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Safety data still sorely lacking in study comparing electronic cigarettes to nicotine patches

FOR IMMEDIATE RELEASE
September 9, 2013
Statement from Tobacco Free North Dakota
Bismarck, ND — Today, national news stories reported the findings of a New Zealand study testing the effectiveness of electronic cigarettes in helping smokers quit, comparing results to that of smokers who attempted to quit using nicotine patches.  Results of this study showed similar quit rates but are not sufficient enough to convince public health experts to embrace e-cigarettes as nicotine replacement therapy (NRT) devices at this time.
“A single study is not sufficient, and safety data is still sorely lacking,” said Dr. Eric L. Johnson, President of Tobacco Free North Dakota.  “We would welcome more efficacy data and safety data from the FDA to back this data up.”
“As well, a 5.7% quit rate as found in this study, is not overly impressive.  FDA-approved NRTs, including nicotine patches and medications like Bupropion and Chantix, have data in the 20-45% quit rate range, and NDQuits, North Dakota’s free tobacco cessation program, has had a 30% quit rate for nine years,” Johnson added.
The release of this study comes just days after the CDC announced disturbing statistics showing huge increases in electronic cigarette use by youth and industry efforts to target them by selling flavors such as cotton candy, bubble gum, and watermelon.
“Until the FDA rules on the safety and efficacy of electronic cigarettes, Tobacco Free North Dakota does not feel comfortable promoting products like e-cigarettes as safe or effective cessation products, especially when North Dakotans have great access to a successful program like NDQuits,” said Erin Hill-Oban, Tobacco Free North Dakota’s Executive Director.

Graphic anti-smoking ads helped 100,000 kick the habit for good, CDC says

Maggie Fox,  NBC News
A graphic, deliberately shocking, anti-tobacco campaign starring former smokers — including a woman who lost her voice box to throat cancer — helped 100,00 Americans kick the habit permanently, government researchers say.
And an estimated 1.6 million people at least tried to quit smoking after seeing the first national mass ­media anti-smoking initiative to be funded by the U.S. government, according to researchers from the Centers for Disease Control and Prevention.
The series of ads, called “Tips,” featured images of an 18-year-old wearing an oxygen mask in the hospital after suffering an asthma attack caused by secondhand smoke; a 57-year-old Army veteran with chronic obstructive pulmonary disease who tearfully declares “I’m running out of time,”; and a heart attack victim showing a gruesome scar from his surgery.
One of the most striking ads featured Terrie Hall, a 52-year-old North Carolina woman who suffered throat cancer caused by smoking. “The only voice my grandson has ever heard is this one,” the well-groomed blonde woman croaks in one video.
“People would come up to her in the grocery store or drug store in other towns and ask ‘if you are the woman on the ad — you inspired me to quit smoking – thank you so much’,” said Dr. Tim McAfee, director of the CDC’s Office on Smoking and Health, who directed the study.
The 2012 three-month campaign reached nearly 80 percent of US smokers, the CDC team says in a report published Monday in the Lancet medical journal.
“The Tips campaign seems to have resulted in millions of non-­smokers talking to smokers about quitting and getting help,” the CDC researchers wrote.
To figure this out, the CDC team sent questionnaires to 3,051 smokers and 2,220 non-smokers completed baseline and follow-up assessments. They found that 78 percent of the smokers and 74 percent of the non-smokers recalled having seen at least one Tips advertisement on television during the three-month campaign.
Before the campaign started, 31 percent of smokers said they had tried to quit for at least one day in the previous three months. This went up to nearly 35 percent after the campaign. And 13 percent said they succeeded.
The differences may look small percentage wise, but when multiplied over the whole U.S. population, they added up. Twenty percent of U.S. adults smoke.
“We found over a million and half smokers made quit attempts because of the campaign,” McAfee told NBC News. “This study shows that we save a year of life for less than $200. That makes it one of the most cost-effective prevention efforts,” McAfee added.
The CDC says half of all smokers try to quit every year, but only 5 percent succeed. Drugs, acupuncture, counseling and nicotine replacement therapies are all available to help, but nothing works perfectly. Over the weekend, researchers reported that e-cigarettes work about as well as nicotine patches to help people quit.
“This is exciting news. Quitting can be hard and I congratulate and celebrate with former smokers – this is the most important step you can take to a longer, healthier life,” said Director Dr. Tom Frieden. “I encourage anyone who tried to quit to keep trying – it may take several attempts to succeed.’’
The CDC says its $54 million campaign, paid for out of the 2010 health reform law, counters the $8 billion the tobacco industry spends on advertising and promotions.
“Tobacco use remains the leading cause of preventable death worldwide, causing nearly 5 million deaths annually,” the CDC team wrote. “For individuals, smoking shortens life expectancy by more than 10 years, whereas adults who quit before age 45 years regain almost a decade in life expectancy.”
CDC says cigarettes kill 440,000 Americans a year, and tobacco use costs $96 billion in direct medical costs and $97 billion in lost productivity.
http://www.nbcnews.com/health/graphic-anti-smoking-ads-helped-100-000-kick-habit-good-8C11111432

