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Working against tobacco

By Nick Smith, Bismarck Tribune
Members of an interim legislative committee heard testimony about tobacco prevention efforts on reservations throughout the state Wednesday.
The interim Health Services Committee heard from health department officials as well as tribal leaders and tobacco prevention coordinators from on and off the state’s reservations.
Krista Fremming, Tobacco Prevention and Control Program director for the state Health Department, said the department collaborates with tribal tobacco program officials and in some cases shares facilities.
“On Dec. 13, 2013, the North Dakota Department of Health coordinated a tribal tobacco strategic session to discuss effective processes to reduce tribal tobacco use,” Fremming said. “Attendees agreed formal tribal tobacco strategic planning is needed to identify the best strategy to address tobacco use on the reservations.”
She said the North Dakota Indian Affairs Commission will be taking the lead on the strategic planning process.
Fremming said due to cessation and prevention programs nearly all schools and colleges on reservations now have tobacco-free and smoke-free policies in place.
Smoke-free tribal buildings are now a staple on reservations, she said, but housing and casinos are another matter.
“The North Dakota Department of Health is partnering with the Intertribal Tobacco Abuse Coalition to address the issue of smoke-free casinos on a statewide level,” Fremming said.
The Sky Dancer Casino in Belcourt has a no-smoking policy and the Four Bears Casino in New Town has a designated room for smoking.
Fremming said the idea is in the planning stages and it would likely take a year or two for any implementation to take place.
Another area of note, Fremming said, is enrollment in the NDQuits program. The NDQuits program pushes to keep people from starting to smoke and help people quit, using online sources, counselors andother services.
“In fiscal year 2013, a total of 152 enrollees were American Indian. In fiscal year 2014 there have already been 125 enrollees who were American Indian during the months of July through November,” Fremming said.
Also testifying Wednesday was Beth Hughes. She serves as executive committee chairman for the North Dakota Center for Tobacco Prevention and Control Policy.
Hughes said two-thirds of its $15.8 million budget is spent on a trio of statewide and community grant programs.
“The policies are to serve all residents both on and off American Indian reservations,” Hughes said. “The Center requires that funded programs show policy and health outcomes that can be documented by adoption of model comprehensive policies and, over time, show reduction in tobacco use.”
Hughes said among the center’s recommendations are continued funding of programs using the federal Centers for Disease Control and Prevention’s recommended best practices.
Chairman Sen. Judy Lee, R-West Fargo, questioned the recommendation. Lee said she believes the center comes off at times as being focusing too explicitly on CDC recommendations and not working as collaboratively as it could with other departments.
“The center is viewed as being a bit heavy-handed,” Lee said.
Lee said the reservations are sovereign nations and cultural sensitivity also needs to be kept in mind.
Hughes said she understood the criticism and it was something she would relay to center staff. She added that there is already a level of collaboration with other departments.
“There is no way that the center could do the work that it does without the other entities in the state,” Hughes said.
http://bismarcktribune.com/news/state-and-regional/working-against-tobacco/article_6ba98b3e-78e6-11e3-a21c-001a4bcf887a.html

US is marking 50th anniversary of surgeon general report that turned the tide against smoking

