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Today's Smokers Are Having a Harder Time Quitting — What Changed?

Dr. Daniel Seidman,  Smoking cessation expert | From HuffPost Healthy Living Blog

Over the last 25 years, cigarette consumption by smokers in the United States decreased by almost one-third. Over that same period, however, many tobacco companies reengineered cigarettes to more efficiently deliver the nicotine that keeps their customers coming back (1,2). This is called the “yield.” Increased yield means smokers, even if they smoke fewer cigarettes per day, still get plenty of nicotine. In other words, most of today’s cigarettes are not the same ones your mother or father smoked.

Not only are today’s cigarettes different — so are smokers. They are more likely to experience stress, worry, and depression regardless of their income (3). Recent research shows that it is quitting that brings stress relief rather than the other way around; cigarette addiction itself is a source of stress, anxiety, and depression (4,5) As the number of smoke-free environments increased, and because smokers smoke fewer cigarettes on average, today’s smokers generally wait longer between cigarettes. This delay increases the psychological and emotional reward value of each cigarette. At the same time, because they can’t smoke whenever they want, the timing is often uncertain, and the payoff — being able to light up — is irregular. Paradoxically, this sort of “intermittent” sporadic or random reinforcement is actually the strongest form of psychological reinforcement, thus making current patterns of smoking behavior harder to extinguish. Waiting to smoke is not quitting smoking!

Another factor making it harder to quit smoking today is that funding for tobacco prevention has been cut significantly. This illustrates the diminished importance society places on efforts to help smokers. Meanwhile, tobacco companies spend $18 to market their products for every dollar spent to support smokers and reduce smoking (6). Ostracized from private homes, work, cars, and public spaces, many smokers report high levels of shame when they leave social gatherings to get a nicotine fix. Our cultural norm of self-help places the burden of quitting, and blame of failure, squarely on smokers’ shoulders. Self-help, however, is clearly not working for many struggling to quit.

The United States has made remarkable progress against smoking, but most of that progress occurred in the 40 years before 2004, when the adult smoking rate was cut about in half to 20.9 percent. The most recent data, released by the Centers for Disease Control (CDC) on May 22, 2015 (7), is that the median prevalence of cigarette smoking in 2011 was 21.2 percent. Even adjusting for changes in the way smoking rates are being measured, this is higher, not lower, than the 20.9 percent reported 7 years earlier! For 2012, the smoking rate was 19.6, and for 2013 it was 19.0, barely budging from a decade earlier!

As we observed World No Tobacco Day 2015 this past Sunday, May 31, many smokers continued to find themselves in a trap set for them by cigarettes. Cigarettes are designed for addiction and not for recreational “take it or leave it” use. Many of today’s smokers therefore find themselves caught between a lack of constructive social and psychological support, and the destructive effects of highly nicotine-efficient cigarettes, creating a tobacco control stalemate.

What can be done?

We can start by requiring manufacturers to limit or taper permitted nicotine levels in cigarettes. All tobacco and nicotine products should be standardized and openly disclose their nicotine levels, and how much is absorbed into smokers’ bodies the same way people track calories or carbohydrates.

Here are five quick tips for smokers trying to quit:

  • Try to challenge beliefs that justify smoking. Beliefs such as “I smoke because I’m stressed,” “I’ll quit tomorrow,” “I’ll only smoke one,” and “I’m not strong enough to quit” are common and tend to cement smoking as a behavior.
  • Consider these three “triggers” to smoking, and be prepared with strategies to cope with them: 1) Other smokers: Avoid other smokers or ask them not to smoke around you, 2) Alcohol: Avoid alcohol or limit drinks as necessary, and 3) Emotional stress: Learn to adjust to situations without smoking.
  • With cigarettes delivering a stronger dose of nicotine, consider using two forms of NRT. The combined NRT approach not only delivers nicotine more aggressively to replace that from cigarettes, the U.S public Health Service 2008 update (8) found this to be the best of the medical options available for helping smokers quit.
  • Beware of cutting down as a strategy to quit unless you schedule your reduction of smoking in advance for a limited and specific amount of time prior to a target quit date. Stalling, delaying, or reducing smoking are tactics to avoid smoking, but are also ways to avoid quitting. Randomly reducing to quit is a common cessation strategy which recent research suggests is associated with lower cessation success rates. A 2013 Gallup poll (9) found smokers who succeed are more likely to quit abruptly (48 percent) vs. gradually (2 percent). A short-term technique for building confidence to prepare a successful quit day is smoking by the clock, otherwise known as “scheduled smoking” (10).
  • Download an app on your smartphone so you always have access to scientifically supported psychological and behavioral techniques. Such an app should help you prepare for and plan a successful quit day, as well as offer relapse prevention tools. It is critical that the app address not only the physical ties to your smoking addiction, but also the emotional side. Of course, I would like to highlight my own Up in Smoke app for iPhone, iPad Android, and the web!

