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Should this be legal? Dickinson commissioners consider anti-hookah ordinance, but say more information is needed

By Nadya Faulx, The Dickinson Press

City Commission members are weighing options for a possible hookah bar in Dickinson, but the idea could be up in smoke before it even starts.
City Administrator Shawn Kessel told commissioners Monday that he has been getting requests for hookah bars to be built in town, but wanted to gauge members’ “desires as they relate to hookah bars.”
“Is that a business model you’d like to see in the community?” he asked.
An unnamed caller reached out to Kessel on Monday afternoon asking for information about how to open the city’s first hookah bar, where patrons could gather to smoke from the water pipes that originated in the Middle East but have become popular throughout the world — just not North Dakota.
“A hookah bar is an interesting term,” Kessel told the commission. “It goes back a long ways, and it has its roots in the Orient. And I had to look this up online, because I wasn’t exactly sure.”
The state’s first and only hookah bar, Dreas Hookah Lounge in Grand Forks, closed last month as a result of the 2012 ban on smoking in worksites and public spaces.
Any hookah bar in Dickinson would be able to serve only herbal products in lieu of the traditional shisha, or flavored tobacco.
Aside from the state smoking law, there are no other legal barriers to opening a hookah bar in the city.
“We can’t deny them,” Kessel said. “And if it’s in the interest of the City Commission to do so, I’m here to tell you that the city staff does not have that ability.”
The only way to put the kibosh on hookah would be to draft an ordinance to block the practice and hold a public hearing with input from community members.
“To get the process going, you either have to have an ordinance saying we’re going to allow these and the conditions we’re going to allow them on,” Mayor Dennis Johnson said Monday, “or you could draft an ordinance saying we’re not going to allow them, and then you get whole public comment and discussion.”
He added that he hasn’t “thought a whole lot about hookah bars.”
In an interview, Johnson said he “didn’t get the sense that anyone at the commission table knows a whole lot about the issue.”
He added: “We would rather get much better educated on it.”
Commission member Klayton Oltmanns said in an interview that there weren’t strong feelings among the commission either for or against a hookah bar, but that more information is needed before a decision is made.
“It is new to each of us as commissioners,” he said. “Just to get ahead of the game, we’re going to issue an ordinance. We’ll be able to gauge the community’s response — pro or con — and make a good informed decision based on what the community says.”
At least one community member would support the ban: Jennifer Schaeffer, tobacco prevention coordinator at Southwest District Health, said hookah smokers face numerous health risks, whether the pipes are packed with tobacco or herbs.
“Anytime you smoke something into your lungs, you’re putting your lungs and heart at risk,” she said. “We’re concerned about that.”
Hookah smoke contains nicotine, tar and carbon monoxide like cigarette smoke, and is at least as toxic, according to the Center for Disease Control.
Schaeffer said she would support the City Commission if it issued an ordinance banning the practice in Dickinson.
“As a health unit, as a tobacco prevention program, we wouldn’t be in support of having hookah bars,” she said.
But talks about the potential hookah bar are in their earliest stages, and Oltmanns said there is “still too little info” to take any definite stance yet.
City Attorney Matthew Kolling and city administration would first have to draft the ordinance, at which point it would go through a first reading and public comment. Oltmanns said the topic is expected to come up again in a June commission meeting.
“Any ordinance in its initial reading isn’t necessarily how it ends beyond that,” Oltmanns said, adding the city wants to hear a response from residents and businesses before it makes a decision.
http://www.thedickinsonpress.com/content/should-be-legal-dickinson-commissioners-consider-anti-hookah-ordinance-say-more-information

E-Cigarettes, by Other Names, Lure Young and Worry Experts

By , NY Times

SAN FRANCISCO — Olivia Zacks, 17, recently took a drag of peach-flavored vapor from a device that most people would call an e-cigarette.

But Ms. Zacks, a high school senior, does not call it that. In fact, she insists she has never even tried an e-cigarette. Like many teenagers, Ms. Zacks calls such products “hookah pens” or “e-hookahs” or “vape pipes.”

These devices are part of a subgenre of the fast-growing e-cigarette market and are being shrewdly marketed to avoid the stigma associated with cigarettes of any kind. The products, which are exploding in popularity, come in a rainbow of colors and candy-sweet flavors but, beneath the surface, they are often virtually identical to e-cigarettes, right down to their addictive nicotine and unregulated swirl of other chemicals.