Article by: MIKE STOBBE , Associated Press
ATLANTA — Fifty years ago, ashtrays seemed to be on every table and desk. Athletes and even Fred Flintstone endorsed cigarettes in TV commercials. Smoke hung in the air in restaurants, offices and airplane cabins. More than 42 percent of U.S. adults smoked, and there was a good chance your doctor was among them.
The turning point came on Jan. 11, 1964. It was on that Saturday morning that U.S. Surgeon General Luther Terry released an emphatic and authoritative report that said smoking causes illness and death — and the government should do something about it.
In the decades that followed, warning labels were put on cigarette packs, cigarette commercials were banned, taxes were raised and new restrictions were placed on where people could light up.
“It was the beginning,” said Kenneth Warner, a University of Michigan public health professor who is a leading authority on smoking and health.
It was not the end. While the U.S. smoking rate has fallen by more than half to 18 percent, that still translates to more than 43 million smokers. Smoking is still far and away the leading preventable cause of death in the U.S. Some experts predict large numbers of Americans will puff away for decades to come.
Nevertheless, the Terry report has been called one of the most important documents in U.S. public health history, and on its 50th anniversary, officials are not only rolling out new anti-smoking campaigns but reflecting on what the nation did right that day.
The report’s bottom-line message was hardly revolutionary. Since 1950, head-turning studies that found higher rates of lung cancer in heavy smokers had been appearing in medical journals. A widely read article in Reader’s Digest in 1952, “Cancer by the Carton,” contributed to the largest drop in cigarette consumption since the Depression. In 1954, the American Cancer Society announced that smokers had a higher cancer risk.
But the tobacco industry fought back. Manufacturers came out with cigarettes with filters that they claimed would trap toxins before they settled into smokers’ lungs. And in 1954, they placed a full-page ad in hundreds of newspapers in which they argued that research linking their products and cancer was inconclusive.
It was a brilliant counter-offensive that left physicians and the public unsure how dangerous smoking really was. Cigarette sales rebounded.
In 1957 and 1959, Surgeon General Leroy Burney issued statements that heavy smoking causes lung cancer. But they had little impact.
Amid pressure from health advocates, President John F. Kennedy’s surgeon general, Dr. Luther Terry, announced in 1962 that he was convening an expert panel to examine all the evidence and issue a comprehensive, debate-settling report. To ensure the panel was unimpeachable, he let the tobacco industry veto any proposed members it regarded as biased.
Surveys indicated a third to a half of all physicians smoked tobacco products at the time, and the committee reflected the culture: Half its 10 members were smokers, who puffed away during committee meetings. Terry himself was a cigarette smoker.
Dr. Eugene Guthrie, an assistant surgeon general, helped persuade Terry to kick the habit a few months before the press conference releasing the report.
“I told him, ‘You gotta quit that. I think you can get away with a pipe — if you don’t do it openly.’ He said, ‘You gotta be kidding!’ I said, ‘No, I’m not. It just wouldn’t do. If you smoke any cigarettes, you better do it in a closet,'” Guthrie recalled in a recent interview with The Associated Press.
The press conference was held on a Saturday partly out of concern about its effect on the stock market. About 200 reporters attended.
The committee said cigarette smoking clearly did cause lung cancer and was responsible for the nation’s escalating male cancer death rate. It also said there was no valid evidence filters were reducing the danger. The committee also said — more vaguely — that the government should address the problem.
“This was front-page news, and every American knew it,” said Robin Koval, president of Legacy, an anti-smoking organization.
Cigarette consumption dropped a whopping 15 percent over the next three months but then began to rebound. Health officials realized it would take more than one report.
In 1965, Congress required cigarette packs to carry warning labels. Two years later, the Federal Communications Commission ordered TV and radio stations to provide free air time for anti-smoking public service announcements. Cigarette commercials were banned in 1971.
Still, progress was slow. Warner recalled teaching at the University of Michigan in 1972, when nearly half the faculty members at the school of public health were smokers. He was one of them.
“I felt like a hypocrite and an idiot,” he said. But smoking was still the norm, and it was difficult to quit, he said.
The 1970s also saw the birth of a movement to protect nonsmokers from cigarette fumes, with no-smoking sections on airplanes, in restaurants and in other places. Those eventually gave way to complete smoking bans. Cigarette machines disappeared, cigarette taxes rose, and restrictions on the sale of cigarettes to minors got tougher.
Tobacco companies also came under increasing legal attack. In the biggest case of them all, more than 40 states brought lawsuits demanding compensation for the costs of treating smoking-related illnesses. Big Tobacco settled in 1998 by agreeing to pay about $200 billion and curtail marketing of cigarettes to youths.
In 1998, while the settlement was being completed, tobacco executives appeared before Congress and publicly acknowledged for the first time that their products can cause lung cancer and be addictive.
Experts agree the Terry report clearly triggered decades of changes that whittled the smoking rate down. But it was based on data that was already out there. Why, then, did it make such a difference?
For one thing, the drumbeat about the dangers of smoking was getting louder in 1964, experts said. But the way the committee was assembled and the carefully neutral manner in which it reached its conclusion were at least as important, said Dr. Tim McAfee, director of the Office on Smoking and Health at the Centers for Disease Control and Prevention.
At the same time, he and others said any celebration of the anniversary must be tempered by the size of the problem that still exists.
Each year, an estimated 443,000 people die prematurely from smoking or exposure to secondhand smoke, and 8.6 million live with a serious illness caused by smoking, according to the CDC.
Donald Shopland finds that depressing.
Fifty years ago, he was a 19-year-old who smoked two packs a day while working as a clerk for the surgeon general’s committee. He quit cigarettes right after the 1964 report came out, and went on to a long and distinguished public health career in which he wrote or edited scores of books and reports on smoking’s effects.
“We should be much further along than we are,” the Georgia retiree lamented.
http://www.startribune.com/lifestyle/health/238716101.html?page=all&prepage=1&c=y#continue