Dr. Daniel Seidman, a clinical psychologist, is director of smoking cessation services at Columbia University Medical Center. He is author of the book Smoke-Free in 30 Days and of the “Up in Smoke” app from Mental Workout for iPhone, iPad, Android, Mac, and PC.

References:

  • Variation in nicotine intake in U.S. Cigarette smokers Over the Past 25 Years: evidence From nHanes surveys. Martin J. Jarvis, Gary A.Giovino, Richard J. O’Connor, Lynn T. Kozlowski, John T. Bernert.
  • SRNT Journal Research Advance Access published July 25, 2014
  • Recent increases in efficiency in cigarette nicotine delivery:implications for tobacco Control. Thomas Land, Lois Keithly, Kevin Kane, Lili Chen, Mark Paskowsky , Doris Cullen, Rashelle B. Hayes, Wenjun Li. SRNT Journal Advance Access published January 13, 2014
  • 2013 Gallup-Healthways Well-Being Index.
  • Tanya R. Schlam, Megan E. Piper, Jessica W. Cook, Michael C. Fiore and Timothy B. Baker. “Life 1 Year After a Quit Attempt: Real-Time Reports of Quitters and Continuing Smokers.” Annals of Behavioral Medicine, Vol. 44, Issue 3, 309-319. December, 2012.
  • West R, Brown J (2015) How much improvement in mental health can be expected when people stop smoking? Findings from a national survey, Smoking in Britain, 3,6. http://www.smokinginbritain.co.uk/read
  • Campaign for Tobacco Free Kids. Broken Promises to Our Children: The 1998 State Tobacco Settlement Fourteen Years Later (Updated in 2014).
  • State-Specific Prevalence of Current Cigarette Smoking and Smokeless Tobacco Use Among Adults Aged ≥18 years -United States, 2011-2013. CDC, Morbidity and Mortality Weekly Report (MMWR) May 22, 2015 / Vol. 64 / 19. See Table 1. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6419a6.htm?s_cid=mm6419a6
  • The 2008 update to Treating Tobacco Use and Dependence, U.S. Department of Health and Human Services Public Health Service May 2008. See page 109 http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/tobacco/clinicians/update/treating_tobacco_use08.pdf
  • http://www.gallup.com/poll/163763/smokers-quit-tried-multiple-times.aspxhttp://www.gallup.com/poll/163763/smokers-quit-tried-multiple-times.aspxThe effects of smoking schedules on cessation outcome: Can we improve on common methods of gradual and abrupt nicotine withdrawal? Cinciripini, Paul M.; Lapitsky, Lynn; Seay, Sheila; Wallfisch, Annette; Kitchens, Karen; Van Vunakis, Helen. Journal of Consulting and Clinical Psychology, Vol 63(3), Jun 1995, 388-399.

http://www.huffingtonpost.com/daniel-seidman/todays-smokers-are-having_b_7471194.html

Forum editorial: Minnesota tobacco use down

The anti-tobacco work of ClearWay Minnesota in conjunction with other tobacco cessation efforts has had remarkable results in reducing smoking rates among all age groups in Minnesota. It’s a record worthy of high praise. It’s unambiguous evidence that focused, science-based anti-tobacco campaigns can work.

Numbers released last week by ClearWay show only 14.4 percent of Minnesotans smoke cigarettes, down from 22.1 percent in 1999. The decline through the time period has been steady, and corresponds to increased education and imposition of legal restrictions on smoking in public places. Add new medical research about second-hand smoke, and graphic anti-smoking television advertising, and it appears the multi-faceted message is getting through.

