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Letter: Commending CVS for tobacco policy

By: Keely Ihry, Moorhead, INFORUM
As a public health agency we are always educating on the harms of tobacco-use and exposure. We know that smoking kills nearly 500,000 Americans each year, and costs $289 billion in health care costs. Even with the dangers of tobacco use being well documented, the pharmacy industry has continued to sell tobacco products, and as a health care organization this has started to raise some ethical questions. Pharmacies are seen by people as places they go to get better when sick, and to stay healthy during the year, not as a place that should be profiting off products that are the leading cause of preventable death in the U.S.
This is why we truly commend CVS for taking one of the strongest actions any business has ever taken to address the public health problems caused by tobacco use. CVS recognized that selling tobacco products did not align with their commitment to improving the health and wellness of its customers. It should also be noted that CVS chooses not to sell e-cigarettes because they are not FDA approved.
This came at a great time with the momentum of the 50th anniversary of the first ever surgeon general’s warning on smoking and health. In the release the surgeon general called for continued work towards encouraging smokers to quit and preventing youth from starting to use tobacco. We know that nearly 90 percent of youth start smoking before the age of 18. CVS’ decision to stop selling tobacco is a huge statement to Americans, especially youth that tobacco use is harmful to their health.
We hope that this will encourage other pharmacies who are selling tobacco to take notice and take similar action. Removing the sale of tobacco products from a healthcare organization just makes good sense.
Ihry is PartnerSHIP 4 Health tobacco coordinator, Clay County Public Health.
http://www.inforum.com/event/article/id/429362/group/Opinion/

5 Things to Know About E-Cigarettes

By , ABC News

Los Angeles is the latest city to outlaw e-cigarette smoking in some public places.

The L.A. City Council voted 14-0 in favor of the “vaping” ban, following in the footsteps of New York City and Chicago.

E-Cigarette Health Row Catches Fire

The electronic cigarette was invented in the 1960s, but it didn’t really take off until a decade ago. The Tobacco Vapor Electronic Cigarette Association now estimates that roughly 4 million Americans use the battery-powered cigs.

Here’s a look at the e-smoke trend: the good, the bad and the unknown.

What are e-cigarettes?

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 at the end when you puff on the e-cigarette to simulate the burn of a tobacco cigarette. The cartomizer is filled with an e-liquid that typically contains the chemical propylene glycol along with nicotine, flavoring and other additives.

The device works much like a miniature version of the smoke machines that operate behind rock bands. When you “vape” — that’s the term for puffing on an e-cig — a heating element boils the e-liquid until it produces a vapor. A device creates the same amount of vapor no matter how hard you puff until the battery or e-liquid runs down.

How much do they cost?

Starter kits usually run between $30 and $100. The estimated cost of replacement cartridges is about $600, compared with the more than $1,000 a year it costs to feed a pack-a-day tobacco cigarette habit, according to the Tobacco Vapor Electronic Cigarette Association. Discount coupons and promotional codes are available online.

Are e-cigarettes regulated?

The decision in a 2011 federal court case gives the Food and Drug Administration the authority to regulate e-smokes under existing tobacco laws rather than as a medication or medical device, presumably because they deliver nicotine, which is derived from tobacco. The agency has hinted it will begin to regulate e-smokes as soon as this year but so far, the only action the agency has taken is issuing a letter in 2010 to electronic cigarette distributors warning them to cease making various unsubstantiated marketing claims.

For now, the devices remain uncontrolled by any governmental agency, a fact that worries experts like Erika Seward, the assistant vice president of national advocacy for the American Lung Association.

“With e-cigarettes, we see a new product within the same industry — tobacco — using the same old tactics to glamorize their products,” she said. “They use candy and fruit flavors to hook kids, they make implied health claims to encourage smokers to switch to their product instead of quitting all together, and they sponsor research to use that as a front for their claims.”