Quiet Anniversaries That Resound Loudly with North Dakotans

By: Erin Hill-Oban
Submitted to: ND Physician, December 2013 publication from the North Dakota Medical Association – pg. 30
With all the chaos and busy-ness in our everyday lives, milestones like birthdays and anniversaries pass by so quickly that, once in a while, we forget
to celebrate the day itself, let alone the importance that occasion brought to our lives. There were two anniversaries that just passed on the calendar, and while we are not upset, as a spouse or child might be upon being forgotten, we thought the occasions provided a great opportunity to remind NDMA members of the progress North Dakota has made in the past five years in tobacco prevention and control.
November 4 and November 6 marked, respectively, the anniversaries of the passages of Measure #3 in 2008 and Measure #4 in 2012. Measure #3 received 54% of the vote and thus implemented and fully funded North Dakota’s comprehensive tobacco prevention and control program. Measure #4 earned 67% approval at the polls and created the strongest statewide smoke-free law in the nation.
These publicly (rather than legislatively) initiated and passed measures have a direct impact on the health of North Dakotans and support for each has only grown stronger since their passages.
In February of 2013, Tobacco Free North Dakota (TFND) commissioned a public poll of North Dakota voters, conducted by Keating Research, Inc., to gauge the public’s feelings toward the aforementioned measures. Results showed support for continuing to fund a comprehensive program had grown from 54% of the voters in 2008 to 89% of those polled, and the statewide smoke-free law, just three months into its implementation, had already reached 72% support, up from 67% of voter support. It is difficult to argue with numbers like that, and it is even more difficult to argue with the effects produced by policies like these.
Medical professionals know of, and many educate, about the harmful role tobacco use plays in the health of their patients and future patients. TFND
has great respect and overwhelming appreciation for the tobacco prevention and cessation efforts our medical professionals practice in their offices. In fact, a recent study showed that physicians and other medical professionals are the best and most effective messengers for advising individuals to quit tobacco use. Though obesity has climbed the ranks, tobacco use still remains one of the leading causes of preventable disease and death, contributing to more than 800 deaths each year right here in North Dakota. Reducing, and even better yet, preventing, tobacco use provides the greatest benefits in reducing the incidences of so many chronic diseases – from lung cancer and diabetes to heart disease and stroke.
While the health benefits of reducing and preventing tobacco use are fairly obvious, a topic often overlooked when discussing the impacts of successful tobacco prevention is the potential savings in annual health care costs. In North Dakota, annual health care costs directly caused by smoking alone is estimated at $247 million, and smoking- related costs covered by the state Medicaid program total $47 million annually. If we, as a nation, and in North Dakota, as a fiscally conservative state, are truly concerned with bringing down our health care costs, we would double- down on tobacco prevention efforts.
According to the Centers for Disease Control (CDC), best practices for comprehensive tobacco control programs is a three-legged stool: 1.) fully-funding the program at CDC recommendations; 2.) implementing strong smoke-free laws; and 3.) passing high tobacco tax rates. North Dakota is one of very few states to successfully enact two of the three, but with a dangerously low tobacco tax, ranking 46th lowest in the nation, North Dakota will struggle to bring tobacco use down much further. Although an obvious source of revenue, we view tobacco tax as a public health measure to reduce tobacco use and save millions in future health care costs. Proven as one of the most effective ways to prevent young people from ever starting and to encourage current users to quit or reduce use, raising the tobacco tax is a lofty, yet achievable goal that organizations like TFND are dedicated to addressing through legislative action in 2015.
Years of research show time and time again the indisputable effects that tobacco prevention and control policy has on public health, so your work in the doctor’s office, combined with TFND and NDMA’s efforts on statewide policy, are certainly making a difference. We are grateful to your organization for your past support, commend you for going on record with us by adopting a resolution of support to raise North Dakota’s tobacco tax, and look forward to opportunities to provide information and education to your members, the public, and policymakers throughout the coming year.
http://www.ndmed.org/
http://tfnd.stewsites.com/wp-content/uploads/sites/26/2013/06/ND_Physician_Dec._2013.pdf

Forum editorial: Progress in tobacco cessation

North Dakota was recognized last week as leader among states meeting national standards for funding anti-smoking programs. It’s a welcome designation. Moreover, it’s more evidence the state is doing an excellent job with the resources it has to educate about the risks of smoking and secondhand smoke and provide programs to help smokers quit.
No thanks to the Legislature.
At nearly every turn in the smoking debate during the last decade, lawmakers, particularly those in the Republican majority, have done the bidding of the smoking lobby and hospitality industry. Lobbyists worked to scuttle statewide smoking curbs, and their legislative allies fell into line, despite clear indications that a majority of North Dakotans wanted a smoking ban. Indeed, several cities, large and small, were ahead of the Legislature in imposing smoking restrictions, most of them via the ballot.
As in the cities, it took the ballot box to spank the Legislature. Two measures did what the legislators refused to do. The first in 2008 established a tobacco prevention and cessation program funded in large part by tobacco lawsuit settlement money. The second passed by a landslide in 2012 with every county voting “yes.” It made all public places 100 percent smoke free.
Despite dire predictions from fans of poisoning their customers (it’s their “right,” you know), the sky did not fall on the bar scene or the hospitality sector. Instead, smoking levels among adults are down significantly. There is more work to do among the state’s youth, and that’s where education programs are focused.
It’s good news. It’s good for the state’s long term public health, which, in turn, is a plus for everything else in North Dakota.
————-
Forum editorials represent the opinion of Forum management and the newspaper’s Editorial Board.
http://www.inforum.com/event/article/id/421219/

