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Cigarette Taxation Helps to Reduce Drinking Among Groups Considered Vulnerable

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

Cigarette Taxes Linked to Binge Drinking

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

Most youth who use smokeless tobacco are smokers, too

By Anne Harding, Reuters
NEW YORK (Reuters Health) – Most young people in the U.S. who use newer smokeless tobacco products are smoking cigarettes too, according to new research.
“These findings are troubling, but not surprising, as tobacco companies spend huge sums to market smokeless tobacco in ways that entice kids to start and encourage dual use of cigarettes and smokeless tobacco,” Vince Willmore, vice president of communications at the Campaign for Tobacco-Free Kids, a Washington, D.C.-based advocacy organization, told Reuters Health in an email.
“From 1998 to 2011, total marketing expenditures for smokeless tobacco increased by 210 percent – from $145.5 million to $451.7 million a year, according to the Federal Trade Commission,” he added.
Swedish-style “snus,” introduced to the U.S. in 2006, and dissolvable tobacco products, introduced in 2008, are arguably less harmful than conventional chewing tobacco because they contain fewer nitrosamines, and have been promoted as safer alternatives.
But public health experts have been concerned that these products could serve as a “gateway drug” to use of conventional smokeless tobacco and to cigarette smoking.
To better understand the prevalence of smokeless tobacco use among young people, Dr. Gregory Connolly of the Harvard School of Public Health in Boston and his colleagues looked at data from the 2011 National Youth Tobacco Survey, which included nearly 19,000 sixth- to 12th-graders from across the country.
Overall, the researchers found, 5.6 percent of young people reported using any type of smokeless tobacco. Five percent used chewing tobacco, snuff or dip, just under two percent used snus and 0.3 percent used dissolvable products.
Among young people who were current smokeless tobacco users, about 72 percent reported smoking cigarettes too, while almost 81 percent of young people who used only snus or dissolvables were also smoking cigarettes.
Just 40 percent of smokeless tobacco users said they had plans to quit using tobacco, according to findings published in Pediatrics.
“We found higher current use than we expected. It’s just not experimentation, it looks like it’s taken hold among adolescents,” Connolly told Reuters Health.
“The most distressing finding was that this is not resulting in children or in young adolescents switching from smoking to these new products that may or may not be safer when used alone. They’re using both in very high numbers.”
Little information had been available on trends in the use of novel smokeless tobacco products, so studies like this one are important, Dr. Neal Benowitz, who has studied the health effects of smokeless tobacco at the University of California, San Francisco, told Reuters Health.
“To me the fact that 72 percent of users concurrently smoke cigarettes is a serious issue,” he said. “These would be safer alternatives only if people used them exclusively, and as soon as you’re talking about dual use you virtually negate any reduction of harm.”
Benowitz, who was not involved in the current research, noted that studies have shown use of smokeless tobacco among U.S. youth can indeed be a gateway to cigarette smoking.
“The most disturbing finding is that a huge percentage of youth smokeless tobacco users also smoke cigarettes,” Willmore said.
“This indicates that smokeless tobacco compounds the problem of overall tobacco use in the United States, rather than helping to solve it as some tobacco companies claim.”
RJ Reynolds, which makes Camel Snus and dissolvable tobacco products including Camel Orbs, Sticks and Strips, did not respond to a request for comment by press time.
“The tobacco industry is facing the 21st century with a whole new strategy, and that is to bring in new products that they claim to be safer,” Connolly told Reuters Health.
He pointed out that under the Family Smoking Prevention and Tobacco Control Act, passed in 2009, the U.S. Food and Drug Administration is charged with regulating tobacco products, including smokeless tobacco.
“When we look at this data I think it is very disturbing to realize that the law has not kept them out, and at least in this data set they’re gaining traction among young people,” Connolly said.
SOURCE: http://bit.ly/13INoAt Pediatrics

