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CDC: No decline in overall youth tobacco use since 2011

Overall tobacco use by middle and high school students has not changed since 2011, according to new data published by the Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration’s (FDA) Center for Tobacco Products in today’s Morbidity and Mortality Weekly Report (MMWR).

Data from the 2015 National Youth Tobacco Survey show that 4.7 million middle and high school students were current users (at least once in the past 30 days) of a tobacco product in 2015, and more than 2.3 million of those students were current users of two or more tobacco products. Three million middle and high school students were current users of e-cigarettes in 2015, up from 2.46 million in 2014.

Sixteen percent of high school and 5.3 percent of middle school students were current users of e-cigarettes in 2015, making e-cigarettes the most commonly used tobacco product among youth for the second consecutive year. During 2011 through 2015, e-cigarette use rose from 1.5 percent to 16.0 percent among high school students and from 0.6 percent to 5.3 percent among middle school students.

From 2011 through 2015, significant decreases in current cigarette smoking occurred among youth, but there was no significant change in the prevalence of current cigarette smoking among this group during 2014 – 2015. In 2015, 9.3 percent of high school students and 2.3 percent of middle school students reported current cigarette use, making cigarettes the second-most-used tobacco product among both middle and high school students.

“E-cigarettes are now the most commonly used tobacco product among youth, and use continues to climb,” said CDC Director Tom Frieden, M.D., M.P.H. “No form of youth tobacco use is safe. Nicotine is an addictive drug and use during adolescence may cause lasting harm to brain development.”

Students use many forms of tobacco

In addition to e-cigarettes and cigarettes, high school students used other tobacco products:

  • 8.6 percent smoked cigars,
  • 7.2 percent used hookahs,
  • 6.0 percent used smokeless tobacco,
  • percent smoked pipe tobacco, and
  • 0.6 percent smoked bidis.

After e-cigarettes and cigarettes, middle school students reported using these products:

  • 2.0 percent used hookahs,
  • 1.8 percent used smokeless tobacco,
  • 1.6 percent smoked cigars,
  • 0.4 percent smoked pipe tobacco, and
  • 0.2 percent smoked bidis.

Among non-Hispanic white and Hispanic high school students, e-cigarettes were the most commonly used tobacco product. Among non-Hispanic black high school students, cigars were the most commonly used tobacco product. Cigarette use was higher among non-Hispanic whites than among non-Hispanic blacks. Smokeless tobacco use was higher among non-Hispanic whites than students of other races.

“We’re very concerned that one in four high school students use tobacco, and that almost half of those use more than one product,” said Corinne Graffunder, Dr.P.H., M.P.H., director of CDC’s Office on Smoking and Health. “We know about 90 percent of all adult smokers first try cigarettes as teens. Fully implementing proven tobacco control strategies could prevent another generation of Americans from suffering from tobacco-related diseases and premature deaths.”

FDA has regulatory authority over cigarettes, cigarette tobacco, roll-your-own tobacco, and smokeless tobacco. The agency is finalizing the rule to bring additional tobacco products such as e-cigarettes, hookahs, and some or all cigars under that same authority.

“The FDA remains deeply concerned about the overall high rate at which children and adolescents use tobacco products, including novel products such as e-cigarettes and hookah,” said Mitch Zeller, J.D., director of the FDA’s Center for Tobacco Products. “Finalizing the rule to bring additional products under the agency’s tobacco authority is one of our highest priorities, and we look forward to a day in the near future when such products are properly regulated and responsibly marketed.”

Regulating the manufacturing, distribution, and marketing of tobacco products – coupled with proven population-based strategies – can reduce youth tobacco use and initiation. These strategies include funding tobacco control programs at CDC-recommended levels, increasing prices of tobacco products, implementing and enforcing comprehensive smoke-free laws, and sustaining hard-hitting media campaigns.

To learn more about quitting and preventing children from using tobacco, visit www.BeTobaccoFree.gov.

http://www.cdc.gov/media/releases/2016/p0414-youth-tobacco.html

ADA News: ADA, others "concerned" about tobacco products

By Jennifer Garvin, American Dental Association News

Silver Spring, Md. — The ADA and 35 other health organizations have asked the Food and Drug Administration to be more diligent about requiring tobacco companies to obtain approval before introducing new tobacco products to market.

