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Faces of the Boom: Smoke shop angles for return customers

By Amy Dalrymple, Forum Communications
ALEXANDER, N.D. – New Yorker Phil Hamda came to North Dakota to scout for real estate opportunities, but his plans changed after paying nearly $8 for a pack of cigarettes in Williston.

Hamda, whose father owned tobacco shops in New York City, noticed that tobacco prices in the Bakken varied widely.

“In New York, if you don’t like the prices, there’s a store right next door,” Hamda said.

Instead of trying to develop housing, Hamda took lessons he learned from his father and opened the Tobacco Depot in Alexander in February. He says his niche is fair, consistent prices that earn him repeat customers.

“Everybody’s nuts about our prices,” Hamda said. “We’re not extortionists.”

He initially struggled to find retail space and planned to operate from a trailer in Watford City. But when that location didn’t work out, he discovered a space for rent along the heavily traveled U.S. Highway 85 in Alexander, between Williston and Watford City.

“You couldn’t ask for better visibility than this,” Hamda said as a steady stream of oilfield traffic goes by his shop.

The North Dakota Department of Transportation is constructing a bypass that will take Highway 85 traffic around Alexander. Hamda said he expects the bypass will actually help his business because the traffic is often so heavy that customers can’t get into his parking lot.

“A lot of guys say they’ve been trying to get in here for a week,” Hamda said.

Hamda said he wasn’t prepared for the demand for electronic cigarettes and personal vaporizers. They account for about half of his business, primarily because smoking isn’t allowed on many oilfield locations and housing camps where workers live, Hamda said. He also sells a lot of chewing tobacco and cigarettes by the carton.

Hamda, who spent 20 years self-employed as a contractor, was in the middle of developing two six-unit condominium buildings in Jersey City, N.J., when the recession hit. He still wants to finish the buildings, and his success in North Dakota will help him do that.

He plans to sell the buildings once they’re complete and make North Dakota his home.

“After I’m done with them, I’m bringing that money here,” said Hamda, who has plans to expand his tobacco business. “There’s plenty of opportunity out here and I think it’s safe to invest.”

http://www.inforum.com/content/faces-boom-smoke-shop-angles-return-customers-0

Increasing popularity of smokeless tobacco poses cancer risk to young men

By , FoxNews.com

Though rates of cigarette smoking in America continue to decline, smokeless tobacco use remains popular, especially among young men — and with potentially dangerous health consequences.

A recent report from the U.S. Centers for Disease Control and Prevention (CDC) revealed that the use of smokeless tobacco among workers in the U.S. has held steady since 2005 – with rates of smokeless tobacco use being highest among males ages 25 – 44.

“In recent years there have been declines in cigarette smoking, but there’s really other tobacco products making up a large proportion of tobacco use in certain populations,” Brian King, scientific advisor at the CDC’s office of smoking and health, and lead author of the study, told FoxNews.com.
The dangers of smokeless tobacco use recently entered the national spotlight after the death of baseball hall-of-fame player Tony Gwynn, who died of salivary gland cancer after spending years dipping tobacco on the field.
According to the CDC, more than 30,000 people in the U.S are diagnosed with oral cancer every year. And every year, over 8,000 die of the disease, which has only a 50 percent five-year survival rate. A 2008 study from the World Health Organization indicated that smokeless tobacco users have an 80 percent greater chance of developing oral cancer than a non-user.
“Smokeless tobacco is a proven cause of oral cancer, including of the lips, throat and lining of the cheeks,” King said. “…With combustible tobacco the primary cancer is lung because people are inhaling, but with smokeless use, it’s primarily in the oral region, [which is] why we’re seeing a lot of cancers associated with smokeless tobacco around the oral cavity.”
In addition to being deadly, oral cancers often have devastating effects on a person’s appearance, as surgeries to remove cancerous lesions often require removal of portions of the face. Smokeless tobacco has also been associated with an increased risk of pancreatic cancer and heart disease.
The CDC’s study utilized data from the National Health Interview Survey to compare rates of smokeless tobacco use in 2005 and 2010. In 2005, 2.7 percent of U.S. workers admitted to using smokeless tobacco, compared to 3 percent in 2010.

