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House panel moves to block Navy proposal to ban tobacco sales on bases, ships

FoxNews.com
House lawmakers approved a measure this week that would protect tobacco sales on military bases and ships and effectively block the Navy’s plans to drop the products in a bid to get servicemembers to stop smoking.
The House Armed Services Committee added language to a fiscal 2015 defense authorization bill that bans defense officials from enacting “any new policy that would limit, restrict, or ban the sale of any legal consumer product category” on military installations, the Navy Times reported.
The Pentagon said last month that no final decision has been made about banning sales to troops, but Defense Secretary Chuck Hagel said he asked for a review to address the “astounding” health care costs associated with tobacco-related illness.
A March 14 Defense Department memo issued guidance to all service chiefs:
“Although we stopped distributing cigarettes to our Service members as part of their rations, we continue to permit, if not encourage, tobacco use. The prominence of tobacco products in retail outlets and permission for smoking breaks while on duty sustain the perception that we are not serious about reducing the use of tobacco.”
Rep. Duncan Hunter, R-Calif., who sponsored the amendment prohibiting the Navy’s plans, said the move amounts to a hand-holding of troops who are responsible adults and should be able to make their own life choices, the Navy Times reported.
“Just because you joined the service doesn’t mean you can’t live comfortably,” said Hunter, a Marine veteran of Iraq and Afghanistan. “If your goal is to make the military healthy, let’s outlaw war. That’s as unhealthy as you can get.”
The measure passed by a 53-9 vote on Wednesday, with some Democrats objecting to limits on the military’s efforts to promote health and fitness. In order for the regulation to become law, the  Senate would have to adopt the House measure.
Rep. Susan Davis, D-Calif., objected to the proposal, arguing that promoting good health is just as important as military readiness, The Washington Times reported.
“This is not telling people that they can’t use tobacco, clearly people can go across the street almost wherever they are and purchase that,” Davis said. “But we are sending a kind of double message, I think, by not saying that we recognize tobacco can cause damage, not only to a sailor, but also to their family, second hand smoke we know is a concern.”
The Navy Times reported that measure covers any product legal in the U.S. as of Jan. 1, including alcohol and sugary drinks. The measure does not cover marijuana.
Fox News’ Jennifer Griffin contributed to this report.
http://www.foxnews.com/politics/2014/05/09/house-panel-moves-to-block-navy-proposal-to-ban-tobacco-sales-on-bases-ships/

Higher taxes on cigarettes make good sense

Washington Post Editorial Board
Maryland has one of the highest state-imposed cigarette tax rates in the nation ($2 per pack) and, unsurprisingly, one of the lowest smoking rates. Virginia has one of the lowest cigarette tax rates in the nation (30 cents per pack); its smoking rate is almost 20 percent higher than Maryland’s.
America is well past the debate about the health effects of smoking, but tobacco taxes in many states remain low, thanks largely to the influence of tobacco companies. Yet it is clear that higher cigarette taxes have a direct effect on smoking rates, and they are particularly effective in dissuading young people from taking up the habit.
In Maryland, where the tax on a pack of cigarettes was raised in 1999 (to 36 cents), 2002 (to $1) and 2008 (to the current rate of $2), smoking rates have fallen by about a third, much faster than the national average. At the time of the last increase, Maryland’s tobacco tax was 6th-highest in the nation; since then it has slipped to 12th as other states have leapfrogged each other in an effort to further discourage smoking — and raise revenue in the process.
In Annapolis, public health advocates and other groups are now pushing for another $1 increase, which would bump the state tax in Maryland to $3 per pack. Depending on how much of the increase tobacco companies decide to absorb, that could raise the average retail price of cigarettes above $7; it’s currently around $6.40.
The projected benefits of a $1 increase in Maryland make a persuasive case. They include $95 million in additional revenue (which health advocates would like to use to extend Medicaid health coverage to the poor); a 10 percent decrease in the rate of youth smoking; thousands of adults who would be persuaded to quit; and the prevention of thousands of premature deaths, which in turn would produce considerable economic benefits.
It’s true that raising the tax would cause more Marylanders to cross the border to buy cigarettes in Virginia or North Carolina. But cigarette sales fell much more dramatically in 2008 in Maryland, the District and Delaware, all of which raised their tobacco taxes that year, than they rose in Pennsylvania, West Virginia and Virginia, which did not. And while cigarette smuggling remains an unquantifiable challenge, declining smoking rates and the associated public health payoffs are real.
Legislation to raise the tax went nowhere in Annapolis this year, possibly because the state has raised so many other taxes in the last few years. Advocates are mounting a push to gather pledges of support from lawmakers to enact the increase next year.
Meanwhile, in Virginia, where the tobacco lobby remains virtually unchallenged, the average price of a pack of cigarettes, about $4.60, is among the lowest in the nation. If Virginia lawmakers want to encourage children to take up the habit, they’re doing a great job.
http://www.washingtonpost.com/opinions/higher-taxes-on-cigarettes-make-good-sense/2014/04/20/aa90bd08-c716-11e3-9f37-7ce307c56815_story.html