In a Feb. 26 letter to Mitchell Zeller, director, Center for Tobacco Products, the organizations shared that they are “increasingly concerned” that tobacco companies are introducing new tobacco products into the marketplace without proper regulatory review.

The Family Smoking Prevention and Tobacco Control Act of 2009 gave the FDA unprecedented authority to regulate the manufacturing, distribution and marketing of tobacco products. It also requires tobacco companies to seek FDA approval before introducing new tobacco products to the market.

“The premarket review provisions of the Tobacco Control Act are intended to prevent the tobacco industry from continuing to introduce new tobacco products that are more harmful, more addictive and more appealing, particularly to young people,” stated the letter.

The letter also points out that the Tobacco Control Act prohibits commercial marketing of a new tobacco product unless FDA has issued an order finding the product “appropriate for the protection of the public health.” It singles out several new products it claims are non-compliant with the act. These products include:

  • Marlboro Midnight, a menthol cigarette;
  • Grizzly Wintergreen, a new snuff;
  • Three new brands of snus from Kretek International Inc: Thunder Xtreme, Offroad and Oden’s Extreme;
  • Marlboro Black NXT, a crushable menthol capsule.

“FDA’s failure to take the actions necessary to remove these products from the market represents a serious failure to protect the public health,” the letter stated.

“Given that the avoidance of premarket review seriously undercuts the public health protections of the Tobacco Control Act, please explain why no enforcement actions have been taken by FDA against these products and indicate what the agency plans to do to prevent additional products from entering the market without the required regulatory review.”

Read the entire letter here.

http://www.ada.org/en/publications/ada-news/2016-archive/march/ada-35-health-organizations-concerned?nav=news

LA Times: First-time tobacco users lured by flavorings, report says

Melissa HealyContact Reporter
A majority of adolescents who are puffing, vaping or chewing a tobacco product for the first time prefer one with flavor, suggesting that fruity, tangy, spicy or minty flavorings add a powerful allure to the uninitiated.
In a nationwide survey of U.S. children ages 12 to 17, the Food and Drug Administration’s Center for Tobacco Products has found that among those trying a hookah, electronic cigarette, cigar or regular cigarette for the first time, 89%, 81%, 65% and 50%, respectively, chose to try their tobacco product with an added flavoring.
In the United States, the marketing of flavored cigarettes — with the exception of menthol — is prohibited. But a wide range of flavorings is used in tobacco that is vaped, smoked in hookahs, chewed or dissolved in the mouth.
When adolescents were asked about their use of a tobacco product over the last 30 days, large majorities underscored that flavorings continued to play a role in their enjoyment of tobacco products. Asked about their tobacco use in the preceding month, 89% among hookah users said they had used flavored tobacco, compared with 85% of e-cigarette users, 72% of  users of any cigar type, and 60% of cigarette smokers.
The results were published Monday in the Journal of the American Medical Assn.
The study offers new insights into what factors pave the way for an estimated 3,200 American kids each day to try tobacco for the first time. A lifetime tobacco habit is overwhelmingly started in the teen and young adult years, and federal regulators have been keen to blunt smoking’s appeal to first-time users.
Since 2009, the FDA has had sweeping powers to regulate tobacco products in the interest of the public’s health. New evidence that flavorings play a key role in easing a would-be tobacco user’s introduction to the product is sure to spark renewed debate over outlawing flavorings.
“Consistent with national school-based estimates, this study confirms widespread appeal of flavored products among youth tobacco users,” the authors write. “In addition to continued proven tobacco control and prevention strategies, efforts to decrease use of flavored tobacco products among youth should be considered.”
http://www.latimes.com/science/sciencenow/la-sci-sn-first-time-tobacco-flavorings-20151026-story.html

Reminder: Smoking Hookah For An Hour Is Like Smoking 100 Cigarettes

AP: House bill aims for less e-cigarette regulation

WASHINGTON — House Republicans are pushing to ease proposed government regulations for companies that sell e-cigarettes and other new tobacco products, a move that Democrats charge could lead to unsafe products on the market.

A spending bill approved by a House subcommittee Thursday would prevent the Food and Drug Administration from requiring pre-market reviews of e-cigarettes that already are on the market.