CDC’s Anti-Smoking Ad Campaign Spurred Over 100,000 Smokers to Quit; Media Campaigns Must be Expanded Nationally and in the States

FOR IMMEDIATE RELEASE:    September 9, 2013
Statement of Susan M. Liss
Executive Director, Campaign for Tobacco-Free Kids
WASHINGTON, DC – Year one of the federal government’s “Tips from Former Smokers” national advertising campaign exceeded all expectations, driving 1.6 million smokers to try to quit and helping more than 100,000 to succeed, according to a study published today in the medical journal The Lancet.  The 2012 campaign, conducted by the U.S. Centers for Disease Control and Prevention (CDC), also inspired millions of nonsmokers to encourage friends and family members to quit smoking.  Researchers estimated that, by quitting, former smokers added more than a third of a million years of life to the U.S. population.  The Tips campaign was the first ever federally-funded national media campaign aimed at reducing smoking.
This study provides powerful, real-world evidence that media campaigns work, they reduce smoking and they save lives.  They are also cost-effective investments that can help reduce tobacco-related health care costs, which total $96 billion a year in the United States.
The CDC’s campaign was highly successful despite lasting only three months and costing only $54 million – less than 0.7 percent of the $8.8 billion the tobacco industry spends annually to market its deadly and addictive products.  To win the fight against tobacco, we need more media campaigns like this, both nationally and in the states.  Fortunately, the CDC recognizes this and conducted a second round of its campaign earlier this year.  Similar national campaigns must be continued and expanded in the future.
It is also critical that the states increase funding for media campaigns as part of a comprehensive program to prevent kids from smoking and help smokers quit.  The states collect nearly $26 billion a year in revenue from the 1998 tobacco settlement and tobacco taxes, but spend less than two percent of it – $459.5 million in fiscal year 2013 – on programs to reduce tobacco use, including media campaigns.  They have cut funding for such programs by 36 percent in recent years.
To counter the marketing barrage of the tobacco industry and accelerate smoking declines in the U.S., both the federal government and the states must increase and sustain their commitment to fighting tobacco use, including with media campaigns.  Campaigns to reduce smoking must be as aggressive and year-round as the tobacco industry’s promotion of its deadly products.
The success of the CDC’s media campaign also illustrates the value of the Prevention and Public Health Fund, which was created by the health care reform law and provided funding for the campaign.  It underscores the public health fund’s enormous potential to improve health and reduce health care costs in the U.S.
The new study adds to the already substantial scientific evidence that mass media campaigns prevent children from smoking and help smokers quit, saving lives and health care dollars. Public health authorities including the Surgeon General, the National Cancer Institute, the Institute of Medicine and the CDC have all examined the evidence and concluded that these campaigns work.
States that have conducted extensive media campaigns as part of their tobacco prevention programs – including California, Florida, New York and Washington – have reduced smoking rates faster and to lower levels than the nation as a whole.  Florida recently reported that its high school smoking rate fell to 8.6 percent in 2013, far below most states and the entire nation (the national rate was 15.8 percent in the most recent equivalent national survey, conducted in 2011).  If every state reduced youth smoking to the same low rate as Florida, there would be 1.6 million fewer youth smokers in the U.S.
Research indicates the most effective anti-smoking media campaigns evoke strong emotions and realistically depict the terrible health consequences of tobacco use – just as the CDC ads do.  We applaud the CDC for its strong leadership in the fight against tobacco use.  We also thank the courageous former smokers who shared their heartbreaking health struggles with the entire country, telling the harsh truth about how devastating and unglamorous cigarette smoking truly is.
While the U.S. has made enormous progress in reducing smoking, tobacco use remains the nation’s number one cause of preventable death, killing more than 400,000 Americans every year.  Media campaigns are an essential tool in winning the fight against the tobacco epidemic.
Smokers can get help in quitting by calling 1-800-QUIT-NOW or visiting www.smokefree.gov.