“In terms of major findings, it primarily is that we haven’t seen any change, so that is concerning to us because obviously we’d like to see it decline over time,” King said. “So that finding is potentially a useful tool to inform strategies to start to address all forms of tobacco use, not just cigarette smoking.”
Another recent study by the CDC indicated that 2.6 percent of the population uses smokeless tobacco on some days, or every day, while 9.6 percent admitted ever having used these products, according to data from the 2012-2013 National Adult Tobacco Survey.

King said a lack of research on the effects of smokeless tobacco, combined with fewer public health initiatives geared towards this form of tobacco use, may be contributing to the steady use of these products in the U.S.
“A lot of campaigns and interventions have focused on combustible tobacco, and smoke-free policies have proliferated,” King said. “But all forms of smokeless tobacco use are really permitted in a lot of areas.”
Furthermore, loopholes in laws regulating cigarette use allow smokeless tobacco to be more accessible – and cheaper to the majority of the population.
“Cigarettes are taxed pretty uniformly in every state, but in most cases smokeless tobacco is taxed considerably lower than cigarettes in most states,” King said. “And we know increasing price is the single most effective way to reduce consumption, so the fact that these are available cheaper obviously increases the potential for people to use them.”
As the CDC continues to monitor the growing landscape of nicotine and tobacco products, they also have an eye on new products coming to the marketplace – including spit-less smokeless tobacco, tobacco sticks, orbs and strips and tobacco products featuring kid-friendly flavors.
While evidence is still emerging on the ill effects of smokeless tobacco, and how to curb its use, one thing is certain: quitting will benefit your health.
“Given the adverse health effects associated with smokeless tobacco, quitting is beneficial and since we know there’s no safe form of tobacco, if you were to quit completely that would considerably improve your health and potential for future disease and death,” King said. “There are a lot of evidence-based treatments to help people quit, and those are same as for cigarettes. The FDA has also approved seven medications including nicotine replacement therapy, and those can be used for smokeless tobacco as well.”

http://www.foxnews.com/health/2014/07/02/smokeless-tobacco-rates-remain-steady-in-us-as-cigarette-use-declines/

Teens Who Prefer Menthols Are Heavier Smokers: Study

It’s a fallacy that they’re safer than other tobacco products, researcher says:

(HealthDay News) — Teens who use menthol cigarettes are heavier smokers than those who smoke non-menthols, a new study finds.

Researchers analyzed data from a 2010-11 survey of more than 4,700 Canadian high school students who smoked and found that one-third of them smoked menthol cigarettes.

Menthol cigarette users smoked an average of 43 cigarettes a week, compared with 26 per week among those who did not smoke menthol cigarettes, the researchers found.

And teens who smoked menthol cigarettes were nearly three times more likely than other teen smokers to say they intended to continue smoking in the next year.

“The appeal of menthol cigarettes among youth stems from the perception that they are less harmful than regular cigarettes,” study author Sunday Azagba, a scientist at the Propel Center for Population Health Impact at the University of Waterloo in Canada, said in a university news release. “The minty taste helps mask the noxious properties, but the reality is that they are just as dangerous as any unflavored cigarette.”

The study, published in the June issue of the journal Cancer Causes and Control, only shows an association between menthol cigarettes and heavier smoking, not a direct cause-and-effect relationship. Still, the findings are worrisome, said Azagba.

“There is a growing concern that the high popularity of menthol cigarettes among youth may hinder the recent progress in preventing other young people from smoking because many of them may experiment with menthol rather than unflavored brands,” Azagba said.

Nearly one in 10 Canadian students in grades 10 to 12 is a smoker, the researchers said.

Moving forward, Azagba said, it’s clear that new laws are needed to ban all added flavors in all tobacco products.

More information

The American Cancer Society has more about menthol cigarettes.

SOURCE: University of Waterloo, news release, June 20, 2014

— Robert Preidt

http://consumer.healthday.com/kids-health-information-23/adolescents-and-teen-health-news-719/menthol-cigarettes-linked-to-more-smoking-among-teens-689105.html

Tobacco companies have made cigarettes deadlier than ever

Updated by 

Over the last five decades, the tobacco industry has engineered cigarettes to be more addictive — and has also made them more dangerous.