Thomas Kiklas, co-owner of e-cigarette maker inLife and co-founder of the Tobacco Vapor Electronic Cigarette Association, countered that the device performs the same essential function as a tobacco cigarette but with far fewer toxins. He said he would welcome any independent study of the products to prove how safe they are compared to traditional smokes.

The number of e-smokers is expected to quadruple in the next few years as smokers move away from the centuries old tobacco cigarette so there is certainly no lack of subjects,” he said.

What are the health risks of vaping?

The jury is out. The phenomenon of vaping is so new that science has barely had a chance to catch up on questions of safety, but some initial small studies have begun to highlight the pros and cons.

The most widely publicized study into the safety of e-cigarettes was done when researchers analyzed two leading brands and concluded the devices did contain trace elements of hazardous compounds, including a chemical which is the main ingredient found in antifreeze. But Kiklas, whose brand of e-cigarettes were not included in the study, pointed out that the FDA report found nine contaminates versus the 11,000 contained in a tobacco cigarette and noted that the level of toxicity was shown to be far lower than those of tobacco cigarettes.

However, Seward said because e-cigarettes remain unregulated, it’s impossible to draw conclusions about all the brands based on an analysis of two.

“To say they are all safe because a few have been shown to contain fewer toxins is troubling,” she said. “We also don’t know how harmful trace levels can be.”

Thomas Glynn, the director of science and trends at the American Cancer Society, said there were always risks when one inhaled anything other than fresh, clean air, but he said there was a great likelihood that e-cigarettes would prove considerably less harmful than traditional smokes, at least in the short term.

“As for long-term effects, we don’t know what happens when you breathe the vapor into the lungs regularly,” Glynn said. “No one knows the answer to that.”

Do e-cigarettes help tobacco smokers quit?

Because they preserve the hand-to-mouth ritual of smoking, Kiklas said e-cigarettes might help transform a smoker’s harmful tobacco habits to a potentially less harmful e-smoking habit. As of yet, though, little evidence exists to support this theory.

In a first of its kind study published last week in the medical journal Lancet, researchers compared e-cigarettes to nicotine patches and other smoking cessation methods and found them statistically comparable in helping smokers quit over a six-month period. For this reason, Glynn said he viewed the devices as promising though probably no magic bullet. For now, FDA regulations forbid e-cigarette marketers from touting their devices as a way to kick the habit.

Seward said many of her worries center on e-cigarettes being a gateway to smoking, given that many popular brands come in flavors and colors that seem designed to appeal to a younger generation of smokers.

“We’re concerned about the potential for kids to start a lifetime of nicotine use by starting with e-cigarettes,” she said.

Though the National Association of Attorneys General today called on the FDA to immediately regulate the sale and advertising of electronic cigarettes, there were no federal age restrictions to prevent kids from obtaining e-cigarettes. Most e-cigarette companies voluntarily do not sell to minors yet vaping among young people is on the rise.

A Centers for Disease Control and Prevention study found nearly 1.8 million young people had tried e-cigarettes and the number of U.S. middle and high school students e-smokers doubled between 2011 and 2012.

A version of this story previously ran on ABCNews.com.

http://abcnews.go.com/Health/things-cigarettes/story?id=22782568#5

CTFK: President's Plan to Expand Early Education with a Tobacco Tax Will Protect Kids and Save Lives