The emergence of e-hookahs and their ilk is frustrating public health officials who are already struggling to measure the spread of e-cigarettes, particularly among young people. The new products and new names have health authorities wondering if they are significantly underestimating use because they are asking the wrong questions when they survey people about e-cigarettes.

Marketers of e-hookahs and hookah pens say they are not trying to reach young people. But they do say that they want to reach an audience that wants no part of e-cigarettes and that their customers prefer the association with traditional hookahs, or water pipes.

“The technology and hardware is the same,” said Adam Querbach, head of sales and marketing for Romman Inc. of Austin, Tex., which operates several websites that sell hookahs as well as e-cigarettes and e-hookahs. “A lot of the difference is branding.”

Sales of e-hookahs have grown “exponentially” in the last 18 months, Mr. Querbach said.

Public health authorities worry that people are being drawn to products that intentionally avoid the term “e-cigarette.” Of particular concern is use among teenagers, many of whom appear to view e-cigarettes and e-hookahs as entirely different products when, for all practical purposes, they are often indistinguishable.

Indeed, public health officials warn that they may be misjudging the use of such products — whatever they are called — partly because of semantics. A survey by the Centers for Disease Control and Prevention found that 10 percent of high school students nationwide said that they had tried e-cigarettes in 2012, double the year before. But the C.D.C. conceded it might have asked the wrong question: Many young people say they have not and will not use an e-cigarette but do say they have tried hookah pens, e-hookahs or vaping pens.

The C.D.C. is sending a tobacco-use survey to 20,000 students nationwide that asks about e-cigarette experimentation but does not identify the devices by other names. The state of California, through a nonprofit partner called WestEd, is asking virtually the same question of 400,000 students.

Brian King, senior adviser to the Office on Smoking and Health at the C.D.C., said the agency was aware of the language problem. “The use of hookah pens could lead us to underestimate overall use of nicotine-delivery devices,” he said. A similar problem occurred when certain smokeless tobacco products were marketed as snus.

Other health officials are more blunt.

“Asking about e-cigarettes is a waste of time. Twelve months ago, that was the question to be asking,” said Janine Saunders, head of tobacco use prevention education in Alameda County in Northern California.

In October, Ms. Saunders convened a student advisory board to discuss how to approach “e-cigs.” “They said: ‘What’s an e-cig?’ “ Ms. Saunders recalled, and she showed what she meant. “They said: ‘That’s a vape pen.’ “

Health officials worry that such views will lead to increased nicotine use and, possibly, prompt some people to graduate to cigarettes. The Food and Drug Administration is preparing to issue regulations that would give the agency control over e-cigarettes, which have grown explosively virtually free of any federal oversight. Sales of e-cigarettes more than doubled last year from 2012, to $1.7 billion, according to Wells Fargo Securities, and 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.

The emergence of hookah pens and other products and nicknames seems to suggest the market is growing well beyond smokers. Ms. Zacks was among more than 300 Bay Area high school students who attended a conference focused on health issues last month on the campus of the University of California, Berkeley. Many students talked about wide use of e-hookahs or vaping pens — saying as many as half of their classmates had tried one — but said that there was little use of e-cigarettes.

Ms. Zacks said the devices were popular at her high school here. “E-cigarettes are for people trying to quit smoking,” she said, explaining her understanding of the distinction. “Hookah pens are for people doing tricks, like blowing smoke rings.”

James Hennessey, a sophomore at Drake High School in San Anselmo, Calif., who has tried a hookah pen several times, said e-hookahs were less dangerous than e-cigarettes. He and several Drake students estimated that 60 percent of their classmates had tried the devices, that they could be purchased easily in local stores, and that they often were present at parties or when people were hanging out.

“E-cigarettes have nicotine and hookah pens just have water vapor and flavor,” said Andrew Hamilton, a senior from Drake.

Actually, it is possible for e-cigarettes or e-hookah devices to vary in nicotine content, and even to have no nicotine. Mr. Querbach at Romman said that 75 percent of the demand initially was for liquids with no nicotine, but that makers of the liquids were expanding their nicotine offerings. Often, nicotine is precisely the point, along with flavor.