Smokers suffer from higher risk of lung cancer and chronic obstructive pulmonary disease (COPD) todaycompared to 1964, when the very first Surgeon General’s report on cigarettes was issued. This infographic, from The Campaign for Tobacco-Free Kids, lays out exactly how cigarettes have changed in the last 50 years.

Screen_Shot_2014-06-23_at_1.50.55_PMCompared to cigarettes in Australia and Canada, tobacco blends used in U.S. cigarettes have higher levels of tobacco-specific nitrosamines (TSNAs), chemicals known to cause cancer. TSNA levels have increased since 1964.

Cigarette companies also introduced ventilation holes in cigarette filters so that cigarettes would look healthier on paper. The ventilation holes cause machines to report lower levels of tar and nicotine when testing cigarettes. However, it’s been documented that these ventilation holes actually change how people smoke cigarettes. Smokers inhale more frequently and more deeply, drawing cancer-causing chemicals farther into the lungs.
The ill effects of these design changes are compacted by efforts to make cigarettes more attractive and more addictive.
Tobacco companies have introduced flavorings to make the taste of cigarettes more appealing, while also introducing chemicals that reduce discomfort and irritation in the lungs. Higher levels of nicotine, ammonia, and sugars have increased the addictiveness of cigarettes over time.
The smoking rate in the United States has hit an historic low — but tobacco use remains the greatest source of preventable death in the United States. According to the Surgeon General, smoking kills 480,000 Americans each year. It’s estimated that half of today’s smokers will die prematurely, losing, on average, ten years of life. It takes a toll on the nation’s economy, too: $289 billion is spent on health care and other financial losses associated with cigarettes annually.
The Tobacco Free Kids report calls for more aggressive oversight of the tobacco industry by the Food and Drug Administration. This is somewhat new terrain for the FDA; the agency wasn’t able to regulate tobacco much until 2009, when Congress enacted the Tobacco Control Act. Early efforts to stretch this regulatory muscle haven’t always been successful — the FDA wasn’t able to require cigarette manufacturers to totally overhaul their labeling to make health hazards more obvious, for example.
http://www.vox.com/2014/6/23/5835158/tobacco-companies-have-made-cigarettes-deadlier-than-ever?utm_medium=social&utm_source=facebook&utm_campaign=ezraklein&utm_content=sunday

'Teens choosing health': Smoking hits a landmark low

Kim Painter, Special for USA TODAY

Cigarette smoking among high school students in the United States has reached a landmark low in a survey health officials have been conducting every two years since 1991.

Just 15.7% of teens were current smokers in 2013, down from 27.5% when the survey began and 36.4% in the peak year of 1997, the federal Centers for Disease Control and Prevention reported Thursday. That means the nation has already met the government’s official goal of getting teen smoking below 16% by 2020.

“I think the bottom line is that our teens are choosing health,” CDC Director Tom Frieden said.

Frieden was referring not just to the progress on smoking, but to other gains in healthy behaviors picked up in the nationally representative Youth Risk Behavior Survey of more than 13,000 teens. Data for the report also come from state and local versions of the survey. The surveys are conducted at public and private high schools.

The data show teens are drinking less alcohol and fewer sodas, getting into fewer physical fights and having less sex with more birth control. Also, despite all the recent news about school shootings, the share of students threatened or injured with a gun, knife or other weapon on school property has dropped to 6.9%, from a peak of 9.2% in 2003.

But it’s not all good news: Condom use among the sexually active (about one third of teens) is down to 59%, from a peak of 63% in 2003. Condoms remain essential for protection from HIV and other sexually transmitted diseases, but teens may not be getting the message, Frieden says.

Even the news on tobacco is mixed: A once-rapid decline in cigar use has slowed, leaving cigars as popular as cigarettes with high school boys. Cigars were smoked by 23% of 12th grade boys in the month before the survey. Smokeless tobacco use hasn’t changed since 1999, holding at about 8%. Other surveys have shown increases in e-cigarette and hookah use. And the declines in cigarette use are uneven from place to place, reflecting varying tobacco control efforts, Frieden says.