E-cigarettes as good as patches in helping smokers quit

Maggie Fox,  NBC News
Electronic cigarettes work about as well as nicotine patches in helping smokers kick the habit, researchers report. And e-cigarettes helped people smoke fewer cigarettes overall, even if they didn’t quit completely.
The study is the first major piece of research to show that the products, which deliver a nicotine mist using a cigarette-shaped pipe, can actually benefit smokers.
The findings, published in the Lancet medical journal, are not quite enough to make public health experts embrace e-cigarettes, which are not yet regulated and which are growing in popularity. But it’s enough to make them look more closely at whether there may be some benefit to them.
“You’re trading one addiction for another addiction,” Dr. Cheryl Healton, president and CEO of the anti-tobacco Legacy Foundation, told NBC News. “(But) it may be that for some people, this will be a better way to quit, and there may be people who’ve tried other things and haven’t been able to quit who will quit with this.”
For the study, Chris Bullen of the University of Auckland in New Zealand and colleagues recruited 657 smokers who wanted to quit. They divided them into three groups, to get either 13 weeks’ supply of e-cigarettes, nicotine patches or placebo e-cigarettes that contained no nicotine.
After six months, 5.7 percent of the volunteers had managed to completely quit smoking. It was slightly more in the e-cigarette group, but not in a way that was statistically significant, Bullen reported.
It’s very difficult to quit smoking, but the e-cigarettes also appeared to have helped people cut back on real tobacco. Bullen’s team found that 57 percent of volunteers given real e-cigarettes were smoking half as many cigarettes a day as before, compared to 41 percent of those who got patches.
“While our results don’t show any clear-cut differences between e-cigarettes and patches in terms of quit success after six months, it certainly seems that e-cigarettes were more effective in helping smokers who didn’t quit to cut down,” Bullen said in a statement.
“It’s also interesting that the people who took part in our study seemed to be much more enthusiastic about e-cigarettes than patches, as evidenced by the far greater proportion of people in both of the e-cigarette groups who said they’d recommend them to family or friends, compared to patches.”
Healton said that was a provocative finding. “It does also suggest consumer acceptability of the product is higher,” she said.
U.S. health officials are very concerned about the rise in popularity of e-cigarettes. The Centers for Disease Control and Prevention and Food and Drug Administration released a report on Thursdayshowing a doubling in the number of high school students who have tried them, to 10 percent.
More than 21 percent of adults have tried them at least once, but the CDC says they are addictive and may themselves be dangerous.
“We don’t know much about them,” says Dr. Tim McAfee, director of the CDC Office on Smoking and Health. But he says they could potentially be useful if tobacco companies would stop making products like cigarettes and make e-cigarettes instead – and if those e-cigarettes did indeed turn out to be less harmful than conventional cigarettes.
“Our nirvana is a world where nobody is dying from death and disease caused by tobacco,” McAfee told NBC News. “If you have a product that doesn’t kill people, that is where the money should be going, that is where the promotion, the marketing should be going.”
They are pricey – an e-cigarette product ranges from $10 to $120, depending on how many charges it provides. And there are dozens, if not hundreds, of brands. FDA says some appear to contain carcinogens, and there is some evidence that nicotine is not only addictive, but may itself damage health.
“They could have inherent dangers that are greater than using something like gum or the patch,” Healton said.
CDC says tobacco is the leading preventable cause of dis­ease, dis­ability, and death in the United States, killing 443,000 people a year.
Public health experts are desperate for ways to help people quit smoking, but it is hard. The American Cancer Society says only 4 percent to 7 percent of people manage to quit on any single given try. Drugs such as Chantix or Zyban can raise this rate to 25 percent.
There’s also counseling, nicotine gum and patches, hypnosis and acupuncture, and companies are working on anti-nicotine vaccines.
Erika Edwards contributed to this report.

