FRIDAY, May 23, 2014 (HealthDay News) — As they learn more about electronic cigarettes, American smokers are becoming less likely to believe that the devices are a safer choice than tobacco cigarettes, a new study finds.
In 2010, nearly 85 percent of smokers believed e-cigarettes were less dangerous than traditional cigarettes, but that dropped to 65 percent of smokers in 2013, researchers report in the August issue of the American Journal of Preventive Medicine.
“This apparent decline in smokers’ beliefs about reduced harm of e-cigarettes compared with regular cigarettes is perplexing against the background of advertising and media messages touting e-cigarettes as safer alternatives and cessation aids,” study co-investigator Cabral Bigman, from the University of Illinois at Urbana-Champaign, said in a journal news release.
“One possible explanation is that the increased media attention over the lack of [U.S. Food and Drug Administration] approval and regulation of this emerging tobacco product, injuries arising from e-cigarette-induced fires, and health concerns from toxic chemicals in e-cigarettes in recent years may have conveyed conflicting information about the relative safety of e-cigarette use,” Bigman said.
The FDA last month proposed long-awaited regulations governing the fast-growing electronic cigarette industry. The new rules would give the agency the authority to regulate e-cigarettes as tobacco products, placing them under the same requirements as cigarettes. That would include a ban on the sale to minors.
E-cigarettes are battery-operated devices that turn nicotine, flavorings and other chemicals into a vapor that can be inhaled. Most are designed to look like a tobacco cigarette, but some look like pens, USB drives or other everyday objects.
The devices are becoming more popular. It’s predicted that sales of e-cigarettes will soon reach $1.7 billion, or about 1 percent of current sales of regular cigarettes in the United States.
The current study included data from the Health Information National Trends Survey. The investigators found that Americans’ awareness of e-cigarettes rose from about 16 percent in 2009 to 77 percent in 2013.
“In the beginning of 2013, more than three in four respondents were aware of this novel product,” study co-investigator Andy Tan, from the University of Pennsylvania, said in the news release. “The rise in awareness of e-cigarettes could reflect sharp increases in advertising expenditures by manufacturers, availability in retail stores across the country, and presence in popular media.”
Those more likely to know about e-cigarettes included young people, current and former smokers, and those with higher levels of education. Those less likely to know about the devices included Hispanics and older people, the study authors noted.
The researchers also found no link between increased awareness about e-cigarettes or beliefs that they are less harmful and smokers being more likely to try quitting.
“One potential interpretation is that adult smokers have not yet accepted e-cigarettes as a means to quit smoking,” Tan said in the news release.
The finding means that any claims that e-cigarettes help reduce the health threat posed by regular cigarettes are likely premature, he added.
More information
The U.S. National Institute on Drug Abuse has more about e-cigarettes.
SOURCE: American Journal of Preventive Medicine, news release, May 15, 2014
The Food and Drug Administration just proposed a set of rules that would ban sales to minors and require e-cigarette manufacturers to disclose their products’ ingredients. If passed, the regulations would bring some much-needed order to an uncontrolled industry. “Right now, because there are about 250 different kinds of e-cigarettes and no regulations, it’s very much the Wild West,” says Tom Glynn, director of science and trends at the American Cancer Society. “Some e-cigarettes are pretty much just liquid nicotine, propylene glycol, and flavorings. But others have lots of contaminants and carcinogens, including heavy metals like nickel and cadmium. It’s very difficult for consumers to determine which is which.”
The proposed regulations still don’t address the biggest issue with e-cigarettes: Their long-term health effects are completely unknown. Experts agree that, compared to regular cigarettes – which contain 7,000 chemicals, 60 of them cancer-causing – e-cigarettes are the lesser of two evils. However, there’s mounting fear that even those e-cigarettes that contain only a few, “safe” ingredients may prove to be hazardous. “Since they’ve only been available in the U.S. since 2007 and didn’t really catch on until 2010, there’s been no opportunity to do long-term study on their impacts,” says Glynn.