Study: Tobacco use declines on prime-time TV dramas

By Saba Hamedy, Los Angeles Times
Prime-time television dramas are less smoke friendly than they were in the 1950s.

According to a study published online in the journal Tobacco Control on Thursday, there has been a dramatic decline in visibility of tobacco products on prime-time U.S. broadcast television.
Researchers at the Annenberg Public Policy Center of the University of Pennsylvania determined this drop in portrayals of smoking and tobacco use in prime-time dramas mirrored the national decline in consumption.
The study examined 1,838 hours of popular U.S. prime-time dramas — everything from “Gunsmoke” (in the 1950s) to “House M.D.” (in the 2000s) — shown on television over 56 years.
Research suggested that from 1955 to 2010, tobacco use on television declined from a high of 4.96 instances per hour of programming in 1961 to 0.29 instances per hour in 2010.
The research also noted a decline in consumption and suggested that less prime-time smoking may have led to less smoking by the general population.
“TV characters who smoke are likely to trigger the urge to smoke in cigarette users, making it harder for them to quit,” said Patrick E. Jamieson, the study’s lead author, in a release.
“We now have further evidence that screen-based media are an important factor to consider in continued efforts to reduce the burden of smoking related illness in the U.S. and around the world,” said Dan Romer, the study co-author and APPC associate director.
However, the study, the largest ever of tobacco use on television, looked only at broadcast television shows. Cable programs, such as AMC’s “Mad Men” — where characters frequently smoke cigarettes on screen — were not part of the study.
“Despite the decline since 1961, tobacco use on TV remains a cause for concern,” Jamieson said. “The decline in prime-time TV tobacco use is welcome news, but we need to learn more about tobacco portrayal on cable TV, YouTube, and other popular Internet-based sources.”

http://www.latimes.com/entertainment/envelope/cotown/la-et-ct-tobacco-use-primetime-tv-dramas-20140403,0,5751556.story#ixzz2yJOrzdCI

Teenage E-Cigarette Use Likely Gateway to Smoking

By Caroline Chen, Bloomberg News
E-cigarettes facing municipal bans and scrutiny by U.S. regulators received a new slap on the wrist from scientists: A report today suggests the devices may be a gateway to old-fashioned, cancer-causing smokes for teens.
Youths who reported ever using an e-cigarette had six times the odds of smoking a traditional cigarette than those who never tried the device, according to a study published today in the journal JAMA Pediatrics. E-cigarette use didn’t stop young smokers from partaking in regular cigarettes as well.
The global market for e-cigarettes may top $5 billion this year, according to Euromonitor International Ltd. estimates. Makers of the devices, including Altria Group Inc. (MO), the largest U.S. tobacco company, market them online and on TV, where traditional tobacco ads are banned, and some have added flavors such as bubble gum to the nicotine vapor that may have extra appeal for youths. That allure is why the U.S. Food and Drug Administration needs to restrict the devices, opponents say.
“The FDA needs to act now,” Vince Willmore, spokesman for the Washington-based Campaign for Tobacco-Free Kids, said in a telephone interview. “We think it’s overdue.”
Concerns about underage use of e-cigarettes were raised last year when the U.S. Centers for Disease Control and Prevention in Atlanta reported that use of the devices by youths doubled in 2012 from a year earlier.
“E-cigarettes are likely to be gateway devices for nicotine addiction among youth, opening up a whole new market for tobacco,” said Lauren Dutra, a post-doctoral fellow at the University of California at San Francisco and the report’s lead author. “We’re most worried about nicotine addiction initiation in youth.”