E-cigarettes: a burning question for U.S. regulators

Marina Lopes, Reuters
NEW YORK (Reuters) – At the Henley Vaporium, one of a growing number of e-cigarette lounges sprouting up in New York and other U.S. cities, patrons can indulge in their choice of more than 90 flavors of nicotine-infused vapor, ranging from bacon to bubble gum.
The lounge, located in Manhattan’s trendy Lower East Side, features plush seating, blaring rock music, and fresh juice and coffee. A sprawling sign on one wall lists all the carcinogens that e-cigarette users avoid by kicking their smoking habits and using the e-devices instead.
But the growing popularity of e-cigarettes has not escaped the notice of the industry’s critics, who have stepped up calls for new regulations, including bans on their use in public places, even though the scientific evidence about exposure to their vapors remains inconclusive.
Selling for about $30 to $50 each, e-cigarettes are slim, reusable, metal tubes containing nicotine-laced liquids that come in exotic flavors. When users puff on the device, the nicotine is heated and releases a vapor that, unlike cigarette smoke, contains no tar, which causes cancer and other diseases.
The product, introduced in China in 2006, has become a worldwide trend at least in part because it may help smokers of regular cigarettes break the habit.
“It’s an addiction – not everyone can quit cold turkey,” said Nick Edwards, 34, a Henley employee who says he kicked a 15-year cigarette habit the day he tried his first e-cigarette. “E-cigarettes give you a harm-reduction option.”
That’s one reason why the market for e-cigarettes is expected to surge, reaching $2 billion by the end of 2013 and $10 billion by 2017, according to Bonnie Herzog, an analyst at Wells Fargo Bank in New York.
Herzog said the U.S. market alone could top $1 billion this year. She predicts that by 2017 e-cigarettes sales will overtake sales of regular cigarettes. That estimate does not take into account the impact of potential government regulations on sales.
E-cigarettes may help smokers save money too. Edwards, for one, says he cut his $60 monthly cigarette bill in half when he switched. On top of the cost of the device, the smoking liquids cost around $10 per refill.
Despite the perceived benefits, critics worry that the addictive nicotine found in e-cigarettes could lure more people into smoking and discourage others from quitting all together.
“Essentially e-cigarette companies are selling nicotine addiction,” said Dr. Neil Schluger, chief scientific officer for the World Lung Foundation, which advocates for tobacco control.
“Once you have them addicted to nicotine, you can sell them all sorts of things, including conventional cigarettes,” he said. “This is a giant Trojan horse.”
In the United States, such concerns have led to calls for increased government regulation.
The U.S. Food and Drug Administration currently has no regulations on e-cigarettes, but it is expected to release rules this month that would extend its “tobacco product” authority over the devices. New FDA rules could follow.
“Further research is needed to assess the potential public health benefits and risks of electronic cigarettes and other novel tobacco products,” said Jenny Haliski, an FDA spokeswoman.
To be sure, no one is expecting the federal government to go as far as Brazil, Norway and Singapore, where the devices are banned outright.
In the United States, Utah, North Dakota, Arkansas and New Jersey have already passed legislation outlawing e-cigarettes wherever smoking is prohibited.
Other jurisdictions are considering new rules of their own. New York City could decide as early as next week whether to prohibit e-cigarette use in public places.
Under Mayor Michael Bloomberg, who leaves office January 1, New York was one of the first cities to ban cigarette smoking in public places, and its decision could influence Chicago and other cities that are considering a similar controls.
The outcome is crucial for tobacco companies, which are banking on the devices to make up for a sharp decline in sales of regular cigarettes in the United States. Smoking among U.S. adults dropped to 18 percent in 2012 from 24.7 percent in 1997, according to the Centers for Disease Control and Prevention.
Reynolds American Inc, which makes Camel cigarettes, began selling its Vuse vapor cigarettes in Colorado retail stores in July and plans on expanding nationwide by mid-2014.
Other companies have also dipped into the e-cigarette business, too. Last year Lorillard Inc, maker of Newport cigarettes, acquired the best-selling blu eCigs brand, while Altria Group Inc, best known for the Marlboro brand, followed suit in August with the launch of MarkTen e-cigarettes.
“As society is transforming, so must the tobacco industry,” said Reynolds spokesman Richard Smith. “It’s just good business sense.”
The arrival of Big Tobacco could mean fierce competition for small e-cigarette companies that do not have the resources or experience to deal with tight government regulation.
But many e-cigarette companies say Big Tobacco is late to the game and has a lot to catch up on. “They are going to need to boost up their game if they want to compete,” said Christina Lopez, a saleswoman at Smokeless Image, an e-cigarette shop that sells smaller brands in Hoboken, New Jersey.
HEALTH RISKS UNCERTAIN
To be sure, there is still a dearth of scientific evidence about the safety of e-cigarettes and their effectiveness in helping smokers quit. For regulators, the big question is, are e-cigarettes a treatment for would-be quitters or “gateway” products to nicotine addiction?
Supporters say some e-cigarettes allow users to slowly reduce their nicotine intake and wean themselves off nicotine completely. A study published in the September issue in Lancet, the British medical journal, said the e-cigarettes are as effective as nicotine patches for smokers trying to quit.
Worldwide, conventional cigarette addictions kill 6 million people a year, in part because of the 250 harmful chemicals found in tobacco smoke, which can cause cancer, heart disease and stroke, says the Centers for Disease Control and Prevention.
But e-cigarettes may not be harmless, either. Nicotine addictions, fed by smoking, chewing tobacco or e-cigarettes, can cause high blood pressure, disrupt heart rhythms and lead to obesity and diabetes.
Electronic devices that feature fruit and candy flavors are even more worrying, critics say, because they could introduce children to smoking.
E-cigarette vendors say the sweet flavors make the process of quitting smoking less painful.
“By taking a sort of ‘Willy Wonka,’ fun approach to a serious matter, it breaks down people’s perceptions of e-cigarettes,” said Talia Eisenberg, owner of the Henley Vaporium, referring to the fictional candy maker.
The Centers for Disease Control and Prevention said 10 percent of high school students surveyed reported using e-cigarettes in 2012, up from 4.7 percent in 2011.
About 60 percent of current users are over 35 years old, and 43 percent are college-educated, according to Reynolds American.
Twelve states, including New York, have passed laws preventing e-cigarette sales to minors.
At a hearing on the proposed New York City ban on e-cigarette use in public places, Health Commissioner Thomas Farley said allowing it could glamorize all types of smoking and encourage teenagers and children to take up the cigarette habit.
“While more research is needed on electronic cigarettes, waiting to act could jeopardize the progress we have made over the last few years,” he said.
(Reporting By Marina Lopes; Editing by Jilian Mincer and Tim Dobbyn)
http://www.chicagotribune.com/news/sns-rt-us-usa-ecigarettes-20131211,0,720952.story?page=2