The first big question surrounds the safety of liquid nicotine, which can cause vomiting, nausea, and eye irritation if too much is inhaled, ingested, or absorbed through the skin. And since it’s impossible to know how much nicotine you’re getting per drag – or how much is even in an e-cigarette – poisoning has become a real issue. According to a new report from the Centers for Disease Control and Prevention, the number of calls received by poison control centers regarding liquid nicotine poisoning skyrocketed from one per month in September 2010 to 215 per month this February. Forty-two percent of these incidents involved people age 20 and over.
But even just continually inhaling nicotine vapor may be dangerous. “Our big concern is that we don’t know how breathing in nicotine vapor will affect people long-term,” says David Abrams, executive director of the Schroeder National Institute for Tobacco Research and Policy Studies at the Legacy Foundation.
Health experts are also concerned about the propylene glycol in e-cigarettes. Although the FDA deems this ingredient safe for use in foods, heating it into a vapor and inhaling it may be a different story. “We don’t know whether inhaling heated propylene glycol is safe, especially if done continually,” Glynn says. “If you take 100 drags a day over 10 years, it could be completely harmless. Or it could be Pandora’s box.” At the end of the day, no cigarette – electronic or otherwise – is truly safe.
https://tfnd.org/wp-content/uploads/sites/26/2017/06/TFND-Logo-300x78.jpg00Erin Hill-Obanhttps://tfnd.org/wp-content/uploads/sites/26/2017/06/TFND-Logo-300x78.jpgErin Hill-Oban2014-05-20 14:17:452014-05-20 14:17:45How E-Cigarettes May Harm Your Health
MOORHEAD – Hoping to curb sales to minors, the city could soon require e-cigarette vendors to be licensed and subjected to compliance checks like traditional tobacco sellers.
State law in Minnesota – and local ordinances in West Fargo and Fargo – prevents the sale of e-cigarettes to minors.
But because Moorhead doesn’t license e-cigarette vendors, there’s no registry of businesses that sell them and no one doing compliance checks to make sure e-cigarettes aren’t being sold to minors, Keely Ihry, of Clay County Public Health, told City Council members Monday.
New state e-cigarette laws give statutory authority to cities to license and regulate e-cigarettes, which Ihry argued are being targeted to and becoming more popular among teens.
Ihry passed around e-cigarette, or “vape pen,” samples to council members Monday, noting the colorful packaging and the myriad flavors like Skittles, bacon and strawberry banana.
“To subject any of our youth to an addictive substance such as nicotine, with the additional pleasures of scent to draw them in, it’s just unbelievable,” said Councilwoman Nancy Otto, who was the most vocal on wanting to license e-cigarette vendors.
“Otherwise, it’s basically a free-for-all,” Otto said. “We’ve got nobody that is going in to check these facilities.”
Council members Mike Hulett and Brenda Elmer said they would support licensing e-cigarette vendors in Moorhead. City Manager Michael Redlinger said the council could vote on it at the end of the month or in June.
Police Chief David Ebinger also urged the council on Monday to consider abolishing what he called a “deceptive sampling practice” in the tobacco industry.
Some tobacco vendors are taking advantage of a broadly worded state law that allows “sampling” of cigars, tobacco or hookah indoors, he said. Instead of offering a taste or two, some shops are allowing lengthy, hour-long smokes.
That’s not the spirit of the sampling provision, Ebinger said,
“You don’t sit down … and smoke an entire cigar or two of them in a bar, and call it ‘sampling,’ ” he said.
The chief proposed that Moorhead set up an ordinance that would prevent lengthy tobacco sampling and only allow limited sampling if a customer was looking to make a “bona fide purchase” of a product, like a hookah.
Hookahs On Main, 815 Main Ave., is the only hookah shop in Moorhead that allows such lengthy sampling, said City Clerk Michelle French, but she and Ebinger said others have inquired about setting up similar businesses.
If the council decides to pass a more restrictive sampling law, Hookahs on Main would be grandfathered in, Ebinger said. Still, the law would prevent more of these shops from setting up in Moorhead, he said.
“It’s a public health issue,” Ebinger said, arguing that hookah tobacco can be just as dangerous as standard cigarettes.
Redlinger said law enforcement also sometimes has disturbance and neighborhood issues with hookah shops.
The City Council denied a tobacco license renewal in February for the former owner of Hookahs on Main, then called Pyromaniacs, after learning that police regularly received complaints of loud noise and parties at the business.