Enticing Product

E-cigarettes “are enticing for kids,” said Donovan Robinson, dean of students at Chicago’s Lincoln Park High School. He said today’s findings weren’t surprising. “They’ll say, ‘Hey, now let’s try the real thing.’”
Children in middle and high school, the target of the research, don’t think about health consequences, he said.
“Everything is a fad with teenagers,” Robinson said. They use e-cigarettes “because it looks cool. Teenagers see somebody doing something cool, and they want to do it.”
The latest research analyzed data from the 2011 and 2012 National Youth Tobacco Survey, conducted by the Centers for Disease Control and Prevention. Almost 40,000 middle and high school students from about 200 schools across the U.S. participated in the survey. Students were asked about their frequency of use of e-cigarettes, conventional cigarettes, cigars, pipes, and other tobacco products.

No Tar

While battery-powered e-cigarettes enable the ingestion of heated nicotine, users avoid the tars, arsenic and other chemicals common in tobacco products that have been linked to cancer, supporters have said.
The study today shows correlation, not causation, said Cynthia Cabrera, executive director of Smoke-Free Alternatives Trade Association, the Washington-based e-cigarette association.
“I’ve yet to see any science that shows there’s a gateway effect,” Cabrera said in a telephone interview. “We want to work with facts and science, we don’t want to make knee-jerk decisions based on emotional responses.”
Cabrera warned against drawing inferences on teen use based on the use of flavors in e-cigarettes.
“We do know that thousands of people were able to switch over to vapor products because of the flavors,” she said in a telephone interview. “Would we deny people who were in a group who could die from tobacco to use flavors that helped them get off killer tobacco?”

Nicotine Effects

Opponents have countered that nicotine alone is so toxic it’s been used in the past as a pesticide. They say the health effects of nicotine, which has proven to be habit forming, are unclear and deserve more study. Until that’s done, they’ve said, advertising of the devices should be closely monitored to make sure it isn’t aimed at underage smokers.
“We’re concerned that the marketing for e-cigarettes risks re-glamorizing smoking” among youths who won’t make the distinction between electronic and conventional cigarettes, Willmore said.
In December, a billboard in Miami used Santa Claus to market e-cigarettes and in the recent Sports Illustrated bathing suit issue there was an ad for one of the devices “right in the middle of a bikini bottom,” he said.
“You couldn’t design an ad more appealing to a teenage boy,” Willmore said.

Pivotal Year

This is expected to a pivotal year for producers of electronic cigarettes, with all major tobacco companies either launching new products or expanding their e-cigarette sales exposure, said Kenneth Shea, a Bloomberg analyst. Altria, Reynolds American Inc. and Lorillard Inc. are all expected to pursue U.S. exposure for their e-cigarettes, while closely held Logic Technology Development LLC and Sottera Inc., the maker of the e-cigarette NJoy, try to keep pace, Shea wrote in a report this month.
While tobacco companies have been under the FDA’s watchful eye since Congress gave the agency authority over the $90 billion industry in 2009, e-cigarettes haven’t been subject to the same oversight. The agency is now in the process of readying new rules for the industry designed to establish clear manufacturing standards and set boundaries for how the products can be marketed.
Federal regulators aren’t the only government officials moving to control use of e-cigarettes. On March 4, the Los Angeles City Council voted to join New York and Chicago in banning the use of the electronic products in in workplaces, restaurants and many public areas.

Bans Criticized

The municipal restrictions were criticized by Miguel Martin, president of Logic Technology, the second-largest independent e-cigarette maker in the U.S. Localities should wait for the FDA to make its views known before taking action, Martin said in an interview before the council vote.
“I find it odd that everybody looks to the FDA for guidance on everything else, but because it’s politically expedient, they don’t on this,” Martin said.
http://www.bloomberg.com/news/2014-03-06/teenage-e-cigarette-use-likely-gateway-to-smoking.html

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

By , The New York Times

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

But then their views diverge.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Glantz disagreed.