Bars one year into smoke-free

Tim Chapman – Tribune Editor , Pierce County Tribune
Rugby bars have been smoke free for just over one year now. Three of the city’s bar owners said business hasn’t been hurt because the state ban made for an even playing field.
Lee Ekren has owned Lee’s Bar for 47 years and said the ban didn’t especially bother him or affect his business. He said it wasn’t a bar of many regular smokers anyway, and people haven’t seemed to mind walking outside for a cigarette.
“Doesn’t make any difference to me,” Ekren said. “I’ve been here so long I figured if I’m gonna get (business), I’m gonna get it anyways.
Dan and Tracy Corum own Third Street Station and Tom Nowell owns I.C. Dubbles. Dan Corum and Nowell are opposed to the law, believing the decision should be up to each business, but neither has seen their profits affected much.
“It’s probably helped our food sales a bit, actually,” Dan Corum said. “Outside we have a lot of extra cigarettes to clean up. It’s kind of tough to stay on top of that.”
Said Nowell: “I don’t think it’s really hurt us much. Initially, there were people not happy about it.”
Dan Corum doesn’t mind going outside because he does the same when smoking at his residence. Tracy Corum, who also smokes, is pleased with the way their establishment feels and looks without cigarette smoke.
“It’s way nicer inside,” she said. “You don’t have all that smoke film.”
As of June, North Dakota was still the latest of 28 states to enact statewide bans in enclosed public places.
http://www.thepiercecountytribune.com/page/content.detail/id/508965/Bars-one-year-into-smoke-free.html?nav=5003#sthash.F2s1ZWEE.dpuf