But not to every age cohort.

In ClearWay statistics from 2010 to 2014, smoking hardly dipped at all (1 percent) in the 25-44 year-old group, from 19.7 percent to 18.7 percent. A similar slight improvement was measured in the 45-64 year-old cohort, compared with a huge drop (from 21.8 percent to 15.3 percent) in Minnesotans age 18-24. Which could lead to the conclusion that some Minnesotans don’t get smarter as they age. But whatever the reason, the overall percentages of all Minnesotans who smoke is down over the longer study period, and that’s good news for smokers who quit, non-smokers and reduced impacts on health costs associated with tobacco use. The trends are good.

ClearWay is not resting on its excellent record. In the eight years it has left in its mandate (funded by the national tobacco settlement of a few years back), the agency’s agenda includes raising cigarette taxes, which all studies show discourage young people from purchasing tobacco, and raising the age for tobacco purchases from 18 to 21. Again, research finds that raising the age to beyond high school age contributes to fewer high school students trying tobacco. New York City and Hawaii have already taken that step.

There is still much to be accomplished to achieve as smoke-free a society as possible. A lot has been done, often led by private sector companies that banned smoking from the workplace before cities and states enacted overall smoking bans in buildings and, in many instances, outdoor public spaces. Decades of research into smoking-related illness and death, and the proven health hazards of secondhand smoke, have been the underpinnings of changing public policy. ClearWay’s work and similar complementary efforts have been pivotal in changing the way enlightened Americans view tobacco use.

Forum editorials represent the opinion of Forum management and the newspaper’s Editorial Board.

http://www.inforum.com/opinion/editorials/3751883-forum-editorial-minnesota-tobacco-use-down

Fargo Forum: Anti-tobacco groups eye raising purchasing age to 21 in Minnesota

By Patrick Springer

MOORHEAD – Minnesota tobacco control advocates may propose raising the legal age for buying cigarettes to 21 years old.
Hawaii, New York City and more than 30 municipalities in Massachusetts have raised the legal age for buying tobacco, and the experiment will be closely watched, said Andrea Mowery, vice president of ClearWay Minnesota, a foundation that promotes prevention and cessation of smoking and tobacco use.
ClearWay Minnesota, funded by the state’s share of the 1998 tobacco settlement, will only move ahead with a proposal if a wide consensus of health groups and public health groups agree the approach has merit, Mowery told The Forum editorial board.
“We’re part of a broad coalition,” she said, and listed the American Cancer Society, American Lung Association and American Heart Association as frequent partners. “There’s a very collegial and collaborative process.”
More than 9 of every 10 smokers start before the age of 19 or 20, a reality that is behind the nascent movement to raise the legal age for buying tobacco, Mowery said.
Earlier efforts, which public health officials credit with reducing smoking rates, have centered on raising tobacco taxes and banning smoking in public places.
Teenagers are especially sensitive to price increases spurred by tax increases, which have been shown to be the most effective means to date of curbing youth smoking, Mowery said.
“Youth and young adults are much more sensitive to price,” she said.
Smoking prevalence continues to decline in Minnesota, where the smoking rate stood at 14.4 percent last year, down 35 percent since 1999 and the lowest rate ever recorded, according to the Minnesota Adult Tobacco Survey in 2014.
“So really significant progress,” Mowery said.
The national adult smoking rate is 19 percent. In North Dakota, the adult smoking rate was 21.9 percent in 2011, according to the Centers for Disease Control.
Persistent gaps remain in smoking rates, with those who have less than a high-school education the most likely to smoke, with a rate of 28.6 percent.
Young adult smoking decreased by 6.4 percentage points over the past four years, dropping to 15.3 percent from 21.8 percent, the only noteworthy decline for any age group.
“That is quite a stark departure,” Mowery said.
But that drop coincided with a sharp spike in the use of e-cigarettes, which jumped from a rate of 0.7 percent to 5.9 percent from 2010 to 2014.
The age group most likely to smoke is the 25- to 44-year-old bracket, with a rate of 19.7 percent for men and 18.7 percent for women.
American Indians smoke at a rate that far surpasses the overall population—a rate of 59 percent, quadruple the 14.4 percent overall rate.
“On the whole we’re making good progress,” Mowery said, adding that challenges remain.
http://www.inforum.com/news/3748538-anti-tobacco-groups-eye-raising-purchasing-age-21-minnesota