Statement of Susan M. Liss, Executive Director, Campaign for Tobacco-Free Kids
WASHINGTON, DC – President Obama today again called for bold action to protect our children from tobacco addiction and save lives, urging Congress to increase the federal cigarette tax by 94 cents per pack and similarly increase taxes on other tobacco products. The evidence is clear that increasing the tobacco tax is one of the most effective ways to reduce smoking and other tobacco use, especially among kids, as this year’s Surgeon General’s Report on Smoking and Health just reaffirmed.
This proposal, part of the President’s FY 2015 budget, would do more to reduce tobacco use among kids than any other single action the federal government can take. The tobacco tax increase would also raise $78 billion over 10 years to fund early childhood education initiatives proposed by the President, according to the Office of Management and Budget. Congress should embrace this proposal enthusiastically – it would provide millions of kids with a strong start in life, while helping them live longer, healthier lives free of tobacco addiction.
The need for Congress to increase the tobacco tax is more urgent than ever.  While our nation has cut smoking rates by more than half since the first Surgeon General’s report was issued 50 years ago in 1964, the latest Surgeon General’s report found that smoking is even more hazardous and takes an even greater toll on our nation’s health than previously thought.  The report found that smoking annually kills 480,000 Americans – causing one in every five deaths – and costs the nation more than $289 billion in health care bills and other economic losses.  Tobacco use remains the number one cause of preventable death in our country.
The report also underscored that tobacco use is a pediatric epidemic – 90 percent of adult smokers began at or before age 18, and 5.6 million kids alive today will die prematurely from smoking-caused disease unless current trends are reversed.  The President’s proposal represents exactly the kind of action needed to accelerate progress against tobacco and ultimately end the tobacco epidemic for good.
Among its key action steps, the new Surgeon General’s report calls for “raising the average excise cigarette taxes to prevent youth from starting smoking and encouraging smokers to quit.”
“Raising prices on cigarettes is one of the most effective tobacco control interventions,” the report concludes. “The evidence is sufficient to conclude that increases in the prices of tobacco products, including those resulting from excise tax increases, prevent initiation of tobacco use, promote cessation, and reduce the prevalence and intensity of tobacco use among youth and adults.”
Even tobacco companies admit in their own documents that tobacco tax increases reduce youth smoking.  Economic research has found that every 10 percent increase in the price of cigarettes reduces youth smoking by about seven percent and overall cigarette consumption by three to five percent.
The health and economic benefits of a federal tobacco tax increase were confirmed in a 2012 report by the highly respected Congressional Budget Office. The CBO found that a 50-cent increase in the federal tobacco tax would raise substantial new revenue while prompting nearly 1.4 million adult smokers to quit by 2021, saving tens of thousands of lives and reducing health care costs, including for the Medicaid program. Based on the CBO’s statement that a $1 tax increase would roughly double those benefits, we estimate that a 94-cent cigarette tax increase would prompt 2.6 million adult smokers to quit and save 18,000 lives over 10 years.
We estimate that a 94-cent increase in the federal cigarette tax would also:
·       Prevent 1.3 million kids from becoming addicted adult smokers;
·       Prevent 493,400 premature deaths from these reductions in youth smoking alone, and
·       Save $55 billion in future health care costs from reductions in youth and adult smoking.
The increased taxes on other tobacco products would have additional health benefits, preventing kids from using harmful and addictive products such as cheap, sweet cigars and smokeless tobacco.
Furthermore, national and state polls consistently show strong public support for substantial increases in tobacco taxes, with most polls showing voters favoring tobacco tax increases by more than a two-to-one margin. Polls consistently have found that large majorities of Democrats, Republicans and Independents and voters from a broad range of demographic and ethnic groups all support tobacco tax increases – as do significant numbers of smokers.
In short, a significant tobacco tax increase is a win-win-win for the country – a health win that will reduce tobacco use and save lives, a financial win that will raise revenue to fund an important initiative and reduce tobacco-related health care costs, and a political win that is popular with voters.

ACS CAN: President Renews Call for Stronger Tobacco Control in FY 15 Budget Proposal