A look at e-cigarettes by M. D. Anderson

HOUSTON – With the third and largest of the U.S. tobacco companies planning an e-cigarette product launch this fall, this next frontier for “Big Tobacco” provides renewed presence in a declining marketplace.
It’s also a potential gateway to new smokers, particularly among teens and in emerging/foreign markets, according to behavioral scientists at The University of Texas MD Anderson Cancer Center.
E-cigarettes are battery-powered devices that provide inhaled doses of nicotine vapors and flavorings. The Centers for Disease Control and Prevention estimates that about 6 percent of adults have tried e-cigarettes, a number that has nearly doubled since 2010. Absent of tobacco, e-cigarettes have been promoted as a possible aid in getting people to stop smoking and thereby reducing their lung cancer risk.
However, MD Anderson cancer prevention experts Paul Cinciripini, Ph.D., director of the Tobacco Treatment Program, and Alexander Prokhorov, M.D., Ph.D., head of the Tobacco Outreach Education Program, caution that more research is needed to understand the potential role of e-cigarettes in smoking cessation.
“Independent studies must rigorously investigate e-cigarettes, as there’s considerable potential benefit in these products if they’re regulated and their safety is ensured,” says Cinciripini. “But promoting the e-cigarettes already on the shelves as ‘safe’ is misleading and, if looked at as a harmless alternative to cigarettes, could potentially lead to a new generation of smokers more likely to become tobacco dependent.”
E-cigarettes are unregulated and there’s little research on their safety or efficacy as smoking cessation tools. “These products are not approved by the Food and Drug Administration and this is concerning because it’s impossible to know what you’re really getting or if it’s safe. In one analysis nicotine levels have been shown to vary widely among e-cigarette products,” says Prokhorov. For now, he recommends that those looking to quit stick with approved devices, such as nicotine inhalers.
Switching from tobacco to e-cigarettes could help smokers avoid approximately 6,000 chemicals, some of which are human carcinogens. “Reduced exposure to harmful chemicals warrants research of these products as a smoking cessation vehicle,” says Cinciripini. “Unbiased studies, free from the ethical and legal challenges of ‘Big Tobacco’-sponsored trials, are needed.”
Branded as “safer,” available in a variety of colors and flavors and promoted by celebrities, e-cigarettes could be a hook for future smokers. “E-cigarettes are a novel way to introduce tobacco smoking to young people, and their potential ‘gateway’ role should be a concern for parents and health officials alike,” adds Prokhorov.
With the impending introduction of another e-cigarette, Prokhorov and Cinciripini urge consumers to know the following information.
“Once a young person gets acquainted with nicotine, it’s more likely that they’ll try other tobacco products. E-cigarettes are a promising growth area for the tobacco companies, allowing them to diversify their addictive and lethal products with a so-called “safe cigarette,” says Prokhorov. “Unfortunately, there’s no proof that e-cigarettes are risk-free.”
Cinciripini has more than 30 years’ experience conducting basic and clinical research in smoking cessation and nicotine psychopharmacology. Prokhorov is the principal architect of MD Anderson’s ASPIRE program, a teen-focused website and, Tobacco Free Teens, a smartphone app – both are new approaches to keeping young people free from the grips of nicotine addiction.
MD Anderson is home to one of the largest tobacco research programs in the nation, part of the cancer center’s Cancer Prevention division. The Tobacco Treatment Program, funded by State of Texas Tobacco Settlement Funds, offers in-person behavioral counseling and tobacco-cessation medication treatments free to MD Anderson patients who are current tobacco users or recent quitters. The program also works with patient families and the general public.
http://www.thevindicator.com/news/article_142fa44c-17cf-11e3-bc86-0019bb2963f4.html