(CNN) — Children can’t light up, but there are some who suffer the effects of nicotine exposure as they labor in U.S. tobacco fields.
There is not an exact figure for how many children work in America’s tobacco fields, but Human Rights Watch interviewed nearly 150 for a new report on the dangers these workers face.
“I would barely eat anything because I wouldn’t get hungry,” one child worker, Elena G., 13, told the human rights group. “Sometimes I felt like I needed to throw up. … I felt like I was going to faint. I would stop and just hold myself up with the tobacco plant.”
Nearly 75% of the children interviewed reported similar symptoms — nausea, vomiting, loss of appetite, headaches, dizziness, irritation and difficulty breathing. These are symptoms of acute nicotine poisoning, Human Rights Watch said.
And nicotine is not the only danger.
Exposure to pesticides from adjacent fields and accidents with sharp tools are also common, the report said.
“Once they sprayed where we were working. We were cutting the flower and the spray was right next to us in the part of the fields we had just finished working in. I couldn’t breathe,” Jocelyn R., 17, told HRW. “I started sneezing a lot. The chemicals would come over to us.”
Altria, one of the biggest cigarette makers, does not employ its own farmers but maintains strict standards on the contractors it buys tobacco from, company spokesman Jeff Caldwell said.
His company’s view is not that the HRW report is critical of the tobacco industry, but that it asks for cooperation with various interests to protect the safety of workers, especially minors, he said.
“Our tobacco companies do not condone the unlawful employment or exploitation of farm workers, especially those under the age of 18,” Caldwell said.
Altria requires that its growers follow certain guidelines that specifically include best practices for labor management when it comes to harvesting tobacco. Issues such as avoiding acute nicotine poisoning and heat stress are addressed in the guidelines, he said.
U.S. tobacco companies intend to work together to further discuss the topics in the report, he said.
The study focused on four tobacco-growing states: North Carolina, Kentucky, Tennessee and Virginia.
Children can legally work in the tobacco fields, and some as young as 11 and 12 years old do. These children primarily work during the summer to help support their families. The majority of them were Hispanic children of immigrants who lived in nearby towns, the report said.
“As the school year ends, children are heading into the tobacco fields, where they can’t avoid being exposed to dangerous nicotine, without smoking a single cigarette,” Margaret Wurth, a co-author of the report, said in a news release. “It’s no surprise the children exposed to poisons in the tobacco fields are getting sick.”
Many of the children the group spoke with reported working long hours without overtime pay or enough breaks, HRW said.
One of the recommendations of the report is that no one under 18 be allowed to work in tobacco fields, due to the risks that such exposure can bring.
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.
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/
https://tfnd.org/wp-content/uploads/sites/26/2017/06/TFND-Logo-300x78.jpg00Erin Hill-Obanhttps://tfnd.org/wp-content/uploads/sites/26/2017/06/TFND-Logo-300x78.jpgErin Hill-Oban2014-05-08 09:33:362014-05-08 09:33:36House panel moves to block Navy proposal to ban tobacco sales on bases, ships
When electronic cigarettes first appeared a little over a decade ago, they were hailed by public health advocates-as well as some smokers-as a godsend: a tool to help smokers quit while mitigating the most harmful effects of tobacco. “The [e-cigarette] market is producing, at no cost to the taxpayer, an emerging triumph of public health,” one health advocate said.
Consisting of a small barrel-shaped design that mimics an actual cigarette, the devices vaporize a liquid nicotine solution, which is then inhaled without the tar and carcinogens found in smoke. Powered by a battery and controlled with a microchip, users can adjust the amount of nicotine they inhale, gradually weaning themselves off of their addiction if they choose.
“The value proposition of e-cigarettes is clear,” saysJohn A. Quelch, Charles Edward Wilson Professor of Business Administration at Harvard Business School. “They provide the dubious pleasure of nicotine without all the cancer-inducing toxins associated with tobacco.”
Very quickly, however, enthusiasm faded, when some public health advocates began worrying that the cure was worse than the disease.
The very fact users could control the amount of nicotine they ingested led to worry that e-cigarettes would cause smokers to take in more nicotine, rather than less. Even more worrisome, “eCigs” could provide a gateway for young people to start smoking tobacco cigarettes, or even lure ex-smokers back to the habit.