“We’re moving in the right direction,” with the help of increased cigarette taxes, better educational campaigns and other measures, says Vince Willmore, a spokesperson for the non-profit Campaign for Tobacco Free Kids, Washington, D.C. “But the fight against tobacco isn’t over and it can’t be over when you still have 2.7 million high school kids who smoke.”

The survey, a treasure trove of data on more than 100 risky behaviors, “tells us what kids do but not why,” says Stephanie Zaza, director of CDC’s division of adolescent and school health. Among other details:

• 25% of students were in a physical fight in the year before the survey, down from 42% in 1991. Just 8% fought at school, down from 16%.

• 32% watched three daily hours of TV, down from 43% in 1999. But some of that time apparently shifted to computers, with 41% using a computer for non-school reasons at least three hours a day, up from 22% in 2003.

• 27% had at least one soda a day, down from 34% in 2007.

• 41% of those who drove admitted to texting or e-mailing while driving. CDC first asked about texting in 2011, but with a differently worded question, so it can’t say whether rates are up or down.

• 2.3 % had ever used heroin, a number that has remained fairly steady through the years. But in some large urban school districts, use was much higher, up to 7.4%.

http://www.usatoday.com/story/news/nation/2014/06/12/teen-cigarette-cdc-survey/10368235/

AMA, Doctor Allies Push CVS Rivals To End Tobacco Sales

The American Medical Association and allied physician groups this week are exacting added pressure on pharmacies and others that sell health products to join CVS’ move to cease peddling cigarettes and other tobacco products.

Earlier this year, CVS grabbed international kudos that included acclaim from the White House for the giant pharmacy chain’s decision to stop selling cigarettes and other tobacco products in all of its more than 7,600 stores by October 1, according to its parent company, CVS/Caremark (CVS).

Public health advocates said CVS’ move was particularly notable given its drugstores would be sacrificing $2 billion in annual sales for public health and future growth.

Now, the largest doctor group in the U.S. and affiliated state and national medical societies are voicing a more unified chorus against retail sales of tobacco products at the AMA’s annual policy-making House of Delegates meeting that runs through Tuesday in Chicago.

Several doctor groups said Sunday that they want the AMA to push pharmacies and “providers of health services and products” to stop-selling cigarettes and tobacco products or work to pressure them to limit sales of such products. An AMA reference committee Sunday considered two resolutions urging the organization to step up the pressure on pharmacies and other retailers.

The American College of Cardiology, for example, said even limiting tobacco has led to its reduced use.

“We urge retailers that sell health related products to follow the example set by CVS Caremark CVS +0.38% and discontinue the sale of all tobacco products,” said Dr. L. Samuel Wann, an AMA delegate representing the American College of Cardiology. “Selling both prescription medicines and cigarettes in the same store is hypocritical. Large pharmacy chains that continue to sell cigarettes appear irresponsible to society. The ACC supports all possible action to reduce tobacco access and use, especially when it comes to our nation’s youth.”

The resolutions before the AMA didn’t name retailers specifically. CVS rivals Wal-Mart (WMT) and Walgreen WAG -0.75% (WAG) continue to sell tobacco products.

The AMA reference committee ultimately reaffirmed the organization’s existing policy which opposes “the sale of tobacco at any facility where health services are provided.” 

The AMA’s annual House of Delegates’ meeting serves as more of a bully pulpit for health issues than anything.

“The power of the AMA is in its role as a single umbrella organization that covers all physicians, across specialty, geography, practice type or career stage,” Dr. Robert Wah, the incoming AMA president, said in a statement at the meeting’s open. “We have the ability to convene all the parties that need to come to the table to work on solutions to the challenges physicians face today. It’s the bringing together of different perspectives that makes the organization stronger.”

http://www.forbes.com/sites/brucejapsen/2014/06/08/ama-doctor-allies-push-cvs-rivals-to-end-tobacco-sales/

Andrew Knight: Extend to parks the push to reduce smoking

By Andrew Knight, Grand Forks Herald

Smoking should be allowed in Grand Forks parks because banning it “clamps down on personal freedom?” (“Too much cost for too little gain,” editorial, Page F1, June 1)

Is the argument really about progress vs. freedom?

The Herald’s “ThreeSixty” opinion section on June 1 includes the phrases “enjoy a cigarette on a park bench,” “cigarette smoke smells like roses,” and that a “(smoking) ban is ‘pointless’ from a traditional perspective.” It felt more like an opinion section from the 1960s.