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

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

Kids who use snus before age 16 more likely to become smokers

BY SHEREEN JEGTVIG
(Reuters Health) – Norwegians who started using snus before age 16 were more likely to become cigarette smokers than those who started using snus later in life, according to a new study.
Snus is moist smokeless tobacco developed in Sweden. It’s contained in a small pouch, and unlike regular chewing tobacco, it doesn’t make the user spit.
Research suggests snus has lower levels of chemicals called nitrosamines than cigarettes and may be less harmful.
In Norway, snus has become a smoking cessation aid and most older snus users are former smokers.
But snus is also becoming increasingly popular among young Norwegian adults, many of whom have not smoked cigarettes. And although research is divided, the current thinking is that snus use reduces the likelihood of taking up smoking.
The authors of the new study wanted to know more about when people start using snus, to see if that ties into whether they also begin smoking cigarettes.
“I already knew about the research investigating associations between snus use and later smoking, but discovered that snus debut age had not been mentioned in that research,” Ingeborg Lund told Reuters Health in an email.
Lund is a researcher with the Norwegian Institute for Alcohol and Drug Research – SIRUS, in Oslo. She and her colleague Janne Scheffels published their study in Nicotine andTobacco Research.
The researchers analyzed surveys of Norwegian teenagers and adults conducted from 2005 to 2011.
Out of 8,313 people, 409 were long-term snus users who had started using snus before cigarettes or never used cigarettes. Of the snus users, 30 percent were long-term smokers.
Just over one third of the snus users started using snus before age 16. The researchers discovered those participants had two to three times the odds of becoming lifetime smokers, compared to people who began using snus after age 16.
They also found that early snus users had about the same rate of cigarette smoking as non-snus users. About 23 percent of early snus users were current smokers at the time of the survey, compared to only six percent of people who started using snus when they were older.
“Snus use seems to protect against smoking if the snus debut does not happen too early during adolescence,” Lund said.
She said it’s particularly important to keep teenagers tobacco-free until they are at least 16 years old.
“At younger ages, even if they start with a low risk product such as snus, there is a high risk that they will switch to – or add – other high-risk products, such as cigarettes,” she said. “This risk is reduced when they grow older.”
Since snus use is much less common in other countries, Lund said she doesn’t know if these results can be generalized outside of Norway and Sweden.
Lucy Popova, from the Center for Tobacco Control Research and Education at the University of California, San Francisco, told Reuters Health the new study was “interesting.” She was not involved in the research.
“Earlier initiation of snus basically makes it a gateway to tobacco use, to cigarette use in the future,” she said.
Popova explained that traditional Swedish snus is less dangerous than cigarettes.
“But it’s not harm-free, and (what) is really bad is when people start using both products because of increased rates of cardiovascular disease, pancreatic cancers and other problems,” she said.
Snus is fairly new to the U.S., and Popova said the version made in the U.S. isn’t like the traditional Swedish product.
“A research study found that it’s different from the traditional low-nitrosamine snus in Sweden – it’s not necessarily going to be as low-harm,” she said.
Popova is concerned with heavy promotion for smokeless tobacco products like snus.
“There’s been a lot of studies showing that more advertisement for tobacco products makes it more likely that children will use tobacco products,” she said, “and it’s important to keep youth tobacco-free as long as possible.”
SOURCE: bit.ly/1dP5O2Q Nicotine and Tobacco Research, online February 5, 2014.
http://www.reuters.com/article/2014/02/17/us-kids-snus-idUSBREA1G16T20140217

Tobacco Companies Agree on Ads Admitting Smoking Lies

By Andrew Zajac, Bloomberg News
Altria Group Inc. (MO), Reynolds American Inc. (RAI) and other tobacco companies agreed with the U.S. on how they will publicize admissions that they deceived the American public on the dangers of smoking.
The companies and the Justice Department resolved that “corrective statements” will appear in the print and online editions of newspapers and on television as well as on the companies’ websites. Expanded information on the adverse health effects of smoking will appear on cigarette packages, according to the agreement filed yesterday in federal court in Washington.
The plan for the statements is another stage in a 15-year-old civil racketeering case against the tobacco companies brought by the U.S.
The ads, fought over in court for more than two years, were ordered by U.S. District Judge Gladys Kessler, who in 2006 found the tobacco companies violated anti-racketeering laws by conspiring to hide cigarettes’ risks. The defendants in the case include Lorillard Inc. (LO)
Kessler also ordered the companies to stop marketing cigarettes as “light” and “low-tar.”
She later approved the text of corrective messages. The tobacco companies lost their bid to overturn Kessler’s decisions on the statements at the U.S. Court of Appeals in Washington in 2012.