(Photo credit: planetc1)
This has created a dilemma for health regulators, says Quelch. Do they regulate e-cigarettes in order to decrease the number of new smokers who may pick up the habit, or do they apply a light hand in order to increase the number of existing smokers who will quit.
“Put crudely,” says Quelch, “how many nicotine addicts is it worth the risk of creating to have one tobacco smoker quit?”
That is one of the many dilemmas Quelch explores in the HBS case, E-Cigarettes: Marketing Versus Public Health, written with HBS Research Associate Margaret L. Rodriguez. It examines the consequences of the products as they have become more popular — and as the big tobacco companies have gotten in on the game. Quelch, who holds a joint appointment at HBS and Harvard School of Public Health, wrote the case for a new course debuting next year called “Consumers, Corporations, and Public Health,” which will enroll both MBA and MPH students to consider the intersections of business and health.
“One of the themes in the course is the tension that exists, quite understandably, between regulators and commercial interests,” says Quelch. “Most people are used to hearing about that in the context of financial regulation, but similar issues apply in other sectors of the economy including health care.”
In the case of electronic cigarettes, existing evidence indicates that they have led to a net decrease in smoking. Of the 43.8 million smokers in the United States in 2012, 3.5 million converted to eCigs; during the same period only 1.3 million eCig smokers converted to tobacco. That means a net decrease of cigarette smokers of 2.2 million, or 5%.
At the same time, 2.8 million nonsmokers converted to electronic smokes. But even that doesn’t tell the whole story, says Quelch, since it leaves out the number of smokers who would have taken up smoking tobacco if e-cigarettes didn’t exist, as well as the number of smokers who would have quit cold turkey without the availability of electronic products. “To really determine the public health impact of e-cigarettes requires a lot of sophisticated market research and analysis,” says Quelch. A Smoking Market
Uncertainty over health data hasn’t hurt the product’s popularity. In 2013, electronic cigarettes tripled in sales in the U.S. to approximately $3 billion. (The overall tobacco retail market in the US is valued at around $100 billion.) Almost 10% of high school students have tried them, according to the Centers for Disease Control, and a growing percentage of middle school students are joining the parade. In 2012, Goldman Sachs declared electronic cigarettes one of the top 10 disruptive technologies to watch.
Like most disruptive technologies, electronic cigarettes were developed by small entrepreneurs with brand names like Logic eCig (founded 2010), Blu (2009) and NJOY (2006). By 2013, according to the case study, the e-cigarette category featured more than 200 brands and their growth was threatening sales of tobacco cigarettes.
“If I am a tobacco manufacturer seeing my sales cannibalized by e-cigarettes, I have two choices: develop my own e-cigarette brand or buy an e-cigarette company,” says Quelch.
Number three tobacco company LorillardLO -2.47%was the first to blink, buying up Blu in 2012 for $135 million and aggressively pushing them at convenience store counters. “Distribution of Blu immediately increased by a factor of three,” says Quelch. Other top manufacturers Phillip Morris and Altria followed suit, acquiring their own brands and using their shelf-space clout to increase visibility of the alternative products.
The growing sales of electronic cigarettes also caught the attention of regulators. The products had been completely unregulated–they could be advertised on TV and sold to buyers of any age on the Internet. But once the major tobacco brands began acquiring e-cigarette makers and displaying those products alongside their mainstay cigarettes, regulators took particular notice.
Public health advocates and parents alike worried about the variety of flavors, including cotton candy, that might make “vapes” attractive to children. Some states and cities responded with restrictions on sales and advertising, and, in April, the Financial Times reported that the World Health Organization will call for e-cigarettes to be regulated just like tobacco cigarettes. The US Food and Drug Administration, under mounting pressure to act, plans to offer marketing and product regulations for electronic cigarettes in the near future.
Ironically, if regulation does go forward, it might help the major tobacco companies, by limiting the marketing playbook of the competitors that were cannibalizing sales of their products.
“Altria or Phillip Morris know how to deal with regulators,” says Quelch, “but with all those entrepreneurs coming out with flavors and advertising, they would no longer be able to get traction in their business.”