Parental smoking tied to kids' risk of lighting up

By Andrew M. Seaman
NEW YORK (Reuters Health) – Children born to parents with a history of cigarette smoking are more likely to light up than kids of people who never smoked, according to a new U.S. study.
Despite falling smoking rates across age groups, researchers found that children raised by current or even former smokers were about three times more likely to be smokers themselves during their teenage years than kids raised by parents who never smoked.
“Things are getting better, but we can see it’s best among the consistent non-smoking households,” said Mike Vuolo, the study’s lead author from Purdue University in West Lafayette, Indiana.
Previous research has produced similar results, but the new study was based on 23 years of data on the smoking patterns of the parents in the study – 214 people who were ninth grade students in 1988 – to see whether their habits from adolescence onward were tied to their children’s risk of smoking.
For example, Vuolo and his colleague, who published their findings in Pediatrics, were able to compare the children of never-smokers and people who had smoked consistently since high school.
They had data on 314 children of the original group of teens. In 2011, the kids of the second generation – all at least 11 years old – were asked if they had smoked cigarettes within the last year. Sixteen percent said yes.
Among the children of parents who had never smoked, about 8 percent reported smoking cigarettes during the past year.
That compared to between 23 percent and 29 percent of the children of current or former smokers.
The researchers also looked at the parents’ “trajectories” of smoking for clues about the parental influence on the children’s behavior.
They found that 23 percent of kids whose parents had smoked as adolescents but quit or reduced their smoking as young adults were smokers themselves.
Among kids whose parents had smoked little or not at all in high school but started smoking in adulthood, 29 percent were smokers.
And 25 percent of children whose parents had smoked consistently since high school were smokers.
In addition, children who said they had smoked during the last year were more likely to be older, to display more symptoms of depression and to have low grades and low self-esteem. They were also more likely to feel distant from their parents and to have an older sibling who smoked.
While the study can’t prove that parental smoking caused the children to adopt the habit, Dr. Jonathan Winickoff, who has studied teen smoking behavior but wasn’t involved in the new research, said the new results support past findings.
“I think the first confirmatory result is that if you are a parent who smokes, your teenage child has a three-fold increased risk of smoking,” Winickoff, an associate professor in Harvard Medical School’s Department of Pediatrics in Boston, said.
He added that there are several theories on why children of smokers may be at an increased risk of picking up the habit, including modeling their parents’ behaviors, easy access to cigarettes and being “primed” for an addiction through second-hand smoke exposure.
He cautioned, however, that the new study can’t determine whether a child’s risk of becoming a smoker falls if the parents stop smoking early-on, such as in their early adult years, because the group that contained those early quitters also included some current light smokers.
“They can’t say – based on these data – whether earlier parental quitting is associated with less smoking in their kids,” he said.
The researchers also warn that their findings may not apply to all smokers, because only 15 percent of the people included in their survey had a bachelor’s degree or more education and most had their first child at a fairly young age.
Vuolo added that they don’t know whether these smoking rates in the second generation are an improvement over the past because they’re only looking at one point in time. Going forward, they will be able to look at smoking rates over time as they collect more data.
“We’re going to be able to answer that question,” he said.
http://kfgo.com/news/articles/2013/aug/05/parental-smoking-tied-to-kids-risk-of-lighting-up/