Grand Forks Park District Commissioner Molly Soeby expertly lays out the issues with several pieces of evidence for this ban, and then non-local public policy wonks (Dennis Prager et al.) are trotted out as the counterpoint, with nary a point made specific to smoking in parks.

Soeby explains 78 percent of the Grand Forks community and 82 percent of golfers and softball managers are for a comprehensive tobacco-free policy. Even with sampling error, we can discern a clear majority opinion here.

How then, does Grand Forks City Council President Hal Gershman think the ban would be “very unpopular?” (“Banning smoking in parks a ‘needless intrusion,’” letter, Page A4, June 4).

This isn’t to say that I don’t expect a small but vocal backlash from the “hey, freedom!” crowd.

The supposed “counter” to Soeby’s arguments and statistics is a smattering of excerpts on the topic of smoking, starting with Simon Chapman from Australia (yes, Australia). Chapman compares car exhaust to secondhand smoke because we breathe in benzene from both sources. There are a LOT of car owners and not nearly as many smokers. How much benzene shoots out of exhausts in cars versus a single cigarette?

This argument fails because he’s using two different scales.

Chapman finishes the tortured analogy saying “we hear no serious calls for the banning of cars.” First, no one is calling for banning cigarettes; it’s about reducing smoking.

Second, there is substantial market pressure on car companies to reduce emissions. Science told us vehicle emissions are pretty bad, so we are trying hard to reduce them. Science also told us smoking is bad, so that’s why the push to reduce places where smoking is allowed needs to continue to parks and other public places.

The slippery slope fallacy continued with an excerpt from a New York Times editorial (from three years ago) to that city’s smoking ban, comparing it outright to alcohol prohibition 90 years ago. If we ban smoking in parks, it may lead to “a civic disaster,” according to the writer.

If this is the best group of arguments to keep smoking legal in parks, maybe it means there are few, if any, locals willing to write against the ban (in which case, kudos to Gershman and the Herald’s editorial board for being lone wolves on this minority opinion).

You have freedom to smoke on your property, in your car, while you walk around town and so on. You have freedom to do a LOT of things in your own home that you cannot do in a park because many of us believe it is better not to expose nature, playgrounds and children to it.

Add smoking to the list. We don’t want children to see adults smoking, feel cigarette butts in their toes or smell the cigarette smoke. Leave the cigarettes in the car for a round of golf or a volleyball match.

Soon my family is moving to Colorado — a state with acres ravaged by fires in recent years. Herald readers can probably understand that the residents there are skittish about smoking in places such as parks and playgrounds, and therefore have enacted smoking bans.

Like people in Grand Forks, they have natural beauty worth preserving, would prefer not seeing people “enjoying a cigarette on a park bench” and don’t want to take the chance that an errant cigarette butt could take down a forest range.

We’re packing up for the move and are already missing people we’ve befriended here, but we won’t miss the overly cautious, conservative approach to environmental protections.

This is not a simple false choice of progress or freedom. The Park Board should feel very confident moving forward in enacting this policy.

And to the Herald editorial board: Yes, the benefits are more than worth the costs.

Knight is an assistant professor in the music department at UND. 

http://www.grandforksherald.com/content/andrew-knight-extend-parks-push-reduce-smoking

NEWS RELEASE: ALA & TFND celebrate WHO “World No Tobacco Day”

FOR IMMEDIATE RELEASE:    Saturday, May 31, 2014

ALA & TFND celebrate WHO “World No Tobacco Day”