Tobacco Companies Take Control
Quelch predicts the big three tobacco companies will gain control of the eCigs market and then undermarket their electronic products in order to retain market share for their more profitable tobacco cigarettes. “Cigarette companies will manage the marketing of e-cigarette brands to maximize profitability for their shareholders,” says Quelch. “Meaning they’ll be able to manipulate prices in order to control the speed with which tobacco users migrate to e-cigarette brands.”
That means that electronic cigarettes, which are now significantly cheaper on a smoke-per-smoke basis than heavily taxed tobacco competitors, will probably start climbing in price and eventually become equal to tobacco brands. That could create an even bigger windfall for Phillip Morris, Altria, and Lorillard. Even if eCigs are regulated like regular cigarettes, they probably won’t be taxed like regular cigarettes, since the tax is on tobacco, not nicotine (and doesn’t apply, for example, to nicotine gum or nicotine patches)-and any new taxes are a nonstarter these days in Congress.
By pricing electronic and tobacco cigarettes to sell similarly at retail, the tobacco companies could reap enormous profits, concludes Quelch-at the same time giving them cover against criticism by allowing them to point to “healthier alternatives” in their product portfolios.
When entrepreneurs first created e-cigarettes and marketed them as a way to quit smoking, they probably didn’t intend to eventually pad the bottom line of mainstream big tobacco companies. But playing out the scenario to the end, that is exactly what may happen-and all in the absence of any definitive data showing whether e-cigarettes are more or less harmful to public health than tobacco smokes.
By pointing out such dichotomies and unintended consequences, Quelch hopes he can motivate MBA students to think more deeply about the public health impacts of business decisions-as well as getting MPH students to think about the business forces that shape public health. Only then will decisions be made that properly balance the greatest good of the public with the ability for entrepreneurs to turn a profit.
https://tfnd.org/wp-content/uploads/sites/26/2017/06/TFND-Logo-300x78.jpg00Erin Hill-Obanhttps://tfnd.org/wp-content/uploads/sites/26/2017/06/TFND-Logo-300x78.jpgErin Hill-Oban2014-04-23 15:52:362014-04-23 15:52:36Are Electronic Cigarettes A Public Good Or A Health Hazard?
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
https://tfnd.org/wp-content/uploads/sites/26/2017/06/TFND-Logo-300x78.jpg00Erin Hill-Obanhttps://tfnd.org/wp-content/uploads/sites/26/2017/06/TFND-Logo-300x78.jpgErin Hill-Oban2014-04-20 15:58:592014-04-20 15:58:59Higher taxes on cigarettes make good sense
By Karen Jowers , Staff writer / AIR FORCE TIMES
The Navy is on the verge of eliminating tobacco sales on all its bases and ships, according to sources inside and outside the Defense Department.
Officials are reportedly considering removing tobacco from all sales venues, to include any exchange-operated retail outlets, as well as MWR-operated retail outlets where cigarettes may be sold. Commissaries on Navy bases currently do not sell tobacco products.
The decision would be made at the service’s highest levels. Navy officials have been gathering information on the impacts of such a decision, one source said, to include the inevitable drop in profits for the Navy Exchange Service Command — which would reduce the flow of dividends that help fund morale, welfare and recreation programs on installations.
Navy spokeswoman Lt. Cmdr. Sarah Flaherty confirmed Monday that there have been discussions about tobacco sales, but said that no decision has been made.
Cmdr. Tamara Lawrence, a spokeswoman for Navy Secretary Ray Mabus, said in a written statement that “maximizing the readiness” of sailors and Marines has been a priority for Mabus since he took office.
Mabus “has implemented a number of initiatives to improve the culture of fitness in the Navy and Marine Corps, and curbing tobacco use is part of that improvement,” Lawrence said.
A source familiar with the military resale industry said that if the Navy pushes ahead on banning tobacco sales on its ships and bases, the idea likely would spread to the other services.
Tobacco products are legal, although by law they cannot be sold to minors. But smoking is a leading cause of premature death and disease in the U.S.; according to the American Cancer Society, more than 43 million people in America still smoke and tobacco will cause an estimated 480,000 deaths in 2014.