WASHINGTON, D.C. – March 4, 2014 – President Obama today unveiled an FY15 budget proposal that prioritizes tobacco control with an increase in the federal tobacco tax, emphasizes the importance of primary care with an investment in workforce training for new doctors and signals his ongoing support for increased investment in medical research.
A statement from Chris Hansen, president of the American Cancer Society Cancer Action Network (ACS CAN), follows:
“The president’s budget proposal shows that he remains committed to increasing the federal cigarette tax by an unprecedented 94 cents, which would save lives and reduce long-term health care costs. Increasing tobacco taxes is one of the most effective ways to keep kids from smoking and encourage people to quit. ACS CAN estimates that nearly doubling the federal cigarette tax would prevent about 493,000 children from premature death, reduce the number of adult smokers by 2.6 million over 10 years and lower health care costs by $55 billion.
“ACS CAN applauds the President’s proposal to invest more than $14.6 billion to expand and train the nation’s healthcare workforce – and investment that is vital to our ability to emphasize prevention and wellness in the health care system.  This proposal builds upon the efforts included in the health care law and will further help cancer patients and their families, especially those in rural and underserved areas, to get the health care they need.
“We are disappointed that the president’s proposal reduces funding for critical breast, cervical and colorectal cancer screenings, offered through the Centers for Disease Control and Prevention to low-income and uninsured. While the Affordable Care Act makes strides in improving access to these proven prevention measures than can help to detect cancer at its earliest most treatable stages, millions of people will still need access to these critical programs in coming years.
“We are pleased that the budget proposal increases funding for medical research at the National Institutes of Health, but disappointed that the National Cancer Institute would receive only a nominal increase under the President’s budget.  We hope that cancer research will be prioritized as details emerge about the proposed $970 million in supplemental funding for the NIH. Investment in cancer-specific research and proven cancer screening programs for low-income and uninsured are essential to eliminating death and suffering from a disease that will kill an estimated 585,000 people in America and cost the economy $216 billion this year.”
ACS CAN, the nonprofit, nonpartisan advocacy affiliate of the American Cancer Society, supports evidence-based policy and legislative solutions designed to eliminate cancer as a major health problem. ACS CAN works to encourage elected officials and candidates to make cancer a top national priority. ACS CAN gives ordinary people extraordinary power to fight cancer with the training and tools they need to make their voices heard. For more information, visit www.acscan.org.

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To the Editor: Curbs on E-Cigarettes

To the Editor:

Re “Hot Debate Over E-Cigarettes as Path to Tobacco, or From It” (“The New Smoke” series, front page, Feb. 23):

As you note, the health effects of e-cigarette use remain unknown, and their use may actually be leading to greater smoking of traditional cigarettes, especially among children.

In fact, a recent study of 76,000 South Korean teenagers indicates that users of e-cigarettes were less likely to succeed in quitting smoking and were more likely to be heavy smokers.

The availability of e-cigarette flavored vapors (mango and watermelon) enhances the attraction. The troubling increase in the use of e-cigarettes among American teenagers found in the survey by the Centers for Disease Control and Prevention, also reported in the article, suggests that e-cigarettes are a gateway to tobacco addiction.

The American Thoracic Society, as a member of the Forum of International Respiratory Societies, supports an age restriction and government regulation of the sale of e-cigarettes, which in many states do not exist. Until more research is done, it is dangerous to promote their widespread use.

PATRICIA FINN
Chicago, Feb. 24, 2014

The writer is president of the American Thoracic Society and chairwoman of the department of medicine at the University of Illinois Chicago.

http://www.nytimes.com/2014/02/28/opinion/curbs-on-e-cigarettes.html?_r=0

Hookah is not harmless, experts say

By: REUTERS/SUSANA VERA
Smoking hookah can be addictive and harmful, though many dabblers may not realize the dangers, according to a new review.
“The cooled and sweetened flavor of hookah tobacco makes it more enticing to kids and they falsely believe it’s less harmful,” Tracey E. Barnett from the University of Florida in Gainesville told Reuters Health.
Barnett has studied the recent rise in teen hookah smoking. She was not involved in the new review, published in Respiratory Medicine.
“One-time use can lead to carbon monoxide poisoning or other diseases, including but not limited to tuberculosis, herpes, respiratory illnesses including the flu, and long-term use can lead to heart disease and many cancers,” Barnett said.
To read more, visit http://www.foxnews.com/health/2014/02/24/hookah-is-not-harmless-experts-say/