In honor of “World No Tobacco Day”, celebrated by the World Health Organization (WHO) each year on May 31, the American Lung Association in North Dakota (ALA) and Tobacco Free North Dakota (TFND) encourage policymakers and all North Dakotans to examine the current taxes on tobacco products in our state and its relationship to above average tobacco use rates in both adults and youth in North Dakota.
Research and studies have long shown the correlation between cheap tobacco and higher use rates.  Unfortunately, North Dakota has both.
While the U.S. average tax on a pack of cigarettes is $1.53, as of today, North Dakota ranks 46th lowest in the nation at just $0.44 per pack.  At the same time, North Dakota’s high school smoking rate of 19.4% exceeds the national average of 18.1%; our youth smokeless tobacco rate of 13.6% almost doubles that of the 7.7% national average; and our adult smoking rate of 21.2% continues to rank higher than the 19.0% national average.
“We challenge our leaders – from top to bottom – to keep the health of North Dakotans, especially our young people, in mind as they set priorities and enact policies in the future,” said Kristie Wolff, Manager of Advocacy and Tobacco Control for ALA.  “We know what policies work, and the health and economic benefits are proven.  We just need leaders with the courage to do what’s right by our kids.”
The World Health Organization (WHO) recommends the per pack cigarette tax should reach or exceed 75% of the total cigarette price.  In North Dakota, that tax would equal a minimum of $3.34 per pack, more than 7.5 times higher than that of the current $0.44 per pack.
– – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – –
Background:  May 31, 2014 marks the World Health Organization (WHO) annual commemoration of “World No Tobacco Day”.  Their ultimate goal is “to contribute to protecting present and future generations not only from the devastating health consequences due to tobacco, but also from the social, environmental and economic scourges of tobacco use and exposure to tobacco smoke”.
This year, WHO is calling on partner countries to raise taxes on tobacco.  Research shows that higher taxes are especially effective in reducing tobacco use among lower-income groups and in preventing young people from starting to smoke. 
Source:  CDC – http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6321a1.htm?s_cid=mm6321a1_x

You Now Have To Be 21 Years Old To Buy Cigarettes In New York City

 | by  Brigitte Dusseau

New York raised the minimum age to buy cigarettes to 21 on Sunday, in its latest initiative to encourage healthier behavior among residents.

The law, signed November 19 shortly before former mayor Michael Bloomberg finished his third term, had a six-month waiting period before it came into effect — but its impact can already be clearly felt.

“Under 21, no tobacco,” warned a small sign at the entrance of a small shop that sells smokes, newspapers, candy, coffee and cakes, in the Nolita neighborhood (North of Little Italy).

No tobacco, either, for anyone who can’t present a valid ID proving their age. Shopkeeper scan IDs to test their authenticity before handing over the box of cigarettes.

The measure — unprecedented among America’s big cities — raises the legal age to buy cigarettes from 18. It also applies to other forms of tobacco and to e-cigarettes.

It’s the latest of New York’s efforts to reduce smoking in the city, which bans cigarettes and, as of April 29, e-cigarettes in restaurants and bars, in parks or squares, and at the city’s public beaches. Some private residential buildings have also banned smoking.

Cigarette taxes in the city are also the highest in the country: $5.85 a carton, which brings the overall price to around $12. In addition, the city has established a minimum price of $10.50 a box for cigarettes.

Nataleigh Kohn, 23, who works at a startup company, underwent her ID check with good grace.
“It is a good thing. People in high school can’t start smoking,” she said.
Thomas Wall, 24, a former smoker who works in architecture, agreed, though he said the measure probably wouldn’t eliminate teen smoking all together.
He compared the new age restriction to the ones around alcohol, which set the US drinking at at 21.
When underage people want alcoholic drinks, they often get them from older people who buy for them.
Shopkeeper Muhammad Arisur Khaman said he’s seen some complaints since the law was implemented, but not many. He just tells unhappy clients: “It’s the law.”
The higher minimum age is “a step in the right direction,” said Pat Bonadies, a teacher walking with a group of students in Union Square.
The 52-year-old said there has been a sea change in attitudes towards smoking.
“When I was younger, smoking was much more prevalent among teenagers and preteens in restaurants and social settings,” she said.
“Even my mother’s friends, they smoked during their pregnancies.”
The city has seen a sharp drop in adult smokers, from 21.5 percent in 2002 to 14.8 percent in 2011, according to official statistics.
But the smoking rate among young people has been steady since 2007, at 8.5 percent, which was part of the impetus for raising the minimum age.
Authorities hope that the new law will cut the smoking rate among 18 to 20 years by more than half.
New York hopes to inspire other cities to pass similar age restrictions.
http://www.huffingtonpost.com/2014/05/18/new-york-city-cigarettes-minimum-buying-age-now-21_n_5348490.html?ncid=fcbklnkushpmg00000063

Health Insurance Surcharge Has Vapers Fuming

By  via GOOD MORNING AMERICA

Under the Affordable Care Act, insurance companies can charge smokers and other tobacco users up to 50 percent more than non-smokers for a health insurance policy. But where do e-smokers fit in?