“We know that policies that restrict access to tobacco products, reduce exposure to tobacco advertising, and limit places that people smoke have a direct effect on reduced smoking rates, especially among youth,” wrote John R. Seffrin, CEO of the American Cancer Society, in a statement issued in February after CVS Caremark announced that its nationwide chain of more than 7,800 pharmacies would stop selling cigarettes and other tobacco products by Oct. 1.
CVS officials said their decision to stop selling tobacco products was consistent with the positions of the American Medical Association, American Heart Association, American Cancer Society, American Lung Association and American Pharmacists Association, all of whom have opposed tobacco sales in retail outlets in pharmacies.
The Navy has taken other steps to promote smoking cessation and discourage tobacco sales, starting with eliminating sales in its commissaries, then eliminating discounts on tobacco prices in Navy and Marine Corps exchanges in 2012.
“Tobacco use is the most avoidable public health hazard in the Navy and Marine Corps,” Mabus wrote in a March, 2, 2012, memo announcing that tobacco products offered in Navy and Marine Corps exchanges would no longer be sold at a discount. At that time, about one-third of sailors and Marines personnel used some form of tobacco, Mabus said.
In the same memo, he said that nicotine replacement therapy products approved by the Food and Drug Administration would be supplied for free to service members aboard all ships, base clinics and pharmacies and battalion aid stations.
In her statement Monday, Lawrence said Mabus “has asked his staff to look at additional ways to improve the health and readiness of our force. We are in the early stages of that process.”
Although her statement made reference to Marines and the Marine Corps, which is part of the Department of the Navy, Military Times could not immediately confirm Monday evening whether the Navy’s discussions about a possible total tobacco ban also would affect Marine Corps bases.
https://tfnd.org/wp-content/uploads/sites/26/2017/06/TFND-Logo-300x78.jpg00Erin Hill-Obanhttps://tfnd.org/wp-content/uploads/sites/26/2017/06/TFND-Logo-300x78.jpgErin Hill-Oban2014-03-24 10:40:302014-03-24 10:40:30Navy mulls banning tobacco sales on all bases, ships
A dangerous new form of a powerful stimulant is hitting markets nationwide, for sale by the vial, the gallon and even the barrel.
The drug is nicotine, in its potent, liquid form — extracted from tobacco and tinctured with a cocktail of flavorings, colorings and assorted chemicals to feed the fast-growing electronic cigarette industry.
These “e-liquids,” the key ingredients in e-cigarettes, are powerful neurotoxins. Tiny amounts, whether ingested or absorbed through the skin, can cause vomiting and seizures and even be lethal. A teaspoon of even highly diluted e-liquid can kill a small child.
But, like e-cigarettes, e-liquids are not regulated by federal authorities. They are mixed on factory floors and in the back rooms of shops, and sold legally in stores and online in small bottles that are kept casually around the house for regular refilling of e-cigarettes.
Evidence of the potential dangers is already emerging. Toxicologists warn that e-liquids pose a significant risk to public health, particularly to children, who may be drawn to their bright colors and fragrant flavorings like cherry, chocolate and bubble gum.
“It’s not a matter of if a child will be seriously poisoned or killed,” said Lee Cantrell, director of the San Diego division of the California Poison Control System and a professor of pharmacy at the University of California, San Francisco. “It’s a matter of when.”
Reports of accidental poisonings, notably among children, are soaring. Since 2011, there appears to have been one death in the United States, a suicide by an adult who injected nicotine. But less serious cases have led to a surge in calls to poison control centers. Nationwide, the number of cases linked to e-liquids jumped to 1,351 in 2013, a 300 percent increase from 2012, and the number is on pace to double this year, according to information from the National Poison Data System. Of the cases in 2013, 365 were referred to hospitals, triple the previous year’s number.
Examples come from across the country. Last month, a 2-year-old girl in Oklahoma City drank a small bottle of a parent’s nicotine liquid, started vomiting and was rushed to an emergency room.
That case and age group is considered typical. Of the 74 e-cigarette and nicotine poisoning cases called into Minnesota poison control in 2013, 29 involved children age 2 and under. In Oklahoma, all but two of the 25 cases in the first two months of this year involved children age 4 and under.
In terms of the immediate poison risk, e-liquids are far more dangerous than tobacco, because the liquid is absorbed more quickly, even in diluted concentrations.