Jim Whitehead: The evidence is in: Ban tobacco use in GF parks

By Jim Whitehead

GRAND FORKS—It seems that the proposed Park Board tobacco policy has some folks blowing more than smoke.
Among the assertions are the following:
▇ The policy is not based on good science.
▇ Youth are not influenced by the behavior of others.
▇ It will be unpopular in Grand Forks.
▇ It is paternalistic and a misuse of power.
▇ Golf and softball are adult activities and should be exempt from a chewing tobacco ban.
Let’s start by stating what is well known: First, tobacco products are harmful when used as intended; second, nicotine is highly addictive; third, most tobacco users start before the age of 18; and fourth, North Dakota has a major problem with youth smoking and chewing tobacco use.
Thus, it behooves local public health professionals and civic leaders to take reasonable action to address the issue—which, of course, begs the question of what is “reasonable.”
Well, is it reasonable to assume that the Grand Forks Park District should be interested in regulating unhealthy behaviors? Given that the district’s mission is “to provide the best parks, programs, facilities, forestry services and other services possible to promote a healthy and enjoyable lifestyle for all citizens of Grand Forks,” I would submit that it is quite reasonable to adopt policies that promote fidelity to its mission.
Is the proposed policy based on good science? Note that the risks of secondhand smoke have not been advocated as the basis for the proposed policy. In contrast, the rationale is far more about social norm issues such as the effects of role modeling and peer influence.
Of course, not all scientists agree, and I could certainly cherry-pick research papers that challenge their effects; but the weight of evidence seems to have impressed the scientists and public health professionals at the Centers for Disease Control and local public health departments.
Moreover, the science has been deemed good enough to underpin similar policies that have already been adopted by other local agencies and institutions that claim health-related missions, including Altru, UND and Grand Forks schools.
This is not “paternalism” in action. It is an objective and evidence-based attempt to address a serious public health concern.
The “good science” issue also is pertinent to the notion that the proposed policy “will be unpopular.” Those who have made that criticism may not be aware of the solid research design behind the two recent studies conducted on Grand Forks residents and on softball-team managers and golf-course users. The data shows that 78 percent of residents support the comprehensive tobacco-free policy (90 percent of frequent park users), and 84 percent of softball and golf participants are in favor. This is hardly an unpopular policy.
Moreover, when asked whether the proposed policy would “discourage youth from starting to use tobacco products, promote positive role-modeling” or “create an environment that promotes a healthy and enjoyable lifestyle,” well over 90 percent of respondents agreed.
Again, these data (obtained using good scientific methodology) overwhelmingly refute the notion that the policy will be “unpopular.”
Will this policy, if adopted, cause some people to bypass the city for destinations further south? Given that Manitoba intends to fine smokers $300 if they are caught puffing in provincial parks, beaches or playgrounds, it could be that hardened tobacco-using golfers might pass us by. But I doubt that will constitute enough of a revenue loss to Grand Forks to outweigh the health and health care cost-savings that will accrue from what is demonstrably a popular and science-based policy.
Thus, I hope that the Park District board will ignore these “smoke screens” and adopt the proposed tobacco policy at its meeting on Monday (May 4).
But I also hope that the board will recognize that golf and softball are not exclusively the domain of adults, and consequently, will be amenable to revisiting the chewing tobacco exemption sometime in the near future.
Given the alarming data on all forms of tobacco use by North Dakota’s youth, plus the near-overwhelming support for an all-inclusive comprehensive policy by Grand Forks’ residents and the city’s golfers and softball-team managers, I suggest that this is not an issue that can be “chewed over” and delayed too much longer.
http://www.grandforksherald.com/opinion/op-ed-columns/3734294-jim-whitehead-evidence-ban-tobacco-use-gf-parks

Fargo Forum: Bill banning e-cigarette sales to minors in ND passes Senate

By Mike Nowatzki

BISMARCK – A bill outlawing e-cigarette sales to minors in North Dakota unanimously passed the Senate on Tuesday, though one lawmaker warned that not defining the nicotine-delivery devices as tobacco products will make it more difficult to enforce the law and protect minors.