Health Matters: N.D. resources for tobacco cessation

By: Dr. Joshua Wynne, Grand Forks Herald
Q. I know that I need to quit smoking cigarettes, but it sure is hard! My doctor tells me that I need to quit cold turkey, but when I’ve done that, I soon restart puffing away. I think I can stop by gradually reducing my smoking. What do you think?
A. Although many might favor abruptly discontinuing cigarettes as the preferred strategy (similar to what often is recommended for abusers of alcohol), the available evidence actually suggests that the gradual route may not be significantly inferior to abrupt cessation. Some patients I’ve worked with have stopped smoking completely by setting targets — and then meeting them. So, for example, a patient might be smoking half a pack per day (10 cigarettes) and cut down by one cigarette/day every week.
Thus, in less than three months, the patient can be free of tobacco use. The key to the gradual option is to hold to the preselected targets — otherwise the patient will end up right back where she started. One very helpful resource in North Dakota is NDQuits, a free telephone-based service available to smokers and smokeless tobacco users. People using NDQuits have about a 10-fold higher chance of staying off of cigarettes after one year than those choosing to go cold turkey on their own. Give them a call at (800) QUITNOW or (800) 784-8669. And please call them soon!
http://www.grandforksherald.com/event/article/id/271022/group/homepage/

Letter: NDQuits wins a commendation

By: Jessie Azure, West Fargo, INFORUM
I would like to commend those with NDQuits on finding a creative way to reach a “tobacco at risk community!”
Clearly, representatives from the North Dakota Policy Council need to sit down and read the 2007 Best Practices manual issued by the CDC on Tobacco Prevention and Control Policy before commenting. Maybe then they’d understand the importance of reaching target populations with education and support.
Their comments make me ask a far more important question: What if the parade had been for an organization raising awareness for mental health (as this is another community with a high rate of tobacco use)? Would Zach Tiggelaar still be compelled to question such actions? I bet he’d agree that we shouldn’t dismiss one community over another; rather, look to find ways to reach all of our citizens, just as the folks at NDQuits did. After all, as Rep. Josh Boschee, D-Fargo, reminds us, the cost of tobacco is far more staggering to treat than prevent.
http://www.inforum.com/event/article/id/406374/

Tobacco tax: Myth vs. facts

To the editor:
We were disappointed to read the opinions expressed in the July 6 editorial. We would like to provide your readers with accurate information based on fact (references readily available).
The following points address several myths presented by Mr. Peterson:
Myth: The new tobacco tax will help pay for the Vikings Stadium. Fact: The revenue from the tobacco tax will go into the general fund. Some of the money from a one-time tax on cigarette inventory in stores may go to the stadium.
Myth: Raising the tobacco tax is unfair to smokers. Fact: The cost of treating tobacco-related disease far exceeds the amount of tobacco tax collected by smokers. Every man, woman and child in Minnesota pays $554 in excess health care costs due to smoking whether they smoke or not.
Myth: Smokers won’t quit even if the price increases. Fact: Research shows that a $1.60 per pack tax increase will help more than 36,600 current Minnesota smokers quit. In our state, we are fortunate that all smokers have access to free cessation services through QUITPLAN. In addition, low-income smokers suffer disproportionately from the health effects of smoking, and are 70 percent more responsive to price increases.
Myth: Tobacco tax revenue isn’t reliable. Fact: Every state that has significantly raised its tobacco tax has seen an increase in state revenue and health benefits for residents.
The new tax on cigarettes and other tobacco products is estimated to generate approximately $400 million over the next two years and will save our state more than $1.65 billion in long-term health care costs.
Myth: Raising the tobacco tax will force people over the border. Fact: In most places, the price difference isn’t substantial enough to cause people to cross the border to buy cigarettes. Some may cross occasionally, but the number of individuals who do this is statistically very low. Most smokers will continue to buy their cigarettes in Minnesota.
Research has consistently shown that raising the price of tobacco is one of the most effective ways to help smokers quit and prevent kids from starting. Saving Minnesota lives and our kids from a lifetime of addiction is “fair” and a great idea in our book (of facts).
Southwest Community Health Improvement Program (C.H.I.P) members
Paula Bloemendaal
Val Dallenbach
Judy Pitzl
Kris Wegner
http://www.marshallindependent.com/page/content.detail/id/540688/Tobacco-tax–Myth-vs–facts.html?nav=5072