“This is one of the most potent naturally occurring toxins we have,” Mr. Cantrell said of nicotine. But e-liquids are now available almost everywhere. “It is sold all over the place. It is ubiquitous in society.”
The surge in poisonings reflects not only the growth of e-cigarettes but also a shift in technology. Initially, many e-cigarettes were disposable devices that looked like conventional cigarettes. Increasingly, however, they are larger, reusable gadgets that can be refilled with liquid, generally a combination of nicotine, flavorings and solvents. In Kentucky, where about 40 percent of cases involved adults, one woman was admitted to the hospital with cardiac problems after her e-cigarette broke in her bed, spilling the e-liquid, which was then absorbed through her skin.
The problems with adults, like those with children, owe to carelessness and lack of understanding of the risks. In the cases of exposure in children, “a lot of parents didn’t realize it was toxic until the kid started vomiting,” said Ashley Webb, director of the Kentucky Regional Poison Control Center at Kosair Children’s Hospital.
The increased use of liquid nicotine has, in effect, created a new kind of recreational drug category, and a controversial one. For advocates of e-cigarettes, liquid nicotine represents the fuel of a technology that might prompt people to quit smoking, and there is anecdotal evidence that is happening. But there are no long-term studies about whether e-cigarettes will be better than nicotine gum or patches at helping people quit. Nor are there studies about the long-term effects of inhaling vaporized nicotine.
Unlike nicotine gums and patches, e-cigarettes and their ingredients are not regulated. The Food and Drug Administration has said it plans to regulate e-cigarettes but has not disclosed how it will approach the issue. Many e-cigarette companies hope there will be limited regulation.
“It’s the wild, wild west right now,” said Chip Paul, chief executive officer of Palm Beach Vapors, a company based in Tulsa, Okla., that operates 13 e-cigarette franchises nationwide and plans to open 50 more this year. “Everybody fears F.D.A. regulation, but honestly, we kind of welcome some kind of rules and regulations around this liquid.”
Mr. Paul estimated that this year in the United States there will be sales of one million to two million liters of liquid used to refill e-cigarettes, and it is widely available on the Internet. Liquid Nicotine Wholesalers, based in Peoria, Ariz., charges $110 for a liter with 10 percent nicotine concentration. The company says on its website that it also offers a 55 gallon size. Vaporworld.biz sells a gallon at 10 percent concentrations for $195.
Mr. Paul said he was worried that some manufacturers outside the United States — China is a major center of e-cigarette production — were not always delivering the concentrations and purity of nicotine they promise. Some retailers, Mr. Paul said, “are selling liquid and they don’t have a clue what is in it.”
Cynthia Cabrera, executive director of Smoke Free Alternatives Trade Association, said she would also favor regulations, including those that would include childproof bottles and warning labels, and also manufacturing standards. But she said many companies already were doing that voluntarily, and that parents also needed to take some responsibility.
“You wouldn’t leave a bottle of Ajax out,” she said. Advocates of e-cigarettes sometimes draw comparisons between nicotine and caffeine, characterizing both as recreational stimulants that carry few risks. But that argument is not established by science, and many health advocates take issue with the comparison.
“There’s no risk to a barista no matter how much caffeine they spill on themselves,” said Dr. Neal L. Benowitz, a professor at the University of California, San Francisco, who specializes in nicotine research. “Nicotine is different.”
Without proper precautions, like wearing gloves while mixing e-liquids, these products “represents a serious workplace hazard,” he said.
The nicotine levels in e-liquids varies. Most range between 1.8 percent and 2.4 percent, concentrations that can cause sickness, but rarely death, in children. But higher concentrations, like 10 percent or even 7.2 percent, are widely available on the Internet. A lethal dose at such levels would take “less than a tablespoon,” according to Dr. Cantrell, from the poison control system in California. “Not just a kid. One tablespoon could kill an adult,” he said.
https://tfnd.org/wp-content/uploads/sites/26/2017/06/TFND-Logo-300x78.jpg00Erin Hill-Obanhttps://tfnd.org/wp-content/uploads/sites/26/2017/06/TFND-Logo-300x78.jpgErin Hill-Oban2014-03-23 10:13:082014-03-23 10:13:08Selling a Poison by the Barrel: Liquid Nicotine for E-Cigarettes