City poised to ban lighting up in public parks

By: Gary J. Remal
Boston is poised to fine anyone who smokes in its parks, including those who light up cigarettes or joints or who puff on e-cigarettes.
City councilors yesterday approved the ban, which also would apply to other property controlled by the Parks and Recreation Commission, and includes a $250 fine for each violation.
“It passed unanimously on a voice vote,” City Councilor Bill Linehan told the Herald.
Mayor Thomas M. Menino must sign the ordinance, and it must be adopted by the city Parks and Recreation Commission before it takes effect, said Nick Martin, spokesman for the Boston Health Commission.
That likely won’t be a problem, as the ban was put forward by Menino, and Martin said the ordinance was crafted by his agency, the parks commission and police officials.
“For the purposes of this subsection, the term smoking shall include inhaling, exhaling, burning or carrying any lighted cigar, cigarette, pipe, or other lighted or vaporized substance in any manner or form, including marijuana used for medical or any other purpose,” the new ordinance reads.
Linehan said he had introduced his own legislation to stop marijuana use in city parks.
“I put one in against pot smoking, but then the administration came in with a complete ban so I supported that,” he said. “It has the same set of criteria and enforcement, so I quickly decided to back that.”
The city has had limited bans on outdoor smoking in toddler playgrounds and in outdoor eating areas associated with restaurants, Martin said. But this is the first widespread ban on outside smoking.
“Those were just an education and awareness effort,” he said. “We posted signs that said no smoking, but there was not any enforcement. This is the first time there has been an 
enforcement effort outside.”
The ordinance says, “There is no known safe level of exposure to secondhand smoke, and secondhand smoke exposure in certain outdoor areas has been found to pose a significant health risk,” noting that “cigarette butts are a leading source of litter in Boston’s parks and pose a nuisance as well as choking hazard for children.”
http://bostonherald.com/news_opinion/local_coverage/2013/11/city_poised_to_ban_lighting_up_in_public_parks

Regulation push catching up with electronic cigarettes

By John Keilman and Mitch Smith, Chicago Tribune reporters
Jay Altman smoked cigarettes for 25 years before deciding a few months ago that for the sake of his wallet and his health, a change was in order.
But Altman didn’t quit — he switched.
The North Side insurance worker swapped his daily pack and a half of smokes for the vanilla-flavored nicotine aerosol of an electronic cigarette. He feels better these days, he said, and not just because he’s saving more than $100 a week.
“My friends have noticed a difference,” Altman said while sampling assorted flavors at Smoque Vapours, an e-cigarette shop in the Loop. “They’ll say, ‘You smell good,’ instead of, ‘You stink.'”
The fast-growing e-cigarette industry has hitched its future to such testimonials, pitching its product as a safer and cheaper alternative to tobacco cigarettes. So far the business has escaped the reach of regulators, but from Washington, D.C., to the Chicago suburbs, that is changing quickly.
The U.S. Food and Drug Administration appears poised to label e-cigarettes a “tobacco product,” a distinction that would give the agency power over their marketing, manufacture and sale. North suburban Mundelein just passed an ordinance banning the sale of e-cigarettes to anyone younger than 18, and on Jan. 1 a similar law will take effect statewide.
Evanston, meanwhile, has gone even further, banning the use of e-cigarettes anywhere smoking is prohibited.
“There hasn’t been a whole lot of long-term research on this, but we really wanted to make sure we were on the front end to protect our residents,” said Carl Caneva, assistant director of Evanston’s health department.
The lack of regulation has turned e-cigarettes into a commercial Wild West, where basement chemists and giant corporations alike concoct mixtures that taste like everything from peach schnapps to Mountain Dew. The novel flavors concern anti-smoking advocates, who note that teen e-cigarette use recently doubled within a single year.
“I don’t think that there’s any question that flavors appeal to young people,” said Danny McGoldrick of the Campaign for Tobacco-Free Kids. “It’s just another way to help introduce them to the habit.”
Researchers aren’t sure of all the chemicals released by the products, but some say there’s ample reason for worry.
The American Lung Association, which favors strict regulation, cites a recent study that found chemicals such as formaldehyde and acetone in exhaled e-cigarette vapor.
“We’re very concerned because we don’t know what’s in e-cigarettes or what the health consequences of them might be,” said Erika Sward, the lung association’s assistant vice president for national advocacy. “Frankly, until the FDA begins its oversight of these products, I think everyone needs to proceed very cautiously.”