“Sometimes the good outweighs the flaws, and that’s precisely how I view this bill,” said Sen. Erin Oban, D-Bismarck, executive director of Tobacco Free North Dakota.

Senators voted 46-0 in favor of House Bill 1186, which makes it an infraction to sell or give anyone under 18 an electronic smoking device or alternative nicotine product, or for minors to buy, possess or use them.

Introduced by Rep. Kim Koppelman, R-West Fargo, the bill also requires child-resistant packaging for liquid nicotine containers and bans self-service displays for e-cigarettes.

The Senate didn’t change the bill as approved by the House 71-20 last month, so it will soon head to Gov. Jack Dalrymple for his signature.

Sen. John Grabinger, D-Jamestown, who carried the bill from the Senate Judiciary Committee with a 6-0 do-pass recommendation, said the committee heard a lot of testimony and efforts to amend the bill but couldn’t decide on any changes that would make it better.

“Your committee decided rather than trying to fix the bill that really was getting these products out of the reach of the young, we should support the present bill,” he said.

Health advocacy groups and the state Department of Health have urged lawmakers to define e-cigarettes as tobacco products because the nicotine in the liquid vaporized by the battery-powered devices is derived from tobacco plants.

The definition would make e-cigarettes subject to tobacco excise taxes and require those who sell them to obtain a tobacco retailer license, as three North Dakota cities – Wahpeton, West Fargo and Grand Forks – have mandated through their city ordinances.

Twenty-three cities have updated their ordinances to prohibit e-cigarette sales to minors, according to the North Dakota Center for Tobacco Prevention and Control Policy.

Oban raised concern about using terms like “alternative nicotine product” for products “that are indeed tobacco products and should be treated as such under the law.”

“Creating multiple definitions makes enforcement and compliance more difficult and protection for minors less effective,” she said. “In addition, currently we have no idea who’s even selling products like electronic cigarettes, and unfortunately this bill doesn’t help us to address that concern, either.”

Still, she encouraged a yes vote with the understanding “that we may need to make some improvements in the future.”

Sen. Jonathan Casper, R-Fargo, said the debate over whether to classify e-cigarettes as tobacco products will continue as the U.S. Food and Drug Administration develops regulations for the devices. He said HB1186 struck a “middle-ground balance” between interests on both sides.

Senators also voted 9-37 Tuesday to defeat HB1078, which would have made it illegal for minors to use or be sold nicotine devices. Grabinger said committee members felt the bill introduced by Rep. Diane Larson, R-Bismarck, didn’t go far enough.

http://www.inforum.com/news/3712175-bill-banning-e-cigarette-sales-minors-nd-passes-senate

Dickinson Press: Debate over on e-cigs as tobacco products overshadows bills restricting sales to minors

By Mike Nowatzki, Forum News Service

BISMARCK – Two bills being heard at the Legislature this week aim to keep e-cigarettes out of the hands of minors, but the burning issue is whether the nicotine-delivery devices should be classified as tobacco products, which would make them subject to additional taxes.

The North Dakota Department of Health believes e-cigarettes should be considered tobacco products because the nicotine contained in the liquid that’s vaporized by the battery-powered devices is derived from tobacco plants, said Krista Fremming, director of the department’s chronic disease division.

“Defining nicotine devices as tobacco products would allow the state to treat and regulate the sale of these products to minors in the same way the state treats and regulates the sale to minors of other tobacco products, such as conventional cigarettes,” she testified to the Senate Judiciary Committee on Tuesday.

Rep. Diane Johnson, R-Bismarck, prefers not to bring the tobacco-product issue into the debate. Her House Bill 1078 – one of two bills the House passed last month to ban the use of e-cigarettes by minors – refers simply to “nicotine devices,” defining them as “any noncombustible product that can be used by an individual to simulate smoking through inhalation of a substance that contains or delivers nicotine or any other ingredient.”

The bill had its first hearing before the Senate Judiciary Committee on Tuesday.