E-cigarettes are battery-operated nicotine inhalers that consist of a rechargeable lithium battery, a cartridge called a cartomizer and an LED that lights up during each puff. Although they contain no tobacco, the U.S. Food and Drug Administration plans on regulating them like cigarettes and cigars. This, it turns out, is complicating things for insurance companies.

While the ACA allows insurance companies to charge higher premiums to smokers and other tobacco users, the definition of a “smoker” is unclear under the law.

One way insurance companies could deal with e-cigarettes is to lump them in with tobacco products – a move that would subject so-called vapers to the same higher premiums as cigarette smokers. The companies could also swing the other way and decide to cover the cost of e-cigarettes as a means to help people quit smoking, despite a lack of evidence that the devices work as well as a patch. Insurers could also choose to ignore e-cigs altogether.

”The Affordable Care Act does not specify e-cigarette use for purposes of cessation coverage or tobacco surcharge application,” the American Cancer Society said in a statement to ABC News. “The lack of clarity may allow health plans to try to add the surcharge for e-cigarettes.”

If and when the FDA regulation of e-cigarettes goes into effect, insurance companies could change any of their current policies to reflect the agency’s direction. In the meantime, most companies claim they have too little experience with the devices to have a position, according to an informal poll by the National Association of Health Underwriters.

Carrie McLean, director of customer care for the online health insurance brokerage eHealth, said some insurers are telling their agents to add a smoking surcharge for those who vape.

“If a consumer indicates they use e-cigarettes, the carriers are expecting them to be uprated just as if they are a smoker,” she said, noting that consumers aren’t actually asked about the type of tobacco products they use during the health insurance application process – just whether they use them at all.

America’s Health Insurance Plans, an association which represents most of the country’s large health insurance companies, recommends that agents ask about regular tobacco use in the last six months and the most recent use. However, if a consumer were to ask for clarification about whether or not e-cigarettes count as tobacco use, then an agent is obliged to add the surcharge, McLean said.

“The problem arises because most people fill out their applications online and, as of now, most applications don’t ask specifically about e-cigarettes,” McLean said. “Consumers are left to decide on their own whether or not they consider themselves a tobacco user.”

It’s an important question to settle, as the price differential can be significant.

For example, a plan for a 40-year-old non-smoker with a $35,000 income that costs $3,857 a year minus a $532 tax credit would rise to $5,254 for someone labeled a smoker, according to the Kaiser Family Foundation’s exchange subsidy calculator. In some cases, the rate increase might even be larger than the 50 percent increase the ACA allows because government tax credits only apply to the base premium and not the tobacco surcharge.

Not surprisingly, e-cigarette advocates are fired up about vaping being likened to smoking by insurance companies. Cynthia Cabrera, executive director of the e-cigarette industry organization Smoke Free Alternatives Trade Association, said that e-cigarettes and other vaping products are a healthier lifestyle choice than combustible tobacco cigarettes, and argued that it seems inconsistent to apply the same higher insurance rates to vapers.

“The SFATA does not agree with any policy that positions users of electronic cigarettes and other vapor products in the same category as smokers,” she said. “These products do not emit smoke and do not contain tobacco, tar or any of the many carcinogens known to exist in combustible cigarettes.”

But the phenomenon of vaping is so new that experts say there’s insufficient science to determine whether e-cigarettes really are a healthier alternative to traditional tobacco products.

Dr. Ravi Ram, the chief medical officer for Blue Shield of Northeastern New York, said that although New York has chosen to eliminate rate increases for e-smokers, he suspects most plans would place e-cigarettes on par with cigarettes in terms of their health risk.

“Until you have some long term data and some actuarial differences to health outcomes such as lung cancer, emphysema, heart disease and other conditions which are significantly impacted by smoking, and likely to be impacted by e-cigarettes as well, you have to rate them the same,” he said.

http://abcnews.go.com/Health/health-insurance-surcharge-vapers-fuming/story?id=23628060