Forum editorial: Take deep breath and relax

Some folks in North Dakota are in a snit because anti-smoking funds are being used to promote the cause at specific events, such as the Fargo-Moorhead gay pride festival. They should take a deep breath, preferably at a nearby smoke-free bar, and calm down.
ND Quits and the state health department are doing what they’re supposed to be doing. They are using funds, some state and federal, some from the multi-year settlement with tobacco companies, to get smokers to quit or others to never start. They are developing and implementing strategies to educate about the known dangers of smoking and secondhand smoke. The efforts can include targeting groups with high rates of tobacco use, such as the gay, lesbian, bisexual and transgender population, which is 70 percent more likely to smoke than the general population, according to the Centers for Disease Control and Prevention.
Since the federal dollars for state smoking-cessation programs come from the CDC, it logically follows that the state effort should include the at-risk LGBT community. It’s no different than spending a portion of the budget for information and education programs aimed at youth, women or oil workers – groups, by the way, that are in the anti-smoking agencies’ sights. ND Quits operates under a clear mandate from the people of North Dakota, who overwhelmingly approved a ballot measure that set up an agency to manage and spend tobacco settlement dollars. That came a few years ago after an intransigent Legislature refused to act responsibly, even as anti-smoking sentiment took hold in the state.
More silliness about the application of anti-smoking money came from the North Dakota Policy Council’s Zack Tiggelaar. He said that while he supports efforts to encourage smokers to quit, “… is it something the public and taxpayers should be funding?” The answer, as made crystal clear by North Dakota voters, is “yes.”
He added: “The government shouldn’t be using taxpayer dollars to support specific causes.”
Where has he been? North Dakota has special state tax that goes to research sponsored by the Lignite Energy Council. That’s pretty specific. The state funds loans and grants for beginning farmers. That’s specific. The Renaissance Zone program for cities uses tax incentives (public money) to stimulate private development. Yet another specific cause.
Purists of the council’s ilk might wag a finger, but such programs evolved from long-standing public policy, and ND Quits is operating within the same ethic.
Oh, and by the way, those partnerships – whether associated with lignite research, farm and city investment or smoking cessation – work. The money is well spent.

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

Letter: Thoreson fronts for Big Tobacco

By: Jay Taylor, Mapleton, N.D., INFORUM
In a recent letter to the editor, Rep. Blair Thoreson, R-Fargo, criticized a Grand Forks physician for not supporting his support for e-cigarettes. Actually, Thoreson’s push was not supported by anyone in the Legislature, but you gotta give him points for keeping at it.
The push today is from those supporting a “Harm Reduction Strategy,” which includes Thoreson. This push kind of sneaks in the door as it’s supported by some of the Big Tobacco folks. Their theory is that we have failed to get everyone in the world to quit using tobacco, so why not try some products that may have less risk. They often recommend the e-cigarette as well as some smokeless tobacco products.
E-cigarettes have not been shown to be safe, and each brand that we look at seems to have different chemicals within. They are not approved by the Food and Drug Administration, and my guess is that they never will have that approval.
What is approved and what does work is three-fold: attitude, education and medicine. First, want to quit! Then learn why you should and use safe, effective medications in the correct dosage to get the job done. Call the Quit Line: 800-QUIT-NOW and get going.
http://www.inforum.com/event/article/id/406052/