Higher Minn. cigarette prices drive more to try to quit

by Mark Zdechlik, Minnesota Public Radio
MAPLEWOOD, Minn. — Anan Barbarawi expected cigarette sales at his store to drop once Minnesota’s $1.60 a pack tax increase took hold in July. But Barbarawi, manager at Maplewood Tobacco, was shocked to see his numbers plunge “50 to 70 percent.”
On the bright side, Barbarawi said, sales of electronic cigarettes have taken off.
A month into the tax increase, it’s not clear yet how much cash Minnesota is collecting. The stiff tobacco levy, though, is changing behavior.
Programs that help people quit smoking say they’ve seen a dramatic increase in the number of Minnesotans contacting them for help because of the higher prices. Demand for tobacco alternatives is up.
State officials maintain that was always the goal when they pushed the total tax to $2.83 per pack. They say they’d be happy if they didn’t get any tax revenue from tobacco and argue the state would save huge amounts of money on health care if Minnesotans didn’t smoke.
There’s no doubt cost led Bob Holmes to stop at the end of May — a month before the cigarette tax increase took effect.
“Yeah, it might have helped push me into quitting smoking,” said Holmes of St. Paul, who’d driven his friend to the Maplewood smoke shop to pick up some cheap cigars.
It’s good the higher tax is getting people to stop smoking, he said. Still, he and many other smokers thinks it’s not fair that many of those hardest hit by the tax can least afford it.
Tobacco tax figures from July on are not yet available, but anti-smoking advocates say the effects are visible already.
Calls to Minnesota’s QUITPLAN program were up more than 250 percent over the same time last year and website hits were up almost 300 percent, for the first half of July, said Mike Sheldon, spokesman for ClearWay Minnesota, the group that runs QUITPLAN.
ClearWay offers free quit-smoking counseling using $202 million from Minnesota’s 1998 legal settlement with tobacco companies. Summer is usually not a busy time, he said.
The group says about 625,000 adults in Minnesota smoke. About three of every 10 QUITPLAN clients abstain from tobacco for at least six months, Sheldon added.
The tobacco tax increase inspired Erik Nordstrom, 38, to look for options. The St. Paul man, a smoker since age 14, hopes to wean himself from nicotine with e-cigarettes. That’s what brought him to the tobacco store in Maplewood.
Quitting tobacco is the ultimate goal, but there was an immediate need to cut spending. He was fed up with paying almost $300 for his monthly cigarette fix.
“When I go into a store and I’m paying $7.75 (for cigarettes), there’s something seriously wrong with that picture,” he said. “I had a pack of Newports on me which is the last pack I’ll be smoking.”
http://minnesota.publicradio.org/display/web/2013/08/02/health/cigarette-prices

Most U.S. youth exposed to tobacco advertising in stores

ATLANTA, July 31 (UPI) — U.S. researchers at the Centers for Disease Control and Prevention say a lot of kids continue to see tobacco ads and be influenced by them.
Dr. Shanta Dube, lead health scientist for surveillance in the Epidemiology Branch, Office on Smoking and Health at the Centers for Disease Control and Prevention in Atlanta, and colleagues examined the proportion of adolescents exposed to pro-tobacco advertising and assessed the association between this exposure and susceptibility to smoking.
The researchers used data from the 2011 National Youth Tobacco Survey to calculate the proportion of susceptible middle-school and high-school students exposed to pro-tobacco advertisements via stores, magazines and the Internet. Susceptibility to smoking cigarettes was defined as “never smoked but open to trying cigarettes,” Dube said.
In 2011, 81.5 percent of middle-school students and 87 percent of high-school students were exposed to tobacco advertisements in stores; 48 percent of middle-school students and 54 percent of high-school students were exposed to such advertising in magazines.
Exposure to tobacco advertisements on the Internet was similar at about 40 percent for both middle-school and high-school students.
Of those surveyed, 22 percent of middle-school students and 24 percent of high-school students were susceptible to trying cigarettes.
Exposure to magazine advertising declined from 71.8 percent in 2000 to 46 percent in 2009 among susceptible middle-school students; but exposure increased to 55 percent in 2011. Tobacco advertising seen through the Internet among susceptible high-school students increased from 26 percent in 2000 to 45 percent in 2011.
The study was published in the Journal of Adolescent Health.
Read more: http://www.upi.com/Health_News/2013/07/31/Most-US-youth-exposed-to-tobacco-advertising-in-stores/UPI-26521375321062/#ixzz2ajGPXhMN