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

Kathleen Sebelius column: Working toward a tobacco-free generation

For Press-Gazette Media

Here’s a sobering statistic about the tobacco epidemic — a battle many Americans think is already won: If we continue at current smoking rates, 5.6 million children alive today will ultimately die prematurely from smoking. That’s one in 13 kids gone too early due to an entirely preventable cause. That is unacceptable.
That’s why we are asking every American to join our efforts to make the next generation tobacco-free.
Today, we are at a crossroads. In the past 50 years, we’ve more than cut the adult smoking rate in half from nearly 43 percent down to 18 percent, and we’ve reduced 12th-grade students’ smoking rate to 16 percent in 2013 from a high of 38 percent in l976.
Yet nearly 500,000 Americans die of smoking-related disease each year. What’s more, the tobacco epidemic costs us nearly $300 billion in productivity and direct medical costs annually.
I believe a tobacco-free generation is within our reach, but it will take commitment from across the spectrum — from federal, state and local governments, but also from businesses, educators, the entertainment industry and beyond.
Already, we are seeing leadership from the private sector. This month, CVS, the second largest pharmacy chain in the country, announced it will no longer sell tobacco products. In doing so, CVS it is at once reducing access to these harmful products and helping to make smoking less attractive.
We know that consumers, especially children, are influenced by pro-smoking messages when they shop in stores that sell tobacco products. This includes the display of cigarettes behind the register known as the “power wall.” For young people, power walls help shape cigarette brand awareness and the sense that smoking is normal and accepted.
In multiple ways, CVS’ decision will have impact. I applaud this private sector health leader for taking an important new step to curtail tobacco use. I hope that other retailers will take up this pro-health mantle.
The stakes are high. Each day, more than 3,200 youth under age 18 in the United States try their first cigarette, and another 700 kids under age 18 who’ve been occasional smokers become daily smokers.
I am thrilled that earlier this month, the Food and Drug Administration launched its first national tobacco education campaign, TheRealCost.gov. The campaign is targeting on-the-cusp youth –— the 12- to 17-year-old kids who are open to smoking or have experimented with cigarettes, but are not regular smokers.
But creating a tobacco-free generation cannot start and end with our youngest citizens: working toward this goal begins in the present, and reaching adult smokers is essential.
In that light, I’m very pleased the Centers for Disease Control and Prevention has started the third season of its impactful Tips From Former Smokers campaign. The 2012 tips series alone prompted an estimated 1.6 million smokers to try to quit, resulting in more than 200,000 additional calls to 1-800-QUIT-NOW, and helped at least 100,000 smokers quit for good.
I am inspired by the ongoing work that is necessary to drastically reduce smoking rates in our country. Whether it’s other retailers following CVS’ lead, more colleges and universities joining the 2,000 schools that are part of the Department of Health and Human Services’ National Tobacco-Free College Campus Initiative (tobaccofreecampus.org), or movie studios taking tobacco use and imagery out of youth-rated films, I encourage new partners to help us stop the cycle of sickness, disability and death caused by tobacco.
Victory will require bold action. What will you do to help make the next generation tobacco-free?
Kathleen Sebelius is secretary of the U.S. Department of Health and Human Services.
http://www.greenbaypressgazette.com/article/20140220/GPG06/302200419/Kathleen-Sebelius-column-Working-toward-tobacco-free-generation?nclick_check=1