Judge’s Approval

The agreement on the dissemination of the ads, which covers details such as the size of lettering and schedules of publication, is subject to Kessler’s approval.
Negotiations are continuing on whether the corrective ads will be required in retail locations, according to the agreement.
The consent order was filed the day before the 50th anniversary of the U.S. Surgeon General’s watershed Jan. 11, 1964, report warning of the health consequences of smoking.
Each of the ads begins by declaring that a federal court found that the four companies “deliberately deceived the American public” and goes on to state “here is the truth.” A description of companies’ wrongdoing follows, along with correct public health information in five areas including the dangers of smoking and its addictiveness, second-hand smoke and false advertising about low-tar and light cigarettes.

Appeals Pending

The ads are scheduled to begin after companies’ appeals connected to Kessler’s order have run their course.
The “agreement ensures that when all potential appeals are exhausted, the corrective statements will be ready to run without further delay,” according to a statement by Tobacco-Free Kids Action Fund and five other public health groups that joined the case.
Brian May, a spokesman for Richmond, Virginia-based Altria and its Philip Morris USA unit, declined to comment on the agreement
Bryan Hatchell, a spokesman for Winston-Salem, North Carolina-based Reynolds American, didn’t immediately respond after regular business hours yesterday to a phone message seeking comment on the agreement. No one responded to an e-mail to Lorillard’s press contact address after regular business hours yesterday.
The case is U.S. v. Philip Morris USA Inc., 99-cv-2496, U.S. District Court, District of Columbia (Washington).
http://www.bloomberg.com/news/2014-01-10/tobacco-companies-u-s-agree-on-ads-admitting-smoking-lies-1-.html

The war on smoking is working — and should continue

By , Washington Post

FIFTY YEARS on, the war on smoking can look back and claim a huge victory. Nearly half of the country used to smoke. Now less than a fifth of the country does. Some say that public health advocates have done enough; let those who still choose to light up, disproportionately from poor and vulnerable communities, smoke away their lives in peace. We disagree. It’s time for more taxes, more regulation and more outreach.
“Cigarette smoking is causally related to lung cancer in men; the magnitude of the effect of cigarette smoking outweighs all other factors; and the risk of developing lung cancer increases with the duration of smoking and number of cigarettes smoked per day, and diminishes by discontinuing smoking.”
Today, we know that smoking and secondhand smoke cause so many health problems across so much of the body that the benefits from the drop in use, accumulated across so many lives, are incalculable. Millions who quit or never started smoking breathe easier, suffer fewer strokes, get fewer cases of lung cancer, pass on fewer birth defects and take fewer sick days.
A new study in the Journal of the American Medical Association attempts at least to calculate the number of premature deaths prevented since 1964 by changing the public’s view of the habit. Based on the assumption that smoking patterns would have continued without a decades-long public health push, the researchers estimated that tobacco-control programs have saved 8 million lives in the past five decades. Should the country forgo the opportunity to save millions more?
Of course not. Plenty of sensible measures that stop short of banning cigarettes but effectively discourage their use are not consistently applied in the United States. The most obvious is taxing cigarettes. Rates vary drastically by state , leading to interstate smuggling. The federal government should raise its excise tax, bringing laggard states closer to those that do the right thing, reducing the opportunity for criminals and increasing incentives not to smoke. If Congress doesn’t act, individual states with low taxes, such as Virginia, should. Similarly, states and localities without strong indoor smoking restrictions should bring them in line with others’ stronger rules.
The Food and Drug Administration, meanwhile, has a range of authorities over tobacco products that it should exercise with ambition. Perhaps the most promising is the possibility that requiring tobacco companies to reduce the amount of nicotine in their products will usefully cut their addictive quality.
Consumer choice might help, too. Electronic cigarettes appear to offer the hopelessly addicted a safer alternative to combustible tobacco products, and smokers’ increasing use of these indicates significant demand for this sort of product. If federal regulation, public education and other efforts combine smartly with smokers’ desire to stop lighting up, e-cigarettes might be a useful tool to reduce harm rather than a gateway to a life of smoking.
Editorials represent the views of The Washington Post as an institution, as determined through debate among members of the editorial board. News reporters and editors never contribute to editorial board discussions, and editorial board members don’t have any role in news coverage.
http://www.washingtonpost.com/opinions/the-war-on-smoking-is-working–and-should-continue/2014/01/10/7af7d9e4-797a-11e3-b1c5-739e63e9c9a7_story.html

War on smoking, at 50, turns to teens: Our view

The Editorial Board, USATODAY

Want kids to quit? Raise cigarette taxes. It works.