C-stores Could Hit $1B in E-Cigarette Sales This Year

NEW YORK — New Nielsen convenience store data indicates that electronic cigarette sales could hit $1 billion this year, with that figure jumping to $1.7 billion when factoring in online sales.
Leading e-cigarette sales at c-stores is Lorillard Inc.’s blu eCigs brand, according to Bonnie Herzog, managing director of tobacco, beverage and consumer research at Wells Fargo Securities LLC. She cited Nielsennumbers showing that blu captured 39 percent of the dollar share in the convenience channel during the most recent four-week period ended July 6, followed by NJOY with a 30.1-percent share.
Looking at extended all-outlet coverage (XAOC) from New York City-based Nielsen, blu came in first again with a 44.5-percent share. Other leading brands in the XAOC channel include FIN at 20.6 percent, Mistic at 11.7 percent and NJOY at 10.8 percent.
“We believe e-cigarette consumption could surpass traditional cigarettes within the next decade and the combined operating profit pool could generate a CAGR [compounded annual growth rate] of 7 percent over the next decade,” Herzog stated.
While electronic cigarette dollar sales grew 189.6 percent in the four-week period ended July 6, according to Nielsen, total cigarette dollar sales in the U.S. convenience channel grew 1.2 percent over the same timeframe, vs. 1 percent in the last four-week period and 1.3 percent in the prior year.
Unit sales posted their best results – meaning their lowest decline — of the past 12 periods, Herzog said, adding that this was likely driven by moderating net price realization.
“We believe the recent cigarette list price increase of 6 cents per pack is now reflected in the c-store channel. Despite somewhat tepid price realization for retailers per the Nielsen data, we expect net price realization for the manufacturers to accelerate to about 4 percent in [fiscal year] 2013, which should offset volume declines, leading to positive dollar sales,” she explained.
As for individual cigarette brands, all three Big Tobacco companies — the Altria Group Inc. Reynolds American Inc. and Lorillard — saw positive numbers during the period, she added.
http://www.csnews.com/top-story-tobacco-c_stores_could_hit_$1b_in_e_cigarette_sales_this_year_-64164.html

The electronic cigarette ignites debate

By Michael Crusan – email
Eau Claire (WQOW) – Electronic cigarettes are technically smoke free, but some businesses and health experts are drawing the line to put them out.
This alternative to smoking is receiving mixed reviews in Eau Claire.
“Have the brown filter, the white battery, I mean it looks just like you’re naturally smoking a cigarette and even the end lights up red,” explains regional manager of Eau Claire Tobacco Shop, Jessica Hartkemeyer.
A red light leading restaurant owners and health officials to say stop.
“Electronic cigarettes, to me, is smoking.  It’s the same thing, it’s the same type of scene it is.  In all our restaurants where we have non-smoking areas, it will be non-smoking for electronic cigarettes,” says Eau Claire restaurant owner Lisa Aspenson.
Especially when the federal government isn’t controlling what’s in a cloud of e-cig vapor.
“The FDA has not evaluated it for the content of nicotine or for other dangerous drugs,” says Mayo Clinic Health System Nurse Practitioner, Kim Edson.
“The FDA, I think, is avoiding putting their stamp of approval on this because it’s not necessarily a quit smoking device.  It can be used as a replacement that’s just a little bit cheaper,” says Hartkemeyer.
So what does your average e-cig contain in a puff of vapor?
“USP grade liquid nicotine, kosher certified natural and artificial flavors,” says Hartkemeyer.
Much shorter than the list of ingredients in a cigarette, but still not approved by doctors.
“For the intent of stopping smoking we don’t recommend it because it still promotes the behaviors of smoking,” says Edson.
Because it’s hard to tell if the cigarette is made with paper or plastic.
“When they first came out I did have customers say, ‘Well bars asked me not to use these or restaurants because it gives the impression that we are smoking in the establishment’,” says Hartkemeyer.
“So I think we’ll just stay with the non-smoking trend and maybe be the first to implement it in the Eau Claire area,” says Aspenson.
Instead asking smokers to step outside whether they light or ignite.
Aspenson also owns the Livery in downtown Eau Claire and says they do allow outdoor smoking for tobacco or electronic cigarettes at that location.
Read more or view video:  http://www.wqow.com/story/22960738/2013/07/29/the-electronic-cigarette-ignites-debate

Letter to the Editor: North Dakota should take lesson from Minnesota on cigarette tax