Safety of e-cigarette vapors questioned

, Buffalo Business First Reporter-Business First
It’s been years since viewers have sat through a cigarette commercial during the Super Bowl, with commercials for beer and cars dominating advertising.
But this weekend’s game included for the second consecutive year an ad for NJOY King, an electronic cigarette, with a theme of friends helping friends.
The response has been mixed from health advocates. While some say inhaling vapors or “vaping” is safer than smoking traditional tobacco cigarettes, others insist quitting entirely is the healthiest course of action. And it turns out vaping also exposes non-users to nicotine in the same way secondhand smoke affects those who spend time around smokers, though at much lower levels.
That’s according to research by Maciej Goniewicz, an assistant professor of oncology at Roswell Park Cancer Institute’sDepartment of Health Behavior, published by the journal Nicotine and Tobacco Research.
Goniewicz and his team studied vapor from three different brands of e-cigarettes, as well as secondhand smoke exposure of vapors and tobacco smoke generated by dual users. The results showed the e-cigarettes emit nicotine at levels of about 10 times less than conventional tobacco cigarettes, though they did not emit substantial amounts of carbon monoxide and toxic volatile organic compounds.
The study was a collaboration between Roswell Park and researchers at the Medical University of Silesia in Poland.
Though exposure to toxins is substantially lower, there’s still no definitive data on short and longterm health: The U.S. Surgeon General has not yet evaluated the short and longterm health risk from secondhand exposure to vapors.
“We don’t know yet the longterm affects of using these products,” Goniewicz said. “We know there are some traces of some potentially dangerous chemicals in the vapor. We don’t know what will happen after 10-20 years of inhaling this vapor.”
Still, vaping is considerably less dangerous than regular cigarettes, since users and those around them are exposed to significantly less toxins.
“The clear conclusion is that these products are safer than tobacco cigarettes. When you compare them, we believe these products are safer than tobacco cigarettes, but there is no doubt for smokers that quitting is the best way,” he said.
The other growing issue is how to handle vaping indoors, including in public places, restaurants and the workplace. The Food & Drug Administration and individual states place limits on advertising and how and where tobacco cigarettes are sold, but there have not yet been any rulings on exactly whether e-cigarettes fall into the same category.
A number of companies have already taken steps to limit vaping in the workplace, while in other places, it’s the state or municipality making the rules: New York City Council in December voted to ban the use of e-cigarettes in all places where smoking is prohibited. The Niagara Frontier Transportation Authority is now considering a ban on its transit vehicles and within its properties.
Goniewicz said he believes vaping should be limited as well to protect non-users, but it’s a difficult question.
“The main reason we have the indoor smoke-free law is to protect non smokers from being exposed to tobacco smoke,” he said. “We should protect these people from being exposed to vapor. But some people also believe that since we know this product is safer for smokers and it has the potential to save the lives of smokers, how can we encourage smokers to use electronic cigarettes instead of smoking? Any regulation should balance between the potential benefits and harm from the products.”
http://www.bizjournals.com/buffalo/blog/health_matters/2014/02/safety-of-e-cigarette-vapors-questioned.html

Lawmakers look again at possible tobacco tax increase

By Shauna Johnson, Metro News
CHARLESTON, W.Va. — Tobacco users may be asked to pay more to fund health programs in the Mountain State.  A proposal to add to West Virginia’s tobacco tax is again being taken up at the State House.
Del. Don Perdue (D-Wayne, 19) has introduced a bill that would raise the state tax on a pack of cigarettes by $1, taking it to $1.55 total or equal to the national average.  On all other tobacco products, an excise tax equal to 50 percent of the wholesale price would be imposed.
Perdue said the state needs the estimated more than $90 million such a tax increase could generate every year.
“I think the interest is very high and getting higher,” he said of the potential for passage of the bill which has been proposed several times in recent years.  “Whether there’s enough there (for passage) this year, in 2014, that remains to be seen.”
As proposed, for ten years, the first $90 million generated from the increase would be designated for the Bureau for Medical Services with $6 million going into tobacco control annually and $1 million per year for five years going to the West Virginia University School of Public Health.
Any additional money beyond that would be allocated as follows: 30 percent for oral health improvement programming, 30 percent for substance abuse prevention and treatment programming, 24 percent for in-home elderly care services and 16 percent for early childhood development programming.
“We just saw it exacerbated by this water crisis,” said Perdue on Tuesday’s MetroNews “Talkline.”  “We need the money to do the things that have to be done for our population.”
The House Health and Human Resources Committee, which Perdue leads, was scheduled to take up HB 4191 during a Wednesday afternoon meeting at the State Capitol.
Perdue has also proposed a separate bill to raise the state tax on alcohol.
http://wvmetronews.com/2014/01/28/lawmakers-look-again-at-possible-tobacco-tax-increase/