As part of a broader rule regulating e-cigarettes for the first time, the agency has proposed that e-cigarette brands marketed since February 2007 undergo those pre-market reviews retroactively once the final rule is approved. Companies would have to submit the applications within two years of the final rule, and then the FDA would ensure that the product is “appropriate for the protection of the public health.” If not, the agency could take it off the market.

In addition to e-cigarettes, the FDA rules and the House legislation would apply to other unregulated tobacco products such as cigars, hookahs, nicotine gels, waterpipe tobacco and dissolvable tobacco products. The FDA already regulates cigarettes, smokeless tobacco and roll-your-own tobacco products.

Republicans said the pre-market review would be a lengthy and expensive process that could drive companies out of business. Alabama Republican Rep. Robert Aderholt, who sponsored the bill, said the provision is just a technical change that would keep the newer products under FDA oversight but allow them to be regulated in the same way as older tobacco products. The legislation would not affect the FDA’s proposal to ban the sales of the products to minors and would still allow certain product standards.

Public health groups said the legislation would hamper the FDA’s ability to prevent tobacco companies from marketing the new products to kids, and Democrats said before the panel’s vote that the change would reduce regulation on the industry at the same time that e-cigarette use is skyrocketing.

The bill “is nothing short of a giveaway to the tobacco industry,” said New York Rep. Nita Lowey, the top Democrat on the Appropriations Committee.

FDA’s proposed rules, expected to be finalized in the coming months, are aimed at eventually taming the fast-growing e-cigarette industry.

E-cigarettes are plastic or metal tubes, usually the size of a cigarette, that heat a liquid nicotine solution instead of burning tobacco. That creates vapor the user inhales.

The nicotine-infused vapor of e-cigarettes looks like smoke but doesn’t contain all of the chemicals, tar or odor of regular cigarettes. Some smokers use e-cigarettes as a way to quit smoking tobacco, or to cut down. However, there’s not much scientific evidence showing e-cigarettes help smokers quit or smoke less, and it’s unclear how safe they are.

Matthew Myers, president of the Campaign for Tobacco-Free Kids, said the House language could keep products on the market that appear to be targeted to children, like cigars and e-cigarettes in a variety of candy and fruit flavors.

Gregory Conley, president of the American Vaping Association, said the FDA regulations could hurt small businesses.

“This proposal does not remove the FDA’s ability to regulate vapor products,” Conley said. “The FDA will still have the full authority to make science-based regulatory decisions on the manufacturing, marketing and sale of these products.”

The FDA would not comment on the legislation, but FDA spokesman Michael Felberbaum said the rules are important consumer protections.

“When finalized, the rule will represent a significant first step in the agency’s ability to effectively regulate tobacco products and, as we learn more about these products, the agency will have additional opportunities over the long term to make a positive difference in the public health burden of tobacco use in this country,” Felberbaum said.

http://www.cbsnews.com/news/house-bill-aims-for-less-e-cigarette-regulation/

MINNPOST: Proposed Minneapolis tobacco licensing changes will help curb youth smoking

By Jan Malcolm | 06/19/15

Imagine a future when tobacco is no longer the leading cause of preventable death and disease. To make this vision a reality, we must prevent more young people from getting hooked by deadly tobacco products. The Minneapolis City Council is poised to do just that by considering changes to the licensing ordinance to restrict the sale of all flavored tobacco (other than menthol) to adult-only tobacco stores and set minimum price limits for cigars. These measures strike at the heart of the tobacco industry’s strategy to sell their products to kids: flavoring and price.

While Big Tobacco is supposed to be prohibited from marketing to kids, it finds many ways around that ban. Tobacco executives know that unless they get to kids before they reach their 20s they’ve lost a customer. Documents released during the tobacco trials of the 1990s reveal how deliberately tobacco companies target young people. On the witness stand, the chairman of the Liggett & Myers Tobacco Co. said, “If you are really and truly not going to sell to children, you are going to be out of business in 30 years.” A Lorillard executive wrote that he wanted to exchange research data with Life Savers to figure out what tastes kids want. And a marketing plan from U.S. Smokeless Tobacco showed a deliberate strategy to start users on sweet flavors, then “graduate” them to plain tobacco.