Take, for example, the offerings of a store in San Francisco called King Kush Clothing Plus, where high school students say they sometimes buy their electronic inhalers. On a counter near the back, where tobacco products are sold, are several racks of flavored liquids that can be used to refill e-cigarettes or hookah pens. The flavors include cinnamon apple, banana nut bread, vanilla cupcake, chocolate candy bar and coconut bomb. They range in nicotine concentration from zero to 24 milligrams — about as much as a pack of 20 ordinary cigarettes — but most of the products have some nicotine. To use the refills, it is necessary to buy a hookah pen, which vary widely in price — around $20 and upward.

It is also possible to buy disposable versions, whether e-cigarettes or hookah pens, that vary in nicotine content and flavor. At King Kush, the Atmos ice lemonade-flavored disposable electronic portable hookah promises 0.6 percent nicotine and 600 puffs before it expires.

Emily Anne McDonald, an anthropologist at the University of California, San Francisco who is studying e-cigarette use among young people, said the lack of public education about the breadth of nicotine-vapor products was creating a vacuum “so that young adults are getting information from marketing and from each other.”

“We need to understand what people are calling these before we send out large surveys,” Dr. McDonald said. Otherwise the responses do not reflect reality, “and then you’re back to the beginning.”

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/

CDC: More teens smoking e-cigarettes, hookah

By RYAN JASLOW / CBS NEWS
More middle and high school students are smoking electronic cigarettes, hookahs and cigars, according to a new government report form the Centers for Disease Control and Prevention.
While rates for those tobacco products have increased, overall youth smoking rates haven’t declined at all, a concerning figure for health officials.
“We need effective action to protect our kids from addiction to nicotine,” Dr. Tom Frieden, director of the CDC, said in an agency press release.
For the new report, researchers combed data from the 2012 National Youth Tobacco Survey, a nationally-representative poll of about 25,000 students in grades six through 12 on their tobacco use habits and attitudes towards smoking.
They found recent e-cigarette use among high school students rose to 2.8 percent in 2012, up from 1.5 percent the year before. About 1.1 percent of middle school students reported using the products, up from 0.6 percent in 2011.

E-cigarette use among youths surges

In September, the CDC released a report that found the number of middle and high school students who ever used an e-cigarette doubled, from 1.4 percent and 4.7 percent of surveyed students in 2011 to 2.7 percent and 10 percent by 2012, respectively.
Hookah use was also looked at in the new report. The CDC finding smoking rates increased from 4.1 percent of high schoolers in 2011 to 5.4 percent by 2012.
Cigar use rose “dramatically” among black high school students, with 16.7 percent reporting using them, up from 11.7 percent in 2011 and a doubling of rates since 2009.
Included in cigars were flavored little cigars or cigarillos, which contain fruit or candy flavorings and tend to look similar to cigarettes. They are often cheaper because they are taxed at lower rates and can be sold individually.
Last month, the CDC also released a report on youth smoking rates for flavored little cigars, finding six percent of surveyed middle and high students said they had tried them.
E-cigarettes, hookahs, cigars and other “new” tobacco products are not regulated by the Food and Drug Administration, the CDC points out. Increases in the marketing and availability of these products — along with a misconception they’re safer than cigarettes — may be fueling these increases in kids.
“This report raises a red flag about newer tobacco products,” said Frieden. “Cigars and hookah tobacco are smoked tobacco — addictive and deadly.”
Overall, about 7 percent of middle school students reported smoking any tobacco product along with 23 percent of high school students, rates unchanged from 2011.
The new report was published Nov. 14 in the CDC’s journal Morbidity and Mortality Weekly Report.
The FDA intends to propose a rule to tighten regulation of non-cigarette nicotine products like e-cigarettes. The authors also called for more tobacco-control measures implemented to these newer products, including increasing the price of them, using media campaigns aimed at curbing smoking, increasing access to services that help people quit and enforcing restrictions on advertising and promotion.
Under the Affordable Care Act, more Americans will qualify to coverage for tobacco cessation services, the CDC added.
http://www.cbsnews.com/8301-204_162-57612410/cdc-more-teens-smoking-e-cigarettes-hookah/