On Wednesday – the annual nationwide “Kick Butts Day” – committee members will take up the other House bill, HB 1186, which would make it an infraction to sell or give anyone under 18 an electronic smoking device or alternative nicotine product, or for minors to buy, possess or use them.

Fremming said the health department supports that bill’s requirements for child-resistant packaging and salesperson-assisted sales to limit e-cigarettes from being marketing to youths. But it’s still concerned that the bill defines e-cigarettes as non-tobacco products.

The bill’s prime sponsor, Rep. Kim Koppelman, R-West Fargo, has argued that while e-cigarettes use nicotine extracted from tobacco, they’re not tobacco products.

Koppelman was among the House lawmakers who voted to defeat a House bill that would have increased the excise tax on a pack of cigarettes from 44 cents to $1.54 while also defining e-cigarettes as tobacco products. He called it a back-door way to taxing e-cigarettes.

Mike Rud, president of the North Dakota Petroleum Marketers Association, said Tuesday the group supports Koppelman’s bill because it’s more comprehensive and opposes classifying e-cigarettes as tobacco products because the U.S. Food and Drug Administration is developing regulations for e-cigarettes.

“I think we’re going to see a lot of changes when those come out. There’s no sense in muddying the waters right now,” he said.

As of December, Minnesota and Vermont were the only states that taxed e-cigarettes and e-vapor products. Twelve state legislatures considered bills last year taxing e-cigarettes but didn’t pass them, according to Tobacco E-News, an industry publication.

In North Dakota, 23 cities have updated their ordinances to prohibit e-cigarette sales to minors, according to the North Dakota Center for Tobacco Prevention and Control Policy.

Three of those cities – Wahpeton, West Fargo and Grand Forks – require those who sell e-cigarettes to obtain a tobacco retailer license. That could become a state requirement if lawmakers classify e-cigarettes as tobacco products, which supporters say would reduce e-cigarette sales to minors.

Rud said most retailers have made a conscious decision not to sell e-cigarettes to minors, already treating them as tobacco products.

E-cigarette users argue the devices are safer than traditional cigarettes, are a useful tool for those trying to quit smoking and shouldn’t be subject to tobacco excise taxes. Fremming said the health department feels nicotine products approved by the FDA for tobacco cessation – which currently doesn’t include e-cigarettes – should be excluded from the definition of nicotine devices because their safety and efficacy is proven.

While the tobacco products definition will continue to be a source of debate, no opposition has surfaced so far to the idea of restricting e-cigarette sales to minors.

Fremming said the rate of North Dakota high school students who reported trying e-cigarettes nearly tripled from 2011 to 2013, from 4.5 percent to 13.4 percent, and high school students who have tried e-cigarettes are almost twice as likely to try conventional cigarettes.

At least 41 states currently prohibit sales of electronic cigarettes or vaping/alternative tobacco products to minors, including Minnesota and South Dakota, according to the National Conference of State Legislatures.

Whitney Klym, a senior at St. Mary’s Central High School in Bismarck and a member of its SADD group, told the committee Tuesday she has seen e-cigarettes used at school, parties and other events by students as young as 14.

“It is becoming a dangerous social norm among youth,” she said.

http://www.thedickinsonpress.com/news/legislature/3702058-debate-over-e-cigs-tobacco-products-overshadows-bills-restricting-sales

Op Ed: How to lower Grand Forks’ high tobacco-use rates

By: Theresa Knox

On Feb. 23, the Herald ran a story about the dismal rates among adults of chewing tobacco use (“N.D. ranks highly in smokeless tobacco use,” Page A1).

As the story reported, North Dakota was ranked 49th out of 50 states and District of Columbia, with 7.6 percent of its adults using smokeless tobacco.

The story went on to interview several people with personal stories about the toll of tobacco in their lives. It ended with the quote, “They all know someone who’s died from tobacco-related cancer.”

These statistics are terrible. And they are not just statistics. As the article referenced, each number represents a person. These are people we know and love — people we work with, and people whom we don’t want to see sick and dying from the No. 1 cause of preventable death: tobacco use.

Nearly one quarter of high school boys in North Dakota use smokeless tobacco (22 percent). That is higher than the adult use rate and the fifth worst in the country.

