Letter: Thoreson fronts for Big Tobacco

By: Jay Taylor, Mapleton, N.D., INFORUM
In a recent letter to the editor, Rep. Blair Thoreson, R-Fargo, criticized a Grand Forks physician for not supporting his support for e-cigarettes. Actually, Thoreson’s push was not supported by anyone in the Legislature, but you gotta give him points for keeping at it.
The push today is from those supporting a “Harm Reduction Strategy,” which includes Thoreson. This push kind of sneaks in the door as it’s supported by some of the Big Tobacco folks. Their theory is that we have failed to get everyone in the world to quit using tobacco, so why not try some products that may have less risk. They often recommend the e-cigarette as well as some smokeless tobacco products.
E-cigarettes have not been shown to be safe, and each brand that we look at seems to have different chemicals within. They are not approved by the Food and Drug Administration, and my guess is that they never will have that approval.
What is approved and what does work is three-fold: attitude, education and medicine. First, want to quit! Then learn why you should and use safe, effective medications in the correct dosage to get the job done. Call the Quit Line: 800-QUIT-NOW and get going.

E-cigarette maker targets Colorado

By Carol McKinley
Colorado Public News
The arrival of electronic cigarettes has raised a red flag for health officials and others who worry the activity of “vaping” nicotine will hook young people into a new addiction that could last a lifetime.

In Colorado, the concern is heightened by the arrival of tobacco giant R.J. Reynolds Tobacco Co. Beginning this month, the maker of Camel cigarettes and other tobacco products began selling its new e-cigarette – called Vuse – along Colorado’s Front Range as one of four test markets.
“We’ve done a lot of work to make it not cool to smoke, and we’d hate to see that rolled back,” said Stephanie Walton, youth policy coordinator for the Colorado Department of Public Health and Environment.
Pat Senecal, director of health policy and systems at San Juan Basin Health Department in Durango, said Friday that the Federal Drug Administration is worried about test marketing and availability of e-cigarettes.
“The FDA has no regulatory authority yet over e-cigarettes, so the risks aren’t known,” Senecal said. “E-cigarettes have flavoring, and studies of other tobacco products show that flavoring appeals to youths.”
The Colorado Department of Public Health and Environment said in a statement Friday: “Too much remains unknown about the potential health risks of these new nicotine products. We are concerned that the tobacco industry is introducing yet another product to Coloradans that is addictive and potentially harmful to their health.”
Also known as personal vaporizers, e-cigarettes broke into the American market six years ago. They look like cigarettes, but do not contain tobacco. They actually are battery-operated inhalers that turn nicotine into a vapor. The liquid, or “E-Juice” that is vaporized can carry a range of tasty-sounding flavors such as cotton candy and peach and names like “Bikini Martini” and “Choco Loco.” E-cigarettes aren’t “smoked,” they are “vaped.”
Studies long have determined that nicotine is as addictive as heroin and cocaine, leaving health officials such as Walton concerned.
“If children see e-cigarettes as popular and fun and start using them, that can lead to a lifetime of nicotine addiction,” she said.
Many Americans report they’ve never heard of e-cigarettes, but the industry now is generating $500 million in sales annually. Business is expected to surpass $1 billion annually within the next couple of years.