Minnesota just raised its cigarette tax by $1.60 per pack, leaving me in envy of our neighbor’s efforts to help people quit smoking.
High cigarette prices and noticeable price hikes like Minnesota’s recent increase prevent young people from getting hooked and help current smokers to kick the habit. That’s good. One in three who try cigarettes get addicted and a majority of those who smoke want to quit. A high tobacco tax is an effective health policy; kudos to Minnesota’s elected leadership for recognizing that and investing in this prevention strategy.
By contrast, North Dakota ranks as one of the “best” states for cheap tobacco. North Dakota’s tobacco tax is outrageously low at a mere $0.44 per pack — the 46th lowest cigarette tax in the nation. Across the river, Minnesota’s cigarette tax is the sixth highest at $2.83 per pack. Is “cheap tobacco” the policy North Dakota wants for its children? From my perspective as a public health advocate and mom, no. North Dakota needs to take action to significantly increase the price of tobacco here. It’d be the first time since 1993.
I love North Dakota, but not the current price of our cigarettes. In addition to its tobacco tax, sometimes I also envy Minnesota for its trees — when the wind blows and we have few to stop it. But we’re proactive and plant trees for the immediate and long-term benefits they provide. For the same reasons, raise North Dakota’s tobacco tax — and the sooner the better.
Valerie Schoepf,
Bismarck
http://www.thedickinsonpress.com/event/article/id/70212/group/Opinion/
http://bismarcktribune.com/news/opinion/mailbag/envying-sister-state-s-high-tax/article_df913772-ee8a-11e2-ad6c-0019bb2963f4.html
http://www.inforum.com/event/article/id/406373/

Are e-cigarettes healthier?