E-cigarettes use tiny atomizers to turn nicotine-infused liquids into an aerosol, which is inhaled by the user. They’ve been sold in the United States since the mid-2000s, but the Electronic Cigarette Industry Group says sales have boomed in recent years, turning the gadgets into a $2 billion-a-year business.
The group’s president, Eric Criss, said e-cigarettes are intended to be a safer alternative for people who already smoke.
“We feel very strongly that we not be taxed and regulated as a tobacco product because our goal as an industry is to distinguish ourselves from traditional tobacco cigarettes,” he said. “We believe there’s a ladder of harm. Cigarettes are at the top of that, and our goal is to get people to move down that ladder.”
The science behind that claim is far from settled. The industry points to research — some of it funded by e-cigarette interests — that shows the products to be less risky to users, sometimes called “vapers,” and bystanders alike. Robert West, a health psychology professor at University College London, maintains that a global switch from tobacco cigarettes to atomized nicotine would save millions of lives a year.
Stanton Glantz, director of the Center for Tobacco Control Research & Education at the University of California at San Francisco, agreed that e-cigarettes appear to be less harmful than tobacco but said they’re hardly risk-free.
He said most smokers don’t give up tobacco cigarettes entirely when they use electronic ones, so their health doesn’t improve much. And while bystanders aren’t exposed to secondhand smoke, he said, initial research shows that they’re still inhaling nicotine, an addictive substance, along with toxic chemicals and ultrafine particles that can cause heart problems.
“Just because someone chooses to service their (nicotine) addiction by using an e-cigarette, that still doesn’t create a right for them to poison people in the neighborhood,” Glantz said.
The FDA says a federal appeals court has given it the power to regulate e-cigarettes as though they are tobacco products. The agency has a proposed regulation in the works, and while officials won’t say what it contains, public health advocates and industry representatives expect the FDA to assert its authority over e-cigarettes.
Many states are waiting for that to happen before deciding whether to incorporate e-cigarettes into smoking bans, but Glantz argues that new rules could take years to finalize and aren’t necessary for states to tighten their clean air laws.
Three states — North Dakota, New Jersey and Utah — already include e-cigarettes in their smoking bans, and about 100 cities and counties nationwide have taken similar steps, according to the American Nonsmokers’ Rights Foundation.
But Melaney Arnold, spokeswoman for the Illinois Department of Public Health, said the research on e-cigarettes’ secondhand effects is still too preliminary to act upon.
“It’s still evolving, and it will still (take) time until we know the total health effects,” she said.
Chicago Ald. Edward Burke, who often takes up health issues, has a proposed ordinance before the City Council to ban the sale of e-cigarettes to minors. He said he might try to amend it to make e-cigarettes subject to the city’s smoking ban.
“I think we certainly should apply the same regulations to e-cigarettes that we apply to regular cigarettes,” the 14th Ward alderman said.
For now, though, the devices exist in a mishmash of vague and confusing regulations. They’re not allowed to be used on airplanes, though the U.S. Department of Transportation doesn’t explicitly ban them. They’re not allowed in Chicago’s airports, though city ordinances are silent on the point.
“As a practical matter, airport staff does not determine if a cigarette that is being smoked is a tobacco cigarette or an e-cigarette,” said Karen Pride, spokeswoman for the Chicago Department of Aviation. “As such, the use of electronic cigarettes, as with tobacco cigarettes, is prohibited in the airports.”
While the city allows bar patrons to partake of e-cigarettes, taverns make their own rules. Declan’s Irish Pub in Old Town and Lange’s Lounge in Lakeview have no problems with the devices, but Joe’s Bar, a Goose Island establishment, says no.
“We don’t allow it inside because it promotes other people to take out their cigarettes and smoke them,” general manager Bob Casey said.
Despite the lack of clarity over e-cigarette use, several boutique shops selling the devices have sprung up in the city. Jared Yucht, owner of Smoque Vapours, said he started creating “e-liquids” in his basement when he stopped smoking. He opened his first store and lounge in Lakeview last spring and added a second location in the Loop this month.
He said he is proud of his safety precautions, carefully monitoring the nicotine levels of his products and refusing to sell to minors, though neither step is yet required by law.
“I don’t know anyone who owns another store who serves underage,” he said. “I have children and I wouldn’t want them taking stimulants at a young age. It’s an unwritten rule in the community that this is an adult activity for adults.”
http://www.chicagotribune.com/news/local/ct-met-electronic-cigarettes-20131115,0,5010760.story?page=1