Candy and fruit flavors

The appeal of flavoring to young people is the reason the FDA banned cigarettes in flavors other than menthol in 2009. Unfortunately, products such as little cigars, cigarillos, chew, e-cigarettes and others are still widely available in candy and fruit flavors such as bubble gum, grape and gummy bear – flavors that clearly appeal to youth. These flavored products are for sale in more than 250 stores throughout Minneapolis alone, and they are easy for children to purchase. One-third of Minneapolis boys under 18 report buying tobacco from a convenience store or gas station.

Research shows that young people mistakenly believe that flavored tobacco products are less dangerous than other tobacco products. In fact, they are just as dangerous, with the same health risks of cancer, heart disease and chronic obstructive pulmonary disease. Candy and fruit flavored tobacco products just mask the harsh taste and feel of tobacco.

Nearly 20 percent of Minnesota high school students have tried a water pipe or hookah, and almost all shisha (hookah tobacco) is flavored. More than 25 percent of Minnesota high school students have used an e-cigarette, and most e-cigarette liquid is flavored. More than 35 percent of Minnesota high school students report that they have tried flavored cigars, cigarillos or little cigars at some point in their lives. In fact, kids are now twice as likely as older people to be cigar smokers. Almost 20 percent of Minneapolis 12th-graders say they smoke cigar products like cigarillos regularly.

Young people known to be price sensitive

Nearly 75 percent of Minneapolis tobacco retailers currently sell cigars and cigarillos, many for less than a dollar. The proposed changes to our city’s tobacco licensing ordinance would set a minimum price of $2.60 for each cigar. Research shows that young people are very sensitive to price increases and are more likely to just quit using a product they can’t afford than adults are.

Flavored tobacco restrictions and price minimum requirements have been successfully implemented in other communities around the country – and right here in Minnesota. No one wants our young people to face a lifetime of addiction and other health problems. We know that policies that restrict access to flavored tobacco and raise tobacco prices keep kids from starting to smoke and help them to quit.

Support the proposed changes to the Minneapolis tobacco licensing ordinance. Stand up for our kids against Big Tobacco.

Jan Malcolm is the vice president of public affairs for Allina Health. She served as Minnesota state health commissioner from 1999 to 2003. Malcolm lives in Minneapolis.

https://www.minnpost.com/community-voices/2015/06/proposed-minneapolis-tobacco-licensing-changes-will-help-curb-youth-smoking

Teen tobacco users likely to use it in multiple forms

By Reuters Media

A national survey of U.S. middle and high school students finds that those who use tobacco or nicotine products are likely to also use more than one type of product.

About 15 percent of the adolescents reported smoking cigarettes, cigars, pipes, bidis, hookahs or water pipes, using dissolvable forms of tobacco or “vaping” e-cigarettes. And twice as many in that group used two or more of these product types compared to those who said they used only one.

“Our study really shows that kids are using more than one of these products at the same time,” said Youn Ok Lee of RTI International in Research Triangle Park, North Carolina, the report’s lead author.

Lee said there are many varieties of tobacco products available. And each type of product also has a diverse range of options, such as flavors.

“So we don’t really know a lot about how this range of products might affect kids’ use of tobacco,” she told Reuters Health.

Using data from a 2012 national survey of nearly 25,000 U.S. students, researchers found that about 7 percent reported using one tobacco product in the past 30 days. About 4 percent said they used two tobacco products in that time. Another 4 percent said they used three or more products.

“I was a little bit surprised by just how many kids were using more than one product,” Lee said. “Even more surprising was that using three or more products is more popular than using cigarettes alone.”

Overall, about 3 percent of kids exclusively used cigarettes and about 2 percent exclusively used cigars. Those products were the most popular and their use increased with age.

The study team also found that almost 1 percent of students reported exclusively using e-cigarettes, which contain no tobacco but deliver a vapor laced with nicotine, the addictive substance in tobacco.

That’s more than the 0.4 percent who reported using e-cigarettes in combination with traditional cigarettes.

The increasing popularity of e-cigarettes is a concern for U.S. health officials as use has tripled between 2013 and 2014.

Lee noted that the results don’t tell why young people are using more than one form of tobacco, or how often the survey participants had used the products.

The researchers did find that being a boy, using flavored products, being dependent on nicotine, being receptive to advertising and having friends who used any tobacco products were all factors linked to an increased risk of using more than one product.