The war on smoking, now five decades old and counting, is one of the nation’s greatest public health success stories — but not for everyone.
As a whole, the country has made amazing progress. In 1964, four in ten adults in the U.S. smoked; today fewer than two in ten do. But some states — Kentucky, South Dakota and Alabama, to name just a few — seem to have missed the message that smoking is deadly.
Their failure is the greatest disappointment in an effort to save lives that was kick-started on Jan. 11, 1964, by the first Surgeon General’s Report on Smoking and Health. Its finding that smoking is a cause of lung cancer and other diseases was major news then. The hazards of smoking, long hidden by a duplicitous industry, were just starting to emerge.
The report led to cigarette warning labels, a ban on TV ads and eventually an anti-smoking movement that shifted the nation’s attitude on smoking. Then, smokers were cool. Today, many are outcasts, banished from restaurants, bars, public buildings and even their own workplaces. Millions of lives have been saved.
The formula for success is no longer guesswork: Adopt tough warning labels, air public service ads, fund smoking cessation programs and impose smoke-free laws. But the surest way to prevent smoking, particularly among price-sensitive teens, is to raise taxes. If you can stop them from smoking, you’ve won the war. Few people start smoking after turning 19.
Long before health advocates discovered this, the tobacco industry knew that high taxes kill smoking as surely as cigarettes kill smokers. “Of all the concerns … taxation … alarms us the most,” says an internal Philip Morris document, turned over in a gaggle of anti-smoking lawsuits in the 1990s.
The real-life evidence of taxing power is overwhelming, too. The 10 states with the lowest adult smoking rates slap an average tax of $2.42 on every pack — three times the average tax in the states with the highest smoking rates.
New York has the highest cigarette tax in the country, at $4.35 per pack, and just 12% of teens smoke — far below the national average of 18%. Compare that with Kentucky, where taxes are low (60 cents), smoking restrictions are weak and the teen smoking rate is double New York’s. Other low-tax states have similarly dismal records.
Foes of high tobacco taxes cling to the tired argument that they fall disproportionately on the poor. True, but so do the deadly effects of smoking — far worse than a tax. The effect of the taxes is amplified further when the revenue is used to fund initiatives that help smokers quit or persuade teens not to start.
Anti-smoking forces have plenty to celebrate this week, having helped avert 8 million premature deaths in the past 50 years. But as long as 3,000 adolescents and teens take their first puff each day, the war is not won.
USA TODAY’s editorial opinions are decided by its Editorial Board, separate from the news staff. Most editorials are coupled with an opposing view — a unique USA TODAY feature.
http://www.usatoday.com/story/opinion/2014/01/08/war-on-smoking-50th-anniversary-cigarette-tax-editorials-debates/4381299/