ND smoking ban: 1 year later; Support increases, businesses see no change

By Katherine Grandstrand, The Dickinson Press
Support has only increased in the year since North Dakota voters decided to end smoking in bars, the group that lobbied to implement the law said.
North Dakotans got the measure on last November’s general election ballot and it passed with a supermajority of 67 percent. Three months later, Tobacco Free North Dakota polled a statistical cross section of the state to find that approval had increased to 72 percent.
“This was actually the people who voted this law in,” said Jeanne Prom, executive director of the North Dakota Center for Tobacco Prevention and Control Policy. “This was not a government mandate. This was a mandate by the voters.”
North Dakota voters took up the issue because the Legislature did not, said Erin Hill-Oban, executive director of Tobacco Free North Dakota.
“When the Legislature doesn’t act for so many years on something and they only meet every other year the way it is, to get things accomplished, the public really stepped up,” Hill-Oban said. “It’s a difficult and expensive way to get something done. But, in my opinion, when the public speaks, their voices should be heard.”
Banning smoking from bars and smoke shops — the last non-residential indoor place people could smoke — was about protecting non-smoking patrons and employees from second-hand smoke, Prom said.
“People still had to be exposed to a known human carcinogen at their place of work,” Prom said. “No one should have to choose between a healthy place to work and an unhealthy place to work. A place to work should be healthy.
“This is really about clearing the air in all workplaces and also all public places.”
In Dickinson, local bars haven’t seen much of a change in business over the past year since the ban.
“It’s a lot less stinky,” said Milissa Bauer, general manager of Army’s West Sports Bar. “As far as business goes, I don’t think it’s changed a whole lot.”
Because the ban went into effect in winter, there was a bit of a dip in business right away at The Rock bar in downtown Dickinson, but people have gotten used to it, said manager Traci Barnum.
“It actually shocks us that it’s only been a year,” Barnum said. “It feels like it’s been a lot longer than that. Everybody pretty much got right on board and nobody really complains about it anymore.”
This is the norm, Hill-Oban said.
“There have been many studies done that show that it does not have an economic impact on business,” Hill-Oban said. “People get adjusted to it and they go back to their regular routine and going back to places they frequented.”
Enforcement has been smooth, Bauer said.
“It’s clearly posted on the front door as you come in,” Bauer said. “There were few incidents where we’d have someone light one up at the very beginning, but not much of a problem.”
Some businesses were upset that they were required to cover the cost of posting smoke-free signs, but the 2013 North Dakota Legislature made a provision that allows the North Dakota Center for Tobacco Prevention and Control to provide signs and templates for businesses, Prom said.
“On request, we do provide signage as well as templates online,” Prom said. “If any businesses need signs, we provide that free of charge. There is no excuse for not having a smoke-free sign in a business or public place.”
State law still allows for smoking in outdoor public areas and in multi-family housing. However, anti-smoking groups are working with municipalities to add these places to the smoke-free list.
“Our local public health units are working with their parks and recreation departments and their city officials to make parks and recreation facilities — which, of course, include outdoor facilities — smoke free as well as tobacco free,” Prom said.
Apartments, townhouses and condos share ventilation systems, so if a neighbor is smoking, second-hand smoke can make its way into the rest of the building.
“It’s mostly just how it affects people who aren’t users,” Hill-Oban said.
Removing smoking from public takes it out of normal social behavior, Prom said.
“It creates a very healthy social norm for youth and young adults,” Prom said. “When they see that there is no smoking in public or in workplaces, the norm is that if you’re going to be out in public and if you’re going to work, it’s going to be a healthy environment and there won’t be smoking there.”
http://www.thedickinsonpress.com/content/nd-smoking-ban-1-year-later-support-increases-businesses-see-no-change?fb_action_ids=10153494288605599&fb_action_types=og.recommends&fb_source=other_multiline&action_object_map=%7B%2210153494288605599%22%3A179267778943604%7D&action_type_map=%7B%2210153494288605599%22%3A%22og.recommends%22%7D&action_ref_map=%5B%5D

Gov. Branstad ‘Absolutely Interested’ in Regulating E-Cigarette

By James Lynch, Reporter

DES MOINES, Iowa –
Gov. Terry Branstad, who made Terrace Hill and the governor’s office smoke-free the day he took office, is open to regulating electronic cigarettes in much the same way as the traditional variety.
Iowa law prohibits smoking in workplaces other than on casino floors, but electronic cigarettes – e-cigarettes – are not covered by the five-year-old Iowa Smoke-free Air Act.
Branstad wouldn’t commit to any specific regulation of e-cigarettes, which are battery-operated products that heat liquid nicotine derived from tobacco plants into a vapor that the user inhales. However, during a visit to Timberline Manufacturing in Marion Tuesday, he said he is “absolutely interested” in looking at proposals by Attorney General Tom Miller to regulate e-cigarettes.
Last week, Miller called on state lawmakers to ban sales of e-cigarettes to minors, add e-cigarettes to products covered by the state’s Smoke-free Air Act and tax them more than the standard state sales tax rate.
In addition to looking at Miller’s proposal, Branstad wants to look at what other states have done before deciding the appropriate course of action.
“My wife and I have been strong supporters of smoke-free workplaces,” Branstad said. “We think this is an important part of our goal to the healthiest state.”
He compared e-cigarettes to synthetic drugs created to circumvent state and federal drug laws.
“They just keep coming up with different things just like we have to deal with all these synthetic drugs,” Branstad said.
According to Miller, Iowa’s smoke-free air act does not address the new technology. He said officials in Arkansas, New Jersey, North Dakota and Utah have included e-cigarettes in their indoor smoking bans and Minnesota changed its definition of tobacco products to include e-cigarettes and subject them to the tobacco taxes.
He called on the Legislature to define e-cigarettes and recommended they be subject to the state cigarette tax — $1.36 on a pack of 20 traditional cigarettes.
Miller didn’t have Iowa numbers, but in a letter to the Food and Drug Administration, he said sales of e-cigarettes, which doubled every year since 2008, now are accelerating even faster and are projected to reach $1.7 billion.
At the same time, the cost has fallen, making them more affordable and more attractive to young people.
http://www.kcrg.com/news/local/Gov-Branstad-Absolutely-Interested-in-Regulating-E-Cigarette-231681781.html