We know that most smokers begin their addictive habit before the age of 18, and nearly 4,000 kids try their first cigarette every day. That’s almost 1.5 million young people per year.

The tobacco industry pours billions into advertising to create a perception that tobacco use is fun and glamorous.

But, guess what? We don’t have billions to counteract that type of messaging — and we don’t need it.

There is a solution that is nearly free of charge; and it works. Research bears out this claim.

I will tell you what that solution is, but first, ask yourself this question: Is it easier to quit using tobacco or to avoid ever taking up the habit?

It is easier (and cheaper) to avoid taking up this addictive habit.

Second, I ask you to rethink your attitudes about tobacco use and why it is not acceptable in indoor and outdoor public places. There is no denying that second-hand smoke and toxic litter from cigarette butts and spitting on the ground are bad for people and animals. But there is an even more important reason to prohibit tobacco use in indoor and outdoor public places: Public policy that keeps kids from seeing tobacco use as a normal activity will decrease youth initiation of tobacco use.

Remember, most people don’t chew or smoke tobacco.

An effective way to keep our next generation of North Dakotans from ever taking up using tobacco is to pass laws that keep tobacco use –including e-cigarettes, cigarettes and smokeless tobacco — out of our parks.

We can pass public policy that creates tobacco free environments. These policies don’t tell people they can’t use tobacco, if they choose to use. People are still free to smoke or chew. These policies prevent the use of products in otherwise safe and healthy places.

Grand Forks Park Board commissioners have the chance to take a deliberate and determined step to protect the health and safety of Grand Forks youth by adopting a comprehensive tobacco-free parks policy. They can take the lead to separate the connection between sports and chew, parks and tobacco.

And the result?

We know the result. A comprehensive tobacco-free parks policy, prohibiting use of all tobacco products in all Park District parks, grounds and facilities will result in cleaner parks and less secondhand smoke exposure.

And the most celebrated result?

Fewer Grand Forks youth will start using tobacco, and fewer among the next generation of North Dakotans will struggle with tobacco addiction and the toll of the illness and death that result from tobacco.

That is the solution. And it costs next to nothing.
http://www.grandforksherald.com/opinion/op-ed-columns/3688567-theresa-knox-how-lower-grand-forks-high-tobacco-use-rates

Letter: Support e-cigarette age restrictions

By Tom Woodmansee, Bismarck

House Bill 1265 would require e-vapor products (commonly referred to as e-cigarettes) to be sold only to adults 18 years of age and above, an important goal that we should all agree on. We support enactment of underage access prevention for e-vapors and alternative nicotine products, which is why we support House Bill 1265.
This bill includes broad definitions to ensure that these new product forms are included in North Dakota’s existing underage access prevention laws.
Products that contain nicotine, whether they are traditional tobacco products like cigarettes, cigars or smokeless tobacco or new e-vapor products, are for adults only. We don’t believe people who are under legal age should be purchasing these products. Currently, 41 states prohibit sale of e-vapor products to minors.
The bill would also establish statewide policy regarding sales of these new types of products such as e-vapor. This bill would provide uniform policy for e-vapor and alternative nicotine product sales across North Dakota and avoid a patchwork of differing local restrictions or ordinances that could cause confusion among adult consumers and retailers.
That’s why we support this legislation to help ensure that e-vapor products are only available to adult consumers and to support retailers in having uniform state standards for tobacco and alternative nicotine product sales to continue to help address underage access to all types of products that contain nicotine.
Let’s do the right thing and pass House Bill 1265. It’s the responsible approach that will help make these products only available to adults and out of kids’ hands.
Woodmansee is with the North Dakota Grocers Association.
http://www.inforum.com/letters/3684232-letter-support-e-cigarette-age-restrictions