By 
John Sweet once smoked two packs of cigarettes per day until a chance visit to a Clearwater flea market in early May led him to the latest nicotine alternative.
For $50 he purchased a battery-powered electronic cigarette — a device that comes in many shapes and sizes and in different price ranges.
With the push of a button, the e-cigarette heats a nicotine-infused propylene glycol fluid, turning it into a vapor that’s inhaled. E-cigarette users call the act “vaping,” not smoking.
These e-cigarettes, or e-cigs for short, often look like real cigarettes, but without the lingering smoky odor. Other devices — invented and manufactured in China — look like large ink pens.
“On the spot (after seeing the e-cigarette), I decided to quit,” Sweet said.
Sweet, 44, last week upgraded his cheaper realistic-looking e-cig at Johnny Vapenhiemer E-Cigs, a Paddock Mall kiosk. He said the cheaper e-cig had a short battery life and he wanted something better.
Sweet loves vaping because it is one-fifth the cost of smoking. And despite health warnings, it’s healthier than smoking traditional cigarettes, he said.
In June, the Food and Drug Administration in the Philippines issued an advisory, warning that e-cigs have not been tested and second-hand emissions could be harmful.
“E-cigarettes contain volatile substances, including popylene glycol, flavors and nicotine, and are emitted as (a) mist or aerosol into indoor air,” according to the June 26 advisory.
The advisory stated the FDA in that country cannot exclude adverse health risks from second-hand emission exposure. However, that agency conceded that e-cig devices produce fewer harmful chemicals than conventional cigarettes.
In the United States, the FDA is moving to release for public comment a proposed rule to regulate additional categories of tobacco products, such as e-cigarettes. FDA officials said they cannot comment on the contents of the proposed rule. Official noted in a statement that “further research is needed to assess the potential public health benefits and risks of electronic cigarettes and other novel tobacco products.”
At the e-cig kiosk in Paddock Mall, owner Johnny Mays — who calls himself Johnny Vapor, master vaporologist — defended the world’s fastest-growing tobacco trend.
Mays held a 48-page e-cigarette study commissioned by the Tobacco Vapor Electronic Cigarette Association (TVECA).
He inhaled an e-cig, one of two that comes in a kit with a battery charger and bottle of fluid, called e-juice, for $64.95. Mays carries e-juice in 60-plus flavors, from tobacco to strawberry.
Users squirt a few drops of fluid into a small tank. The battery heats the e-juice to 92 degrees. With a push of a button, users inhale vapor through a mouthpiece.
Mays says the industry is misunderstood and that e-cigs are much safer than traditional cigarettes.
“Cigarettes have thousands of harmful chemicals; e-juice has one chemical,” Mays said as he helped Sweet pick a red e-cigarette kit.
June’s advisory came three years after the agency attempted to block the sale of e-cigarettes all together in the United States. The FDA claimed that an e-cigarette was a drug device and should be regulated as a heavily scrutinized medicine, not a tobacco product.
The federal court ruled e-cigarettes do fall under the FDA’s tobacco regulations. After all, nicotine comes from the leaf and stems of tobacco.
Tom Kiklas, co-founder of TVECA, maintains that e-cigarettes are not being touted as a cessation product, like nicotine lozenges, patches and gum. Therefore, e-cigs can be marketed like any other tobacco product.
The American Lung Association doesn’t buy Kiklas’ claims. Erika Sward, American Lung Association’s vice president of national advocacy, said e-cigs have not been thoroughly studied and no one really knows the chemical content in the e-juice. She also criticized the FDA and the Obama Administration for not moving fast enough in regulating e-cigarettes.
“The American Lung Association is very concerned about the potential health impacts of e-cigarettes,” said Sward, adding another big concern is the product is being marketed to children. “When I see a product with a cotton candy flavor, I don’t think that is for adults.”
Sward said there is also ample proof that e-cigarette companies are marketing the products as a tobacco cessation aide.
Kiklas said manufacturers of cessation products, not the tobacco industry, is leading the charge against e-cigarettes. Most tobacco manufacturers are — or soon will be — joining the e-cigarette market after tobacco sales declined by 5 percent last year.
Kiklas said regular tobacco cigarettes have 7,000 chemicals, 600 of which become carcinogens when ignited. E-cigarettes only have five basic ingredients: nicotine, flavoring, water, glycerol and propylene glycol — less than one half of 1 percent of the harmful chemicals, he said. Propylene glycol has caused concern among e-cig opponents because it is an ingredient in anti-freeze. Kiklas said the ingredient, which has long been approved by the FDA, is in many products, including asthma inhalers and food since the 1930s.
Health officials said since the product is not regulated — or even properly studied — then who knows officially what e-juice contains from one manufacturer to another. The Florida Department of Health’s Tobacco Free Florida agency stated it “is wary of any perceived benefits.” The agency noted there is no credible medical or scientific research to support the safety of e-cigs.
“Preliminary research from the FDA revealed that some e-cigarettes contain toxic substances and carcinogens, which are known to cause cancer,” the state health department noted.
The group Americans for Nonsmoker’ Rights (ANR) cited the Indoor Air journal study. The study showed nicotine causes the formation of carcinogens — including formaldehyde — when exhaled indoors, and could remain on surfaces for weeks. Users could then absorb the carcinogens.
“The authors (of the study) concluded the e-cigarettes are a new source of chemical and aerosol exposure and their potential impact is a concern that should be investigated,” the statement noted.
ANR’s immediate concern is the use of e-cigs at smokefree locations, like the workplaces and restaurants.
Evelyn James, health education specialist with the Florida Department of Health in Marion County (once called the Marion County Health Department), said e-cigarettes have not been studied.
James urged potential users not to “replace one product that has been proven to be bad for you” for another that has not even been tested.
The FDA’s June advisory comes as the popularity of e-cigarettes is starting to gain worldwide momentum.
E-cigarettes is a $500 million industry, a minute share of the annual $80 billion U.S. tobacco market. The e-cigarette market has grown globally by 30 percent in the past three consecutive years.
Marion County resident Jan Spagnol, an opiate user who has been clean for one year, said during her recovery, she has relied heavily on cigarettes. Last week, she purchased an e-cig kit from Mays to ratchet down her nicotine intake.
E-juice comes in different strengths, ranging from 24 milligrams of nicotine per milliliter down to zero. One 12 milliliter bottle, which costs $8.99 at the Paddock Mall kiosk, will last a one-pack-per-day light cigarette smoker about two weeks.
The e-cigarette device itself can be reused. The consumer will also have to buy a replacement tank for $6.99 about once a month, depending on usage.
In the end, a one-pack-per-day light cigarette smoker will spend about $25 per month vaporing, compared to about $150 per month smoking.
“I wanted a way to wean myself off cigarettes,” she said, adding that nicotine patches was one option.
She decided against patches because e-cigarettes allow her to still inhale and exhale, retaining that oral fixation associated with cigarettes.
“After I quit smoking, I really will be clean and sober,” she noted.
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