Policymakers and researchers should look at how these products affect tobacco use among middle and high school students, said Lee, because little is known about the influence of non-cigarette products.

Moreover, these products may create a public health issue by introducing people who would never have smoked cigarettes to nicotine, she said.

Lee emphasized that it’s important to look at all tobacco products together – not individually.

SOURCE: http://bit.ly/1za0ykL Pediatrics, online February 2, 2015.

http://www.inforum.com/news/3671610-teen-tobacco-users-likely-use-it-multiple-forms

​Hookahs deliver toxic benzene in every puff

Many young people consider hookahs a hip and safer way to smoke, but a new study finds fumes from the water pipes contain the toxin benzene.
Benzene has been linked to an increased risk for leukemia in prior research, according to a scientific team reporting Nov. 21 in the journal Cancer Epidemiology, Biomarkers & Prevention.
“In contrast to what is believed, hookah tobacco smoking is not a safe alternative to smoking other forms of tobacco,” study author Nada Kassem, associate director of the Center for Behavioral Epidemiology and Community Health at San Diego State University, said in a journal news release.
Researchers analyzed levels of S-phenylmercapturic acid (SPMA) — a metabolite (byproduct) of benzene — in the urine of 105 hookah smokers and 103 nonsmokers exposed to smoke from the water pipes.
After an event in a hookah lounge, SPMA levels were four times higher than normal in hookah smokers and 2.6 times higher than normal among people who had attended but hadn’t puffed on a hookah. After a hookah-smoking event in a private home, SPMA levels were two times higher among hookah smokers, but normal among nonsmokers.
“Hookah tobacco smoking involves the use of burning charcoal that is needed to heat the hookah tobacco to generate the smoke that the smoker inhales,” Kassem explained.
“In addition to inhaling toxicants and carcinogens found in the hookah tobacco smoke, hookah smokers and nonsmokers who socialize with hookah smokers also inhale large quantities of charcoal combustion-generated toxic and carcinogenic emissions,” she said.
Kassem believes that “because there is no safe level of exposure to benzene, our results call for interventions to reduce or prevent hookah tobacco use, regulatory actions to limit hookah-related exposure to toxicants including benzene, and include hookah smoking in clean indoor air legislation.”
http://www.nlm.nih.gov/medlineplus/news/fullstory_149609.html

Q: Is hookah or water pipe smoking a safe alternative to cigarettes?

By Sanjay Gupta, MD

A: Absolutely not. In fact, as Daniel Neides, MD, medical director of the Wellness Institute at Cleveland Clinic points out, hookah smoking “may actually be worse than smoking.”

Hookahs are water pipes in which charcoal is used to heat up flavored tobacco. An ancient form of smoking that originated in the Middle East and India, it has become increasingly popular among American adolescents and young adults. Roughly 1 out of 5 U.S. high school seniors had smoked a hookah in the past year, according to recent data.

The hookah’s gaining popularity is largely due to the misconception that it’s not harmful. That’s not the case. “First, the tobacco used in hookah contains the same cancer-causing agents found in cigarettes,” Dr. Neides says. “Secondly, there is charcoal that is used to heat the tobacco, which gives off carbon monoxide and heavy metals as a by-product when it is heated.”

A hookah session usually lasts longer than time spent smoking cigarettes, with hookah smokers puffing more frequently and inhaling more deeply. A 2010 study reported the amount of smoke inhaled during a hookah session can be nearly 200 times the amount inhaled when smoking a cigarette. Earlier this year, researchers at the University of California, San Francisco, found that hookah smoking raised nicotine urine levels as much as 73 times.

Neides adds that because water pipes are usually smoked in specialty hookah shops or bars and shared among friends, users are exposed to greater levels of secondhand smoke and are at a higher risk of contracting viruses or infections.

The bottom line, Neides says, is that “hookah smoke should be considered the same as cigarettes and cigars – a very unhealthy habit that leads to chronic disease and death.”

http://www.everydayhealth.com/columns/paging-dr-gupta/is-hookah-or-water-pipe-smoking-a-safe-alternative-to-cigarettes/

Moorhead leaders discuss licensing e-cigarette vendors, abolishing lengthy tobacco sampling

By: Erik Burgess, INFORUM

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.

http://www.inforum.com/event/article/id/435266/