Big Tobacco

The Legislature showed some guts last week in standing up to the tobacco lobby and its political money.

It could have shown more, however, by mustering the courage to raise taxes on cigarettes, cigars and chewing crud.

California’s tobacco tax is among the lowest in the nation and hasn’t been hiked since 1998 — and then only by the voters, not the weak-kneed legislators.

The national average state cigarette tax is $1.61 per pack. California’s is about half that, 87 cents. We rank 35th. New York is first at $4.35.

But give our lawmakers credit: They did the next best thing, even if it was a punt to local government. They passed a bill allowing counties to seek voter approval of a local tobacco tax.

The tax revenue could be used to help smokers kick the habit and treat their tobacco-related ailments.

The main purpose, however, is to discourage people from buying smokes, a strategy that works — and worries cigarette makers. Researchers have found that for every 10% increase in the cigarette price, there’s a 4% reduction in use.

Let’s put the rap on legislative fortitude in perspective: To pass any tax increase, a two-thirds vote is needed. Passing a bill that allows someone else to raise a tax requires only a simple majority, which Democrats can handle without buying off Republicans.

The local tax bill, by Assemblyman Richard Bloom (D-Santa Monica), passed the Assembly on a 46-27 vote, far short of the 54 needed for two-thirds.

“Tobacco is a poison,” Bloom told me. “We shouldn’t even be debating this anymore. We should be doing everything to keep it out of the hands of young people.”

It was a bad day for tobacco interests. The Assembly passed two other bills that could have even greater immediate impact.

One, by Sen. Ed Hernandez (D-West Covina), would raise the smoking age from 18 to 21.

Opponents argued it wouldn’t be fair that someone under 21 could die for their country but couldn’t smoke. So active military personnel were exempted.

The bill passed 49 to 25.

Hernandez says research shows that 90% of smokers begin puffing before age 21, and 80% before 18.

San Francisco last week raised its smoking age to 21. So have Hawaii and New York City.

But I’m skeptical. Come on! We can’t even enforce the age 18 limit. Kids get smokes at 14 or whenever they want.

Yes, argue the proposal’s advocates, but the 14-year-olds get their cigarettes from 18-year-olds. They wouldn’t be close enough to the 21-year-olds.

Perhaps. But what’s to stop the 18-year-olds from being supplied by those who are 21, and then passing them down to little sister?

The second big bill that passed makes total sense and is overdue. The measure, by Sen. Mark Leno (D-San Francisco), would regulate electronic cigarettes like tobacco. Their use would be prohibited everywhere cigarettes are banned: in restaurants, theaters and other public places.

These cute vapor devices are particularly appealing to minors, sold with yummy flavors such as chocolate, cotton candy and cherry — and usually laced with addictive nicotine.

The bill passed 52 to 21.

One Los Angeles study, Leno says, found that 9th-graders who use e-cigarettes are four times as likely to get hooked on tobacco.

“Clearly, Big Tobacco’s next move is to addict a new generation to nicotine,” Leno says.

Three other anti-smoking bills also passed the Assembly the same day. One would close loopholes in the state’s smoke-free workplace laws. Another would require all schools to be tobacco free. The third would impose a state licensing fee on tobacco retailers.

Passage of the six-bill package earned kudos for Speaker Toni Atkins (D-San Diego) on her last day as Assembly leader. Assemblyman Anthony Rendon (D-Paramount) takes over this week.

Last year, the tobacco lobby and its legislative minions stalled the bills in the Assembly after two key measures — raising the smoking age and regulating e-cigarettes — passed the Senate.

One reason is obvious: So far in this election cycle, the major tobacco companies have plied legislators with nearly $364,000 in campaign contributions, according to MapLight, which tracks political money. Of that, 83% has gone to Republicans — who make up only 35% of the Legislature — and 17% to Democrats.

Add the last election cycle to this one, and Big Tobacco has donated $894,000, 71% to Republicans and 29% to Democrats.

Most Democrats voted for the anti-tobacco legislation. Most Republicans voted against.

The Senate intends to approve Assembly amendments and send the entire package to noncommittal Gov. Jerry Brown this week. Unless.

Behind the scenes, Senate leader Kevin de León (D-Los Angeles) quietly is offering to negotiate with tobacco. If the industry were to allow the Legislature to pass a state tobacco tax, perhaps some of the package could be snuffed.

Then sponsors of a November ballot initiative that would raise the state cigarette tax by $2 per pack might be persuaded to withdraw their measure. That would save the tobacco industry upward of $100 million fighting the initiative.

And unions that are pushing it could plow their money into Democratic legislative races instead. Plus, there wouldn’t be a tobacco tax on the ballot to complicate life for a union-sponsored extension of Brown’s soak-the-rich income tax hike.