E-cigarettes generally are sold in places where tobacco products are available, as well as in specialty shops and in shopping malls. Since at least 2009, the federal Food and Drug Administration has warned about potential health risks associated with e-cigarettes. In addition to nicotine, the products contain substances such as propylene glycol and artificial flavors that might, the agency warns, penetrate deeply into the lungs. However, the products – at least for now – are not regulated.
More than a dozen states, including Colorado, have banned the sale of e-cigarettes to minors. But Walton and others are concerned that advertising, and the tasty-sounding flavors, will directly appeal to young people.
“We would love to see the FDA look into this, especially with some of the larger tobacco companies really taking an interest in these products now,” Walton said.
But some vendors who sell e-cigarettes say they promote the product as a healthier alternative to traditional cigarettes and a way to wean people off of tobacco products.
Within three days of last summer’s mass shooting in Aurora, Colorado-based e-cigarette company began offering trial kits for free to anyone who had been at the theater and was suffering from post-traumatic stress disorder.
“Above all, we are a company that cares for the health of our customers. We understand that they are going through a difficult time, and we want to help,” the company announced.
John Paul Pollock of The Vapor Store in Golden described e-cigarettes as “a dignified alternative for people who smoke.”
However, Walton rejects comparison to other stop-smoking products – such as the FDA-approved nicotine patch and nicotine-infused gum.
“There is no research that shows that (e-cigarettes) are an effective cessation or stop-smoking aid or device,” she said.
Still, e-cigarettes are catching on worldwide. A recent survey found that nearly 10 percent of Parisian schoolchildren between the ages of 12 and 17 have tried them. There are many active e-cigarette forums and Facebook pages. One website discussion in Colorado asks if people can “vape” in casinos in the mountain gambling town of Black Hawk and advertises meet-ups where fellow “vapors” can connect.
Because e-cigarettes are not a tobacco product, companies can get around 42-year-old laws that ban cigarette advertising. Currently, the largest concentration of e-cigarette ads is online. But with big companies such as R.J. Reynolds entering the marketplace, some predict advertising on TV, radio and billboards is not far behind.
“By around August, we should start seeing significant TV advertising, as well as online,” said Colorado-based marketing executive Brent Green. In addition, he said, “there will be live sampling at nightclubs and festivals where people gather.”
Green, a critic of e-cigarettes, highlighted the dangers of romanticizing e-cigarettes. For example, recently, actor Leonardo DiCaprio was seen vaping in public.
“You show celebrities, you show cool adults using the product – kids always aspire to act and react like adults. They want to be grown up,” said Green.
It is unclear why R.J. Reynolds selected Colorado as its test market for the new product. During a recent press conference, R.J. Reynolds Vapor Co. president Stephanie Cordisco would say only that “Colorado represents just one of our major states as we are rolling this out.”
Company officials did not return subsequent calls from Colorado Public News.
Even the Colorado Department of Public Health and Environment says it can’t get a definitive answer as to why Colorado was selected.
“We’re not sure why. We would love to know,” said Walton.
The Centers for Disease Control and Prevention reports nearly 1 in 5 Coloradans smoke cigarettes, ranking the state 10th nationally.
Durango Herald Staff Writer Dale Rodebaugh contributed to this report. Colorado Public News, a nonprofit news organization, reports on issues of statewide interest. It partners with Colorado Public Television 12, Denver’s independent PBS station.