More U.S. Teens Try E-Cigarettes, Hookahs: Report

By Steven Reinberg, HealthDay Reporter – US News
(HealthDay News) — The rapidly growing use of electronic cigarettes, hookahs and other smoking alternatives by middle school and high school students concerns U.S. health officials.
While use of these devices nearly doubled in some cases between 2011 and 2012, no corresponding decline has been seen in cigarette smoking, the U.S. Centers for Disease Control and Prevention reported Thursday.
“We have seen, between 2011 and 2012, a big increase in the percentage of middle- and high-school students who are using non-conventional tobacco products, particularly electronic cigarettes and hookahs,” said Brian King, a senior scientific adviser in CDC’s office on smoking and health.
These products are marketed in innovative ways on TV and through social media, he said. “So, it’s not surprising that we are seeing this increase among youth,” he added.
E-cigarettes and hookah tobacco come in flavors, which appeals to kids. And since hookahs are often used in groups, they also provide a social experience, which may be adding to their popularity, King said.
Teens may also believe that e-cigarettes are safer than tobacco, said Stanton Glantz, director of the Center for Tobacco Control Research and Education at the University of California, San Francisco. However, nicotine is addictive and can hamper the developing brains of teens.
“This paper shows that the return of nicotine advertising to TV and radio, combined with an aggressive social media presence and use of flavors is promoting rapid uptake of electronic cigarettes by youth,” said Glantz.
The report, based on data from the 2012 National Youth Tobacco Survey, was published in the Nov. 15 issue of the CDC’s Morbidity and Mortality Weekly Report.
King said efforts are needed to curb use of these tobacco products and prevent other teens from ever trying them. “We know that 90 percent of smokers start in their teens, so if we can stop them from using tobacco at this point, we could potentially prevent another generation from being addicted to tobacco,” King noted.
Smoking is the leading cause of preventable death and disease in the United States, killing more than 1,200 people every day.
E-cigarettes simulate the experience of smoking without delivering smoke. They are shaped like cigarettes but users inhale a vaporized, nicotine-based liquid.
“Nicotine is an addictive drug that affects brain development, especially in adolescents, whose brains are still developing,” he said.
According to the report, from 2011 to 2012 use of e-cigarettes among middle-school students rose from 0.6 percent to 1.1 percent. Their use by high school students jumped from 1.5 percent to 2.8 percent.
Over the same period, hookah use among high schoolers jumped from 4.1 percent to 5.4 percent, the researchers found.
Currently, electronic cigarettes, hookah tobacco, cigars and certain other new tobacco products are not regulated by the U.S. Food and Drug Administration.
The FDA has said it intends to classify these products as tobacco products, putting them under the agency’s control.
The popularity of these new products hurts ongoing tobacco-prevention efforts, experts say. “This proliferation of novel tobacco products that are priced and marketed to appeal to kids are slowing our progress in reducing tobacco use among kids,” said Danny McGoldrick, research director for Campaign for Tobacco-Free Kids.
“You have the marketing of electronic cigarettes that are using all the themes and tactics that have been used by cigarette companies for decades to market to kids, like flavors, the use of celebrities, the use of sports and entertainment, as well as glamour, sex and rebellion,” he said.
This is why the FDA needs to assert jurisdiction over all tobacco products, McGoldrick said.
Cigar use is also rising among adolescents. Their use by black high school students rose from about 12 percent to nearly 17 percent from 2011 to 2012, and since 2009 has more than doubled, according to the report.
Cigars and cigarettes were smoked by about the same number of boys in 2012 — more than 16 percent.
Cigars include so-called “little cigars,” which are similar in size, shape and filter to cigarettes, King said. But since they are taxed at lower rates than cigarettes, they are more affordable. “You can buy a single, flavored little cigar for mere pocket change, which could increase their appeal among youth,” he said.
Fruit and candy flavors, which are banned from cigarettes, are added to some of these little cigars, King said.
According to the CDC, about one in three middle- and high-school students who smoke cigars use flavored little cigars.
Every day, more than 2,000 teens and young adults start smoking. Smoking-related diseases cost $96 billion a year in direct health care expenses, according to the CDC.
More information
For more information on stopping smoking, visit the American Cancer Society.
http://health.usnews.com/health-news/news/articles/2013/11/14/more-us-teens-try-e-cigarettes-hookahs-report