It’s all very complex. And unlikely. The Legislature has exhibited about all the courage it can against terrifying tobacco.

U.S. News/HealthDay: Graphic Cigarette Warnings May Target Brain's 'Quit Centers'

By Robert Preidt, HealthDay Reporter

FRIDAY, Feb. 26, 2016 (HealthDay News) — Disturbing images on cigarette pack warning labels activate brain regions crucial in quitting smoking, a new study suggests.

“Regulators can and should use this research to craft more effective warning labels and messages to smokers that both deliver facts about the negative effects of smoking and trigger thoughts and actions that move smokers toward quitting,” said study senior author Raymond Niaura. He is director of science at the Schroeder Institute for Tobacco Research and Policy Studies at the Truth Initiative in Washington, D.C.

“Tobacco is still the leading preventable cause of death in the U.S., and the growing body of research showing the effectiveness of warning labels should energize policymaking,” Niaura said in a news release from Georgetown University Medical Center, in Washington, D.C.

For the study, the researchers conducted brain scans on 19 young adult smokers. During the scans, the smokers were shown non-graphic and graphic pictures used on cigarette pack warning labels. For example, one image included an open mouth with rotten teeth and a tumor on the lower lip. The images were accompanied by the text: “WARNING: Cigarettes cause cancer.”

Seeing the graphic pictures triggered activity in areas of the brain called the amygdala and medial prefrontal region, the study showed. These areas are involved in emotion, decision-making and memory, the researchers said.

“The amygdala responds to emotionally powerful stimuli, especially fear and disgust. And experiences that have a strong emotional impact tend to impact our decision-making,” said study co-lead author Adama Green, a cognitive neuroscientist at the Georgetown University Medical Center and the Truth Initiative.

The study was published online recently in the journal Addictive Behaviors Reports.

“What we found in this study reinforces findings from previous research where scientists have asked participants to report how they think and feel in response to graphic warnings on cigarettes,” said co-lead author Darren Mays, an assistant professor of oncology at Georgetown’s Lombardi Comprehensive Cancer Center.

This study should help researchers understand the biological factors underlying responses to such warnings. And it may help them learn how these warnings can work to motivate a change in behavior, Mays said.

Duluth News Tribune: Training targets high tobacco use among addicts, mentally ill

By John Lundy

If someone is dealing with other addictions or mental health issues, it’s not the time to ask them to stop smoking.


Wrong, says an addictions psychiatrist from New Jersey who’s in Duluth to help lead a two-day training seminar on helping individuals with special challenges overcome tobacco use.

“The newer research suggests that when people address their smoking they actually have better long-term outcomes,” said Jill Williams, who specializes at Rutgers University’s Robert Wood Johnson Medical School in treatment of tobacco and other addictions in mentally ill populations. “When you cue the brain with nicotine, it’s really not different than other drugs.”

Williams is making her third visit to Duluth at the behest of the American Lung Association in Minnesota. After conducting a one-day session in the Twin Cities, she came to the Public Safety Building in Duluth on Thursday to work with about 60 behavioral health professionals from throughout Northeastern Minnesota; the training continues today.

The target is a topic that has “been shuffled to the side,” in the words of Pat McKone, regional senior director for the American Lung Association.

Even as tobacco use overall in the United States continues to decline to unprecedented lows, use by vulnerable groups such as addicts and the mentally ill remains stubbornly high, McKone and Williams said.

For instance, according to Williams:

  • Although the rate of smoking in Minnesota is down to 14 percent, the rate for Minnesotans with addictions or mental illness is between 40 and 60 percent.
  • The No. 1 cause of death in alcoholics is health problems related to tobacco use.
  • Fifty percent of people with mental illness die of tobacco-related causes.

“We always remark to the audience: Imagine if 50 percent of our patients died of suicide, how that would be front page news,” Williams said. “Fifty percent die from tobacco and we don’t do anything about it.”

People with serious mental illnesses die, on average, 25 years earlier than the rest of the population, McKone said. “And it’s not from suicide; it’s not from drug overdose. It’s from heart disease, COPD and cancer.”

Over a couple of years, Williams has offered the training to about a thousand specialists in Minnesota, she said. But they still represent a minority.

“What we hear them say … is that they’re the lone voice at their agency and everyone else is sort of opposed or still believes the myths or the idea that we should let people smoke and not pay attention to it,” Williams said. “So we still have a lot more people to get to.”

One sign of that is that only one in four mental health treatment centers has a smoking-cessation program, she said.

Families of individuals being treated for addiction or mental illness should advocate for treating their loved one’s tobacco addiction along with the other problems, McKone said. She called the reduced life expectancy for people with addictions and mental illness a social injustice.

Williams added: “Everyone has someone in their family with mental illness or addiction, and we can’t just look the other way.”