Electronic cigarettes could rekindle battles over smoking in public

Article by: ANDREW WAGAMAN, Star Tribune
It was trivia night, and Michael Jamnick didn’t want to leave the TGI Friday’s in Maple Grove to go outside and have a smoke. So he started puffing right where he sat.
The 27-year-old from Minnetonka wasn’t breaking the law: He was using an electronic cigarette.
Still, Jamnick said he felt uncomfortable vaping (the e-cigarette term for lighting up).
“It’s been, what, six years now since they passed the smoking ban in Minnesota?” he said. “You give it a funny look because you haven’t seen it in a while.”
Electronic cigarettes have been on a slow burn for years, but they’ve recently caught fire. National sales jumped to $500 million in 2012 and are projected to clear $1 billion this year. In the Twin Cities, at least a dozen e-cigarette specialty shops have opened and shop owners say the growing business will likely see a boost from the $1.60-a-pack tobacco tax hike, which went into effect July 1.
The e-cigarette industry is promoting vaping as a hip, healthier alternative to smoking — and as a way to quit. But while health experts largely agree that the vapor from e-cigarettes poses less of a threat to public health than tobacco cigarettes, some worry that welcoming the so-called “clean nicotine” could erode smoking bans, encourage smokers to trade one addiction for another and hook nonsmokers.
“Shifting entirely over to vaping from smoking would be a big public health plus,” said Robert Proctor, a history of science professor at Stanford University. “But the question of whether e-cigarettes are good or bad isn’t that simple.”
Supplanting cigarettes?
E-cigarettes are battery-powered devices that create a vapor mist from a heated liquid solution when the user inhales on a mouthpiece. The solution, or “e-juice,” and vapor mist, which looks like smoke, typically contain nicotine, but users can regulate the amount. That’s why some vapers say e-cigarettes have helped them quit tobacco — and wean themselves off nicotine altogether.
Research released in late June by Italy’s University of Catania lends support to those claims. The study found that 13 percent of participants who used high-dose e-cigarettes quit smoking. Seventy percent of those who quit smoking eventually gave up e-cigarettes, too.
“As evidenced in this study, when people switch to electronic cigarettes, it absolutely makes it easier to quit nicotine use completely,” said Michael Siegel, a professor at Boston University School of Public Health who studies e-cigarettes. “It’s not as simple as saying people are substituting one addiction for another.”
In fact, Siegel said the quit-rate for e-cigarettes is comparable to rates in other nicotine-replacement therapy studies.
But others maintain that it’s not yet known how harmful vaping could be.
“We frankly don’t know much about them,” said Robert Moffitt, an American Lung Association media relations director.
Concerns about harm from secondhand vapor are not at the forefront. While a 2012 German study found that the vapor is an “aerosol of ultrafine particles,” no studies have shown it to be dangerous. But Moffitt and others question claims that e-cigarettes can help smokers quit.
“We’d strongly recommend anyone from using them,” he said, “especially with so many other valid smoking-cessation devices and techniques that we know work.”
He also doubts that the e-cigarette industry, which includes big tobacco companies, would encourage people to stop using nicotine entirely. “They’re looking for new young people to get hooked on nicotine products,” he said, “and e-cigarettes seem to be the latest.”
Stanford’s Proctor, however, sees both the promise and the threat in the recent rapid spread of e-cigarettes.
“E-cigs seem to offer us the possibility of keeping the addiction, while losing the cancer,” he said. “But is addiction itself a bad thing? That question is splitting the public health community, and it’s not yet clear which direction we’ll go.”
Bans cropping up
Michael “Troop” Wolberg, 41, used to smoke two packs of cigarettes a day. After trying to quit several times, he turned to e-cigarettes. On his third day of vaping, the Stacy, Minn., man says he lit his last cigarette. Since then, he’s become a champion of e-cigarettes. He’s written online reviews of vaping products, become a member of the Minnesota Vapers Club and helps run an online business that sells flavored e-juice.
Wolberg, who calls himself an advocate of “tobacco harm reduction,” isn’t shy about using his e-cigarette. “I’m rather proud to display it in public because I think it needs to be seen,” he said.
Cynthia Hallett couldn’t disagree more. Hallett, executive director of Americans for Nonsmokers’ Rights, says vaping could undermine the hard-won battles to establish non-smoking areas.
Proctor echoes her concerns. “If you can’t tell whether someone is vaping or smoking, that could work to erode established no-smoking zones,” he said.
So far, e-cigarettes aren’t widely regulated.
In 2012, Minnesota passed a law banning the sale of e-cigarettes to minors. But, in part because e-cigarettes don’t burn anything, they haven’t been legally prohibited in public places. (This spring the St. Paul City Council proposed banning e-cigarettes in indoor public spaces, but the proposal was dropped.)
However, the electronic cigarettes have been banned in K-12 schools in the state and some colleges and universities also have moved to ban them.
“It was part of promoting a healthier lifestyle and clean environment for our students,” said Amber Luinenberg, coordinator of communications for Minnesota West Community and Technical College, which prohibits vaping on its five outstate campuses. “I think students in particular are very accustomed to tobacco-free locations, so there was no controversy at all. They were very receptive to it.”
Managers at local restaurants and bars say they are just starting to see people use e-cigarettes in their establishments. While some have banned them, others are taking a wait-and-see approach.
Parasole Restaurant Holdings bans vaping at its restaurants, said Kip Clayton, public relations director. “To not do so when dealing with thousands of people a night,” at restaurants like Uptown Cafeteria and Chino Latino, “would be inviting trouble,” he said.
The Lung Association’s Moffitt hopes legal measures will be taken to ban e-cigarettes in public places before they become more common.
“Maybe we need to put the kibosh on these right now,” he said.
For now, using e-cigarettes may come to down to common courtesy.
Jamnick, who has quit smoking cigarettes, doubts he’ll use his e-cigarette much anymore when he’s out.
“Generally, I try to avoid using it around other people,” he said, “because some people just don’t like it.”