Cigarette tax and e cigarettes debated in ND legislature

By KX News

Bismarck, ND -A bill that would have substantially raised taxes on cigarettes in North Dakota failed Friday afternoon.
But two others limiting access to electronic cigarettes passed.
The proposed cigarette tax would have raised taxes more than 200 percent on a package of cigarettes.
Currently the cigarette tax in North Dakota is 44 cents.
By contrast, the tax in Minnesota is 2.90 and in South Dakota it’s a 1.53.
Supporters of the bill say the increase would reduce the number of smokers and lower health care costs.
“Whenever a tobacco tax is increased, smoking, especially youth smoking goes down and it goes down dramatically. That I believe is undeniable,” says Rep. Jon Nelson, R – Rugby.
Bill opponents argued that a tax won’t stop smoking, and burdens business.
“If it truly is our duty to coerce people into a healthy lifestyle through taxation, why don’t we tax fast food with high fat content and high cholesterol, all things supersized and salt,” says Rep. Rick Becker, R – Bismarck.
The cigarette tax bill failed by a 56-34 vote.
The house passed two bills designed to keep e-cigarettes away from kids.
The two bills differ in these ways —
One labels e-cigarettes as tobacco products, tying them to the laws and enforcement already in place for cigarettes.
Those laws include things like compliance checks from local police and how cigarettes are displayed in stores.
The other bill separates e-cigarettes into their own category with their own set of enforcement laws.
“I don’t know how we can separate the idea of discussing e-cigarettes and then we’re going to talk about the taxing of tobacco when it’s clearly a tobacco product,” says Rep. Kenton Onstad, D – Parshall.
“We do not want kids under the age of 18 to buy cigarettes, whether it be on the internet, whether it be in the store. E-cigarettes, anywhere. We don’t want them to by regular cigarettes, we don’t want them to buy e-cigarettes,” says Rep. Al Carlson, R – Fargo.
Both bills now move to the Senate where only one, if any, is likely to pass.
http://www.wdaz.com/news/north-dakota/3679119-cigarette-tax-and-e-cigarettes-debated-nd-legislature

Forum editorial: Raise cigarette tax in ND

North Dakota should raise taxes on tobacco products. The state’s tax is among the lowest in the nation (44 cents on a pack of cigarettes); indeed lower than some of the major tobacco-growing states.
Raising the tax, which has been at an embarrassing low level for decades, comports nicely with North Dakota’s successful anti-tobacco public health efforts, and specifically would deter young people from buying cigarettes. Every state that has raised cigarette taxes has found it is a significant factor in preventing youngsters and young adults from buying.
Two bills are in the legislative hopper. A House bill calls for an increase to $1.56 a pack; a Senate bill would raise the tax to $1.10. Both bills have bipartisan sponsors, recognition that recent public opinion surveys found support for a higher tax among all political persuasions, with the only resistance to a higher tax coming from smokers. The tax increases in both bills are too low, but would be a start if a majority of lawmakers see the issue for what it is: a public health initiative, not retail sales problem.
It is first and foremost a public health matter. Of course retail sales of cigarettes and other tobacco products would take a hit. That’s the aim of a higher tax. So the crux of the matter is the choice posited by columnist Steve Andrist in the Crosby (N.D.) Journal: “In the final analysis, it comes down to what you want to save: sales or lives.”
The retail lobby and legislators who oppose a higher tax are confronted with that stark choice.
The most recent poll of North Dakotans’ attitudes about a higher tobacco tax (and the e-cigarette phenomenon) shows a majority of all partisan subgroups support an increase. Not surprisingly, the state’s smoke-free law, which was resisted for years by the Legislature and was at last approved by ballot measure, has support across all partisan and demographic lines, according to the December 2014 Public Opinion Strategies poll.
Furthermore, the polling found that attempts to allow e-cigarettes in public places (that is, exempt them from the state’s tobacco restrictions law), “is a non-starter with North Dakotans.” The few lawmakers pushing e-cig exemptions might want to rethink their proposals.
Finally, the lesson of the Legislature’s longtime refusal to act on a statewide tobacco-use ban is instructive for the tax debate. A ballot measure to enact a ban – after several cities, large and small had imposed their own bans – easily passed a statewide vote. It was a clear repudiation of the Legislature’s intransigence on the tobacco issue.
If lawmakers remain in the pocket of a shortsighted and out-of-step retail lobby (the same group that vigorously fought a statewide smoking ban), North Dakotans would be justified in taking the tobacco tax to the ballot. All indications suggest it would win easy approval.
Forum editorials represent the opinion of Forum management and the newspaper’s Editorial Board.
http://www.inforum.com/opinion/editorials/3675987-forum-editorial-raise-cigarette-tax-nd