Smoking Rates Still High Among the Mentally Ill

By John Gever, Deputy Managing Editor, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner
Smoking rates among Americans with mental illnesses didn’t budge from 2004 to 2011, a period during which rates in the rest of the population fell 14%, researchers said.
Data from the federal Medical Expenditure Panel Survey (MEPS) found that, among respondents with mental illnesses, 25.3% reported current smoking in 2004-2005 (95% CI 24.2%-26.3%), versus 24.9% in 2010-2011 (95% CI 23.8%-26.0%, P=0.50) after adjustments for other predictors of smoking such as income and education, according to Benjamin Le Cook, PhD, MPH, of Harvard Medical School in Cambridge, Mass., and colleagues.
Over the same interval, adjusted smoking rates in other MEPS respondents declined from 19.2% (95% CI 18.7%-19.7%) to 16.5% (95% CI 16.0%-17.0%, P<0.001), the researchers reported in the Jan. 8 issue of the Journal of the American Medical Association.
On the other hand, individuals with mental illnesses who were undergoing treatment showed somewhat greater quit rates than those who were untreated (37.2% versus 33.1%, P=0.005), Cook and colleagues found from a different data set, the 2009-2011 National Survey of Drug Use and Health (NSDUH).
“The mechanisms that support persistently higher rates of smoking among individuals with mental illness are complex and remain understudied,” they wrote. “Patients with mental illness may attribute greater benefits and reward value to smoking compared with patients without psychiatric disorders or may experience more difficult life circumstances, higher negative affect, or a relative lack of alternative rewards.”
Other experts contacted by MedPage Today offered differing views on the high smoking rates among the mentally ill.
John Spangler, MD, MPH, of Wake Forest Baptist Medical Center in Winston-Salem, N.C., said in an email that the nicotine in cigarettes “is very effective at relieving stress and improving mood. You can ask any smoker about that. It also can increase concentration in those with ADHD, and it improves memory as well.”
But Joseph McClernon, PhD, of Duke University, told MedPage Today that smoking as self-medication is not very effective. “Among dependent smokers, much of the relief or improvement in cognitive performance they experience from smoking likely has as much to do with reversing the effects of withdrawal,” he said in an email, which appears to be more severe in patients with some mental illnesses.
A similar viewpoint was expressed by Glen Getz, PhD, of Allegheny Health Network in Pittsburgh. The positive subjective effect of smoking “is only briefly effective and ultimately has counterproductive effects on mood, anxiety, and other emotional problems,” he said.
There was general agreement, however, that it may be more difficult for the mentally ill to quit smoking.
Among the factors cited by Cook and colleagues is a “smoking culture” that has long pervaded the mental health community, including clinicians as well as patients.
They noted that psychiatric inpatients historically were allowed and even encouraged to smoke “to decrease agitation and encourage patient adherence.” Even today, they suggested, many mental health professionals shy away from encouraging their patients to quit smoking for a variety of reasons, ranging from concern that it may distract from other therapeutic efforts to “lack of confidence” that patients can succeed in quitting.
But although such a culture did exist in the past, that’s changing, Douglas Ziedonis, MD, MPH, of the University of Massachusetts Medical School in Worcester, told MedPage Today.
“Nowadays we’re much more focused on wellness in recovery and also looking at the physical health of individuals who have mental illnesses,” he said in an email. “Mental health treatment providers are now realizing that they need to better address tobacco and wellness issues in mental health treatment.”
Said Martin Mahoney, MD, of Roswell Park Cancer Institute in Buffalo, N.Y., and director of New York state’s smoking quitline, “I don’t think there’s anything more important than helping a patients who is addicted to nicotine to get off of that addiction.”
For the current study, Cook and colleagues analyzed data on more than 32,000 MEPS respondents with mental illnesses and some 133,000 without. Participants were considered to have mental illness if they met any of several criteria: having a healthcare visit linked to a psychiatric ICD-9 code, receiving psychotherapy or mental health counseling, filling a prescription for a behavioral health disorder, or having scores on neuropsychiatric tests indicating severe psychological distress or at least moderate depression.
The data on quit rates associated with mental health treatments covered some 14,000 participants in the NSDUH from 2009 to 2011 whose responses indicated at least mild mental illness according to criteria established by the Substance Use and Mental Health Administration.
Differences in smoking prevalence in the MEPS data between those with and without mental illnesses were most pronounced among respondents with apparent depression or distress, for whom the gap was consistently around 15 percentage points through the 8-year study period.
Cook and colleagues acknowledged that the ascertainment of mental illness in both surveys could be faulty because they didn’t use structured diagnostic interviews. Also, as in most federal surveys, persons in institutional settings (including psychiatric inpatients) were excluded.
Another limitation was that the NSDUH did not include data on the timing of smoking cessation versus provision of mental health treatment, leaving open the possibility that some respondents may have quit smoking before receiving treatment. The researchers cautioned that “reverse causality” could therefore have occurred: patients may be more likely to seek mental health treatment after they quit smoking.
Primary source: Journal of the American Medical Association
Source reference: Cook B, et al “Trends in smoking among adults with mental illness and association between mental health treatment and smoking cessation” JAMA 2014; 311: 172-182.
http://www.medpagetoday.com/PrimaryCare/Smoking/43690?xid=nl_mpt_DHE_2014-01-08&utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&eun=g436493d0r&userid=436493&email=megan.houn@tfnd.org&mu_id=5533639