Letter: Use all anti-tobacco strategies

By: Rep. Blair Thoreson, Fargo, N.D., INFORUM
Several weeks ago, a letter from Dr. Eric Johnson appeared in The Forum in which Johnson made inaccurate accusations regarding a resolution I introduced in the 2013 North Dakota Legislature aimed at reducing the risk of death and disease among smokers. By attempting to distort my motives and tie me to special-interest groups with which I have never had any affiliations, the letter’s author distracted from what should be a productive conversation.
Because smoking harms us all, the state ought to pursue an all-of-the-above strategy to reduce cigarette consumption. In addition to conventional anti-smoking measures, like messaging to youths and promoting smoking cessation, one strategy our state should consider is tobacco harm reduction, which seeks to minimize the damage tobacco does to users and society alike.
Tobacco harm reduction is a secondary strategy that could be used when traditional anti-smoking measures fail. It’s not in question that quitting is the single best thing smokers can do for both themselves and society, but despite our efforts to encourage quitting, thousands of smokers remain unable or unwilling to snuff out their addiction. Tobacco harm reduction targets these individuals by accepting that they will continue to use nicotine, and explores ways to reduce the costs and harmful effects of their nicotine usage.
One alternate product current smokers could turn to is the electronic cigarette, which delivers nicotine without the toxic carcinogens and doesn’t produce secondhand smoke. In fact, a study by the Boston University School of Public Health found that electronic cigarettes are significantly safer than conventional ones, with carcinogen levels 1,000 times lower. If smokers who refuse to quit entirely could be persuaded to switch to electronic cigarettes, North Dakota would pay less in smoking-related health costs, and our children would be at less risk of secondhand smoke exposure.
It may seem like an unconventional method of reducing risk, but studies have shown that smokeless tobacco carries significantly lower health risks than cigarettes. No one should mistake smokeless tobacco for a healthy product, but compared to smoking, it may be less deadly and a better choice.
National and state anti-smoking campaigns have been highly effective, as the smoking rate is half of what it was 50 years ago, and smoking among teenagers is at an all-time low. Yet there remains a persistent minority of nicotine users for whom our conventional outreach has failed. In efforts to promote public health, cut health care costs and reduce preventable deaths, we can’t afford to give up on messaging to these smokers.
It’s clear, however, that we need to think outside the box to reach them. Tobacco harm reduction, endorsed by the American Association of Public Health Physicians, won’t eliminate all the health risks created by persistent smokers, but it could lower their death rate and medical expenses, and take secondhand smoke out of the air.
Instead of making false claims, I believe it would be much more productive to work together and address the public health problems created by smoking on as many fronts as possible. The Legislature’s interim Health Services Committee recently launched a study of the overall effectiveness of North Dakota’s tobacco control programs, which gives us the opportunity to expand and improve our outreach. As we move forward with developing the next generation of public health strategies, tobacco harm reduction should at least be part of the conversation.
Thoreson, R-Fargo, is a small-business owner and represents District 44 in the North Dakota House.

Are E-Cigarettes a Boon, a Menace or Both?


Rapidly growing numbers of consumers are turning to electronic cigarettes to satisfy their nicotine addiction without inhaling the carcinogens and toxic chemicals found in tobacco smoke. Buyers need to beware. Unlike nicotine gum and skin patches, electronic cigarettes have not been evaluated for safety or effectiveness.

Global sales of electronic cigarettes, although small compared with overall tobacco sales, have been rising quickly in both Europe and the United States. Several major tobacco companies have announced plans to introduce new or revamped e-cigarettes. And regulators for the European Union and Britain have released plans to regulate e-cigarettes more stringently, possibly starting in 2016.

Electronic cigarettes turn liquid nicotine into a vapor inhaled by the user. The liquid comes in dozens of flavors, mimicking everything from a standard cigarette to a piña colada or bubble gum. Smoking the devices is undeniably safer than inhaling tobacco smoke, a carcinogen, but there are some risks. Nicotine is extremely addictive, and very high doses can be dangerous. Toxic chemicals have been found in some devices, suggesting serious quality control problems at the factories.

Health officials also fear that flavored vapors coupled with advertising aimed at young people might induce them to start smoking and then move on to traditional cigarettes.

The Food and Drug Administration has two avenues for regulating e-cigarettes. If a manufacturer claims its device will help smokers quit smoking, the agency can demand proof that it is safe and effective for that purpose. However, if a manufacturer makes no such claim and leaves it to smokers to infer that the devices will help them kick the habit, courts have held that the F.D.A. must regulate under a different law that doesn’t require the same level of proof.

Even under that weaker standard, the agency has broad powers to protect public health. It could ban flavorings (like fruit or candy) that make products appeal to youngsters and even ban sales or marketing to buyers under 18. It could ensure that advertising is not deceptive and that factories follow good manufacturing practices.

The F.D.A. has been working since 2011 to draft new regulations to exert its authority over nontraditional tobacco products, potentially including electronic cigarettes. It needs to move as aggressively as possible to protect the public in this rapidly expanding market.